We had another visit at the skin clinic. This time we finally had an appointment with a doctor who was seeing specifically patients with eczema. The doctor was very friendly, and he did not push us to use steroids or immune suppressant but respected our skepticism towards this drugs. He took some time to make notes about all the creams etc. we are using and also approved our homemade cream.
He recommended a treatment plan focusing on two things: moisturizer and scratch prevention:
- Because the skin barrier of eczema skin is broken, it is very important to provide and maintain moister in the skin. He recommended to use Dermifant Kinderlotion. Because of our problems with skin infections he recommended to mix the lotion with 1% Triclosan, which is an antibacterial and antifungal agent.
- Scratching damages the skin barrier further, which leads to more itching etc. Therefore it is important to prevent scratching as much as possible. The doctor recommended to relieve the itch by giving antihistamine as much as needed. He suggested to give antihistamine whenever J. scratches, or when we anticipate strong itching.
The lotion seems to be ok, but it leaves a weird feel on the skin. We use it but it is not ideal. After using it for a week or so we might be able to tell if it is really good for J.’s skin.
The recommendation to administer antihistamine ad libitum leaves us weary. I simply cannot believe that giving antihistamine to a three year old twice a day is ok. Our pediatrician once told us that antihistamine just makes tired and therefore also suppresses the itch, but it does not affect the itch per se. This makes sense, because the antihistamine and the itch pathway are not the same, as I understand. It would be more useful, in my opinion, to use a topical analgesic, since itch and pain use the same pathways. But according to the doctor, there is not therapeutic solution available. I wonder why not?
The doctor agreed that we use antibiotic cream very sparsely and locally when we have an acute bacterial infection. Although there is the risk of resistance and allergy, the benefit of preventing wide-spread infection out-wights the risks. So, whenever we see a pustule somewhere we attack it immediately with the antibiotic cream before it can spread.
Over all, the visit was petter than previous visits, mainly because the doctor was quite relaxed and not imposing too much one treatment over an other. But it also reminded us again how frustrating the treatment of eczema is. It seems, the main strategy is to just wait until “they outgrow it”. It reminds me of the ostrich who sticks his head into the sand…..