Something other than eczema?

[S.K.Knight]

2 yr old caucasian female with extensive body rash that has slowly, progressively worsened over the past year.  Pediatrician diagnosed as eczema, and prescribed pediatric eczema cream.  Cream had no effect, no over-the-counter creams have offered much relief.  Rash began on trunk area, has spread to arms and legs. Neck, face, head area not affected. Red, splotchy, slightly raised, eventually covering entire trunk so the skin feels coarse, rough like sandpaper.  Symptoms of itching, burning worsen when hot and sweaty.  Now, the palms of her hands, and bottoms of feet itch and burn to the point the she cannot sleep;  whining, rubbing, pulling at hands and feet. Oral Benedryl helps with sleep. Seems to have chronic sinus and ear infections with amoxcillin prescribed as treatment.  Dreft laundry detergent seems(?) to help slightly, Epsom salt baths, oatmeal baths, as does replacing cow milk with soy milk (but only slightly)..... Any suggestions would be greatly appreciated.

[Alan Rockoff, MD]

I can't tell from your reprt.  Does the cream having "no effect" mean that nothing happened, even temporarily, or that it got better and then relapsed?

If your pediatrician isn't sure, he or she may want to consider referring you to a pediatric dermatologist.  The most common extensive rash at this age is eczema, but if regular use of effective creams does nothing, then a skin evaluation and possibly a skin biopsy may be worth considering.  Or perhaps it's just a tough case of eczema, requiring more elaborate methods of treatment.

Sounds like it's worth another opinion, at the very least.

Best.

Dr. Rockoff

[S.K.Knight]

The ezcema (eczema) cream as well as OTC Benedryl ointment seemed to have a "one-step backward, two-steps forward" affect meaning that initially it seemed to help, only for the condition to worsen within a week.  Could it be an allergic reaction to the Amoxcillin, or possibly a vitamin B deficiency?  Any other thoughts greatly appreciated........

[jules2003]

hello- I'm not a dermatologist or anything, and it is not my intention to give you any medical advice- but I can tell you a bit about my own personal experiences.

Eczema- is there any indication that the child also has asthma? They are closely linked. Has there been any allergy testing done- environmental and food. I'm wondering if there isn't an allergy or allergies at work here. You mentioned that replacing milk with soy milk has helped a little. Milk is a very common allergen but it can easily go unrecognized. Reactions to foods in general can happen several days after exposure so it is difficult to make the connection. Actually, there are two different reactions that can happen to foods- an IGE reaction is like the classic peanut/shellfish allergy. The person reacts immediately and violently. It can be life threatening. An IGG reaction is more chronic- stuffy nose, sore throat, ear infections (from chronic stuffiness and mucus bild up), nausea, sore stomach, cramps, etc etc etc. If there is an allergy replacing milk with soy milk alone will not do it. There is the obvious milk foods that also have to be avoided- cheese, butter, ice cream, yogourt, margarine, milk chocolate etc. And then, there are hidden sources of milk- places you don't think to look. For example, there is milk in hotdogs and many deli meats (the milk protein casein is used as an emusifier). If the allergy is severe enough, only a small amount can start a reaction. In fact, if it is a milk allergy, for the first little while even beef must be eliminated from the diet until the antibodies drop to an acceptable level. A good allergy specialist or dietician will be able to instruct you how to elimate and then slowly reintroduce trouble foods. By the way, a food allergy will not be outgrown. You will eventally either learn to manipulate your exposure or grow to accept the symptoms.

So, consider what Dr. Rockoff suggested, and perhaps consider allergy testing. I only recommend this because my nephew struggled with allergies- milk in particular. As an infant, he presented with excema like you describe, then asthma. Once milk was COMPLETELY eliminated from his diet, the excema improved drastically. However, there are tons of other things that might cause what you are seeing, and they may have nothing to do with allergies. It's just something to consider.

[shelbert6]

My 4 yo daughter (today is her 4th b-day) has had a similar rash since she was in diapers, starting at about 1 yo.  I thought at the beginning that it was a yeast infection, and treated accordingly.  However, as time went on, and on, and on, these treatments didn't work.  I moved on to hydrocortisone USP 1%.  This helped for a time, but never completely cleared it up.  I gradually moved up a step to triamcinalone cream.  This, too worked, but only for a relatively short period of time.  I got another Rx for some other cream used for eczema, cannot remember the name, that did absolutely nothing.  No improvement at all.  I live in Alaska, and a small rural village to boot.  I have the advantage of working as a rural health care provider for a regional IHS (Indian Health Service).  They sent me, by chance for trial, Devil's Club ointment.  The natives rely upon natural medicines a great deal here.  The ointment actually worked, but then made the rash worse as she developed a reaction to the ingredients.  Then the Public Health Nurse turned me on to Flaxseed Oil, to be taken orally.  This worked.  This is a tough skin disease that, when left to continue to spread, leaves a thick skin in it's place when the acute symptoms finally stop.  That is what is left.  She had her skin problem on her trunk, legs, and buttocks.  Never head area, and rarely on the arms.  So ask about that treatment when you next see your dematologist.  Keep in mind that when used for an extended period of time, steroid creams can actually make the rash worse.  These treatments should be used sparingly, and only until symptoms improve.  If you see no improvement after using for a week, ask your dermatologist if you should continue, or change treatment.  
Sorry for the "novel" but we have been battling this problem for years.  I also have it on my leg.  Same scenario.  Good luck.

[mollea]

I have fought with the same thing for years.  Went to DR. after DR. with little help.  I was put on anit-depressants to help with anxity, which helped some.  I have now switched to toxin free household products, and my itching is gone.  I think I am chemical sensitive.  Not saying this is what is going on with you, but it may be worth exploring.  The company I buy my products from seems to be the most reasonable.
E-mail me if you would like to discuss this further
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[worriedmumof1]

My son is two years old. I breatfed him til he was about 10-11 mths old he didnt really take to cow milk straight away but then soon got into it. For about a week, every month or so he's really sick and usually only after he has a bottle of milk(cows).But about a year ago we had problems with the water supply in our area and this affected his skin, the doctors put it down to eczema? but hasnt really had an outbreak apart from 2 big patches (1 on his cheek and one on the back of his leg) but he's also in the last 2 months had a few colds this last one has left him with a very bad chesty cough and he's wheezing a lot. When i was younger i had chils Asthma and just wondering if he could have it too, although the doctor did check but couldnt hear anything loose on his chest and back, but has given me a Salbutamol Inhaler, (just to ease the wheezing) but somebody did suggest maybe he has a problem with the cow's milk. I've heard it could affect children in different ways and just wondered if you could help at all.  thank you