Diaper Rash From Hell

Amy,

I know I have requested advice with a lot of issues, and I really hope you can help me out with this one. My daughter is two and around the time our third baby was born (five months ago) she started breaking out in this horrible rash. The worst was her diaper area, but it was also all over her body. It would go away a little and flare up again. We took her to the pediatrician a few times and nothing he suggested seemed to work.

I finally took her to a pediatric dermatologist (there was a two month wait). By the time I got in her diaper area was bleeding constantly and the rest of her body was a complete mess. The first person we saw was a PA and she diagnosed her with severe eczema. She told me I needed to keep her skin moist constantly. I was told to mix vaseline with a specific lotion and rub it all over her during every diaper change. She had the worst allergic reaction to that. I spent all weekend taking pictures of her and e-mailing them to the head of the pediatric dermatology practice. I took her back in the following Monday and they put her on a steroid cream (triamcinolone). It cleared it up pretty quickly. I was told to lotion her up a lot (with a different lotion). We found out she is allergic to a component called balsam of peru, which is in a lot of lotions and shampoos. It is also in baby wipes. We avoid a lot of things now.

The problem is her eczema still flares up a lot. The dermatologist told me to just put on the steroid cream when that happens. The thing is I feel like I am putting it on her almost everyday. I don’t know how good it is to put steroid cream on a two year old every day. The dermatologist kind of brushed me off when I asked her about this. We already had to drive an hour and a half to get to her, and there are no other options to see another doctor (yea for living in a small town). So my question is: Is it ok to use steroid cream this often? Is there anything else I can do? I have tried every diaper cream possible and nothing seems to help except for the steroid. Is there another diaper cream that might work on that area? We use disposable diapers and I thought about switching to cloth, the problem with that is she can’t be in cloth diapers in preschool.

Help please!
Ally

Okay, first off: I CANNOT give you medical advice here. Or anything close to it. So the questions about the safety of the steroid cream…whoooooosh, way over my head and out of my realm of expertise.

I’m sorry that your second opinion options are so severely limited, but it sounds like you need to find a way around that somehow, since YEAH. I think your concerns about regular, long-term use of a steroid cream are incredibly valid and you (and your daughter) deserve to get those concerns ANSWERED and not “brushed off.” Gah. From here, I’d say your options are:

1) Talk to the pharmacist who fills the prescription. Ask questions about it, about side effects, about any research or studies on its use on children, etc. Ask for any over-the-counter or home remedies he or she might know about that you haven’t tried yet. Hopefully one of the benefits to your small town is a helpful, involved pharmacist.

2) Find another pediatric dermatologist who is willing to do a phone consultation, maybe look at the photos over email, offer any additional suggestions or confirm that yes, that particular steroid cream is your best option. This may be difficult to impossible, and I have no idea if anyone would agree to do it or how your insurance would view it, but it’s worth a try?

3) Go back to your doctor and ask again. Call the office and ask again. Refuse to let her brush you off. Make sure she knows you’re still using the cream almost daily and that things are still not fully under control. Tell her right to her face if her answer isn’t satisfactory to you. It’s entirely possible that you’ll be dealing with this practice for a long time, if your daughter doesn’t outgrow the problem, so while I’m sure you’re trying to stay on their “good side” and all…well, NO MORE BRUSH-OFFS. NOT ACCEPTABLE. YOU TALK TO ME LIKE A GROWN-UP, DOCTOR.

As for any other treatment options, yeah: There’s a wealth of suggestions all over the Internet (diluted bleach baths, various emollients, etc.) but many of them should not be implemented without the blessing of your doctor in a case of eczema this severe. I’m sorry.

Has your daughter been tested for food allergies in addition to the lotion/shampoo/etc. ingredient allergy? Eczema can be triggered by allergens in a baby’s diet — cow’s milk and eggs being the usual suspects, but wheat, soy, nuts and fish are also common triggers. Not in all cases, but some.  If you don’t have a good allergist nearby or you’re faced with another long wait for an appointment, you can try eliminating these foods COMPLETELY, one at a time. Rule of thumb for elimination diets is that it can take up to two weeks for the food to completely leave a baby’s system, at which point you would either notice an improvement or nothing at all. However, I think a trip to the allergist is still definitely called for here, because if she has multiple food allergies (like milk AND soy or wheat AND eggs), it can get very difficult to figure that out on your own.

As for cloth diapers, some daycares and preschools will make exceptions for medical reasons like allergies. However, they might require something disposable-like, such as an all-in-one or a pocket style with a waterproof cover, and just like I mentioned in the diapering in a humid climate column, those aren’t breathable fabrics. At home, though, I would SO vote for keeping her in breathable, natural fibers all the way down to her diaper.  A cotton, bamboo or hemp fitted would work great, and you can let her go without a cover for as much time as possible around the house. (If you need a cover, I’d vote for fleece, since wool is specifically mentioned as a NO in several of the online articles I read about eczema. Wool diaper covers are felted to be soft, but it might still be too scratchy for skin that sensitive.) Even if she wears a disposable for a few hours at preschool, she’d still be in cloth the majority of the time to make the switch worth it for her poor little rashy bottom.

Again, I’m sorry I can’t really address the majority of your concerns or offer specific alternatives. I hope you get to the bottom of everything that’s potentially causing your daughter’s reaction, if there are other allergies, food or chemical or otherwise. Or that she outgrows it, or that you get a good answer from SOMEBODY about her current course of treatment.