my grandson 0f 4mos has very weepy eczema on cheeks bach of head and folds of sklin in arms knees back of neck etc. we have tried many differeny creams ect and it just keeps getting worse. he has to wear mitts all the time as hes always scratching. i am a retired nurse and have tried all i can think of. he is breastfed and weighs about 16 pounds. it would be great if you could suggest some things we could do. we are trying to get an appointment to see a dermatologist in edmonton but it is taking forever. hope you can help us. shirley, st. paul,ab
Hi there I can chat with you.
So I am going to give you my eczema discussion while I am waiting for you to come online.
So eczema is 2 things: Dry skin and sensitive skin. You need to attack both in order to treat it.
Dryness needs to be treated as many times as you can remember to put on an emmolient. Think at least 3 for babies I like to recommend with each diaper change when the skin is exposed.
The emollient needs to be greasy (hydrates well!) and clear without perfumes or dyes. I like plain old Vaseline or white petroleum jelly especially for the baby cheek area that gets wet frequently with milk/saliva etc..
Other brands include Eucerin (tub), Cetaphil, Aquaphor.....
These should be applied on the whole body as well as all of the spots. Soaps should also be hypoallergenic (unscented and without dyes). Parfum in body products is a leading irritant and easy to avoid, There is actually a huge list of some chemical irritants but just starting with fragarence and dyes is a good start.
Laundry detergents as well the same...unscented, no softener after as these all are scented....I like Tide clear or all free and clear as they are less $ than the brand baby detergents which as well still are scented.
Once you have your moisturizing down (sometimes limiting bathing as well to a few times a week can help as applying water to the skin will dry it out) you need to work on the immune reaction that makes it itch. This is where the steroid creams come in.
These are probably the creams you have tried as most people skip the long explanation on skin care and go right to the creams...they do work but are only half the battle!
On the face Hydrocortisone 1% is really the maximum potency as a stronger cream may leave white spots as the eczema heals and the facial skin is thin. Rarely do kids need a stronger one and then only sparingly. For the body spots it sounds like your grandson will need at least moderate potency steroid like HC 2.5% or triamcinalone 0.1% 2x every day until the spots improve.
Another big pitfall for people is being worried to use the steroids. Without this medicine to stop the itch he will scratch and continue to make more rash.
As his lesions are weepy keep always in mind the possibility of superinfection with bacteria. Often common skin bacteria can cause an impetigo like infection that needs a topical or even oral antibiotic....as a RN you will recognize this as the yellow crusting really weepy type lesions.
There also may be yeast superinfection as he has it in his folds....baby fat folds are a good place for yeast to grow as they are nice and moist. This would look red and almost cheesy with a slight odor.
I see that you entered the chat and probably are reading my monologue. Any thoughts? What creams have you shared? I find the key to controlling eczema is being hyper vigilant about skin care and every day following the same extensive routine. Rarely there are some food allergies that can affect eczema but your grand baby is breastfed so I doubt this would be the case now.
Sometimes a sedating antihistamine can be used for really sedating the first phase of sleep so that they scratch less....as eczema is not itchy from a histamine release it doesn't stop the itch this way but can make them more sleepy and scratch less at night.
Occasionally I will try benadryl or atarax with a kid who just scratches a lot.
The trick to knowing your child's eczema is being able to determine when you can downgrade to a less potent steroid or even skip the steroid and when to restart it again to in essence use the medicine as little as possible. This needs a daily skin check and knowing how the lesions look when they start to come out.
To be honest as a general pedi I have never found sending kids to the dermatologist to be that helpful. They have less time to explain the above talk and really use the same steroids as we do...there is no magic medicine it is routine and skin care and knowing how to daily make decisions on what to put on his skin and what to avoid. If his skin is really weepy and having some yellow crusting go ahead and use a topical antibiotic even an over the counter for a few days and see if it is better use it for a week (the weeping should get better) if not just continue with the steroid. If the spots are really open I suspend the steroid until they start to heal.
It is uncomfortable to be itchy and frequently babies with more significant eczema don't sleep well and are irritable as well as inventing ways to scratch even with the mitts on!
Are you still there? Any further questions?
I will be signing off for the night soon. Please let me know if you need anything else thanks!
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