>> Friday, 20 April 2012
I am unashamedly recycling a post. To those of you who have been kind enough to stick around reading this blog since August 2009, apologies for that, but after seeing a tweet this morning asking for help in dealing with childhood eczema, I think that what I wrote back then is still of value now, and could be useful for parents dealing with this condition in their children. And the title of this post is a suggestion that Tara at Sticky Fingers made in her comment on the post first time round - so thanks for that, Tara!
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...).