What else should I do for 7-month old Baby?
Q: I have a 7-month-old baby girl with severe eczema. We have been doing bleach baths two to three times per week, daily and sometimes two-times-a-day baths followed by 2.5 percent hydrocortisone cream and Aquaphor. I hate using the hydrocortisone on her. She has milk, egg, and almond allergies and also some immune deficiency problems. We have been seeing an allergist, a pediatrician, and a pediatric dermatologist and are still not getting much relief. She is on Neocate and things have gotten better (in terms of allergies and eczema). Yet she is constantly itching and drawing blood on her legs, face and arms; no matter how much I try to cover her she still gets to herself. What else should I do?
A: This is a really tough situation. At 7 months of age we are more limited in terms of The additional immune problems that you mention may also make certain treatments inadvisable. You sound like you are seeing all the right people and doing all the right things. It is really important that you let these people know that things are still pretty bad—even though it sounds like there has been some improvement.
The main thing I think is that if she is scratching to the point of bleeding, it sounds like stronger treatments are still necessary. One thing that might help would be Unna wraps (you can see a picture of them at http://www.mountainside-medical.com/products/Unna-Boot-Bandages.html. These are zinc oxide paste-coated gauze wraps that are cooling and soothing and can be gently wrapped over eczema areas (like arms and legs) at bedtime. Many kids seem to like these (even if they initially don’t love them), and even babies tend to do well with limited areas wrapped gently at night. It has a cooling and soothing effect, the zinc is good for the skin, and the wrap itself keeps the scratching down, which lets the skin heal.
Vitamin D supplementation, if you are not doing it already, may have some effect on eczema and the immune system in general. There is a vitamin D drop for babies, and you might consider something like 400-800 IU per day.
Additionally, although everyone hates topical steroids since they do have some real risks, if used carefully they can provide tremendous relief and help break the scratch-itch cycle. My sense is that a more potent topical steroid may provide real benefit. There are some new ideas that perhaps by being more aggressive (putting out the fire completely) we might actually need less medications overall and help put patients into a form of remission or at least sustained control of their eczema.
For parents who are really concerned about topical steroids, I try to bring up a couple key points:
• They are actually incredibly natural. Our bodies make steroids naturally, and our cells know exactly what to do with the steroid molecule. We have many years of experience with them, and can usually tell when we are overusing them with plenty of time to prevent bad things from happening.
• They provide tremendous relief from the terrible itchy inflammation in the skin, which helps patients (and families!) get their life back. This is important for babies, too, because they need their sleep, and sleep inter-rupted by itching and scratching all night is not good sleep at all. I firmly believe that this also creates a stress cycle that worsens eczema.