To suppress or not to suppress excema

[snanna]

We're less than a week into our gluten-elimination for ds's (age 2.5) excema (gluten being the only thing that showed a blip on an IgG blood test), and we are both already showing signs of less inflammation. Which is awesome!

But today we went to the pediatric dermatologist, as referred by our doctor, and I left feeling really bad that I've let his rash get this bad without trying to treat it topically (other than moisturinzing) while we sort out possible allergies. The derm assured me that I can give him benadryl at night and treat his almost-full-body excema with desonide (mild topical steroid) in order to make him more comfortable while we are eliminating gluten. Her feeling was that when we challenge it, the excema would flare through the medication.

Has this been your experience, if you've done "suppression" treatment along with "empirical study" processes like elimination diets? I guess I'm picturing a situation where I won't know what's going on with anything. But ds has a fever at the moment, is itching like crazy, and I just want to make him BETTER!

Thanks for your thoughts, I love having you all as a resource!

[ASusan]

It's been our experience that it is easier to see cause-effect of this-food-results-in-more eczema when we have been doing suppression. Observations like these have taken place when our son has been on a 3-day course of oral steroids for asthma. The oral steroids have the "side-effect" of clearing his skin of eczema, so you can more clearly see the rash when it does occur. It has not suppressed a new breakout, but that may be because the steroid is in his system for only a few days.

Unfortunately, we are at a point where Benedryl and steroid cream is not even touching our son's massively itchy hand eczema. (Hence me writing this at 3:45am - I'm awake because DS is scratching in his sleep.) It was so bad last night that I was almost crying. I was mentally cursing the writer at the NYT who did the article suggesting "food allergies are not real/ are all in parents' heads" (even if that wasn't the writer's intent, the comments clearly show that many, many people hold this idea). OK, enough about me.


My "rule" about giving Benedryl and using steroid cream is if the active itching goes on for over an hour/disrupts our sleep for over an hour. Then, it's clear that the eczema is interferring with sleep, and I feel "justified" in using the benedryl (whatver the effective course of action is - reducing the itching and/or putting my son back to sleep).

Sorry for typos. Doing this without glasses on.

[gigismom]

Originally Posted by ASusan

My "rule" about giving Benedryl and using steroid cream is if the active itching goes on for over an hour/disrupts our sleep for over an hour. Then, it's clear that the eczema is interferring with sleep, and I feel "justified" in using the benedryl (whatver the effective course of action is - reducing the itching and/or putting my son back to sleep).

This is very similar to my rule... sometimes I can just nurse him back to sleep but when his eczema is very flared, and I try nursing back to sleep and it doesn't work for about 30 minutes to 1 hour, we get up and give benadryl. Or during the day, if his play is disturbed by itching and he is fussing because he is itching, miserable etc...we give the benadryl. My experience is that when he is actively reacting to something the benadryl just relieves the symptoms temporarily but does not make it go away, just makes it more tolerable. When it is time to dose again, the eczema is itchy again. This is clearly different than when he stops reacting and the eczema clears (meaning we found the culprit and pulled it).

glad to hear that your ds is responding to being off gluten. It is tough in the begining but very worth it to see the little one get better. Our whole family is happier now that ds is not as itchy!

jen

[JaneS]

For us, it was food chemical intolerances (salicylates) that do not involve the immune system that was causing my DS's skin to flare.

[DevaMajka]

We used steroids on ds's rash when it seemed to be bothering him, but only for a couple days, just until it was clear enough to stop bothering him. We found that the rash came back shortly after (I hadn't eliminated the right things), but not as bad as it had been.

[snanna]

Originally Posted by ASusan

It's been our experience that it is easier to see cause-effect of this-food-results-in-more eczema when we have been doing suppression.

Thanks, ASusan-- I guess I just needed to hear that from another mom. And I see now that you wrote a little about the phenomenon on my other thread too. I'm a little slow on the uptake, but all the pieces are slowly assembling in my head. It's a slightly less fuzzy head, even, since the gluten went away!

I hope you got some sleep last night.... And I haven't even clicked the link on that NYT article! SO not what I need to hear right now!

[snanna]

Originally Posted by gigismom

This is very similar to my rule... sometimes I can just nurse him back to sleep but when his eczema is very flared, and I try nursing back to sleep and it doesn't work for about 30 minutes to 1 hour, we get up and give benadryl. Or during the day, if his play is disturbed by itching and he is fussing because he is itching, miserable etc...we give the benadryl. My experience is that when he is actively reacting to something the benadryl just relieves the symptoms temporarily but does not make it go away, just makes it more tolerable. When it is time to dose again, the eczema is itchy again. This is clearly different than when he stops reacting and the eczema clears (meaning we found the culprit and pulled it).

glad to hear that your ds is responding to being off gluten. It is tough in the begining but very worth it to see the little one get better. Our whole family is happier now that ds is not as itchy!

jen

And does the benadryl make him super sleepy if you give it to him in the daytime? I'm still waiting to try it (the dr wants me to give the one they prescribe rather than an OTC, I don't know why).

It is SO TRUE that the whole family is happier when he's not as itchy. The whole world is a sunnier place when you don't have a miserable two-year-old for company 24 hours a day....

[snanna]

Originally Posted by JaneS

For us, it was food chemical intolerances (salicylates) that do not involve the immune system that was causing my DS's skin to flare.

I can imagine that took some figuring out! Wow. Another thing to keep in mind....

[snanna]

Originally Posted by DevaMajka

We used steroids on ds's rash when it seemed to be bothering him, but only for a couple days, just until it was clear enough to stop bothering him. We found that the rash came back shortly after (I hadn't eliminated the right things), but not as bad as it had been.

You know, I don't even think we'd have to use it on his whole rash to give him substantial relief-- just the parts that are exposed and can be scratched (neck, hands, wrists) seem to cause the majority of his discomfort, even if they are not the most severe areas.

What do you guys do in hot weather? He's SO much more comfortable when he's covered with long sleeves/pants, and it's kind of amazing how fast he turns into a scratching, fussing, clingy baby when he's got his clothes off-- then back into his happy self when he's covered. The derm told us to keep him in long-sleeved "loose fitting" cotton clothing, and I meant to ask her what we should do at the beach.

[ASusan]

Originally Posted by JaneS

For us, it was food chemical intolerances (salicylates) that do not involve the immune system that was causing my DS's skin to flare.

Ding, ding, ding!!! THAT may be what is going on here. I cut apples/applesauce last week because I suspected it, but DS is STILL breaking out/itching, and benedryl isn't TOUCHING it. Of course, there are sals in a whole lotta things besides apples, and we haven't taken anything else out yet.

Originally Posted by snanna

And does the benadryl make him super sleepy if you give it to him in the daytime? I'm still waiting to try it (the dr wants me to give the one they prescribe rather than an OTC, I don't know why).

We rarely give benedryl in the daytime, but when we give it to him near 5am, it does make him sleep in more (sometimes until 8:30 or 9, which is late for him). *I* don't think it makes him more sleepy after that, but he's at daycare most days. DH is concerned about having him sleepy in the daytime, but we give only half the recommended dose, so I think it's clearing out of his system pretty quickly.

Originally Posted by snanna

You know, I don't even think we'd have to use it on his whole rash to give him substantial relief-- just the parts that are exposed and can be scratched (neck, hands, wrists) seem to cause the majority of his discomfort, even if they are not the most severe areas.

What do you guys do in hot weather? He's SO much more comfortable when he's covered with long sleeves/pants, and it's kind of amazing how fast he turns into a scratching, fussing, clingy baby when he's got his clothes off-- then back into his happy self when he's covered. The derm told us to keep him in long-sleeved "loose fitting" cotton clothing, and I meant to ask her what we should do at the beach.

We only put the steroid on the parts he's actively scratching (unless, say, the back of his knees are weepy and sticking to his pants, then we'll put steroid there). He will even show us what finger, or hold out his wrist for cream.

When DS was an infant, I had pjs made by a local mama, in woven cotton material - long pants and sleeves for summer. They were styled after scrubs, in a similar material.

He does wear shorts to bed, and some nights, I think he'd be better off in long pants, if they didn't also make him sweat. But the part that he scratches the most is his hands/wrists and clothing doesn't cover those. (When he was an infant, socks worked until he learned to take them off at about 10 mos.)

[BirthKathy]

But today we went to the pediatric dermatologist, as referred by our doctor, and I left feeling really bad that I've let his rash get this bad without trying to treat it topically (other than moisturinzing) while we sort out possible allergies.

I felt the same way about my son's eczema. I had not used medication for him for months because I was concerned about side effects. (topical hydrocortisone) One of the books I read said to not withhold relief while investigating, and I really felt bad. The misery and scratching were holding up his development. Once we started treating him, he started crawling and gaining weight and was able to be more independent.

We found a lot of his food triggers and started using the HC around the same time. So he got much better quickly. The HC is like a miracle cream when there's not much going on trigger-wise. He still has active eczema around his mouth that I treat every other day, but most of his other areas are clear. I was also concerned about being able to see reactions since we are introducing one new food every 4 days. When he's reacting to something, I can usually tell because he'll get new spots on his face or forehead or his knee or elbow spots will reappear. It is a little tricky, but when he was completely untreated he was miserable and it was still hard to tell when the flare-ups were happening.

We have used Benadryl twice (just one dose) when he had hives, and I didn't see any change in disposition or eczema.

We've been using long sleeves and pants, but now that it's warmer I'm switching to short sleeves. I think we'll keep him in pants since he's still crawling and since he does scratch the back of his knees when they flare. Our problem is at night. We've been swaddling his arms for a while (to protect his face), but he's one year old now and i feel like we need to do something else.

[gigismom]

Originally Posted by snanna

And does the benadryl make him super sleepy if you give it to him in the daytime? I'm still waiting to try it (the dr wants me to give the one they prescribe rather than an OTC, I don't know why).

It is SO TRUE that the whole family is happier when he's not as itchy. The whole world is a sunnier place when you don't have a miserable two-year-old for company 24 hours a day....

he does not get sleepier in the day time when given benadryl... not sure why

Originally Posted by JaneS

For us, it was food chemical intolerances (salicylates) that do not involve the immune system that was causing my DS's skin to flare.

my ds was reacting to sals quite a bit a while back, not so much anymore. This definitely resulted in very itchy skin that did not respond to the benadryl as well as when it is due to one of his allergies. the rash was also, different, hard to explain how but definitely different than when it is allergen related. it was almost burn-like and concentrated in certain areas different from the typical itchy areas.

Originally Posted by snanna

What do you guys do in hot weather? He's SO much more comfortable when he's covered with long sleeves/pants, and it's kind of amazing how fast he turns into a scratching, fussing, clingy baby when he's got his clothes off-- then back into his happy self when he's covered. The derm told us to keep him in long-sleeved "loose fitting" cotton clothing, and I meant to ask her what we should do at the beach.

When ds is reacting he can not have any exposed skin (except for hands and face). I even have to make sure he is in a long sleeved onsie so he does not scratch his belly/back. He sleeps in footed, long sleeved all cotton pjs. Lately, since he has not been reacting, he is able to wear short sleeves and shorts. I also make sure to keep his nails clipped short, but he can scratch until he bleeds even with short nails. I am relieved that he seems to be clearing right in time for summer.

[Blessed_Mom]

Why exactly do you guys give benadryl to your LOs? To help them sleep better? What is it supposed to treat? I am confused.

[gigismom]

Originally Posted by Blessed_Mom

Why exactly do you guys give benadryl to your LOs? To help them sleep better? What is it supposed to treat? I am confused.

benadryl is an antihistamine and as such calms allergic reactions. for some kids it also makes them sleepy as a side effect. this has not necessary been our experience and am not an advocate of giving benadryl just to make a kid sleep. i don't think any of us were suggesting that (not that you were saying that anyone was suggesting that). anyway, as was mentioned above, if the eczema is not caused by an allergic reaction (ie involving the immune system) such as in the case of sals intolerance, the benadryl will not be as effective or not effective at all.

[Blessed_Mom]

Originally Posted by gigismom

benadryl is an antihistamine and as such calms allergic reactions. for some kids it also makes them sleepy as a side effect. this has not necessary been our experience and am not an advocate of giving benadryl just to make a kid sleep. i don't think any of us were suggesting that (not that you were saying that anyone was suggesting that). anyway, as was mentioned above, if the eczema is not caused by an allergic reaction (ie involving the immune system) such as in the case of sals intolerance, the benadryl will not be as effective or not effective at all.

When my DD was 2 mo old she had really really slight eczema (more as skin discoloration on stomach than anything else). Her ped told us it was eczema. So to preempt stuff we started giving her milk baths (to keep skin soft). She was fine until 4 mo when one day she suddenly reacted by developing hives to the milk bath. So there was our diagnosis - dairy allergy (she is 11 mo now and I know she has more allergies than that.....anyway that is a story for another day). She now has 2 very stubborn eczema patches and gets some more (which again disappear off and on). It is obvious she has more allergies and we are on the loooong road of discovery......

NOW - can Benadryl help her? Her dairy reaction has to be from immune system right? Although I have eliminated dairy from my diet long time back. But her other food allergies have to be from immune system reactions - right?

[Panserbjorne]

What about taking a palliative approach as opposed to a suppressive one? I have no idea the state of your child's eczema or what you have done thus far-just throwing a different option into the ring.

[Blessed_Mom]

Originally Posted by Panserbjørne

What about taking a palliative approach as opposed to a suppressive one? I have no idea the state of your child's eczema or what you have done thus far-just throwing a different option into the ring.

Can you please elaborate? What does that mean? And I have just been applying California baby products to treat her eczema. No soap while bathing just oatmeal powder with a washcloth.

So sorry snanna for the hijack.

[Panserbjorne]

Well it would depend on the kind of eczema. I have seen calendula (not the commercial lotions that have calendula in them) do amazing things for eczema. It doesn't heal it, it doesn't suppress it, it just makes it better while you work on the underlying cause.

I have had many people who have used a preparation in the store with no effect, but moving to calendula lotion (just calendula and water) made all the difference.

A high grade ointment could work too, but I don't tend to use that if the skin is weeping.

[Blessed_Mom]

Originally Posted by Panserbjørne

Well it would depend on the kind of eczema. I have seen calendula (not the commercial lotions that have calendula in them) do amazing things for eczema. It doesn't heal it, it doesn't suppress it, it just makes it better while you work on the underlying cause.

I have had many people who have used a preparation in the store with no effect, but moving to calendula lotion (just calendula and water) made all the difference.

A high grade ointment could work too, but I don't tend to use that if the skin is weeping.

Skin isn't weeping, just dryness. Please name the high grade ointment....anything?

And when you say Calendula and water - what form is Calendula in? Where do you buy it? Thanks so very much.

[franklin907]

I'm always hesitant to give antihistamines in case I'm masking what's really going on, but sometimes they really do provide DS with relief (which means we all get relief!). We typically use zyrtec, for whatever reason benadryl does not make a difference at night, but during the day it makes him sleep, zyrtec has the opposite effect. It's really hard not knowing why DS is itching, sometimes we can actually figure it out, but a lot of times we don't know why. We did a stool sample about a month ago and some bacteria showed up, clostridium spp., so he is now on flagyl, an antibiotic to treat that. I am not a fan of antibiotics (I think a lot of our issues stem from overuse), but I also want to see if getting rid of this bacteria helps, and it really seems to be. The last few nights he has been sleeping significantly better and the days are significantly less itchy! He is also on nystatin once a day. He was on nystatin and diflucan twice a day for yeast overgrowth, but no yeast showed up in his stool so we're trying to cut back on antifungals. I am not sure if anyone else has had any experience with bacteria in stool samples and eczema, but I'm holding out hope that this may actually be helping us. Click here if you'd like to check out my blog, too, I started it because I'm always online looking for information/support, so I wanted to start offering that back to other parents of children with eczema and allergies.