We had our appointment at the skin clinic on Wednesday. We talked to a very nice young doctor who had even done her doctoral thesis about atopic dermatitis, but she was very young and obviously not very experienced. We came with a whole catalog of questions, and some were answered. As I realized, this visit to the skin clinic was only the beginning. We are finally scheduled for the actual atopy consultation with an expert who treats mainly atopic patients and who supports and guides the patents through the treatments. This appointment will be in about a month. Nevertheless, I thought I’d share with you what we learned on Wednesday.
The doctor recommended to treat the open eczema with corticosteroids (hydro-cortisone), and use in general Elidel or Protopic (I think that are also the names in the US), which are both immune suppressants or immune modulators. I haven’t understood exactly how they work but the idea is that the immune response is locally suppressed and thus the outbreak of eczema is diminished. She gave us a prescription for Protopic but I am not very happy with this choice and we haven’t decided about using it. The doctor ensured us that using Elidel or Protopic does not increase the risk of cancer, but I still don’t feel very good about it. Will it not increase the chance for infections? And what do we do then? Using cortisone? And then switching between cortisone and Protopic back and forth?
As moisturizer she recommended creams containing glycerin. We are now using a mixture of eucerin and evening primrose oil and we like it. She also prescribed us another glycerin containing cream which we haven’t bought yet.
Against the bacterial infection she only recommended to restore the skin as good as possible (haha). Using topical antibiotics is not a good idea because it can breed resistance or induce allergies. However, she agreed that underwear containing silver, which is antibacterial, could be a helpful. We will buy a silver overall and see if that really helps. Those overalls are not cheap and I hope the insurance will contribute. She did not think that UVB radiation is good, it is only recommended for children above 15 years.
About allergy tests she said that most of them are pretty useless because atopic children tend to react to almost everything because of their hyper-sensibility. However, she mentioned a new patch test that might work. We have to see about that when we see the specialist.
We asked about creams containing ceramides, the substance which holds the upper layer of the skin together. It is contained in many anti-aging creams and in the US there are several brands for eczema patients (e.g. CeraVe) which seem to be quite helpful. However, the doctor did not believe that the ceramides in the creams make any difference, but rather suggested that the base-cream is very good, in these cases probably containing glycerin. We could not find a cream equivalent to e.g. CeraVe or the prescription cream EpiCeram here in Germany. So we can’t try ourselves. That will be an other question for the specialist.
One thing she said was of some relieve, though. She agreed that we should not restrict J.’s diet, unless we observe an obvious reaction. And so far we are doing well without any deterioration of his skin. He is allowed to eat everything, as long as it is healthy, though. But she did not think we should give him any supplements, especially not vitamin D without checking his blood values.
Over all the visit was a bit disappointing. But, honestly, what did we expect? We did expect the recommendation to use cortisone or immunosuppressant. But we had hoped that the ceramides might be something that could be helpful. So, we will see what we will learn from the experts (at least I hope this will be an expert). We have also lined up a visit to the atopy specialist at the children’s hospital in mid April (yes, this is how long one has to wait for an appointment).