Excema - how should I treat it?

[AngieL]

My 15 mo daughter has got quite a lot of excema at the moment. She has got a large patch on the side of her face near her eye and it has become infected. She has an immune deficiency and the doctor has now given her oral antibiotics.

He hasn't really told me how I should be treating the excema though and it is weeping and bleeding. Do I put any cream or anything on - I can't use the hydrocortisone at the moment. Should I cover it up, to stop dd scratching it?

Any advice would be great. TIA.

[Jimjams]

eczema herpeticum is when eczema becomes infected with the herpes virus. It looks quite like chickenpox although the blisters are in a kind of pit (IYSWIM)- described as "pittiform" See this picture here . Children can have a localised outbreak, although in ds1's case it covered his whole body except his feet. His face became totally infected- people used to scream when they saw him (literally) or they'd ask how he had been scalded. The good news is it cleared up totally without a single scar. Eczema herpeticum is usually only seen in young children (ds1 was 11 months) as once children have encountered the herpes virus they should buid up immunity and thne not get eczema herpeticum- the problem arises if the first time they meet it it is via broken skin. It's taken quite seriously as it can lead to blood poisoning and death! Ds1 was treated with oral acyclovir, athough if he'd been at all ill (rather than just itchy) he would have been given it by iv.

To be honest the resulting bacterial infection -especially on his face- was more of a pain. The dermatology department eventually got the right oral antibiotic and then it went. I'd recommend giving your child some sort of acidophillus- ds1 ended up with three courses of antibiotics before they got the right one and I wish wish wish I'd given him acidophellus or some other gut bacteria. You can get powder to add to food/drinks from health food shops- or just give loads of live yoghurt etc.

[Jimjams]

angiel- something else- has your daughters face been swabbed so they can get the correct antibiotic? We were invited back as a case study for student doctors and the consualtant was really emphasising the importance of culturing to find the correct anitbiotic (actually my GP had already tried but the path lab managed to mess up the sample). It was only after the dermatology department got the reuslts of the swab back that they were able to give the correct antibiotic- then the infection went very quickly and we were just left with the eczema to clear up (sorted out by wet wrapping eventually).

[Jimjams]

The 2 piccies here look more like ds1's case of e herpeticum- you can see the kind of pit in the skin. Most GP's have never heard of it so if you ever suspected your child had it it would be worth asking them outright "could this be e herpeticum?" I think that's the advice the national eczema society gives.

[LIZS]

I finally came across the article to which I referred below - Practical Parenting Nov 2002.p159. Ointment called Protopic claimed to reduce inflammation by suppressing immune system. Implies it is only suitable for children over two, doesn't cause skin thinning but costs more than other treatments so may be used only if other treatments have n't worked.

May be worth enquiring about although wonder about its suitability especially in Angie L's case. Perhaps someone here has already used it.

hth

LizS

[CER]

The spa we went to was near Montpellier. It's got its own website at www.avenehydrotherapycenter.com. From talking to other people there I think there are quite a few similar places around France as it's well recognised there as helping eczema and other skin conditions and the French even get their treatment paid for on the French health service!

The only thing is that it's not the kind of thing you can do for a couple of days. They like you to book in for 3 weeks but say 2 is ok as you need this long to benefit from the treatment. But it is a fantastic place to go on holiday if you've got a child with eczema as the treatment only takes an hour or two and you have the rest of the day to enjoy yourself. You also don't have to worry about problems with managing the eczema, or it getting worse or infected whilst you're away as you see a dermatologist everyday.

[tinyfeet]

I'm sure someone has already mentioned this. DD has severe excema. For prevention, we use Aveeno - heavy moisturizing cream - not sure what it's called exactly. If I haven't been diligent, and she gets patches, then we use 15 hydrocortisone - patches disappear within 1 or 2 days.

[Jimjams]

protopic is used a lot in the States- trials have been very successful. Worth enquiring about if eczema is severe and long lasting.

[AngieL]

Jim Jams - That must have been terrible for your ds, I'm glad that he didn't have any scarring. Looking at the pictures, I'm pretty sure my dd hasn't got that. I was going to try and take a picture and link to it but haven't had the chance yet.

The doctor did a swab on Tuesday but the results aren't back yet. He did ring earlier though and he wants me to take her back in tomorrow. He is going to get one of his partners to have a look to see if they have got any suggestions, and then put her on another antibiotic which I have completely forgotten the name of.

Thanks again for all your suggestions, I really do appreciate it.

[AngieL]

Click here to see a picture of dd sore bit. Not a very good pic unfortunately. If anyone has got any better ideas on treating it, now they’ve seen it, I’d be grateful.

[Jimjams]

ooh does look sore. Think you're ok on the e herpeticum though- there's no pit really (I remember the consultant getting very excited about the pits on ds1's legs :-) ). No idea really- maybe lots of emollient (I actually found vaseline- or 50:50 a really gloopy vaseline good) and covered at night to stop scratching in sleep? I think skin conditions are notoriously difficult. I was lucky in that my GP realised that he was out of his depth and hot ds1 an emergency appointment with the dermatologist- maybe check to see if there's a drop in clinic? If not good luck with getitng the results of the swab. And with all those antibiotics just get lots of probiotic into her- that's the one thing I wish I'd done- if I could change one thing in my life it would be that (honestly :-) )

[AngieL]

Hi JimJams - I have bought loads of probiotic yoghurts for dd and luckily she loves them. Sorry if I sound a bit dense, but what is the importance of probiotics and how are they going to help?

Anyway went back to the Doctors this morning and he now thinks there may be a fungal infection there as well - ringworm. Which is strange because a pharmacist said it was a fungal infection a couple of weeks ago. They have now given me a cream that is supposed to be a cure all - Trimovate. Anyone got any experience of this? It contains a steroid and I'm a bit nervous of using it but the main thing I suppose is to try and get it under control.

[hmb]

I had a multi anti-biotic/antifungal/steroid cream to treat my eczema when I was a child. Not the same one as you mentioned, but the theory is the same. The steroid damps down the immune response, which calms down the eczema, and the other two prevent/treat oppertunist infections. I used it a lot as a child, and my skin is fine now. Thankfully I grew out of it. Dd and Ds both have eczema, and we have now foung the treatment regime that works for them. Very occasionally we have to use a steroid cream to dampen down a flare up, but 98% of the time we keep things under contol just using emollients. They just were not used when I was a kid. I hope things improve asap for your dd.

[Jimjams]

angiel- if it was a fungal infection it would explain why it was being so stubborn. good to try the new cream.

The probiotic is just to replace the freindly bacteria that the antibiotics destroy. Obviously antibiotcs are needed at times but if you have cycle after cycle of one's that aren't even working (as has happened in both our kiddies cases) the gut bacteria can take a bit of a battering. DS1 has all sorts of problems to do with his gut now which date back to that time so I just wish I'd done it differently then :-(

[Hebe]

Hi Katierocket - do you remember what the Radio 4 programme about eczema and steroid creams was called? I missed it and would like to try to listen to it.

[Hebe]

Hi CER - I have tried looking up 'elenascollection.com' on the WEB but could not find it - can you help?

[CER]

Hebe, sorry my mistake. It is www.elenascollection.co.uk".

AngieL Hope things are improving with the Trimovate. It always makes me feel anxious putting steroid on, and I'm no huge fan of them despite ds being on them for so long, but I think that if you've tried other things and you feel like your dd is suffering with the itchiness etc. it's definately worth it.

If it's any reassurance to you I've had loads of dermatologists tell me that a mild steroid won't cause any long term problems - because I keep asking them about it!

[AngieL]

Hi CER

Thanks for asking about dd. Amazingly the trimovate has worked wonders and her face is much much better than it was, all the rawness has gone and it has stopped weeping. The aveeno cream which I am using on her arms and legs has also worked miracles and her skins feels and looks pretty good now.

We've finished the cephalexin now and she's back on the low dose antibiotics so hopefully things will calm down for a while.

[donnie]

my daughter is 15 months old and developed awful eczema at around 3 months...anyway to cut a very long story short we eventually saw Dr Atherton at Great Ormond Street who is a paediatrician specialising in skin disorders and he recommended wet wrapping. we havent looked back since. We put them on her for about a week every bed time and the eczema disappeared; after that it was every 3 days, then once weekly. Now we no longer use the bandages at all but just use a bit of the steroind cream perhaps once weekly on the odd little patch she has. She is a different child.Wet wraps ARE a hassle to begin with but you quickly get the hang of it and they are so effective it's a miracle. So we are glad we took that path. We tried every cream avery homeopathic remedy under the sun, we cut out dairy in favour of soya etc, you name it we did it !!!!! all to no avail. All I can say is the wet wrapping worked and it's all available on prescription, so go for it.

[CER]

AngieL, that's great news about your daughter. You must be so relieved - and you can get those passport photos done now!

I'm really glad that wet wrapping worked for you donnie because for us it was the low point in the treatment of ds's eczema. So it's good to hear that some people do have a positive experience with it.

We wet wrapped for two months when he was about 6 months old with him screaming through the whole process every day. Didn't make a blind bit of difference as he was allergic to the base of the steroid ointment and the emollients we were putting on the rest of the time, as well as all his dietary allergies which weren't being addressed.

Like I said before, I really feel that everyone's eczema is so different that what works for one person won't make a blind bit of difference to the next person. That's why it's so good to have mumsnet to get as many suggestions as possible!

[bunny2]

Donnie, we also saw David atherton and he remains my hero. We had already tried wet wraps to no avail. DS developed a fungal infection which thrived under the damp bandages. When we saw David Atherton he put ds onto protopic. We jumped the 6 month waiting lsit by paying to see the Dr privately and this meant we had to apy for the protpic - £80 a small tube and we were prescribed 12 tubes! It is a miracle ointment for children where everything else has failed and should be avaialble on the NHS. It is in some areas and having come to the end of our original prescription we are trying to get our local gp to prescribe it - without much success so far. On the fungal infectio we used Canesten H (the H refers to the hydrocortisone content) and it worked well. We also tried Chinese medicine, restricted diets etc but for us the protopic was the only thing that worked. Every case is different and it is trial and error. Good luck to everyone with this problem. Ds now has his eczema quite well controlled but there are stil flare-ups which we have learnt to live with. One thing that helps the scratching at night is mild sedatives - piriton is an antihistamine and causes drowsiness, there is also phenergan and vallergan. They help an itchy child to sleep and cut down on the itching. We have piriton on prescription but you can buy it over the counter.

[bunny2]

Forgot to add - it wasnt only the protopic that helped. Dr A also prescribed a high dose of oral steroids and it took a year to wean ds off of them. Most doctors are reluctant to prescribe oral steroids as there are possible severe side-effects. We were willing to take the risk because our son was fading fast and had absolutely no quality of life. This medicine is only availabe to very bad cases (one doctor said ds was the worst case she had ever seen). We also moved to Spain for a year to give him time to heal - sun and salty water work wonders.

[Jimjams]

donnie- I'm a huge fan of wet wrapping as well. Even without steroid (we had propaderm initially) just for relief. It is very important though that there is no infection when wet wrapping otherwise it makes verything worse. It made such a big difference - and ds1's skin was lovely when it came out of the banadges each morning.....

[anniethenannie]

Have you tried Elenas nature collection? Atotally natural alternative to steroids, specialising in babies and young children withan 80-90% success rate! www.elenascollection.co.uk

[wiltshirelass]

My daughter has eczema - she is odd in that she can be completely clear for ages and then has enormous flare ups - 85% in one episode. We went to a fabulous consultant derm at Great Ormond Street, who put her on protopic, the new non-steroidal treatment. It is licensed for children in a weak strength (0.03%), he gave it to her in the non-licensed, adult strength (0.1%) which worked like a dream. His tips:
Emollient cream are only any good if they follow bathing, to trap in the water. Bathe once or twice a day in really tepid water with emollient oil in it, no soaps or shampoos. Use aqueous cream as soap, but get it out of the pot with a spoon as by using your fingers you may be putting infection in the aqueous cream tub and reinfecting later. Use emollient cream after a morning bath, and hydrocortisone or protopic with NO emollient after the evening bath. Putting the hydrocort etc on over or under emollient dilutes the effect of the drug.
Don't use E45 or Oilatum, which makes more children worse than it does better.
Shampoo their hair after a bath, over the bath - rinsing shampoo in the bath water they are sitting in disperses the emollient.
Keep them in cotton clothes, no fabric conditioners, non-bio fabrics.
When you need to use hydrocort etc, put it on fairly lavishly. He said it was much better to knock the eczema on the head and then manage the skin with emollients etc and no hydrocort, than it was to put little bits of hydrocort on all the time and never really get the ezcema under control.

He made perfect sense, and since we really whacked her with all of the creams etc that he said, she has never had a serious recurrence. We are back down to one bath a day, are a bit lax about washing her hair in the bath, and haven't used any hydrocort or protopic on her for months.

[wiltshirelass]

ps our consultant was john harper. and we use cetomacragol (sp?) as a bath and cream emollient, seems to be fine.