Suggestions for improving skin barrier / microbiome / eczema

March 5, 2022 2:14 AM

My son (8) suffers from a fairly mild eczema. For several years it was just red spots on his cheeks in the winter, and we didn't need to do any treatment. But last summer he had a much more serious breakout (inner elbow, chest, inner knee), which coincided with a molluscum contagiosum infection (the dr. said the latter took hold because skin barrier was weakened because of the eczema). He has been doing a regimen of daily strong moisturizing balms (with high lipid content, for example Avene Trixera) and occasional hydrocortisone.

This has worked well. We started with small amounts of hydrocortisone twice daily, reducing this after a week and stopping altogether after two. Occasionally a small dry patch will return after, say 2 months without hydrocortisone (the moisturizing balms daily though), but we can then treat just that small spot. So this has gone from some very large and very dry patches to occasional spots. Plus, finally, the molluscum is going away.
The last few days, however, he has a cut on his foot that does not seem to get better. He had something like this two years ago - a small cut continued to get bigger, and he needed oral antibiotics, in addition to a serious topical treatment with iodine gel. If I'm not mistaken, the doctor said it was a staph infection. A month later, we had to treat him for impetigo. (I could be mixing up staph and streptococcus). Am I right in thinking that his skin is still suffering from bacterial imbalance?
One thing is: we have not been putting cream on his feet as often, and that is surely part of the problem.
But I am looking for suggestions for how to improve the skin barrier yet further. I have read a few things about treating the bacteria on the skin directly (https://www.nih.gov/news-events/news-releases/probiotic-skin-therapy-improves-eczema-children-nih-study-suggests) or through oral probiotics (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6517242/). There are some products available here in Europe, such as https://www.amazon.de/-/en/AktivaDerm-neurodermatitis-condition-clinically-probiotics/dp/B08MWPY33M/ and https://www.amazon.de/-/en/nupure-probaderm-Microbiotic-intensive-itching/dp/B093C7DK8W . But I am not in a position to evaluate them at all. I'm wondering if anyone has any expertise on this issue. (The Dr. was dismissive of topical probiotic treatment).
... or any other suggestions. Thanks in advance.

posted by melamakarona to Health & Fitness (17 answers total)

I've worked in this field, and there are really no easily-available resources for assessing the real life value of the basic research publications you're finding. I'm with your doctor on this one—topical probiotics are still an interesting idea and not yet a reliable therapy.

You don't mention if you'd tried UV phototherapy, so I'll encourage you to seek that as a concrete suggestion. The difficulty with eczema (and similar conditions) is that their causative mechanisms are still hazy, as are the factors that induce and maintain remission. UV phototherapy is remarkably effective for some, and it's potentially due to local inhibition of the white blood cells that erroneously attack the skin although even that mechanism is only suggested by research and hasn't been rigorously confirmed. Nevertheless, there are UV phototherapy clinics and at-home UV phototherapy devices available that have been approved by regulatory agencies. If you're able, bring up this approach with your doctor and see where it leads. Good luck.
posted by late afternoon dreaming hotel at 3:41 AM on March 5, 2022 [6 favorites]

Have you tried bleach baths?

https://www.rch.org.au/kidsinfo/fact_sheets/Skin_infections_bleach_baths/
posted by kinddieserzeit at 5:33 AM on March 5, 2022 [1 favorite]

The best lotion I've ever used for eczema is Aveeno Ezcema Therapy. It has colloidal oatmeal to help repair the skin barrier.
posted by tiny frying pan at 5:48 AM on March 5, 2022 [4 favorites]

Response by poster: @tiny frying pan Do you know if that is the same as Aveeno Dermexa emollient? I am having trouble finind the Eczema therapy here in Germany. This is promising, I remember that a tiny bottle of some Aveeno product helped with some reddish patches when he was very small.
I'm also wondering if this has as strong moisturizing properties / lipids as the emollient creams I have been using (I mentioned Avene Trixera Balm, also La Roche Posay Lipikar AP Balm, Bioderma Atoderm Intensiv Balm, Bepanthol/Bepanthen Sensiderm).
posted by melamakarona at 6:28 AM on March 5, 2022

Some people with eczema (e.g., me) also benefit from antihistamines -- I started taking a daily OTC antihistamine to address other issues and the stubborn eczema that had been recurring on my hands for years and not responding much to corticosteroids cleared up, so far seemingly permanently (it's been about a year now).
posted by space snail at 6:36 AM on March 5, 2022 [2 favorites]

I struggled with this as a kid, teenager and young adult, including the infections, though my eczema was so serious that I was on the verge of hospitalisation more than once, up to in my early thirties.

In retrospect, I never had any eczema when I was at my grandmother's house and that levels with what I believe finally stopped it: I entirely stopped eating processed food, including food with added MSG at restaurants and all the candy and processed cereals. My grandmother cooked everything from scratch and we had oatmeal or yogurt for breakfast. For treats, home made cake, high quality chocolate and fruits are all fine. It's not about the sugar but about the stabilisers, the flavor enhancers and the glucose. Not to mention the artificial sweeteners.

Some people here may think that this is not sufficiently evidence-based, but I was sick, and now I am not sick.

Sometimes when I fall back into some (not all) of the bad habits I learnt as a child, I get IBS instead of eczema. Getting back on the healthy lifestyle quickly eradicates that.

Adding in what we know now about the gut microbiome, you might also try to get a lot of variation in your son's vegetable food, and a pet!
posted by mumimor at 6:54 AM on March 5, 2022 [6 favorites]

I had bad dandruff for years, so I am familiar with annoying skin conditions. Doctors say it is incurable and to use medicated shampoos, but that is not the case - and likely not the case for your son's eczema. Recently my dandruff went away almost entirely after I stopped consuming all dairy. I was intolerant and did not realize it. I'm now pursuing a stricter elimination diet that, like mumimor mentions, focuses on whole foods with the goal of seeing what other triggers I may have. Your son may have similar intolerances, and an elimination diet is a low cost and low risk way of figuring out what may be irritating his gut, which is then translating to his skin. Please memail me if you'd like more details. I would also be wary of continuing to use steroids for his treatment - No Moisture Therapy is something I've seen people online pursue after longtime topical steroid treatment, and it does not look fun.
posted by randomquestion at 7:15 AM on March 5, 2022 [2 favorites]

Like Aveeno Eczema Therapy, Eucerin Baby Eczema Relief Body Creme has 1% colloidal oatmeal, and it also contains a licorice root derivative called licochalcone that has been found to be more effective than hydrocortisone in treating mild to moderate eczema in children when applied twice a day. Eucerin products are much more readily available in Germany than Aveeno products.

I hope your son's skin heals soon.
posted by virago at 9:21 AM on March 5, 2022 [2 favorites]

Acure makes a 24 hour moisture lotion with colloidal oatmeal and cocoa butter that's working on my diabetic/eczema ankles. It's reasonably priced and not stinky.
posted by markbrendanawitzmissesus at 9:24 AM on March 5, 2022

Response by poster: @virago thank you. I actually was a bit reluctant to use something with petrolatum (aveeno), so I will look at the Eucerin. I just ordered AproDerm Colloidal Oat Cream. ... It seems that that Eucerin baby cream is not marketed in germany, though Amazon sells it. But some of Eucerin's other creams here (Atopi control) have Licochalcone but as far as I can tell no oatmeal extract. I need to look more closely.
posted by melamakarona at 9:38 AM on March 5, 2022

I've been looking, too, and apparently Eucerin sells an Eczema Relief line of products in which the key ingredients are 1% colloidal oatmeal, licochalcone, and ceramides. This includes not only the Baby Eczema Relief Body Creme but also Eczema Relief Hand Cream, Eczema Relief Body Cream, and Eczema Relief Flare Up Treatment Cream. (The company just added a soap-free Eczema Relief Body Wash, which has 2% colloidal oatmeal and ceramides but no licochalcone.)

I'll cross my fingers that you can find at least one of these creams at your local pharmacy!
posted by virago at 10:04 AM on March 5, 2022

Using Desitin completely works for my family. My suggestion is to put Desitin on half of the area and see what happens. If it works for you and you don't like that first ingredient is petrolatum, there are many "natural" alternatives that have the ingredient, zinc oxide, 40% in Desitin.
We recently had the opportunity to see a wound specialist when my husband had a bedsore. He was tested and it was not a staph infection. But they used Manuka Honey cream on it and it went away in just a couple days. I haven't tried it on eczema, I am happy with Desitin, but I am so happy to have found Manuka Honey for wounds and sores the form in the same area as the eczema.
posted by cda at 10:19 AM on March 5, 2022

My dermatologist recommend petrolatum jelly as an occlusive for my eczema. Just a small dab - a thin layer - as a finishing step after I've moisturized.
posted by Constance Mirabella at 10:23 AM on March 5, 2022

I have nothing new but can confirm that antihistimes, Aveeno lotion with colloidal oatmeal, & dealing with dietary intolerances/allergies (eggs and dairy) all really helped my eczema. I haven't had an issue with it in years now, and the last few times I noticed it starting, Aveeno cleared it up entirely in a couple of days.
posted by DTMFA at 11:03 AM on March 5, 2022

My kids had bad eczema, which has been mild since we treated it with the following things:
1) Wet-wrapping twice a day
2) Cheryl Lee’s true lipids ointment (following wet wrapping)
3) Protopic ointment twice a day (at a different time then wet wrapping)

The wet wrapping is a lot of work, but we saw improvements almost immediately. This Youtube link describes the process.
posted by tinymegalo at 2:47 PM on March 5, 2022

I’m going to thumbs up the aveeno with colloidal oatmeal. The on,y thing that we found that worked half as well was Desitin with fish oil, which is messy and smells bad. My doctor also suggests occasional bleach baths (look up directions for doing safely). Some people find tar soap helps.
posted by bq at 4:42 PM on March 5, 2022

As a sufferer of winter eczema, two thumbs up to Aveeno.

Other things that have been an absolute winner this winter are 1. a daily anti histamine and 2. no more hot showers, just warm ones. I've had no out breaks at all this season.
posted by Faff at 2:03 AM on March 6, 2022