Prather Pediatric and Allergy Center - Ask Doctor Brent
Printer Friendly Version
Title: ECZEMA PEARLS
Category: Lagniappe - a little extra
- It is important to explain its serious nature and chronicity; 80% will out grow it but it may take years.
- In general, the most severe patients have the highest IgE levels (sometimes several thousand international units).
- Controlling itching is primary.
- I think Zyrtec works best at a high dose eg. one 10 mg tablet at night for a 4 year old or one teaspoon twice daily etc.
- You can still use Benadryl or Atarax or other antihistamines at night or every six hours as an add on when needed.
- Doxepin (10 - 100 mg) at night is effective for bad night time scratching in very severe cases.
- Fototar or 3% crude coal tar in petroleum can be rubbed on the skin overnight for a safe, cooling, healing effect.
- Aspirin is an excellent itch suppressant even better than antihistamines (watch out for Reye's syndrome).
- Bathe or soak in non-hot water, pat dry and add emollient (Vaseline, Eucerin, Lubriderm, Cetaphil) over entire body.
- It is okay to bathe or soak up to three times a day if it helps keep the skin moist and less itchy.
- For resistant cases, think food allergies especially eggs, milk, wheat, peanuts, fish, soy and corn.
- Some resistant cases are over reacting to staph on the skin and can be cleared with aggressive anti-staph prescription (Duricef, Keflex, Cloxacillin, etc.) and Bactroban to patient's nose and each family member's nose for two weeks to reverse carrier state.
- Rarely, resistant cases are due to secondary fungal infections, even pitysporium orbiculare with heightened IgE response.
- Always review mite, cat, dog, and smoke avoidance.
- Don't get discouraged on severe chronic cases, there's always hope and most do well by adulthood.
- Use the best consultants available:
- Dr. Shapiro (Tulane Pediatric Dermatologist) at
Children's Hospital in Lafayette Specialty Clinic,
phone # 981-9100 ext. 305.
- Dr. Cleveland Moore (LSU Pediatric Immunologist, phone # 504-568-2578) did NIH work on eczema. His unique solution works well in stable patients. It is 80 mg Cromolyn per 1 oz of Velvachol four times a day on affected skin.