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Eczema not getting better

baby with eczema

My daughter has been dealing with eczema on her face for the past month or so but recently it's gotten pretty bad. It has started to crack and is extremely dry. I have tried the Aveeno and it didn't seem to help her face but did help the small spots on her body. I have started using coconut oil and it seems to be helping a little but not completely. I attached a picture so you can better see what reaction she is having.

I agree it looks like your daughter is struggling with eczema. One of my boys battles eczema daily, so it is a topic near and dear to me. Beating eczema requires daily effort.

Eczema is essentially allergies of the skin. It is common in individuals who have allergies and asthma and it tends to occur in individuals with a family history of eczema, asthma and allergies. Fortunately, most children with eczema will improve given time.

There are three skin findings in eczema: redness, dryness and hypopigmentation.

1.) Redness is inflammation of the skin. In young children it tends to appear on their cheeks the moves to joint creases (elbows, wrists, ankles, or the back of the knees) as children age. Steroids (over the counter hydrocortisone and a huge variety of prescription creams) are the most effective weapons to fight this inflammation.

2.) Dryness is the most common skin finding for eczema. Principally, lotions (especially after baths) are the main treatment for skin dryness.

3.) Hypopigmentation is a temporary loss of skin pigment. This commonly happens after an individual’s skin becomes red and inflamed. Hypopigmentation appears more dramatic in the summer when the rest of an individual’s skin tans. It usually takes 3 to 4 months for healthy skin to regenerated its normal pigmentation. If you address the redness and dryness, hypopigmentation will eventually resolve.

To help your daughters skin we need to address her skin redness and dryness.

For her redness, try over-the-counter hydrocortisone. The strongest you can purchase without a prescription is 1.0% hydrocortisone. Apply that to the red areas of her skin up to three times daily.

To address her dryness we need to try regular baths and a new lotion.

Nightly baths - You will hear experts argue that bathing causes eczema to get worse and other experts recommend baths to help her eczema. There is truth in both lines of thinking. If you bath your daughter and let her air-dry some of her skin’s natural oils with evaporate with the water and her skin will get dryer. To help her skin bathe her for 10 to 15 minutes, quickly towel dry and then coat with a lotion while she is still a little wet.

Lotions - I personally use and recommend regular Aveeno lotion. I don’t like the Aveen eczema product as a few of my patients and my son have complained it stings. I do not recommend coconut oil as it rarely helps my patients that have tried it. In your daughter’s case, it seems that both the Aveeno and Coconut oil have failed. You could try an ointment (like aquaphor or vaseline) as they work well. Unfortunately, ointments don’t rub in well and are especially messy on a child’s face. On the face, I prefer to use a lotion that rubs in. In your daughter’s case, try Vanicream. Use the Vanicream three times a day applied on top of the hydrocortisone.

As the redness goes away you can reduce and even stop the hydrocortisone and as her dryness improves you can reduce the number of times a day you apply the Vanicream. Every individual’s eczema is unique. As such, each patient needs their own individual plan to address their eczema. Lets call this her plan for now. If her skin does not improve, she we need a new more aggressive plan.

 

 

Written August 2015 by
Gregory Gordon MD, Orlando Pediatrician

 

 

 

 

 

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