SOMEONE Managed Allergic March for Son with Eczema

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Sarah, with her 3 children, shares on managing allergic march

Sarah, with her 3 children, shares on managing allergic march

This is a 2013 series focused on personal journey with eczema while managing a certain aspect of life. Today, we have Sarah Chapman, whose third son has eczema since three-month old. Today, she shares how she managed her son’s Allergic March. Sarah is a volunteer with AllergyUK and had shared her allergy knowledge nationwide.

Marcie Mom: Hi Sarah thanks so much for taking part in my Friday blog series ‘Someone has Eczema’! Let’s start with you sharing a little of your family’s eczema and allergy history, and when did eczema or allergy start and what’s the severity?

Sarah: I had eczema soon after birth, and throughout my childhood. I still get it every now and then. My maternal grandfather had it all his life. I can remember him scratching! My mother and her brothers had eczema as well. There is also a lot of asthma in my family and nickel allergies.

My husband has asthma with links to environmental allergies.

Marcie Mom: I understand that your son, now 17 year old, experienced the Allergic March, progressing from eczema to allergies.  What was his condition from birth to a young child?

Sarah: Our 3rd son had eczema day 10 after birth, and as time went by he had a poor sleep pattern (by that I mean an  inability to sleep for longer than 2 separate hours a night, and 20 min cat naps a day) He also had very slow and poor weight gain, even though breastfeeding was going well. These are the early signs of food allergy in a breast fed infant before three months old.

As he grew his eczema was very hard to control, his daily treatment was 5- 8 all body emollients and twice daily low dose steroid cream. Just before we were about to start wet wrapping treatment we discovered that he had an egg allergy and then peanut at 13 months old. I had also started to suspect that environmental allergies, like pollen, dog and cat were a problem.  At 18 months old immunologist confirmed allergies to, dust mite, cat, dog, tree pollen, hay fever, egg, tree nut, peanut.

As we paid a great deal to lesson dust mite exposure and pollen in our home, and controlled diet and his skin improved. When I stopped breastfeeding him, his skin got instantly better, but he began to catch every infection going, and skin became infected and so on.

Treatment added to original eczema plan, change of emollients, eye drops, nasal sprays, antihistamine during hay fever and tree pollen season.   Age 2 epi pens, and emergency plan for anaphylaxis.

Like many allergic children he physically shows signs of being an allergic child. He has a ‘captains salute’ a small dry crease on top of nose from rhinitis, from using hand to push up nose from constant nose drip. He is a mouth breather child, again a sign of poorly controlled rhinitis.

He has dark rings, and an extra dry crease under his eyes. He also has derma- graphism (am not sure about the spelling of that btw!) which means that if he is slightly scratched a wheal will form within minutes. He also snored as a child which isn’t normal and is a sign of rhinitis.

Rhinitis has a major impact on sleep quality, and babies and young children require sleep to grow. Concentration at school when you have a totally blocked nose 24/7 is very difficult and so has impact on education.

Marcie Mom: How did the eczema progress when he started elementary school?

Sarah: As he neared 5 his eczema improved, this is typical of an allergic march child, and at the same time his rhinitis and environmental allergies were making more of an impact. We had discovered more food allergies to add to list.  Eczema treatment 3 full body emollient a day, and no steroid cream required. Except after food reaction in which eczema would appear as hives and other IgE response symptoms disappeared.

Age 5   allergies, Dust mite, Tree Pollen, hay fever, dog , cat , egg, peanut, legumes, tree nut, kiwi fruit.

Age 7   Dog allergy considered life threatening, change to emergency treatment plan, oral steroids and asthma inhaler (has asthma response during allergic reaction, but not asthmatic) yeast extract new food allergy.

Food challenge in allergy clinic confirmed outgrown cooked egg allergy = increase in  food  choice with higher calories.(still underweight.)

Age 10 Outgrown raw egg allergy in food challenge. Dog allergy lessoned and quality of life improved, for instance sleep overs with friends who have dog, controlled with antihistamine.

Eczema,dry skin only.

Marcie Mom: What was his condition as a preteen and teenager? Did puberty change his condition? And how is your son now, as a young adult?

Sarah: By 12 redeveloped raw egg allergy, and by 13 possibly cooked egg, now at 17 prefers to avoid himself.  Food allergies: Egg, Peanut, some Legumes, Brazil nut, Yeast Extract, Kiwi Fruit, Hay Fever, Mold, Tree Pollen, Dust Mite.

Skin very dry, but otherwise OK!

We have used epi pen 3 times so far, but despite this is gaining confidence in his ability to buy food independently and going out with his friends.

Marcie Mom: Thanks Sarah for taking time to share your son’s allergic march, it is useful for parents to know but hopefully, won’t go through the full allergic march!

Eczema Medication Series – Prednisolone

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Marcie says 'Prednisolone worked for me!' MarcieMom says THANK YOU GOD

Marcie says ‘Prednisolone worked for me!’ MarcieMom says THANK YOU GOD

This is a series on some of the medication that I’ve collated from parents who shared in forums. For this week on Prednisolone, my baby with eczema had been prescribed a one-time 3 week reducing dosage course at about 7 month old, and it had cleared her eczema which then became manageable after the course. I know of many other young children, who did not respond well after the course, and some who did – please freely share your experience in the comments, your sharing can help encourage and comfort another parent.

 

What is Prednisolone?

Prednisolone is a type of corticosteroid which is prescribed to control inflammatory and allergic conditions like eczema, severe psoriasis and severe seborrheic dermatitis, colitis, asthma and rheumatoid arthritis. It works by stopping the release of chemicals that cause inflammation. Prednisolone is also used to treat blood cancer and lymphoma, to reduce the destruction of platelets by the body’s immune system.

It is usually an oral prescription (for my girl, it was solution) that must be complied strictly. Self-altering the dosage is not acceptable as the dosage is decided by a skilled physician, taking into account a combination of factors such as the skin condition and weight. If you are in a highly stressed season in life, do let your doctor know as that is a factor for deciding on the dosage.

From personal experience, the skin of the baby changes during the course – it may get better than worse, for my child, better again. Terminating halfway on your own, due to fear of oral steroid or deterioration of eczema, will make it more difficult for the doctor to make an assessment of how the course worked (or not).

Monitoring

Monitor your child’s growth and if concerned, discuss with the doctor. Steroid course may slow a child’s growth if used over long period or cause thinning of bones (osteoporosis), as it impairs calcium absorption and new bone formation. Look out also for signs of vision changes.

Warning

There are interactions with other medications so it’s best to let your doctor know of medication, vitamins and supplements that you or your baby/child is taking. Taking steroid over a long period can lower the body’s immunity. Avoid contact with people who are ill (esp. with chicken pox, measles or shingles), and also those who have taken a recent live vaccine (also check with the doctor before your child gets vaccinated). Wash hands also to prevent infection.

Side Effects

Watch for side effects, one of which is adrenal issue whose symptoms are fainting, irregular heartbeat, thirst, irritability or unusual fatigue. Click here for a list of common to less seen symptoms.

There is no particular diet to follow (except avoid liquorice), unless directed by your doctor.

Most Importantly, Does it Work?

I’ve found a study of 21 patients, only 1 achieved stable remission of eczema versus a higher rate (6 out of 17) for those prescribed cyclosporine. I find it strange though that I couldn’t find more study on Pubmed for prednisolone than for other medications in this series, which are licensed for use later. I’m glad that oral steroid course worked for my child, and love to know how it worked out for you.

Sharing Treatment for Eczema Children

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Elomet ointment

Last Friday’s lunch sharing session with Dr Lynn Chiam was a fruitful one – the topic was Treatment for Kids’ Eczema and we had pizza and chicken wings for lunch at the NSC!

The few notes shared:

1. Moisturizing within 3 Minutes After Shower

This is inline with Dr Jennifer Shu’s tip here, so it appears that it’s an international recommended practice. Dr Lynn shared that should it be difficult to do so, or if skin is still dry, wet wrap can be implemented. For practical purpose, should the child not be able to tolerate wet wrap overnight, instead implement at least an hour, 5 times a week. Even a dry wrap will retain moisturizer better for the skin.

2. Removing House Dust Mite (if it is an allergen for your child)

Dust mite can be killed either by extreme cold or heat – so wash bedsheet in at least 60 deg C water (read this post) and for stuff toys, freezing them may help decrease the amount of dust mite as they are affected by extremes of temperature. Dr Lynn recommended sunning mattresses and changing mattress once per year, i.e. don’t get a thick and very expensive one. Remove carpets.

3. Use of Topical Steroid – Don’t be Steroid-Phobia

I shared that there is a lot of fear out there among parents on using even the mildest steroid cream, and I’ve heard of increasing number of children hospitalized for infections due to fear of using steroid. Read more here on ‘Is Steroid Cream Safe?’. Dr Lynn explained 4 side effects of topical steroid (i) skin thinning (ii) easy bruising, (iii) fragile blood vessels and (iv) excessive hair growth. However, these can be avoided if patients ensure they use (1) the right steroid (2) at the right part of skin and (3) for the right amount of time. 

For anyone who emailed me (and we’re talking many!) who ask if steroid cream is safe because they’ve read about the side effects (which further reinforces FEAR spread like FIRE), you know my reply is the side effects of MISUSE should not be confused with Right Use. There are also many who have an agenda for propagating fear – to sell a steroid-alternative. Again, there is no need to use one and not the other. You can use steroid safely to treat flare-ups and skin inflammation, while at the same time, moisturize, wet wrap, have healthy diet, healthy lifestyle, distract your child, protect their skin, covering their fingers..

Dr Lynn shared that steroid treatment should be used pro-actively, to treat skin inflammation even after the rash disappear, and this is also consistent with what Dr Bridgett shared in this post. Protopic can be used for maintenance, and I’ve clarified with Dr Lynn that the stinging sensation that some experienced with Protopic will not be manifest as rashes. For more on Protopic, see here.

4. On Oral Steroid

This is usually a treatment for severe active cases, not lightly prescribed due to its side effects of osteoporosis, stunting growth and increased vulnerability to infection. Tomorrow’s post is on prednisolone, and you can also refer to previous post on cyclosporine.

5. This is my afterthought – Don’t Jump from Fear to Fire

I’ve shared earlier that Fears spreads like Fire, and I like to remind parents not to jump from fear into fire – for instance:

Is someone telling you not to use steroid but something natural? If so, do ask them and search Pubmed for studies. I’m not against natural and I’m not against any parent wanting to try something natural. Do check 1. It’s safe to consume/apply, 2. Keep up the standard treatment.

Is someone telling you that a steroid cream is not working and that the flare is caused by it? Think back – did your child have rashes before the steroid? and Dr Lynn shared that each steroid cream has its own molecular structure, suited for different purpose. You may wish to work with your doctor on another cream.

Is someone telling you their skin recovers after doing a,b,c and d? Ask them, did they do a,b,c and d while applying the steroid?

Is your doctor (I really hope not) telling you that established clinically trialed cream is no good and their own concoction is better? I do not know if it is/not, how would anyone know if it’s kept a secret, even without a medical name. If it doesn’t work for your child, it’d be impossible for the next doctor to understand what your child has been prescribed and how the skin reacted.

This is a very long summary of the discussion. But as you can see, I’m really AGAINST people who spread fear of steroid – again, I’m not saying steroid is the only way, I’m saying it has its place and fear shouldn’t be propagated for personal means.

94 of the 101 things that Moms with Eczema Child do Differently – Kid has Grown, Seat has Changed, but…

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Still Scratching!

Still Scratching!

This is the 94th of my “101 Things that Moms with Eczema Child Do Differently“, a tongue-in-cheek look at the many unique situations that we face. For more cartoons, click here to view.

SOMEONE Managed Diet for Child with Eczema

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Judy Converse, nutritionist and a registered dietitian, shares about managing diet for her son.

Judy Converse, nutritionist and a registered dietitian, shares about managing diet for her son.

This is a 2013 series focused on personal journey with eczema while managing a certain aspect of life. Today, we have Judy Converse, founder of Nutrition Care for Children LLC, whose son showed signs of eczema in his first two months. Today, she shares how she managed her son’s diet. Judy is a licensed nutritionist and a registered dietitian for more than 20 years, and had shared on Eczema Kids Nutrition here.

Marcie Mom: Hi Judy, thanks so much for returning to take part in my Friday blog series ‘Someone has Eczema’! Let’s start with you sharing a little of your son’s eczema history – when did eczema start and what’s the severity?

Judy: My son’s rashes became visible just after birth. It was confusing – he was breast fed; I had received no medications or interventions during delivery. There seemed to be nothing, as far as I knew, that he could have reacted to. Within the next few weeks, it was bad enough that he might bleed from scratching at it, unless we covered his hands for sleep. I know this is controversial, but we came to strongly suspect this was part of an adverse reaction to his newborn dose of hepatitis B vaccine, which had been given without our knowledge.

Marcie Mom: I understand that you got into your current field to understand more about helping your son.

Share with us: What perplexed you so much when you were managing his diet that spurred you to be a nutritionist and dietitian?

Judy: I became a dietitian years before my son was born, and had already worked in this field. But I had not been involved with pediatric nutrition up to that point, other than some work in the WIC program in my training. My son’s circumstances are what triggered me into this niche. What perplexed me – or I should say – stunned me – was that even though he was having rashes and many other concerning symptoms, we were repeatedly told it was “normal”. He had projectile vomiting, terrible hard screaming (one nurse said to me “he’s too young to have colic” when he was just a few days old and screaming until he was blue), seizure like events, and runny liquid stools – at 8 or 12 months old, he would have 10 liquid runny mucousy stools a day, that ran up to his neck and down his legs. Even my father, then about 70 years old, brought it up to me. Five kids plus three other grandkids and he’d never seen poop like that. But the doctors insisted it was normal. It isn’t normal. It’s clearly a sign of a problem with digestion, absorption, inflammation or all three.

My son was born full term weighing 7 lbs 8 oz, but slid down the growth chart so that by age 2 months, he was hovering at the 5th percentile. This was the wrong direction. Obviously, his digestion was not working normally. But I could not get any of my son’s pediatric providers to see that. I found this quite disturbing, to see that a baby’s nutrition, growth, feeding and eliminating were not a priority to them.  My training had given me thorough evidence based information about how crucial these are for normal brain development and learning. It was a shocker to me that no one was concerned. No one seemed to realize this can impact a baby’s brain.

Marcie Mom: Was it easy to figure out his allergies or did the allergy testing not corroborate with your observations?

Judy: Though I had excellent training in my undergrad and graduate nutrition studies, allergies in infants was new territory for me. I had no guidance from my son’s health care providers. I reached out to La Leche League, which I knew about because one of my graduate advisors had been involved with them. They gave me helpful information about breastfeeding an allergic baby. This was in 1996-1997. No internet to speak of. I opened my text books and dove into learning as much as I could. I requested allergy testing when my son was 8 months old. This is young for this testing, but he had dramatic allergic responses to several foods he had never eaten. The doctor apologized, saying my son would probably have asthma and eczema for the rest of his life. Neither came true – I was determined to redirect that.

I later learned that these reactions were only part of the story. These were IgE allergy reactions. When my son was about two years old, we checked IgG food sensitivity reactions. There were several reactions there as well. They didn’t correspond to the IgE. It filled out the rest of the story, and confirmed he had other foods we had to prioritize. This is something I have seen often in my practice since. There is plenty of debate about IgG food allergy testing, especially in children as young as 2 years old. But once we mapped both the IgG and IgE reactions, we could make a more effective plan. My son was eczema free and has been his whole life since. His stools and growth normalized. He was happier. Over the years, he has had a few asthma episodes. Every time we are offered an inhaler, he seems to use it once or twice, then it sits in a drawer and expires before he needs it again.

Marcie Mom: One final question – now that your son is an adult, did that shared experience managing his diet give him fond memories of your care and love for him?

Judy: My son is in high school – not always the moment when parents feel appreciated by their kids! But he understands all the effort made on his behalf. We as a family have learned to enjoy many foods that we never would have discovered if it weren’t for his needs. He is sort of a foodie. He loves good food, is interested in cooking, and has an adventurous palate, because at a very young age, we had to have other options for him. He has taught me a lot.

Marcie Mom: Thanks Judy for taking time to share your journey on managing your son’s diet – am sure many moms like me are inspired to study to help our children!

Eczema Medication Series – Cellcept

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cellcept eczemaThis is a series on some of the medication that I’ve collated from parents who shared in forums. My baby with eczema hadn’t been prescribed these, but my usual investigative self got interested after reading mixed feedback on these medicines. Do share in the comments your child’s experience, and the effect on his/her eczema.

What is Cellcept?

Cellcept is the product name for mycophenolate mofetil, which is an immunosuppressant. Similar to cyclosporine, it is prescribed to lower the risk of organ (kidney, heart or liver) transplant rejection via lowering the activity of the immune system.  It is also prescribed for Crohn’s disease. It may also be prescribed for those with severe eczema who has not been responded to conventional treatments over prolonged periods.

It can be taken orally or by intravenous infusion, and patient needs to follow the prescription carefully, including how many hours to take it before food. The capsule or tablet should be swallowed whole, not crushed or chewed and thus ask for a suspension if you have problems swallowing whole. For the medication in this series that work on the immune system, altering the dosage of the same drug can be used to treat different conditions. Thus, it is important to follow the dosage and frequency designed by your doctor and not to self-adjust through your own observation of the skin’s condition. Doing so not only risks side effects, it also makes it difficult for your doctor to prescribe a follow-up treatment.

Monitoring

Certain tests may be requested by your doctor to assess the side effects of Cellcept, such as blood tests (blood count and chemistry panel), particularly to monitor the blood count of white blood cells, red blood cells and platelets.

Warning

There are medications that can reduce the amount of the active ingredient of Cellcept in the bloodstream, thus making it less effective. Some of these are antacids, colestyiramne, iron tablets, ciclosporin and rifampicin. It’s best to let your doctor know of medication, vitamins and supplements that you are taking.

There is associated risk of   lymphoma and skin cancer, so sun protection measures are important. Also take good care of your gums and visit dentist regularly as swollen gums is a possible side effect. Do not drive as a possible side effect is dizziness. Avoid contact with people who are ill, and also those who have taken a recent live vaccine (also check with the doctor before getting vaccinated) as Cellcept is an immunosuppressant. Wash your hands also to prevent infection.

Side Effects

Watch for side effects, and let your doctor know; some of the side effects are:

Constipation, stomach upset, gas, chills, fever, rash, swelling, headache, vomiting, diarrhea, nausea, loss of appetite, hair loss,  swollen gums, bleeding, bruising, paleness, difficulty breathing, excessive fatigue, yellowing of skin or eyes, muscle cramps, water retention and increased heartbeat.

Symptoms of flu such as sore throat, fever, night sweats, or painful urination, vision changes, reddened skin that cannot heal or sore may indicate infection that warrant seeing your doctor.  Stomach or intestinal bleeding is also a side effect, and signs to look out for are stomach pain, blood in your stool, or dark, sticky stools. There are also reports of risk of brain infection (progressive multifocal  leukoencephalopathy) whose symptoms include visual loss, seizures, movement and speech difficulties, weakness, confusion and headaches. Do call your doctor immediately.

Refer here for a list of more to less common side effects.

There is no particular diet to follow, unless directed by your doctor.

Most Importantly, Does it Work?

I’ve found a few studies online, and the various conclusions are:

  1. In a retrospective case series of 14 children with severe eczema, 1 failed to respond to treatment while others improved significantly.
  2. In a study of 16 patients over 34 weeks, 1 had pancreatic cancer and the rest had improved significantly.
  3. In a retrospective study of 20 patients, 17 improved over 4 weeks of the course, but 7 patients developed various infections.
  4. In a study of 12 patients with paediatric severe eczema at the University of North Carolina at Chapel Hill pediatric dermatology clinic, 8 out of 12 reported significant improvement.
  5. In this study of 10 adult patients, mycophenolate mofetil is found to be effective in reducing the severity of eczema after 12 weeks.

A point to note is above studies were small sample sizes (and I’ve found a few others of even smaller sizes), possibly due to methotrexate prescribed only for severe instances that had not responded to corticosteroids or cyclosporine. Do share your experience in the comments!

Hangout with OzSuperNanny – Avoiding Inflammatory Foods

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2nd Google Hangout with OzSuperNanny, Linda Black, Vivian Pei and Zurina Bryant

2nd Google Hangout with OzSuperNanny, Linda Black, Vivian Pei and Zurina Bryant

This is the second Food Google Hangout with OzSuperNanny, Angela Jacobsen, along with Vivian Pei doing a live cooking session (food writer, editor, stylist and cooking instructor), Linda Black (model and TV host) and Zurina Byrant (celeb photographer). And a ‘me’ who experienced technical problems and couldn’t get on the hangout live. Notwithstanding the lovely ladies accommodated my technical issues, and helped to ask my questions and Angela (and everyone) chipped in and had great fun!

1. How to reduce sugar in dessert, yet have it taste sweet?

Reply is not to have sugar and use natural juice and fruits as alternatives. And train the kids to have less sweet tooth. Or replace with quality chocolates. Linda doesn’t recommend ‘sugar-free’ and definitely not high frutose corn syrup, she likes date sugar though. Zurina does fruit juice popsicles.

I’ve interviewed Toby Amidor, registered dietitian and the founder of Toby Amidor Nutrition, and Nutrition Expert for FoodNetwork.com on inflammatory foods in this post. Her tips:

Parents can manage the amount of sugar in their kids’ diet by being conscious of the foods they buy. Sugary beverages like soda and juice drinks are typically the number 1 source of sugar. In addition, the guidelines for 100% juice is 4-fluid ounces per day for a younger child— which makes it tough to follow if you buy the individual juice boxes which usually 6.75-ounces. Get your kids used to good old water—there is nothing more refreshing!

2. Do you have alternative suggestions to frying, yet retain the crispiness?

Vivian’s reply is to use breadcrumbs, sprayed with olive oil and oven bake. Outside fried food is high in trans fat, and this study showed children who eat fast food 3 times or more a week, there’s a 30 percent increased risk in severity of the above conditions.  See this post.

3.  Drinking soda is not good either – empty calories. Is there a way to make a healthy ice blended?

Linda’s suggestion is to add sparkling water to fruit juice for a little bubbly effect. Refer to this post collaborated with Dr Sears Lean team, on healthy drinks. Dr Sears’ tip:

Drinks with the main ingredient ‘high fructose corn syrup’ may result in overeating because it does not trigger a hormone, leptin, that creates fullness. Moreover, children who drink more than 12 ounces per day of concentrated juice are more likely to be overweight.

4.  Is ice blended coffee or tea an acceptable drink for kids, say occasionally?

All the fab ladies had a laugh with this one, with a BIG NO to caffeine! *offline note*- seriously, I’ve seen kids gulping starbucks frappucino! A relaxing and fun hangout, watch the hangout here!

93 of the 101 things that Moms with Eczema Child do Differently – Kid has Grown and Still No Sleep

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93 eczema cartoon

This is the 93rd of my “101 Things that Moms with Eczema Child Do Differently“, a tongue-in-cheek look at the many unique situations that we face. For more cartoons, click here to view.

Someone with Eczema Baby Managed Returning to Work

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Kelly shares on how she managed returning to work!

Kelly shares on how she managed returning to work!

This is a new series focused on personal journey with eczema while managing a certain aspect of life. Today, we have Kelly who will be sharing on returning to work, at about the time when her son with eczema was six-month old. Kelly is the founder of Bamboo Bubby, and is a return guest of my blog, see here for her interview on the bamboo bubby sleeping bags.

Marcie Mom: Hi Kelly, thanks for taking part in my new blog series ‘Someone has Eczema’! Let’s start with you sharing a little of your son’s eczema, when did he started to have eczema and how was it at 6-month old and now?

Kelly: Thanks for the opportunity to share my experiences Mei! My son was around 6 months old when we finally found a doctor who put the word eczema to his dry, red and irritated skin and who referred us to a specialist eczema clinic. It wasn’t however something that just started overnight. I remember starting to search pharmacy shelves when he was two weeks old looking for a cream that would take away some of the dryness and irritation. We had also need numerous doctors over this time too who were quite blasé about it and would tell us to just use sorbolene (which made it worse!). I think we tried every other cream known to man in that time too as well as trying every type of formula in the hope of finding one that he would drink, because we thought he was just a ‘difficult drinker’ who fought every single feed, often pushing his bottles out of our hands so hard they’d fly across the room!

It wasn’t until our eczema clinic appointment and after a round of allergy tests showed up an intolerance to cow milk protein, that the link between his milk refusal and his eczema became clear for us. We then went through a process of trying soy formula (this was the worst his skin had ever been), then a couple of prescription ones (which he outright refused) before we tried a goats milk one as a last resort and the change was instant from the first bottle. For the first time in his short little life, he drank a whole bottle instead of us forcing 10mls at a time into him. So we just kept giving him this and after a month or so his skin improved A LOT! We were of course also layering moisturizers on him after every nappy change as the eczema was all over his body, but especially bad on his cheeks, stomach, back and legs.

Now, at 3 years old, he still gets eczema flareups, but we know what to do to control and manage it now. Flareups are now usually caused by sickness, fatigue or seasonal allergies.

Marcie Mom: What were your son’s triggers and were they easy for you to communicate to your caregiver?

Kelly: I think we were very lucky that we discovered his trigger not long after I returned to work and he started at our local childcare centre. They were fantastic about accommodating to his needs and being in the baby room, we took all his milk bottles each day anyway. Our Child Care Centre though is required to have policies and procedures in place to meet local and other legislative requirements, meaning they have a Healthy Eating Policy plus several around medication management. So, once we had a written management plan from the doctor that stated his trigger and that he needed moisturizers applied in a certain way after every nappy change it was a very easy process to communicate his needs. They have a very organized system of keeping track of all the babies various different needs and they did a really wonderful job of ensuring he was looked after in this regard.

Marcie Mom: What was the eczema skin care routine you were using, and was it difficult to get the caregiver to understand and be committed to the same routine?

Kelly: Of course there is probably no one else in the world who would do for your child exactly the same as you would yourself, because that’s what we do as parents for our children, often going above and beyond to feel we’ve done everything and the best possible job! However for us, obtaining the GP Management Plan really was the key to ensure the centre provided as close to what we were doing as possible with the regular application of various moisturizers and to make sure his trigger food was avoided.

The aspect I found the most difficult to deal with though, was the sleep routine (or lack of) that our baby desperately needed, yet due to the eczema and milk intolerance we’d never had a chance to establish at home before then throwing child care into the mix! It was around this time that I made my first sleeping bag for him, which helped the caregivers to know that he wouldn’t be damaging his skin while sleeping.

Marcie Mom: One final question – every mom needs to let go, at some point, of our newborn and especially difficult if the child requires special care. Was there a moment that tugged, pulled or pierced your heart when returning to work?

Kelly: I think there was more than a single moment! For me the hardest part was actually knowing in my heart that returning to work was not the best thing for our family, but that it was unfortunately a financial necessity.

I honestly never contemplated just how difficult it is to manage a condition like eczema on top of my own post-natally triggered condition AND return to work with the stress that this brings too, however I believe that having to ‘do it all’ has strengthened who we are as people and what we now know we can cope with. When I look back over the past three years, I’m now grateful for it all. I’ve learnt a lot about juggling of work, baby, household and about the importance of focusing only on doing what is important and necessary – everything else can wait and does get there eventually – it just takes longer than it used to.

Marcie Mom: Thanks Kelly for sharing your journey on returning to work, we all go through it at different degree and different stages in our life, HUGS!

Eczema Medication Series – Methotrexate

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Sharing your experience can Help

This is a series on some of the medication that I’ve collated from parents who shared in forums. My baby with eczema hadn’t been prescribed these, but my usual investigative self got interested after reading mixed feedback on these medicines. Do share in the comments your child’s experience, and the effect on his/her eczema.

What is Methotrexate?
Methotrexate is an antimetabolite which slows down the metabolism of new cells (for instance prescribed to reduce growth of cancer cells). It works via inhibiting dihydrofolate reductase (DHFRase), an enzyme involved in the synthesis of DNA, RNA. It may be prescribed for advanced stages of cancer, severe active rheumatoid arthritis and certain types of cancers. It is also used to treat skin conditions – severe psoriasis, whereby methotrexate decreases the formation of skin cells to prevent the formation of scales. It may also be prescribed for those with severe eczema whose treatment using cyclosporine or corticosteroids are discontinued, as methotrexate has anti-inflammatory properties. Methotrexate also lowers the activity of the immune system.

It can be taken orally or by injection, and patient needs to follow the prescription carefully, especially the dosage or frequency (may be weekly for treatment of skin condition). The dosage prescribed will be determined by the doctor, usually for skin-related, it will be a low dosage, and dosage may vary during the course. It is important to follow-through with the prescription, and not terminate it once you self-assessed your condition has improved.

Monitoring
Certain tests may be requested by your doctor, to assess the side effects of methotrexate, such as blood and liver tests.

Warning
Check with your doctor how much fluid you need to be taking during the course as drinking more water can help to reduce toxicity in kidneys. If you are on non-steroidal anti-inflammatory medication such as aspirin, ibuprofen, choline magnesium or magnesium salicylate, do check with the doctor the safety of these medications as they can increase the level of methotrexate in the blood. Also check on medication such as acitretin, azathioprine, isotretinoin, sulfasalazine or tretinoin that may increase concentration of methotrexate in the blood or increase toxicity for certain body organs – liver, kidney and bone marrow (better to tell the doctor of drugs, medicines, supplements and vitamins you are taking). There is associated risk with liver damage, so do check on alcohol consumption.

There may also be sensitivity to light, so take sun protection measures and avoid sunlight. Do not drive as a possible side effect is dizziness. Avoid contact with people who are ill, and also those who have taken a recent nasal flu vaccine or who has chickenpox (also check with the doctor before getting vaccinated) as methotrexate has mild immune suppressive effect. Also check on what sports you can engage in, to prevent cuts or injury. Wash your hands also to prevent infection.

Side Effects
Watch for side effects, and let your doctor know; some of the side effects are:
Chills, fever, rash, peeling skin, headache, mouth sores, vomiting, diarrhea, nausea, loss of appetite, hair loss, swollen gums, red eyes, sore throat, bleeding, bruising, paleness, difficulty breathing, excessive fatigue, yellowing of skin or eyes, seizures, fainting, difficulty with body movements, vision changes and painful urination.
Symptoms such as diarrhea, black, tarry or bloody stools or bloody vomits may be related to damage to the lining of intestine due to Methotrexate. Do call your doctor immediately. Also, if you had stomach ulcers or previous medical conditions related to intestines, do inform your doctor.
Refer here for which side effects are more common, and which are less.

Diet
Folic acid may be prescribed as a supplement during the course, but this depends on your doctor as studies are not definitive in this area. Folic acid may in some ways reduce the effectiveness of methotrexate, thus may be prescribed on days when patient need not take methotrexate.

Most Importantly, Does it Work?
I’ve found a few studies online, and the various conclusions are:
1. In this study of 60 patients, methotrexate found to improve mild to moderate eczema
2. In a study of 42 patients, both methotrexate and azathioprine showed clinical improvement in eczema for adult patients in the short term.
3. In a study of 25 patients with paediatric discoid eczema, about 19 children showed improvement after 10.5 months.
4. In this study of 20 patients, methotrexate found to be effective, but there were also patients who dropped out from the study due to side effects.

A point to note is above studies were small sample sizes (and I’ve found a few others of even smaller sizes), possibly due to methotrexate prescribed only for severe instances, which had not responded to corticosteroids or cyclosporine. Do share your experience in the comments!

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