Eczema

Use of topical corticosteroids for eczema

Before reading this blog post I just want you to know that if you are struggling with eczema or have a loved one suffering from eczema, I’m sorry. I know how horrible it is & I hope you can find your triggers & heal soon.

Our son Lakyn is now free from eczema (unless he reacts to his triggers) We have found his triggers & now avoid them. He reacts less to those triggers than he did before & I believe it’s due to the healing diet he was & is on still to this day. It has been a tough ride but we have done it & you can too.

This post is just my thoughts on an article I read after we had healed him. I was very surprised with what I read & how simple it would have been to make all the diet and skin care regimen changes back when he was a few months old. (we were not spoken to about these things by any doctor or allergist.

A lot of articles I have looked at about eczema and steroid addiction & withdrawal talk  about the fact that parents have a steroid phobia & the fact they are safe. This is also the attitude of Doctors & Allergists, at appointments I was talked to this exact same way. I was always told topical steroids were safe & I was told I wasn’t using enough & to use more.

So here is some of the article I found on the National Eczema Association called Education Announcement: Use of topical corticosteroids for eczema. I was a little baffled after reading its appropriate use of topical corticosteroid. I was once again angry at Doctors & Allergists and the fact that they had in fact not followed these simple guidelines, actually far from it. Here is there statements:

APPROPRIATE USE OF TOPICAL CORTICOSTEROID

Topical corticosteroids are recommended when patients have failed to respond to a consistent eczema skin care regimen, including the regular use of moisturisers (emollients), appropriate anti-bacterial measures, and trying to eliminate any possible allergens that may be contributing to the underlying problem.”

-I took my son to the Doctor when he was about 3-4 months old with eczema on his cheeks and in the creases of his arms & legs. I was not asked about the skin care regimen I was using & i was not asked or spoken to about possible allergens. I was perscribed first & foremost topical steroids, without any other thought from the Doctor. I asked if they were safe for him as he was so young & I was told yes of course.-

The next part of the article,

GOALS FOR TREATING ATOPIC DERMATITIS:

  1. Prevent flares: Practice a consistent skin care regimen. Use gentle, non-irritating products, use moisturizers regularly, reduce bacterial colonization and infection (for example, with the use of dilute bleach baths), and identify and eliminate any possible allergens, irritants or triggers.
  2. Induce remission: Use TCS once or twice daily for up to 14 days. Once or twice daily application is recommended for most preparations. More frequent administration does not provide better results. Low-potency steroids should be used on the face and with caution around the eyes.
  3. Maintain control:
    a. Eliminate all possible underlying allergens, irritants, and triggers.
    b. Use appropriate moisturizers frequently and liberally.
    c. Apply TCS twice weekly to problem areas.
    d. Stay in close contact with your provider and consider adding other therapies such as calcineurin inhibitors or phototherapy if eczema is not responsive to medication or control is hard to maintain. Also, consider patch testing by a specialist who can test an extended allergen series, including corticosteroids and all potentially allergenic components of corticosteroids, as well as other skin care and environmental allergens.
  4. Rescue flares using TCS: the sooner applied, the more quickly controlled–then   back to maintenance therapy. Your doctor may prescribe a stronger steroid to be  used immediately for flares for a few days and then ask you to go to a weaker steroid once the flare has improved.

My Thoughts!!!

Low-potency steroids should be used on the face and with caution around the eyes.”

-I consistently asked about this, and told Doctors I was worried & informed them I had been applying them since he was young baby.  We were told not to worry & to use the steroids around Lakyn’s eyes on several occasions. I was concerned as it is written very clearly on the packaging not to use around eyes.-

“Eliminate all possible underlying allergens, irritants, and triggers.”

-When I took Laky to the Doctor’s when he was a few months old I was never spoken to about possible irritants or triggers. First option was steroids.-

“consider patch testing by a specialist who can test an extended allergen series, including corticosteroids and all potentially allergenic components of corticosteroids” 

-This one is surprising, can they actually test for this?-

-We used topical steroids on our son for nearly 2 years. Over that time whenever we stopped his eczema would return within a few days & the process would start again. We consistently felt it was not right to be using steroids so much & for such a long time. We asked on several occasions if we had anything to worry about & was told no. His eczema got worse & worse & worse.-

Another part of the article:

“Do not use daily TCS continuously for more than two to four weeks—then the frequency should be tapered to twice weekly use. Your provider should strive to help create a safe and effective long-term treatment plan that does not include daily use of TCS, especially on more sensitive areas. Close follow up and careful monitoring with good communication will help ensure this.”

-Two to Four weeks is such a short time, we were using steroids for nearly 2 years only breaking for two days at a time before the eczema would return worse than the time before. We could not stop. I was told not to worry & to use more to get it under control.-

This next part of the article is about symptoms to look for when steroid overuse has occurred.

WHAT TO LOOK FOR? Burning, stinging, and bright red skin are the typical features of topical steroid overuse and withdrawal. The signs and symptoms occur within days to weeks after TCS discontinuation. In general, TCS withdrawal can be divided into two distinct subtypes: erythematoedematous and papulopustular. Clinical features differ between the 2 types, but there is some overlap of some signs and symptoms.

The majority of erythematoedematous type was found in patients with an underlying eczema-like skin condition like atopic or seborrheic dermatitis. Patients with this type of withdrawal experience swelling, redness, burning, and skin sensitivity usually within 1-2 weeks of stopping the steroid.

photo

-I took lakyn to the children’s hospital the same day this photo was taken. I informed the Doctor off all his symptoms & asked if I could be referred to a specialist as he was getting worse and worse and had developed asthma. The Doctor informed me that no she wouldn’t refer me to a specialist & that he just had eczema, use more steroids and yes use them around his eyes.

When leaving the hospital I broke down, I cried the whole way home. How could they not see that steroids were not working for him. How could they dismiss everything I told them. My family told me to listen to the doctor & that the Doctors know what they are doing. I couldn’t. So I didn’t. This day was the day I decided to stop steroids. I was never going to use them on Lakyn ever again.-

Next part of the article,

WHAT TO DO? Consult your healthcare provider. Your doctor will most likely rule out other conditions such as allergic contact dermatitis, a skin infection or, most importantly, a true eczema flare. Confusing the signs and symptoms of eczema for steroid withdrawal could lead to unnecessary under-treatment of the eczema. Once a diagnosis of steroid addiction or overuse is made, the goal should be to discontinue the inappropriate use of topical steroids and provide supportive care. Consideration might be given to some of the treatment options discussed in the literature: supportive care including ice and cool compresses, psychological support, systemic doxycycline, tetracycline, or erythromycin, antihistamines, and calcineurin inhibitors.

Natural and alternative treatments can sometimes be used in addition to or rather than conventional treatments. However, they also may have associated risks. Discuss any natural or alternative treatments with your doctor so that, together, you can devise the safest, most effective personalized treatment plan.

Please check out the article for yourself here national eczema organisation

I hope you have found this article helpful & if you or someone you love are suffering from eczema I hope you can find your way out without the use of steroids.

Ali xx

Disclaimer

The views and opinions on this blog are of personal circumstances only and are things that have worked for us.  I am not a medical professional and Please understand individuals are unique, some conditions are life threatening and do require medical attention. Always seek medical advise before changing your diet or stopping medication.

 

 

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4 thoughts on “Use of topical corticosteroids for eczema”

  1. Aww bless Lakyn I hope he gets better. It’s always worse when a young child or loved one is suffering from this but what you’ve done and doing is a great thing. Doctors don’t know what they are doing when it comes to eczema. They aren’t the ones who have to live with the consequences.

    Like

    1. Thank you,
      he is so much better now 🙂
      They are only doing what they know. That’s very true they don’t have to live and see the consequences on a daily bases.
      Of course for some topical steroids will work & do no harm. But unfortunately for others it is not the case. I’m so glad & thankful we stopped & it’s helped him.

      Liked by 1 person

  2. In my experience, inflammation around the eyes, such a you show in the photos of Lakyn, is almost always due to an allergic response, either environmental-, or food-related allergy.

    Do you have pets?

    Do you use any products in the house, and around Lakyn that have fragrances? This includes perfumes, deodorants, soaps, shampoos, laundry detergent, candles, air fresheners, cleaning products, dish detergents, etc. etc..

    Do you have a mould problem in the house (even a small one)?

    Do you have excessive dust? Carpeting? Lots of upholstered furniture? Do you vacuum and dust on a regular basis? Do you use furniture polish? Febreeze?

    Have you tried using only plain, unscented petroleum jelly around Lakyn’s eyes, and on his eyelids? Wet down his skin before applying it. This will not only seal in the moisture, but it will protect against environmental contact allergens.

    Have you taken Lakyn to an ophthalmologist to check for giant papillary conjunctivitis or even infection?

    Have you attempted any elimination diets on your own? Such as all soy and soy derivative products? Egg? Dairy? Wheat? Tree nuts/peanuts?

    Are there times (other than when using the steroids) when Lakyn’s skin is better than usual? Have you kept a diary recording everything with which he has come into contact during these times, and at other times when his skin gets worse?

    Steroids are best used for short periods of time, in order to get a flare-up under control. However, they are not the solution to eczema control. In some cases, long term use of low-dose corticosteroids at reasonable intervals is the only path to a decent quality of life. But, every effort should be made to find and eliminate the source(s) of the bulk of inflammation before deciding on maintenance doses of steroids.

    You need to be diligent, and pay very close attention to everything with which Lakyn comes into contact. Note the progression of his skin condition, and look for trigger associations, and patterns that develop over time.

    The real issue is that eczema is a multi-faceted immunodeficiency disorder with no simple control mechanism. There is no cure as it is genetic. But, you can find for Lakyn a comfortable level of existence. It’s just not easy to find.

    Is it at all possible for you to see specialists without a referral? If so, do it. See a pediatric dermatologist, and an allergist well versed in eczema and environmental allergies.

    Try eliminating certain foods for at least two months at a time. Reintroduce them slowly, and be diligent and methodical about recording the progress and any reactions Lakyn may have.Go for the big ones first, and be mindful that it may be a combination of food allergens, not simply a single food at the root of his condition.

    Remove all scented products from the home. Use products with a minimalist ingredient list as often as you can find them. Try the plain petroleum jelly around the eyes.

    Make every attempt to stop using corticosteroids so close to the eyes, and on the eyelids. The risk of cataract formation is very high. Try to keep the steroid use to a minimum of three or four inches away from the eyes.

    Feel free to read any of the articles I have written, and to use what you feel is helpful. But, do what you need in order to find a better primary care doctor for Lakyn, as it seems the one you have now is rather useless.

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    1. Hi Greg,
      Thank you for your comments & caring about us.
      We have found Lakyn’s triggers and he is eczema free( apart from the rare flare if he has too much of a trigger food.)
      I thought the same thing when he was swollen & we went to the allergist & hospital. They would not test him for anymore allergens & said more steroids even around his eyes. Thats the day we stopped listening to doctors and started listening to ourselves. We stopped steroids and have not used them again. He is asthma and eczema free. Yay!!
      We had him on a very strict elimination diet & gut healing diet & have found his triggers. He now tolerates most of his trigger foods. We most def removed all cleaning products, detergents, scented products etc, from our home.
      Thank you again 🙂

      Like

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