Eczema. Please help with next step...

[3Taureans]

I'm sure the eczema questions get asked A LOT.  Sorry for that, but I'm having a hard time finding relief for my son.  I could use some advice on where to turn next.

My son is 17 months old and has had eczema since birth.  His older sister also had it, but seems to have outgrown it (she's nearly 4 yo).  I have taken DS to a naturopath where she ran a food intolerance test on him.  It showed that he is intolerant to dairy, so that has been removed from both of our diets since October.  He still has eczema terribly and appears that dairy is not a cause.

I have a skin patch test scheduled for him in May (the soonest we could get into a dermatologist).  Is this the logic next step I should be taking?  My question is whether or not there is necessarily an environmental trigger.  My husband has hay fever really bad and it's my understanding that there's a hay fever/asthma/eczema connection.  If it's genetic, then is there any point in further testing? 

The poor baby sleeps horribly at night because he is constantly scratching.  I'm having a hard time finding anything to keep him comfortable.  It's been much worse in the dry winter air, but I moisturize him every diaper change.  He bathes once a week.  Any other suggestions?  Any homepathics that have been helpful for anyone?  Oh, and the other thing is that he only has it on his legs.  His legs are covered in weeping scaly patches, but the rest of his body is perfectly clear.  Odd, yes??

Thanks for your help!

[Karamom]

First of all because I know what a terribly frustrating issue this can be. My son has been struggling with very serve eczema since he was 3 months old and he is now 4 years. I will share with you some things that I have found work for us.

It sounds like he may have some infections on his leg from the open wounds. I know this has been a big problem for us. I guess once it gets infected it is even harder to heal and his body can actually  develop an allergy to the invading bacteria on top of the infection so even if you remove the other allergens it can make it hard to clear up. All the scratching will spread the bacteria.  I noticed you said he takes a bath once a week. My son used to be an infrequent bather mostly because he said the water hurt his skin (always had open wounds) and I had heard conflicting advice whether frequent baths or rare baths are better for eczema. The last doctor we visited told us we should absolutely be giving him a bath every night. He said the soaking is good for the skin but also it help keep the area clean. When things are really bad we have been adding a small amount of bleach to the bathwater which I know sounds awful but it kills the bacteria on the skin and I feel much more comfortable doing this than taking all the internal antibiotics that they always try to give us whenever they see his skin.

As soon as he gets out of the bath we use a heavy cream which I'm sure you already do. If his legs are really bad I would apply a wet wrap after the bath right before bed. Here's some quick info on that : http://www.rch.org.au/emplibrary/derm/Wet_dressings_A3.pdf but basically you apply a thick layer of cream to the area medicated or not then you wrap a couple of wet paper towels around his leg. Then you use a waterproof bandage wrap around the towels. This way his skin is moist all night long which helps the cream really soak in and his PJ's and bedding will stay dry. It will also helps with the scratching.

I also make sure to change my son pants very regularly and wash them in hot water to get rid of any bacteria. Doing all this has really helped control the infections. I just try to focus on keeping the whole area super clean.

I would not stop testing and trying to find the trigger. He may be reacting to the dairy but also something else which is why it didn't clear up by just removing the dairy. If it is an environmental trigger there is a lot you can do to help. If it's hay fever, pollen type allergy I would think a hepa air purifier would really help.

I just found out my son is allergic to dust mites so I had to get allergy covers on his pillow and mattress and I have been washing his bedding in hot water every other day.

I know you will have to find what works for you but hopefully something I have shared from our experience can be of some help to you. It is so hard to watch your child suffering and you want to help them so bad but nothing seems to be working. It can make you feel really helpless. I know I have spent many hours and hours laying in bed at night racking my brain for some way to help my son so I can really feel for you.

[3Taureans]

Thanks, mama.  I really appreciate you taking the time to share your discoveries.  It is very frustrating to not be able to help my son find some relief.  I didn't even consider an infection, but that may be exactly what is going on.  Is there a way to tell just by looking at it?  What doctor was able to provide you with answers?  Is this your family doc or an allergist?

The wet wrap link is super helpful.  I think this will be worthwhile just to get him to stop scratching all night.  Can you tell me what oil/cream/ointment you used?  My thinking is that coconut oil would be useful for it's antibacterial properties with a heavier cream overtop (I have been using shea).  I've been avoiding taking my son to the doctor because I didn't want to be handed a tube of steriod cream and left with no answers.  In waiting to see if dairy was the culprit, I may have waited too long in seeking relief for him and would have been better off with the steriods.

[deminc]

Hi 3T,

Our experience has been similar to Karamon's - infections and a severe allergy to dustmites prevented the sores from healing and was the main trigger for his eczema. We live in a warm humid climate, and my son had bacterial and fungal infections that I was totally clueless about and the various family doctors I took him to gave me a generic cream that they say is antibacterial, antifungal plus mild steriod - ie a catch them all cream, that did absolutely nothing to relieve his discomfort. Similarly, we were given the 'usual' eczema advice - less showering, thick moisturising cream , and for our weather, airconditioned rooms - but it made things worse BECAUSE of the infections, esp the fungal infections. I really gave up for almost a year and things went from bad to worse. Much later we received sound lifestyle and managerial advice separately from an elderly dermatologist (who diagnosed seafood allergy and fungal infection) and an allergist (who diagnosed dustmite allergy and bacterial infection).

Looking back, I really feel SO bad for all the pain and sleepless nights he went through. He is also sensitive /allergic to some other food that had impact on his growth, but dustmites and infections were the two main things that we couldn't get a grip on for the longest time with regards to his eczema.

So, please do consider if there are infections, AND the nature of the infections. Bacterial infections are very different from fungal infections in terms of management. For my son, the skin will be swollen and pink and it looks very wet. If there are weeping sores, there are definitely infections. When severe, there is a thick yellow liquid oozing out. This is pretty serious and you should take him to a specialist for that. Wounds that are uninfected do not have the same appearance and the scabs form quickly - even if they are scratched off the very next night - and the skin does not have a persistent inflamed appearance (raised, pink and tender).

This is what we do, but bear in mind that I live in a humid climate and my son is prone to both fungal and bacterial infections. For fungal infections, moisture must be kept to a minimum at infected areas.

- Daily baths, but keep it short and in tepid water. No prolonged soaking. I have three shower products - physiogel for atopic skin, medicated mild anti-fungal wash from doc, and Johnsons and Johnsons Tip to Toe Wash. J&J is the main standby as advised by elderly dermatologist, anti-fungal wash foamed up and gently applied only on areas with infection, Physiogel on occasion when I feel his upper body is getting too dry. I use Physiogel cream only during good spells and when he has to be in airconditioned rooms, avoiding all his rashy areas.

- After showering, dry with patting motions, paying attention to all creases. Straight into clean clothes before sitting down ANYWHERE. (we are a bit paranoid because of his severe dustmite allergy).

- Mattress is vacuumed nightly just before sleeping using a HEPA fully sealed unit. We experimented and found that any vacuuming done in the afternoon or at less than maximum power is useless. (And yes, I have anti-dustmite covers and duvet.)

- For infections, we use single use satchets of antiseptic wash available at pharmacies. I stock up on this and we clean his rashy areas AND fingers every night just before sleeping. It makes a huge difference in preventing and managing infections. Soak cotton pads in the solution and leave it on the spot for 5min. During a period of severe infection, we were given antibiotic cream used also by burn patients. That was also very good, but because his infections keep recurring, we use the wash for long term management.

All this gets us a reasonably good night's sleep and a cheerful preschooler.

[deminc]

By the way, I did try coconut oil and many other natural products e.g. tea tree, oregon oil, and natural moisturisers. They made things worse. It's best to stick to the antiseptic wash and a very strict cleansing routine (and moisturising routine if applicable to your child's skin.) His rashy areas were on both his ankles (very very bad, lots of weeping sores) knees, buttocks, and a little on the elbow. Now one foot has been 100% in the clear for almost a year, and the other foot which has not healed completely, is very much better with the affected area halved. Knees and bum also very much better. On most days, I can now shower him without him crying.

[3Taureans]

Thanks, deminc!  Good info.  I guess I had no idea how involved treatment for this type of thing could be.  I can't even imagine how painful the process must have been to finally get the answers needed to effectively help your son.  I now know, without a doubt, that I need to keep pursuing this for my own son.

My son's legs are definitely red, raised and tender.  The inflammation just never seems to wane.  The inside of his knees are cracked and this is where it can get a little oozy/bloody (aside from the random spots of blood where he's scratched his legs raw).  However, he doesn't have any thick yellow pus.  His legs are just so very dry.  No amount of moisturizer can come close to keeping them hydrated.  You're right about the natural products; I have tried every thing I can get my hands on and it only seems to aggrevate him further.  Time for the heavy-hitters, I suppose.

Perhaps my first course of action should be to see the family doc.  From there, maybe she can refer us to a dermatologist sooner than May or refer us to an allergist.  By the sounds of it, both tests were needed to effectively diagnose your son, correct?

My other question is whether or not a food intolerance test and an allergy test would reveal the same food triggers.  For instance, with my son being intolerant to dairy, would this result also show on an allergy test?  Or vice versa?  Would another food that he is potentially allergic to have shown up on his intolerance test?  I should've inquired further with his naturopath, but I'm unclear how the two differ (other than through his reactions).  Thanks again!

[Momo123]

I'm so sorry to hear that your DS's eczema, it is so hard to see little ones so itchy. My DS is now 20 months and he had some significant eczema for some time, but it has greatly improved now. His was the worst on his legs also, behind the knees and on his ankles and it never seemed to heal totally because it was at the joint. I agree that the wet wrapping overnight can help, but it does take a while to figure out the triggers. DS's were both food and environmental (laundry detergents, soap, moisturzers etc.) so it was after a lot of trial and error that it finally got better. He still gets flares and tends to have very dry/sensitive skin.

I think it would be good to get it looked at to make sure there's no bacterial or fungal infection there. I took DS as well, and I just never used the steroid cream that they prescribed.

I'm not sure what type of test your naturopath ran, was it for IgG allergies (which are food intolerances)? Was it a blood test or muscle testing? Allergists/dermatologists usually test for IgE allergies (skin or blood test) which are what people traditionally think of as allergies. So if your DS tested IgG positive for dairy, he may be intolerant to dairy but may not necessarily test positive on the IgE test. That is the case with DS, he only tests IgE positive to dairy and egg, but he is intolerant to other things as well. Plus there can be false positives (and false negatives), especially in babies/children so watching for reaction is probably the best way. Does he have any other symptoms of food sensitivities (like weird poops, digestive issues)?

Homeopathics can be helpful, but some guidance from a professional might be needed to figure out the proper remedy. Have you checked out the cell salts thread in Health and Healing? Cell salts are a different type of remedy and it seems much less intimidating to try out at home (at least for me!) I have used it successfully to help DS with other health issues.

FWIW, my side of the family is very "atopic" with various people having asthma, food allergies, eczema etc. so I think there is be a genetic component to be more reactive but it doesn't mean we can't stop trying to make things better. Hugs, and you are doing a great job!

[anechka]

I have been an eczema sufferer since childhood and my mother started treating me same way as some members described here. She did not want to use steroids at first but then things went from bad to worse. I had developed unending skin infections which no amount of antiseptic wash or even antibiotics could combat (second colonization, then fungus appeared, then yellow pus started flowing out of my wounds). At this stage the doctors switched me to antibiotics, ant-fungal, steroids and God know what else but nothing really worked. I ended up having deep scars on my both arms and legs that look like burns. Just horrible, really. Keeping this in mind and I began applying steroids to my daughter's skin AS SOON as she began showing sings of eczema. And that is how we keep this at bay. I'd rather use steroids on her instead of having to use antibiotics and anti-fungal when things would go totally out of control.

[Karamom]

3T, I would go see your family Dr. or pediatrician. You said you were worried about him just handing you steroids with no answers and you may be right but that would depend a lot on the individual Dr. Our first pediatrician did exactly that and also gave us internal antibiotics. She did not believe it could be allergies and because I was naive I followed her advice for longer than I should have. After I became more aware and natural minded we switched pediatricians to one who was able to give us some helpful advice and willing to refer us to an allergist. Unfortunately our insurance would not OK the allergist until a while later when my son was also diagnosed with asthma. My point is you just have to keep trying.

I used the steroid cream underneath the wet wraps because at that time we had removed all the triggers and his skin just needed some intense help to clear up. I understand not wanting to use the steroids and really your not suppose to use them longer than a week anyway so if you haven't removed the triggers it will come right back and there really isn't much point but if you use them in-conjunction with finding triggers it can be really helpful.

[elisheva]

I'll just give you my experience, FWIW.

Ds1 has had eczema somewhere on his body almost since birth. He is prone to dry skin. His eczema usually flares in the creases in his knees and elbows but spreads to his torso with changes in weather (dry to wet, wet to dry, or warm to cold usually). We tried everything within reason: dietary changes (elimination of various things), constitutional homeopathy, acupressure, fish oil... No visible success with ANY of these. The other day I had an AHA! moment when reading about this crazy idea called the bleach bath (not as toxic s it sounds, I assure you - it basically amounts to a trip to the pool) and there is actually some recent evidence to back it up. We're trying it in combo with caledula salve post-pool and for the first time we are seeing results. He's also still taking fish oil with Omega-3s. I don't ahve the bleach bath study to hand but I believe it was published in Pediatrics in 2009.

Our doc was totally unconcerned about the eczema but did offer steroid cream. Ds1 did have one round of vaccinations at 2 mo before we made the decision to delay. I'm still assuming there is some underlying reason for ds1's predisposition (DH and MIL both have eczema) that I will continue to look into but I wanted to share our results with you.

[deminc]

I've seen various reports of the bleach bath study. You can read one here. http://www.webmd.com/skin-problems-and-treatments/eczema/news/20090427/bleach-baths-may-help-kids-with-ezcema

It is aimed at managing chronic eczema where bacterial infections is often a factor. Antibiotic cannot be used as a long-term treatment for these because the bacteria may become resistant to the antibiotic, making it even harder to target. I think that's what happened to Anechka when she was younger. (the combination of strong steriods and antibiotic is actually very bad - since steriods surpresses the skin's natural immnunity, and this makes the infection stronger, and once it becomes drug-resistant strain of bacteria, things get really complicated.) Anyway, our allergist's advice was to use antiseptic solution which is perhaps just a more expensive form of diluted bleach??!! But it removes the guesswork of correct dilution.   We were also advised to go for weekly swims (as pp said, like diluted bleach bath) followed by thick cream, which we did faithfully for one month but it brought the FUNGAL infection back with a vengeance. Ran back to elderly dermatologist who shook his head and sighed and cleared it up with ASTRINGENT. (wow, never thought of that!) Once the infection healed, we quickly followed up with the antiseptic washes, and moisturisers ONLY on unbroken skin for the rest of his body, skirting around all patches. So it really depends on your child's particular set of problem, as well as the climate you live in.

And yes, you must find the trigger(s), especially if you are using steriods as an interim measure. We did use steriods in the beginning, but because of the recurring nature of his flare-ups, it resulted in thinning of the skin and his skin became very prone to infections. It got to the point when we could no longer use steriods without digging for the triggers because the new skin was so brittle it fell with one scratch followed by profuse bleeding.  But it really goes both ways. The key is how you use it. For stronger steriods like elomet to dermovate (v v strong), less is better. Use only on areas that is required (no smearing!), carefully applying a thin layer. Mark the date on your calender. You cannot use it consecutively for more than 10 days (for some it will be 15 days). After 10 days you must stop for about a week before you take it out again if you need to. If you are using moisturisers, first you apply the steriods. Moisturisers go over about 10-15 min later.

If your child has fungal infections BUT you need to bandage it at night to prevent him from scratching further (airing is best), do not put any cream as the emolliont base will provide moisture that favours the fungus. Only apply cream when you can air that area of the skin.

(Sorry if I sound a bit like an out-of-job nurse, but hopefully this will help someone out there.)

Edited by deminc - 3/2/11 at 11:56pm

[MrsJewelsRae]

Aww, poor baby!  :(  My dd had eczema as well, she is 6 and has mostly outgrown it for a couple years now, except she is prone to really dry skin.  We tried everything with her.  The steroid creams burned on contact and made her scream so horribly I just couldn`t handle it.  Her triggers were milk, soy, dogs and cats (she is fine with all of these in moderation now) but we couldn`t clear her eczema patches that were weeping and she would scratch them until they bled.  Eliminating triggers helped somewhat, adding probiotics, absolutely no scented detergent or bleach in her clothes and linens, massaging with cream (non medicated, non steroid creams like Eucerin) every night and after every bath, covering her patches with cloth- we cut socks into tubes to cover her arms at night.  Then we stumbled on something accidentally- she had to have antibiotics at 3 yrs old for an abscessed tooth and suddenly her eczema cleared up almost overnight- her skin was super clear all over!  (This only lasted a few days actually because, as it turns out she is allergic to penicillin and broke out in a full body horrid rash from an allergic reaction on the last day of her amoxcicillan).  But it showed us that her patches were actually infected and that is why we could not clear them. So with occasional use of Polysporin we could treat the flare ups.  The biggest help of all was when we moved into a new house that had a water softener, her skin was SO much better after that, we knew it was the soft water because every time it ran out of salt she`d flare up again,  HTH!