How to cure eczema: toddler edition
March 16, 2011 6:25 PM   Subscribe

Can you help me understand my toddler's eczema, and what I can do about it?

He got his first dry red spot in June of 2010, when he was 14 months old. Since then, the spots have responded to hydrocortizone (prescribed by his pediatrician), but have never gone away completely. They seem to go in cycles of more patches and rougher, and then calm down a bit. But we've never gotten them back to pure smooth skin with this topical method. The patches are only on his legs, not on hands or feet. They itch him only a little bit -- maybe for 10 seconds once a week or so. He doesn't have seasonal allergies.

So, what next? I have fairly detailed records of his life so far; should I be looking at sudden changes that happened around last June, like changing soaps or sheets? I have a complete account of everything he's ever eaten; should I enter it into a spreadsheet and look for patterns? Should I take him to an allergist? (If so, for what kind of testing?) Should I put him on an elimination diet? Should I test the surfaces in our home (couch, play rug) where he spends most of his time?

I want to take this seriously because if some unknown element is stressing his body, I want to eliminate it now.
posted by misoramen to Health & Fitness (22 answers total) 5 users marked this as a favorite
Just an anecdote: my little brother had eczema when he was young, starting when he was a toddler. I was young, too; I remember that he had some sort of cream, but don't know what kind. Nothing was done to remove any stressing elements. He grew out of it when he was about 12.

Which is also roughly about the time he developed a really bad cat allergy. Poor kid's face gets soooo puffy.

I don't know if they're related.
posted by phunniemee at 6:30 PM on March 16, 2011

Yes, eczema and allergies -- especially food allergies -- are very much related. See if you can find a pediatric allergist in your area.
posted by Wordwoman at 6:34 PM on March 16, 2011 [1 favorite]

It was food intolerances for us - red berries for the first one, and honey/dairy for the second. The eldest has pretty much grown out of it, the youngest has a while to go with the honey thing. After months of mucking about with creams and changing soaps / detergents it was a relief to find it was something so simple.

So try cutting out the common allergens for a week or so and see if it clears up, then reintroduce them one at a time, a day at a time. If it's anything like our experience you'll identify the culprit(s) pretty quickly.
posted by obiwanwasabi at 6:37 PM on March 16, 2011

If you can't get to an allergist soon (excema = food allergies for many people), try eliminating the top 8 allergens - egg, dairy, wheat, soy, peanuts, tree nuts, fish and shellfish - and see if that clears it up. If it is a food allergy, it can take a couple of weeks for the trigger to be eliminated from the body and then time for the skin to heal. In fact, to spare my kid the testing I might just go ahead and try the elimination diet to see if it helps.
posted by PorcineWithMe at 6:42 PM on March 16, 2011

Yes, I've heard that one of the most common responses to eczema is to try to cut out dairy.
posted by cymru_j at 6:52 PM on March 16, 2011

For me it was cats and chocolate. The cats were obvious, the chocolate didn't get figured out until I got tested many years later. The simple skin test is a bit painful and annoying, but was well worth it.
posted by lab.beetle at 9:08 PM on March 16, 2011

my eczema started when I was an infant. it took a very long time to get under control. they even gave me cortisone shots before they understood the steroids could have serious effects on a developing system.

unlike many, mine has followed me into adulthood, so I've done additional research and discovery to work out what improves the situation.

here's what I've learned:
* eliminate harsh detergents - it's easier now that there are so many products more suited to those with sensitive systems. try 7th Generation or Charlie's laundry powder; this goes for any cloth that comes in contact with him: sheets, towels, washcloths in addition to his clothes. don't put bleach or other heavy chemicals in the tub just before his baths; rinse well after cleaning, perhaps even spraying down with a combination of vinegar and lemon juice to get rid of the residue. use that kind of thinking for any surface he comes in regular contact with. simply discontinuing bleaching my clothes helped a lot. immediately rinse after any time in a chlorine pool and have him wear fresh clothes after rather than sitting in chlorine-soaked shorts or towel.
* eliminate unnecessary environmental irritants - Febreze and other air fresheners/"cleaners" stick to fabrics and can cause skin/systemic reactions. same with pet hair, cigarette residue, and even colognes and hair products.
* lock down a moisturising/irritant-free hygiene regimen - find a breathable moisturiser with very few ingredients and high emollient properties that he tolerates and apply it after baths. aloe vera (make sure it has no alcohol, artificial colours, or scents) is generally soothing and healing. once weekly oatmeal baths help heal the sites. use soap-free, low-ingredient products like Mustela. keep in mind that "natural" does not mean "non-irritating" and everyone's balance is different, so he might react to things other eczematics tolerate (glycerin is a good example of something that can go either way; lanolin, too).
* watch temperature extremes - some eczema is made worse by too much cold, heat, or even by too much time in a climate controlled environment. fairly easy to observe his indoor/outdoor pattern and the weather and compare to flare-ups to uncover.
* do watch foods & other metabolised intake - this isn't the cure-all that many would like it to be and nearly everyone has a different set of things they should avoid, but common systemic irritants like nightshades, corn, and even Red 40 can be "invisible" culprits. I would simplify before eliminating (whole foods that don't use artificial colouring and preservatives, for example), unless you've already done that.
* natural fabrics - often, synthetic fabrics can be the "a-ha!" item that leads to the breakthrough and no more flare-ups. cotton, bamboo, and other natural fabrics are the best choice year-round, at least as the layer closest to his skin. note that wool very frequently sets off eczema.

I would recommend a dermatologist before an allergist, personally.

everyone's different, though, so maybe my experience won't be of any help/YMMV. whatever you end up trying, I hope you discover effective solutions quickly for all your sakes. good luck!
posted by batmonkey at 9:13 PM on March 16, 2011 [5 favorites]

My daughter had patches of what the pediatrician diagnosed as nummular exzema, which would come and go but never quite clear up. What fixed hers was eliminating soap in her bath and greasing up the spots with Vaseline (recommended by one of the pediatricians).
posted by leahwrenn at 9:46 PM on March 16, 2011

I am a life-long eczema sufferer, so I'll be watching this thread closely for anything new. In rare cases, there's never a real good answer. My flair-ups can be attributed to almost everything and nearly nothing. I agree you should try altering the diet, testing fabrics and cleansers, but make sure you take enough time with each alteration to know.
These are the things I know about my horrible skin issues:
1) I can have an eczema flair up and a heat rash at the same time. Sometimes even on the same leg.
2) Changes in weather, especially sudden changes from one temperature to another; doesn't have to be extreme.
3) Stress, but I'm sure that's not your toddler's problem; however, keep it in mind as he gets older (I had really bad, like covering an entire thigh bad, flare-ups during some troubling times in my teens)
4) Dyes & fragrances, dyes and fragrances, and omg is there a detergent that doesn't make me itch??

Things I've found that reduce the severity, longevity and regularity:
1) Aveno Naturals Lotions - I don't know why, but it's the only drug-store moisturizer/lotion I can tolerate. Also check out their spray-on sunscreen, as I've found that a little bit of sunbathing with it in the summer has reduced the summer eczema/heat-rash war for skin-territory, and leaves my skin incredibly soft.
2) Sensitive Skin/Natural/Fragrance & Dye free body washes - as somebody mentioned up thread, this might be a roulette game.. I'm still playing it, as it seems my skin issues develop "tolerances" to stuff.
3) Staying hydrated. This seems like a no-brainer, but I need to remind myself how dried out my skin gets when I don't drink enough water. I also try not to sweat, or stay sweaty too much, but I'm also a heat rash sufferer.

I don't know if any of this will help you, but I hope so. And for the little one's sake, I hope you find the triggers and if not completely eliminate it, find ways to temper it or reduce the severity/regularity.
posted by MuChao at 9:58 PM on March 16, 2011

Get your child to a pediatric dermatologist to eliminate anything exotic that your general pediatrician may have missed.

Many of the most common things have been covered such as, topical irritants and food allergies. Seriously start looking into that and begin with the dairy and wheat.

The medication that has been prescribed for my eczema suffering children have been:

* eledil -- pretty miraculous stuff BUT maybe a cancer risk;

* dermasmoothe -- most common stuff we use and works on the long term to deal with all over eczema including the scalp (my kids have it bad)

* protopic -- for real bad areas where dermasmoothe does not help BUT you need to apply it at night and make sure that part of the body does not undergo sun exposure

* bleach bath -- children with severe eczema, like mine, take occasional bleach bath because of the vulnerability to staph infections

There is another product that used in combination with bactroban or an antibacterial cream seems to work under certain circumstances (on the road now or else I would look it up for you).

My children are doing fine. But we have eliminated wheat and dairy in their lives and avoid most detergents. We still use the dermasmoothe and protopic. Good luck.
posted by jadepearl at 10:34 PM on March 16, 2011

Nthing getting a second or third opinion. Our daughter has mild eczema, but we got diverging input from the GP and dermathologist.

Personally, we've found nothing food-related that seems to trigger it, and have resorted to lotions to keep it in check. We already used non-perfumed, allergy-friendly fabric softener. We also rarely use soap on her, as that seems to bring it out. But it seems like everyone is different.
posted by Harald74 at 1:30 AM on March 17, 2011

IANYD - You should talk with a pediatric dermatologist. It's highly unlikely that this is due to soap, sheets, or anything else that comes into contact with his entire body if it's only on his legs. If you use soap when bathing him, you may try eliminating that since it can dry his skin and make it worse.

Unless you're under the CLOSE supervision of a specialist, and they recommend it, food elimination is a really bad idea. Please ignore everyone suggesting otherwise. Would you really want to eliminate entire food groups from your growing child's diet, just to maybe pin down the cause of something that bothers him "maybe for 10 seconds once a week or so"?

And definitely do not give your child a bath in bleach.
posted by sero_venientibus_ossa at 2:25 AM on March 17, 2011

Another vote here for possibly allergy-related causes: I've got a nephew like this, and it cleared up when his diet was restricted to remove the triggers. Eggs, dairy, gluten: when he was tested that turned out to be the problem. Talk to your pediatrician, get a recommendation for a good allergist.

(Weirdly enough, he is *not* allergic to peanuts, and could eat peanut butter by the jar-full, if he didn't hate the stuff!)
posted by easily confused at 2:53 AM on March 17, 2011

A bleach bath is a tablespoon of bleach in the bathwater, not a bathtub of bleach ! *shudders*
posted by slightlybewildered at 3:32 AM on March 17, 2011

It's hard to watch your little one suffer, especially when something you do might be contributing to it. But the process of finding out the answers can also be difficult, both for you and the kid. If it's just a mild problem you may want to wait until your kid is a little older to do testing. And I've found that dermatology can be an inexact science--lots of "well, I guess try this and we'll wait and see what happens". That can be frustrating.

Our son's issues ended up being due to a mild-moderate peanut allergy. We had eliminated as many allergens as we could and he was still broken out. It was only when his reactions to peanuts escalated that we cut peanut butter from his diet. Shortly after, his skin was perfectly clear and he's never had another problem.
posted by wallaby at 3:39 AM on March 17, 2011

adding to the anecdotes: for me it was two things: eggs, and Yellow Dye #5 (found in welch's white grape juice at the time, apparently). I outgrew the intolerances at some point.
posted by dpx.mfx at 6:08 AM on March 17, 2011

My son's eczema was triggered by dairy in my diet. He was nursing exclusively when it started. I'd been eating dairy to my heart's content all along, but his eczema was a sudden-onset thing. I have hazy memories of going on a blue cheese bender right around the first signs of rough skin. Once I eliminated dairy, it two weeks for his skin to clear up. I triggered a couple more outbreaks by eating just trace amounts of dairy before getting really disciplined about it, and each time the resultant breakout was worse, but always took exactly two weeks to clear. About three months in, I slipped up and ate something containing a small amount of dairy, but he didn't have a reaction. So I started slowly adding it back in and he hasn't had an issue at all since. He eats all kinds of dairy himself now and hasn't had any more skin issues.
posted by pajamazon at 6:59 AM on March 17, 2011

Our son has Eczema. And he's been to a pediatric dermatologist and an allergist - he has food allergies too.

Eczema is a disease - all by itself. The only thing you can do is treat the symptoms - with creams/lotions (which you are doing), and make a reasonable effort to eliminate anything that exacerbates the symptoms.

We started out (with our son) doing all the usual - hypoallergenic soaps, lots of lotions (both Rx and OTC), perfume free everything, etc. Turns out that with him, none of that stuff made a difference (except the lotions).

He's now 5. And we hardly need to do anything special. He seems to have pretty much outgrown it.
posted by thatguyjeff at 7:06 AM on March 17, 2011

I had occasional eczema when I was younger, but was never treated for it because it was pretty infrequent and always just in one small spot (the inside of my elbows). I had a lot of environmental allergies, but no food allergies, so it may have been related to that. My mom used fish oil to clear it up - just poked a hole in a capsule and smeared it on the area. It always seemed to work pretty quickly. I had one small patch as an adult and tried the fish oil, and it went away within a few days. So you might want to give that a shot. But allergy testing is useful anyway, just to know what, if anything, he's allergic to. The skin prick test (if that's what they're still doing) might be really tough on such a little one, though - I had it when I was about 8 and it didn't faze me.
posted by Safiya at 9:13 AM on March 17, 2011

One of my boys had a small issue with it when he was younger. I was advised to not use any soaps or lotions or shampoos with Sodium Laureth Sulfate in it. (Or maybe it was no sulfates at all? I don't really recall.)

In any case, I switched to Burt's Bees bath stuff and it cleared up pretty fast.

I had also recently started using fragranced laundry detergent, so I went back to Free & Clear stuff straightaway.

(I had taken him to a dermatologist, but after she prescribed a $100 cream, I decided to find other ways to deal with it.)
posted by pyjammy at 9:23 AM on March 17, 2011

Here is the link to the Mayo Clinic and bleach baths for chronic eczema. Please do not imply that I am endangering my children. All care was done under the supervision of their dermatologist. Take the advice already stated, see a pediatric dermatologist and also a food allergist.
posted by jadepearl at 11:11 PM on March 17, 2011

My heart goes out to you. I also have eczema (dyshidrotic dermatitis) and can fully empathize with your concerns. There is hope! There are lots of gentle, natural ways you can relieve the symptoms, but first I was you know the specific type of skin condition your son has?

I ask because my daughter developed what we thought was eczema around the same time as your son did. Her rash started as a barely noticible patch of dry, bumpy skin that would cause itching if she was reminded of it :). Otherwise, she would pretty much not even notice it was there. My husband took her to her the pediatrician who identified it as a skin condition known as Lichen Striatus. It took the form of a rectangular "stripe" of small, raised dry bumps about 2 inches wide and 3 inches long along the outside of her right thigh. The doctor also prescribed a topical cream to be applied twice a day until they subsided.

The worst of it was when she scratched (even though that was infrequent) the bumps would turn red and sometimes bleed ever so slightly. We've been told by the pediatrician that Lichen is a temporary skin condition that will fade as she gets older. So if that is the type of skin condition your son has, there is hope in that.

In the meantime, here are the natural remedies that have given me great results with my own eczema.

* taking short soaks in baths with colloidal oatmeal (Aveeno makes some and there are store brands that are just as effective. I've tried both.)

* taking short soaks in baths with apple cider vinegar - I use 3 or 4 cups for a full tub. You can adjust that as you see fit for the depth of water your son uses. The vinegar doesn't sting when diluted and is a natural astringent, anti-inflammatory and antifungal. Be sure to dry your baby thoroughly after his soak or do as we do and let him run "commando" for a little while :). I've even tried combining both the oatmeal and the apple cider vinegar. Didn't notice any big difference using both vs one or the other.

* Tea tree oil is also effective in helping skin heal - BUT if you use it make sure you do so sparingly and with a binder like olive oil. Also, olive oil is great for helping skin to heal itself. I made my own home remedy mix of tea tree oil and olive oil that I rub on my eczema after a bath. My own mixture was 7 drops of tea tree oil to 1/3 cup olive oil.

* I SWEAR by a product that Melaleuca makes called "Mela Gel". I use it on my eczema rashes when they get out of control and within a week the flare up is down to manageable levels.

* I also swear by Burt's Bees "Farmer's Friend Hand Salve". As a gardener, I use it all the time to keep the eczema on my hands under control even through weeding, potting and multiple washings. It is safe, gentle, natural and can be used regularly. It smells great, too!

There are lots of people who make their own homemade salve with comfrey, calendula, bees wax, lavender and olive oil. I am growing my own comfrey, calendula, german chamomile and lavender this year to try my hand at making my own salve. (its pretty simple). Comfrey is acknowledged by many as promoting skin healing as well as reducing inflammation. Calendula and German Chamomile have been known for years to reduce inflammation. You can find people selling these homemade salves on the LocalHarvest website.

Ok I think I've given you enough to chew on for now. :) Feel free to ask me anything about the remedies I've tried. By the way, I haven't used any oral steroids or corticosteroid creams in 6 months. I knocked my last flare up out (the worst I'd ever had) in just 2 weeks using most of the suggestions I mentioned. Best of luck to you and your son. You're an awesome mom to seek any relief possible for your son.
posted by feeshbitZ at 11:32 AM on May 11, 2011 [1 favorite]

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