Sometimes the Drugs Do Work; Dealing with Childhood Eczema

>> Wednesday, 12 August 2009

A while back, a friend of mine suggested I wrote this post after hearing of our experiences with the Boys’ eczema, thinking that others might benefit. I haven’t written it before as I think it might come across as preachy – which I know I can be, especially on this subject as I'm quite passionate about it – so apologies if it does.

Question.

If you see a baby or a child with bad eczema, what is your first thought? Is it:

A: What a pity, such a shame, but it won't do any long term damage and I'm sure he/she will grow out of it...
B: Gosh, that looks uncomfortable. I suppose they've tried everything they can to shift it. I wonder if they've tried changing his/her diet?
C: I have a pretty good idea how the parents of this child might improve this situation, but they might not want to hear it. Should I say something, or should I just mind my own business?

Before my sons were born – or rather, before Boy #2 was born - I used to default to answer B. I’m a long-term sufferer of eczema myself, although nowadays you wouldn’t know it, and growing up in the 1970’s and 1980’s there was only one recognised way to deal with it; moisturising and steroid cream, lots of it. Oh, we knew that the latter could have nasty long-term effects, like thinning of the skin etc, but the benefits to me as a crusty-faced 14 year old girl of smooth skin vs resembling what I imagined at the time a leprosy victim looked like, meant that those potential drawbacks were usually ignored.

As often happens, my eczema decreased as I got older, leaving me only with the belief that there must be some way other than steroids to deal with this condition. I convinced myself that what I ate was the key, and tried various different diets throughout my early twenties, but looking back now I think I just grew out of it.

When Boy #1 was born, it turned out that he also suffered from fairly severe eczema. Remembering the scare stories from my youth, I tried everything under the sun rather than bring out the steroids. We went dairy free, we went soy free, he drank goat’s milk formula when he went onto bottles, we went wheat free. We even had him allergy tested at 7 months old, but nothing showed up, not even the nuts and sesame that would nowadays hospitalise him. It didn't help that 'eczema' is a generic term; there are many different things that can cause it, and at the time we had no idea what they might be.

Still he had those persistent patches of eczema that occasionally flared up into something nasty, and which would then necessitate a course of antibiotics and the grudging application of the thinnest layer of hydrocortisone cream imaginable. Basically, he itched, but got by.

Then, Boy #2 was born. He also suffers from eczema, initially even worse than his brother, and after 4 months of skin infections, hospitalisations and a constant round of on-again-off-again courses of antibiotics we discovered that MRSA is particularly fond of children with eczema. Not the best of times, but this last did at least get him treated – finally – by the excellent team of paediatric dermatologists at Chelsea and Westminster Hospital who helped us get a handle on the problem.

And you know what I found out?

Steroid creams have evolved. They are no longer as aggressive as they used to be, and nowhere near as harmful.

Now I freely admit to being a touchy-feely middle class parent. If there is a way of dealing with a problem without resorting to drugs, I will take it. If I feel a headache coming on, I’ll drink more water rather than take a pain killer, and if I feel bloated I’ll reach for the organic remedy rather than a pack of laxatives. But I’ve tried that approach to my children’s eczema, and it doesn’t work. This is one time when, as a parent, I had to forget about all the alternative therapies I automatically drifted towards.

It’s natural in today’s less intrusively-inclined culture not to want to put chemical substances on your children’s skins, and instead to change their diets, or to take them to chiropractors, cranial osteopaths, kinesiologists etc (all of which I put my hand up to, by the way) but believe me, I’m now a convert to the conventional medicine route in this situation. As a fantastic consultant once told me, a little bit of steroid cream and a rigourous moisturising regime as prescribed by someone who knows what they are talking about is a great deal better than dealing with the fallout of not treating eczema properly, and early.

Having seen my baby hooked up to an iv which delivered two different types of antibiotics because the skin cultures that had been taken from the infected area wouldn’t be back from the lab for 5 days – 5 days that we couldn’t afford to wait in treating our son - I have to agree.

However, therein lies the rub. ‘Someone who knows what they are talking about’ can be very hard to find. After the last six years of caring for my two eczema-prone sons, I know that in reality it’s practically impossible. I would even hazard a guess that I know more about the condition than most GP’s – and certainly most health visitors. And that’s not to blow my own trumpet, but simply to highlight how poorly informed they often are.

To look at my sons now, you wouldn’t notice they had eczema. Paradoxically, my younger son – who has been treated almost from the start in a much more aggressive steroid-slap-happy manner than his older sibling – is the one who now has much better skin. You can draw your own conclusions from that.

So, whilst I know that every child is different, and the root causes of this condition can be any one of a number of things, here is the checklist that we use and which I hand out to friends and family who find themselves at their wits’ end trying to sort out their child’s eczema.

1. If your child’s eczema is not simply the type that manifests itself as an occasional flare-up which can be treated with prescribed hydrocortisone, get your child referred to a paedriatric dermatology team as soon as possible. Some hospitals will have better teams than others I know, but all of them will be better equipped to deal with this than your local GP or health visitor.

2. Whilst you’re waiting for this appointment, you will no doubt find different ways of coping. We follow this routine;
a) Moisturising morning and night, even the eczema free zones. We use Cetraben lotion twice a day; I was told by a very experienced eczema nurse ‘this stuff is magic’, and compared to the others on offer out there I couldn’t agree more.
b) Our boys have a bath every day, rain or shine. It’s often said that children with eczema should only be bathed once a week, but this may not necessarily be the case. In fact, of the serious sufferers that I know, almost all of them have been prescribed daily baths by a dermatology consultant.
c) Before they get in we cover them with a mild anti-bacterial lotion; we use Dermol 500, and this replaces the need for soap.
d) We use a capful of fragrance-free Oilatum or similar in the warm water.
e) We wipe off the Dermol 500 with a clean flannel in the bath.
f) No soap, and once a week or so, the gentlest shampoo we can find. When we do wash their hair, we rinse them off with clean water from a shower attachment as they get out of the bath to avoid the shampoo staying on their skin.
g) After drying off, we moisturise all over as detailed in point a.

3. This is our routine only, but whatever you do, when you get your appointment with the consultant make sure to tell him exactly what you’ve been doing as they may wish to try something completely different.


Finally, as unfashionable as it may be to say it in today’s increasingly alternative therapy-keen society, whilst the routine I’ve listed above has improved our children’s skin immeasurably, it’s been using the prescribed drugs – the dreaded steroids - that has really made the difference.

Sometimes, the drugs do work.

Note: Oilatum Fragrance Free, Dermol 500 and Cetraben Lotion are all available over the counter from your pharamcist or on prescription from your doctor. I would recommend the latter; a large tub/bottle of each will set you back between £9 - £11, and will only last around 3 - 4 weeks (although I do have 2 children...).

16 comments:

Tara 13 August 2009 at 00:42  

Wow that us really interesting and really good if you to detail it all. I know there must be so many parents needlessly suffering when all they need is another parent who has been through a similar thing
you should have headlined this ' how to deal with childhood eczema - from a parent who knows!'

Mummy McTavish 13 August 2009 at 01:10  

It does take gutts to share information as parents because we are worried we'll be preaching if we know that our thoughts are not the popular ones. You handled it well! I hope your little men are the end of the line for the eczema gene... it's a nasty itchy-itch!

geekymummy 13 August 2009 at 05:01  

What a great informative post. One of my very dear friends suffers dreadfully from eczema (even now as an adult), but has found a regime such as you describe the only thing that works for her. That and reducing stress in her life, which as a working mother of two is quite hard!

The Green Stone Woman 13 August 2009 at 06:10  

I have eczema and after reading your post, I will start using the dreaded ointments again, which I had been avoiding because of the reasons you mentioned. I guess they are not so dreaded after all. I thought olive soap would take care of it, but it hasn't. I stand corrected. Thank you.

Rachel 13 August 2009 at 09:57  

I have begun suffering from eczema type symptoms on my spine and the pharmacist asked me what washing powder I used.

When I thought about it, the itching and flakiness is worse when I use anything other than ecover or other ecofriendly washing liquids. The washing powder and any other washing liquid or powder makes it worse.

I am sure this has nothing to do with childhood ezcema but I thought I might pass on this info.

Potty Mummy 13 August 2009 at 10:26  

Hi Tara, good point - I probably should have used a different title!

Mummy McT, it would be nice if their kids don't get it - but unlikely, I'm afraid.

GM, yes, stress is definitely a contributer - as I know too!

Irene, wouldn't it be nice if treating eczema was as simple as using the right soap? If only!

Hi Rachel, that's a good point, and we use non-bio washing powder for the same reason. However, what you've highlighted is that the root cause of eczema can be any number of different things. In fact, as I understand it, 'eczema' is something of a generic term to cover dry itchy flaky skin, in much the same way that 'a cold' can be caused by any one of a number of different viruses. That's why I would never say that eczema is NOT the result of too much dairy / allergies / intolerances. It could be - they just don't know.

memoriesdad 13 August 2009 at 12:21  

Really great post. I had really bad eczema on my feet when I was a teenager!! It started just before my GCSE's and flared up again at A levels - so I am proof that stress is a very large factor! I grew out of it too, but It came back when I started work!!! The potions and creams didn;t work when I was a kid, but, like you say, when i tried them as an adult they cleared it up in no time. Interestingly I also developed IBS when i started work, proving that a change of lifestyle (getting up earlier and drinking more coffee) can be a very big factor too. It disappeared after i changed jobs. So I think that 'shocking the system' can not only create illness, it can also help get rid of it too.

Daniel 13 August 2009 at 13:21  

I recommend Aveeno lotion or bath oil (I don't work for them, honest!) - it's oat based and very soothing, not abrasive. Failing that, put a handful of oats in the bath. Brilliant for my boy.

Iota 13 August 2009 at 14:25  

That was brilliant post: informative, not preachy.

Might interest you to know that here, 1% hydrocortizone cream is available over the counter.

My sons have both had mild eczema, which I know is a very different thing to serious eczema. If I had one piece of advice, it would be 'find what works for your child, and stick to it'. I think most parents find that out for themselves though.

Annie and Jen's blog 13 August 2009 at 17:22  

I developed terrible eczema on my hand when my daughter was a baby and I'm still battling in. Best thing for mine: keeping hands moisturised all the time (i use lotion approximately 5 times a day).

Bush Mummy 13 August 2009 at 19:08  

Hi Potty hope you are well.

Senior has always suffered from mild eczema and i have often wondered whether London water and pollution exacerbate it? Whenever we are staying with various grannies around the country, it completely clears up..

Mini seems to have escaped thank god.

I myself suffer from psoriasis which amazingly seems to go in pregnancy.

Great post

BM x

allgrownup 14 August 2009 at 04:07  

Hello, my 20 month old has mild eczema, which virtually disapeared when we started using only water to bathe him, even on his hair. I would recommend for other parents of mild eczema sufferers is a cream available in a hightstreet shop, sold as a moituriser. It's from Lush (also available online) and is called Dream Cream. Even works for my sister in law, who is allergic to water.

Potty Mummy 14 August 2009 at 13:47  

MDad, thanks for visiting and commenting, and you may well be right.

Daniel, thanks for commenting and I have heard that Aveeno is good stuff.

Iota, thankyou, and that's so true about finding what works...

Hi Jen, yes, I'm constantly 'creaming up' (as the Boys call it) as well. Funny how pregnancy sometimes starts things off and in other cases (see Bush Mummy's comment) clears them up.

Hi BM, thanks, and yes - my eczema improved in pregnancy too. Although that could have had something to do with the vat of oil I used each day to try and avoid stretch marks!

Hi Allgrownup, thanks for visiting and for the recommendation!

happy day 14 August 2009 at 17:03  

Yes I can vouch for going to see the consultant, as she diagnosed a wheat intolerance(not allergy)and used propaderm (for flare ups)or epaderm cream for our now three year old boy. I'm sure chocolate makes him itch as well!

furbi123 18 August 2009 at 01:43  

My doc prescribed Cetraben for my baby daughter. However, I have an aunt who runs a specialist skin clinic at a well known hospital. She told me to stop using that on the baby and use Epederm instead in the bath and as a moisturiser. Its magic! She gave me some interesting info; latest research suggests that aqueous creams actually worsen exzema; do not use a cream containing lanolin as this will actually sting a baby's skin (my doc told me to use E45 on baby's skin and she SCREAMED when it was being applied. My aunt explained the stinging so I switched creams and she no longer screams); use the hydrocortison for 4 or 5 days after the exzema has 'gone' or it will come back straight away; 'ointments' contain fewer additives and therefore tend to be better for sensitive skin than other creams. I was lucky that my aunt sent me a pack detailing how much hydrocortisone to apply and how often. If it hadn't been for her I'd be applying a fraction of what I should and would still be using the E45 as per the doctor. Not enough information given to people!

Anonymous,  11 November 2010 at 02:48  
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