How GPS are adding to the agony of eczema
Handing out steroid cream can leave children in pain when they just need a different diet
LOOKING down at my 20-month-old daughter sophia’s feet, my heart nearly broke. The skin was angry, cracked and bloody. she had similar patches on her legs, tummy, back and arms and was frantically scratching any area she could reach until the skin split.
I tried gently to restrain her but it just upset us both further.
The next day I took her to our GP — again. He took a brief look at her feet (by now so red and scabbed they looked burnt), said he’d seen worse, then handed me yet another prescription for steroid cream, even though I told him we had several half-used tubs at home.
sophia had seen various GPs for eczema every month or so for as long as I could remember. each time we’d been given steroid creams with barely a word.
Then, just after her second birthday, she suffered a vomiting bug and for two days had just water and dry toast. Her skin became beautifully clear. When she was better she had a beaker of milk and her eczema came back immediately.
I told my GP, who scoffed at the idea of a food allergy — even though my husband Dan is allergic to milk and eggs and had eczema as a child.
At this point Dan and I had had enough — we decided to get private treatment and, at a cost of £760 and with a change of diet, sophia’s skin is finally clear.
But all that expense — and months of misery — could have been avoided if the GPs we saw had done the right thing.
‘GPs often don’t know how to handle eczema,’ says Dr susan Mayou, a dermatologist from the paediatric department at the chelsea and Westminster Hospital.
‘It’s not life-threatening, there’s no one-cure-fits-all and they often don’t have enough training.’
While there is no single cause of eczema, experts agree that it is largely inherited. If a parent has or had it, their child is 60 per cent more likely to get it. This rises to 80 per cent if both parents have it.
As many as two-thirds of children with eczema (but especially those who develop it before the age of one) will also have a food allergy, according to the nHs. Under guidelines from the national Institute for Health and clinical excellence (nIce), GPs are meant to ask parents to ‘consider a diagnosis of food allergy’ if children under 12 have eczema that isn’t responding to treatment. If f ood allergy is suspected, GPs should refer the child to a dietitian or dermatologist.
GPs Are also meant to advise parents on how to prevent and spot infected eczema — this bit angered me most when I learnt about it, as a patch around sophia’s mouth once became badly infected but was misdiagnosed as impetigo (an infectious skin condition) and we had to cancel her first birthday party.
It’s clear that too many GPs don’t know about these guidelines, or stick to them if they do.
‘I worked on putting the nIce guidelines together and it’s frustrating that some GPs just don’t follow them,’ says Dr Adam Fox, the private dermatologist whom we ended up seeing.
‘Parents feel fobbed off and see specialists like me — or, worse, they start to self-treat their children by cutting out foods or using steroid creams without proper advice.’
Margaret cox from the national eczema society adds: ‘Your GP will be lucky if they’ve had six days’ training in dermatology. Many see eczema as a minor complaint, know little about it and have no idea of the challenges faced by families living with it.’
Bad eczema is the condition Dr Fox says he would least like his own child to have.
‘It’s horrendous. I meet tearyeyed parents who are exhausted and struggling,’ he says. ‘Their child has been up all night scratching for weeks, even years. The family don’t sleep properly and are miserable, yet their GP treats them the same as somebody with a small patch of dry skin.
‘Many dermatologists would love to get their hands on some GPs and teach them about eczema.’
sophia’s eczema dominated our life. It first appeared on her tummy at four months old and spread everywhere, bar her face. I lost count of the hours of sleep we lost comforting her at 3am as she scratched herself bloody. Play dates and parties were ruined by her sitting in a corner scratching.
On our two family holidays, the sand and seawater made her cry out in pain and sun cream caused flare-ups so she barely spent time outside. Or she sat in her pushchair watching other children build sandcastles or play in the waves.
Bath time was torturous. eczema needs to be clean (split skin allows bacteria to enter and becomes infected) and moisturised. But water and cream sting raw skin, causing screams during flare-ups.
eczema affected sophia’s behaviour, too. Anyone who thinks toddlers are a handful should try looking after a sleepdeprived one who has a burning sensation all over their body.
research published in the journal Psychology Today, found that 83 per cent of children with eczema have trouble sleeping. They are also more likely to ‘suffer from behav- ioural disturbances’ caused by broken sleep, according to the Jo Journal of clinical sleep Medicine — sophia’s worst behaviour coincided with bad bouts of eczema.
Desperate, we paid £580 to see Dr Fox. He asked about my and Dan’s health and ran allergy tests, wh which involved gently pricking so sophia’s thigh and applying a differ ferent allergen (such as dust mi mites, milk and egg). We quickly discovered that so sophia, like her father, was allergic to milk and eggs. Dr Fox said die diet would help but al s o pre prescribed a week’s course of elocon, a strong steroid cream, to control her eczema while the He die diet kicked in.
HE EXPLAINED that eczema — which means to bubble and boil over in Greek — is like a bush fire fire: when it takes hold, it rages. You need to put out the fire with strong steroids, then keep it out with suitable treatment.
A dietitian ( a further £ 180) created an egg- and milk-free diet for sophia and we started using Aveeno twice a day — a fantastic cream that contains finely milled oats (an anti-irritant) and leaves a protective pro barrier on the skin. Within three days the red patches had softened and after a week sophia’s skin was clear. she hasn’t had eczema since. she sleeps better, behaves better and our family life is transformed.
‘sixty to 70 per cent of children who get eczema in the first year of life have a food allergy,’ Dr Fox told me. ‘And children with eczema that doesn’t respond to standard treatment with steroid creams tend to have food allergies.’ In fact, the same applies for adults.
‘GPs see an enormous number of children with eczema as it affects 20 per cent at some point. Most have it mildly and steroid cream works fine. But some don’t respond and alarm bells should ring. GPs should refer them to a specialist.’
Dr Mayou adds: ‘If your child’s eczema isn’t improving, ask your GP why. Push for a referral to a dermatologist and flag up any family history. Give your child regular baths that are warm, never hot, and apply Aveeno several times a day.’
sophia now has butter-soft skin and a happy nature. I can’t wait to take her to the beach this summer.
eczema.org