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mamashark

Daughter diagnosed with eczema

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She has it up and down her arms and legs, and it has worsened in the past week. We were told how to "manage the symptoms" with lotions and hydrocortisone cream, etc. But I would like to figure out what is causing it to happen in the first place! Can someone point me to some resources that would help me learn about eczema as a reaction? 

 

my mom suggested sugar as the cause, since she knew a lady who was allergic to sugar. 

I am allergic to gluten (possibly celiac but never tested) and I avoid almost all sugar naturally as well. 

My youngest son who is 15 months is allergic (intestinal issues) to milk - he can eat dairy products, and can have milk in cooked things, just not drink a cup of milk.

 

Also, this is my daughter who was allergic to dairy, soy, eggs, and wheat as a baby - severe intestinal distress and failure to thrive type allergy. All allergy tests were negative, though, it was only the intestinal Dr. who helped us figure out what was going on. She outgrew all the reactions to those foods by somewhere around 2 years old.

 

 

 

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She is having new reactions to her food sensitivities. Eliminate the foods that bothered her before. After the eczema clears up (hopefully) you can figure out what is causing it by testing one food at a time. 

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And be careful using the hydrocortisone. It can cause more problems.

What kind of problems? The dr. Told us to try it first and that she would prescribe something stronger if that didn't work.

 

Is also been 3 years since she's had a reaction to those foods, do you really think its them again?

 

 

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Hydrocortisone thins the skin. But so does scratching yourself to you bleed. It is generally advised not to use it long term especially on the face.

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My child gets it based on weather. I have always gotten it based on the season too. My son has Cortisone 10 on right now.

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My child gets it based on weather. I have always gotten it based on the season too. My son has Cortisone 10 on right now.

Well she's had it on her arm for a few months, it's recently spread to both arms and legs and got bad enough that I consulted her dr. So I don't think it's the weather.

 

 

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My dd gets eczema from dairy.  Our allergist gave us Protopic to use, which works very well.  He has also recently been prescribing some cream that starts with Tri... but we still have tons of protopic so we use that.  It can be used on the face.  I'm  thinking it is not steroidal.

 

If you are working with a pediatrician and not an allergist, I would recommend seeing an allergist.  It's their specialty :)

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My dd gets eczema from dairy.  Our allergist gave us Protopic to use, which works very well.  He has also recently been prescribing some cream that starts with Tri... but we still have tons of protopic so we use that.  It can be used on the face.  I'm  thinking it is not steroidal.

 

If you are working with a pediatrician and not an allergist, I would recommend seeing an allergist.  It's their specialty :)

 

my daughter also recently cut out diary because of eczema.  It seems to have helped quite a bit.  She's also noticed some intestinal issues whenever she re-introduces it.   I think I'll see if she willing to try the Probiotic.

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You aren't at this point yet, but you may want to do some research if you end up using steroid creams.

This is one source of info http://itsan.org/, but you should do more.

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Food sensitivities can develop at any time. Since she had them before, and because of family history, it's pretty likely they are the culprit. 

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I think it sounds like a wheat/gluten intolerance.  (Or as others have said, it could be a sensitivity to dairy too.)

 

My dd has eczema off and on, and uses a prescription cortisone cream very, very sparingly.  We were told to use the smallest possible amount, just enough to very thinly cover.

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I think it sounds like a wheat/gluten intolerance. (Or as others have said, it could be a sensitivity to dairy too.)

 

My dd has eczema off and on, and uses a prescription cortisone cream very, very sparingly. We were told to use the smallest possible amount, just enough to very thinly cover.

I'd honestly prefer gluten to dairy. Guess a food trial is the only way to figure it out for sure.

 

 

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I would cut out the foods that you know have bothered her in the past, and see if that helps.  Also, anything such as sugar that increases the body's inflammation response should be avoided - that's what my daughter's dermatologist said when I asked her about preventing/reducing outbreaks.  She recommended a low-glycemic diet.

 

Another thing we've found, which you may already be doing:  avoid fragrance like the plague!  No scented laundry detergents, body wash, lotion, shampoo, hand soap, anything!  And I may have people disagree with me on this one, but that absolutely includes "natural" fragrances like essential oils.  At the chemical level, they are still aromatic hydrocarbons, they should still be avoided.

 

Also, a very wise person on these boards recently recommended that we try low-pH shampoo and body wash, and that seems to be helping as well.

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my daughter also recently cut out diary because of eczema.  It seems to have helped quite a bit.  She's also noticed some intestinal issues whenever she re-introduces it.   I think I'll see if she willing to try the Probiotic.

It's not Probiotic, it's an ointment called "Protopic."  Available by prescription.  Just to clarify.  :)

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Regardless of the underlying cause, keep in mind that eczema isn't just a rash; it's extremely dry skin.  Lotions aren't thick enough to protect the integrity of the skin.  Our doctor recommended VaniCream for daily use, with prescriptions for when there's a flare-up.  Drinking a lot of water can help, as can fish oil in the diet. 

 

FWIW, at our house dairy, gluten, and sugar are all part of the problem. 

 

 

 

 

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Get her off of all cows milk dairy products.

 

That was my itchy girl's problem.

 

BTW, she can have raw milk but store products cause her problems.

 

A humidifier helps, gentle soaps, and having her shower as cool and infrequently as possible. (even as a teen, my girl doesn't need to shower daily or she's itchy. ) If she's sweaty, have her shower with just water every other day instead of soap every day.

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Regardless of the underlying cause, keep in mind that eczema isn't just a rash; it's extremely dry skin. Lotions aren't thick enough to protect the integrity of the skin. Our doctor recommended VaniCream for daily use, with prescriptions for when there's a flare-up. Drinking a lot of water can help, as can fish oil in the diet.

 

FWIW, at our house dairy, gluten, and sugar are all part of the problem.

Yes that's a good point, I am planning on going to the store to look for a good cream, as I am sure what I have is not good enough. What are good options to look for? Any ingredients I want?

 

 

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See a board certified allergist who treats children.

 

Try different creams and lotions.  Cetaphil is good, if she's not allergic to tree nuts or peanuts (I can't remember which one).

 

Our allergist highly recommends using Crisco (!!) on eczema skin but if there's a peanut allergy - don't do that.

 

Another option:  warm bath for 10 minutes, get out of the bath, coat skin with vaseline, very carefully get back in tub, warm bath for another 10 minutes, get out and pat dry.  She will be very slippery, so this requires a lot of caution.  

 

What you really need to to know is the cause of the eczema.  For DS, it was wheat allergy.  Not gluten, and it was a true Ig-E mediated allergy.  He has many allergies, and we'd never have guessed wheat as the culprit.  You really need a board certified allergist.

 

 

 

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Also egg could be an issue. Stop using fabric softener and dryer sheets.

Haven't used fabric softener it dryer sheets in years, so that's an easy one.

 

I am also giving her oatmeal baths, which the dr. Said was good. Do you find oatmeal baths help?

 

 

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You aren't at this point yet, but you may want to do some research if you end up using steroid creams.

This is one source of info http://itsan.org/, but you should do more.

:iagree: I know that many people successfully use steroid creams, but I have been suffering from topical steroid withdrawal for 2 years eight months and twenty-three days...

 

Just be informed about the possibilities, OP. :grouphug:

 

UVB light therapy and going dairy-free have helped me the most.

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Our allergist refers to it as part of the golden triangle of allergic reactions: rhinitis, asthma and eczema. Eczema triggers are different for everyone. Dairy is a big one. So is gluten. But if your child is allergic to ragweed and eats a lot of melons in the summer, there's likely to be a reaction because ragweed and melon are cross-reactive.

 

I would definitely try a strict elimination diet.

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Haven't used fabric softener it dryer sheets in years, so that's an easy one.

 

I am also giving her oatmeal baths, which the dr. Said was good. Do you find oatmeal baths help?

 

 

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Oatmeal is a big trigger for one of my kids, so no, we wouldn't go anywhere near an oatmeal bath.

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Another vote for food.  I would consider doing additional allergy testing as well.  As far as which food(s), the most likely culprits start with the top 8 food allergens.  If this is severe eczema, I would not hesitate to visit an allergist.

Edited by wapiti
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Yes that's a good point, I am planning on going to the store to look for a good cream, as I am sure what I have is not good enough. What are good options to look for? Any ingredients I want?

 

 

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We used Aquaphor when we were getting my daughter's under control, then were eventually able to switch to Cetaphil. Dermatologist back then recommended soaking in a warm (not hot) bath for 10 minutes, then pat dry with towel and slather on the Aquaphor.

 

Erica in OR

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Eczema runs in my side of the family together with hay fever and asthma. None of us have food allergies. Link article is very close to what we have.

https://medlineplus.gov/ency/article/000853.htm

 

ETA:

My nephew was covered in cream and gauze before bedtime to prevent him scratching until the "rash" bleed.

Edited by Arcadia
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Good point - environmental allergies can do it too.  Even my non-food-allergic kids seem to react to grass, especially in the spring...

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Another vote to eliminate prior known food issues. Remember it can take dairy 6 weeks to fully leave your system. Probiotics and digestive enzymes are a great thing to add, but make sure they're dairy free too. 

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Allergy testing otherwise it's just a guessing game.

 

I would also look for an environmental dermatologist. My regular dermatologist sent me to one to treat my eczema.

 

Both my son and I had allergy testing.

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Also, a very wise person on these boards recently recommended that we try low-pH shampoo and body wash, and that seems to be helping as well.

 

Can you recommend any brands of these products?

 

My daughter is 14 and has eczema since she was an infant.  We have taken her to dermatologists and allergists with no success.  She is very self-conscious about her skin now and we don't know what to do for her.  It is very frustrating.

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Allergy testing otherwise it's just a guessing game.

 

I would also look for an environmental dermatologist. My regular dermatologist sent me to one to treat my eczema.

 

Both my son and I had allergy testing.

Even with allergy testing, it can still be a guessing game. My middle guy only tests positive for some of his allergies/intolerances. The ones that don't show up on the tests involve his worst reactions.

 

OP, for my youngest, gluten causes excema. We don't have any symptoms to manage now that he's gluten free. I agree that your daughter is having new/different reactions to some or all of those allergies that you had identified when she was a baby.

 

Edited for autocorrect

Edited by BooksandBoys

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Our ND told us that ~90% of eczema is due to food allergies/sensitivities and 90% of the time that food is dairy or gluten. He mentioned a correlation between eczema and asthma and really pushed to figure out the culprit vs treating symptoms in order not to increase risk of developing asthma. He also mentioned that eczema can be triggered by weather--during more moist months (in our area, during the rainy fall...and winter...and spring...), eczema will likely appear more (but if we lived in a humid area, the summer might be more of an issue).

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Eczema runs in my side of the family together with hay fever and asthma. None of us have food allergies. Link article is very close to what we have.

https://medlineplus.gov/ency/article/000853.htm

 

ETA:

My nephew was covered in cream and gauze before bedtime to prevent him scratching until the "rash" bleed.

 

Agree with this--eczema is not a food allergy, though many people with it also have food allergies. Just verified that on WebMD. I read an article a few years back that said eczema has a genetic component where your body is lacking a particular protein. I think my skin does not have as good a barrier function as normal skin. So things that are triggers for my eczema:

 

-heat

-direct exposure to sun (even if it's not that hot)

-dry environments, being at higher elevations

-cold, dry winter air

-exposure to some allergens like cat hair (yes, I have a cat, and not a problem unless he rubs all over my face/neck or hands that are experiencing a flare up)

-stress

 

Some people's triggers may be food--mine are not. Things that help:

-Eucerin cream. Love that stuff. I use it as my daily face moisturizer.

-Aveeno lotion with oatmeal as a basic moisturizer (Eucerin on top where I have specific problems with dermatitis)

-Triamcinolone for flare-ups on my hands (Rx steroid, but I have no problems with it and used it in childhood)

-Desonide (Rx steroid, milder than triamcinolone) for flare-ups on my neck. I have permission to use it sparingly on my face, but usually don't.

-Clinique mild clarifying lotion (no alcohol). This just feels good. I think it gently exfoliates, but it can also remove surface irritants on my face. Like if my cat snuggles with me, I can apply that to my face and feel better.

-Vaseline. I think this helps provide the barrier that my skin lacks. I use it above my mouth, sometimes on eyelids.

-No perfumes, dyes, etc--anything that hurts my ultra sensitive face. Like Eucerin is good but closely-related Aquaphor kind of stings.

 

I had eczema as a child, had very few flare-ups from puberty through adulthood, began having more frequent flare-ups that need constant daily maintenance at age 46--daily maintenance meaning attention to moisturizing, saving steroid creams for bad days.

 

Regarding Protopic--I think that's the one I couldn't get because it was horrendously expensive (like $400-$500 dollars) and not covered by my insurance.

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Can you recommend any brands of these products?

 

My daughter is 14 and has eczema since she was an infant. We have taken her to dermatologists and allergists with no success. She is very self-conscious about her skin now and we don't know what to do for her. It is very frustrating.

I'm so sorry that she's having such a rough time with it. I really hope you can find something that will help.

 

My daughter is currently using CeraVe facial cleanser not only for her face but also as her body wash. And she uses Joico shampoo. Both are available at Ulta. I think there are other brands out there, we just started with those because I found them easily.

 

My dd doesn't do this anymore because she doesn't like the feeling of oil on her skin, but when she was a baby, I would use either pure coconut or almond oil on her skin, and it really seemed to help. So if your daughter is more tolerant of heavy emollients than mine is, you might consider that as well.

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I tried coconut oil, eczema cremes that had oatmeal in them, cocoa butter. Nothing helped. My two year old tested sensitive to all of those and many other things. The only thing he doesn't react to is Vaseline. 

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I tell you this to establish my credentials:  every dermatologist I ever went to said I had the worst case they had ever seen.  Well, it is nice to be good at something.  I guess.

 

Hydrocortisone and steroids are really wonderful tools but not solutions.  IF your kiddo has the kind of eczema that is caused by allergies/sensitivities, do everything you can to eliminate those from her life.  Sometimes, you will need to use the steroids to get back to a liveable life, and then this can be maintained by careful attention to the things that cause flare-ups.  I had to make this decision at a very young age, knowing that there were likely tradeoffs with end-of-life realities.  I decided (and I would decide again) that there needs to be a life worth having in the middle, even if it is shorter or *I* am shorter (which I am--5'5", when my growth curve put me over 5'9").  

 

However, it is also really worth doing without cake, cookies, pies, custards, omelettes, and the host of other things I can't eat because of eggs to keep the skin under control.  So I do that...fastidiously.  

 

I'm not going to bore you with my history.  But I will tell you that it has had its ups and downs, and that while I would not wish this on anyone, there are upsides...learning that you are not valued because you have beautiful skin.  Learning to control yourself in OTHER areas because you have learned to control your diet.  Learning not to feel sorry for yourself because of the hand you were dealt.  My mother was brilliant at helping me along with this last one.  I hated it, in a way, but shortly after I left home, I had a sub-mom fawning all over me because she felt so sorrrrrry for me, and it was really nice to be made much of...for about 15 minutes.  At minute 16, I became immensely glad for my matter-of-fact, do what it takes, don't be a special snowflake mom.  

 

But she sacrificed a lot for that, too.  She made me a special meal (allergies), one for herself (constant diet) and one for my dad and sister...every meal, every day.  It wasn't easy, but she set me up to be a (relatively) normal person, one with a lot of self control and very little self pity.  She *also* was great because she knew how hard it was, and when I cheated, she never came down on me.  She just said, "If you're going to screw this up by eating ice cream, at LEAST get a flavor you like...and GOOD ice cream."  She had a sense of humor that went a long way.  But she sacrificed a lot of time, energy and money, too.  

 

 

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If creams/lotions burn, then use vaseline. Otherwise, the Aveeno BABY eczema cream is amazingly great. One of the few things that doesn't make it burn. Get the baby version though, the adult Aveeno products irritate my skin. 

 

Warm bath, then IMMEDIATELY apply the cream/vaseline, within 1 minute or less of getting out. Like, have it all ready by the side of the tub. Do not wait until getting to another room. Pat dry gently, then apply the cream/vaseline, then go get dressed. Soak and Slather is the routine, you can google it. 

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If creams/lotions burn, then use vaseline. Otherwise, the Aveeno BABY eczema cream is amazingly great. One of the few things that doesn't make it burn. Get the baby version though, the adult Aveeno products irritate my skin. 

 

Warm bath, then IMMEDIATELY apply the cream/vaseline, within 1 minute or less of getting out. Like, have it all ready by the side of the tub. Do not wait until getting to another room. Pat dry gently, then apply the cream/vaseline, then go get dressed. Soak and Slather is the routine, you can google it. 

I had to bathe, slather unscented cream then cover with ointment (like vaseline or Eucerin) to keep the moisture in.  

 

Creams:  try California Baby eczema cream, which costs the earth.  I am newly a fan of Vani-Cream which comes in a tub with a pump top which is incredibly annoying as a delivery device but the cream is wonderful.  

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I've been growing more and more convinced lately that eczema is related to our gut flora. I sent this link below to a friend who suffers pretty badly with eczema and she gave the probiotics a try. She called me a little while later and told me that the eczema that she's had for years cleared up within three days of starting the probiotics! It probably won't work for everyone but you might give this a thought.

https://mrheisenbug.wordpress.com/2014/01/27/l-plantarum-cured-my-eczema/

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Eczema due to gluten/Celiac. (honestly it may not be ecezema if it is the same on both sides of the body - that can be dermatitis herpetiformis often mislabeled as eczema or psoriasis)      

 

I treated my daughter by coating her every night in mayo - full fat. If I remember it was a couple of weeks.    let it sit on her for 10 - 30 minutes and then washed her off with mild full fat goat soap.    Got the diet under strict control.  NO gluten, no dairy, no anything that the mimics gluten in the body.   Applied Vaseline to all the raw or soon to be raw spots.  it did go away.  Hers never returned except when my hubby lost his mind and used dryer sheets in her laundry.  Child can not use dryer sheets!

 

Mine has been a little worse.   I haven't been strict with the diet and flare ups happen.  They just take forever to heal.  I use coconut oil every night and apply avocado or grapeseed oil every morning.  This has kept the rest of my skin from being dry in the first place and helped heal up the areas.  I have applied tea tree oil to the worst spots to keep infection and fungal infections from starting.   I am now nearly spot free.  (it has taken 5 years along with a strict diet of no gluten, no dairy, and absolutely no sugar at all, that part i started a few months ago to see if it made a difference)  The last areas begin to heal and disappear.  I also did a week of beach therapy.  I stayed in salt water for hours (4-5 a day) at the beach and noticed within that week that my 2 last worst spots improved, almost over night it seemed.  I have since added in a Dead sea salt soak to those areas every day.   

 

So combination approaches.   I think for me tightening up my diet, applying full fat oils and eating more full fat along with salt soaks has finally turned the corner for me.

 

But if the areas are pretty much the same on both sides of the body, I would consider a skin manifestation of Celiac and see if I could get her in to a dermatologist who knows how to biopsy for that and see if that is the root cause.

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I tell you this to establish my credentials:  every dermatologist I ever went to said I had the worst case they had ever seen.  Well, it is nice to be good at something.  I guess.

 

Hydrocortisone and steroids are really wonderful tools but not solutions.  IF your kiddo has the kind of eczema that is caused by allergies/sensitivities, do everything you can to eliminate those from her life.  Sometimes, you will need to use the steroids to get back to a liveable life, and then this can be maintained by careful attention to the things that cause flare-ups.  I had to make this decision at a very young age, knowing that there were likely tradeoffs with end-of-life realities.  I decided (and I would decide again) that there needs to be a life worth having in the middle, even if it is shorter or *I* am shorter (which I am--5'5", when my growth curve put me over 5'9").  

 

However, it is also really worth doing without cake, cookies, pies, custards, omelettes, and the host of other things I can't eat because of eggs to keep the skin under control.  So I do that...fastidiously.  

 

I'm not going to bore you with my history.  But I will tell you that it has had its ups and downs, and that while I would not wish this on anyone, there are upsides...learning that you are not valued because you have beautiful skin.  Learning to control yourself in OTHER areas because you have learned to control your diet.  Learning not to feel sorry for yourself because of the hand you were dealt.  My mother was brilliant at helping me along with this last one.  I hated it, in a way, but shortly after I left home, I had a sub-mom fawning all over me because she felt so sorrrrrry for me, and it was really nice to be made much of...for about 15 minutes.  At minute 16, I became immensely glad for my matter-of-fact, do what it takes, don't be a special snowflake mom.  

 

But she sacrificed a lot for that, too.  She made me a special meal (allergies), one for herself (constant diet) and one for my dad and sister...every meal, every day.  It wasn't easy, but she set me up to be a (relatively) normal person, one with a lot of self control and very little self pity.  She *also* was great because she knew how hard it was, and when I cheated, she never came down on me.  She just said, "If you're going to screw this up by eating ice cream, at LEAST get a flavor you like...and GOOD ice cream."  She had a sense of humor that went a long way.  But she sacrificed a lot of time, energy and money, too.  

Thanks for sharing this Patty Joanna. Your story is very moving, and I am sorry that you have suffered so much. Your mom sounds awesome. Eczema is, alas, a big part of my life. :grouphug:

 

---

OP, you can probably surmise from all of the replies that there is usually a lot of trial and error involved.

Edited by Penguin
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my mom suggested sugar as the cause, since she knew a lady who was allergic to sugar. 

I am allergic to gluten (possibly celiac but never tested) and I avoid almost all sugar naturally as well. 

My youngest son who is 15 months is allergic (intestinal issues) to milk - he can eat dairy products, and can have milk in cooked things, just not drink a cup of milk.

 

Also, this is my daughter who was allergic to dairy, soy, eggs, and wheat as a baby - severe intestinal distress and failure to thrive type allergy. All allergy tests were negative, though, it was only the intestinal Dr. who helped us figure out what was going on. She outgrew all the reactions to those foods by somewhere around 2 years old.

your son may be allergic to casein - which is the protein in milk, and the most  common cause of milk allergy.  you want to know that, because casein is an ingredient in many other things. (including paint.)

butter often doesn't have casein in it.

 

you can have gluten sensitivity WITHOUT having celiac.

 

My understanding is eczema is an overloaded immune system response.  food allergies can cause more than just intestinal distress.  my son would get aggressive with nitrates. 

I would assume this child still has food allergies - and that her reactions have changed. if she was allergic to it before, try removing all those things again and see how she responds. it may take a month or more to notice any improvements.

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Thanks for sharing this Patty Joanna. Your story is very moving, and I am sorry that you have suffered so much. Your mom sounds awesome. Eczema is, alas, a big part of my life. :grouphug:

 

---

OP, you can probably surmise from all of the replies that there is usually a lot of trial and error involved.

Thank you for your kind words.  I want to tell you some wonderful news, though...I should have included it in the original post.

 

In a miraculous and overnight change, I now have normal skin.  First time ever.  I can wear sandals, not dress for camouflage and so on.  To say I am thankful is putting it mildly.  Almost 60 years old! and I get to dress like a gur-relll.  :0)  I have pedicured and painted toenails, and am working out to keep the arms in shape so I can wear my new tank tops. 

 

This was my cross, and it can be borne.  (ETA:  My current cross is alopecia--no hair at all on my head.  It DID come back on my legs...Someone has a sense of humor.)  But I will not say that I am sorry to be able to lay it down.  :0)  And I hope that this is true for you and all someday.  

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Regardless of the underlying cause, keep in mind that eczema isn't just a rash; it's extremely dry skin.  Lotions aren't thick enough to protect the integrity of the skin.  Our doctor recommended VaniCream for daily use, with prescriptions for when there's a flare-up.  Drinking a lot of water can help, as can fish oil in the diet. 

 

FWIW, at our house dairy, gluten, and sugar are all part of the problem. 

I have had eczema my whole life and I am working with an allergist and dermatologist right now. I definitely agree to eliminating scented detergents and soaps. My allergist recommended Free & Clear for shampoo, conditioner etc... you can get it on Amazon or at Walgreens I believe.

 

Cerave and Vanimcream are two other lotions I swear by. A lot of prescriptions come in ointment form which I understand acts as a better barrier for skin but they actually made me itch more. I always ask for a cream version. One other prescription product is called "Elidel" and it is used when eczema areas clear up a bit. It keeps the rash from recurring and is not a steroid cream. It also thickens the skin so if you have thin skin damage like I do it can help. Elidel is $$$ but they have cards you can use to make sure you don't pay more than $35 for a tube.

 

Aveeno also used to have an Oatmeal powder you could put in a bath with lukewarm water and that can be soothing to the skin as well. Summer is always the worst for me especially if I sweat at all. All I do is itch. Winter is more dry skin than actual breakouts.

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Yes that's a good point, I am planning on going to the store to look for a good cream, as I am sure what I have is not good enough. What are good options to look for? Any ingredients I want?

 

 

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Cerave moisturizing cream (in the tub form) with ceramides and hyaluronic acid.

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If I started using a good lotion and removed Gluten from her diet, is 24 hours too soon for diet change to make a difference? The rashes are still there but a couple bad patches are showing significant improvement. Is that diet or the cream? Or both?

 

 

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