The Routine

Our daughter has moderate eczema on her cheeks, arms, and legs.  It has been severe at times and has begun on other parts of her body, but now it is mild and those remain the only three maintenance areas.  She has been prescribed three potencies of corticosteroid creams and a topical antibiotic.  However, I am happy to say that after five months of trial and error we do not have to use any prescribed medication except on her face.  The photos show the progression of her eczema from six to twelve months old, both before and after using medication on her face.

I give her a bath every day.  I mean, every single day.  That is the only way besides drinking that you can hydrate your skin.  Eczema is a defect in the skin, a deficiency of proteins possibly, that does not leave it with the ability to retain moisture.  It is much more complicated than "dry skin."  All of the lotions out there and creams and lubes are either filled with junk or are oils or are truly beneficial substances but are still filled with a bunch of irritating junk.  If you find differently, and know of a product that works, send me an email.  I'm willing to try any product with an ingredient list of five or fewer ingredients that have purpose.  Let's make that ten or fewer.

I was given some bad information about baths six months ago.  A dermatologist told me that baths in our town have a net drying effect and so despite what the National Eczema Association recommends, bath infrequently.  There are two problems with this.  Not only does the skin continue to dry out, but the patient is then reliant on anti-inflammatory medications to control their eczema.  And since there is nothing to clean away bacteria, the broken skin becomes more irritated and prone to infection.  There is not any way I can see that this bath avoidance routine can ever work but there are many ways to make a bath routine work well.  I fired that doctor after the first visit, and it was a long visit during which I asked many questions and received many odd responses.  It is true, though, that our climate is unique.  It is extremely dry and many people who would never have symptoms in another place suffer here.  Our daughter's aunt is a perfect example of someone who suffered her whole life here in interior Alaska and still does when she returns but is unaffected in her present home in Washington.  Extreme climates are a risk factor for developing eczema on top of genetics.  We have both of those working against us.  

I put epsom salt in the bath so that she gets some extra magnesium.  That is a good thing for everybody to do.  I don't think it helps control bacteria, possibly sea salt would do that, but I have not tried it because that would have to be washed off I would imagine.  The water can't be too warm and the bath can't be too long or she'll lose her natural oils.  She needs them.  I have put bleach in her bath before but I don't like to do it because that can be irritating as well.  A bleach bath is equivalent to a swimming pool, and swimming in chlorine is something people with eczema are prescribed.  It is the only way that I know besides vinegar to kill staph (which is ever present) besides using an antibiotic, prescribed or not.  People with skin that has been compromised have staph infections and the staph and other bacteria that are inside the skin perpetuate the inflammation.  Killing all of the bad bacteria on and in the skin is the first step toward healing.

After she is dry, I put a thick layer of a thick oil, such as petroleum jelly, shea butter, or palm oil, all over her arms and legs.  I used to reapply this layer at every diaper change, but it was not enough to hold the moisture not to mention very expensive.  You should see the empty jugs and jars and containers I have collected!  I have tried other miracle, nutritious oils such as coconut, jojoba, hemp, olive, but they are not thick enough for her case.  I found something that works better than reapplying the thick oil:  old socks.  Well, old socks made into leggings for arms or legs, that is.  They can be new socks, of course.  Or one can buy and use BabyLegs or Bambino or other brands if they are skin tight.  And I have.  I found bandaids can help too, to heal problem areas, but they have to be waterproof and they have to have adhesive that is stronger than the Man of Steel ... or moisture will escape or those baby pincer fingers will pull it off right away.  And they have to be large enough and then too they have to recover from the irritation from the adhesive.

So, under her long-sleeved clothing, she wears a stretchy hand-less and foot-less tight on each arm and each leg.  She wears these all of the time.  And it's so simple and easy.  Back when I only had one pair, I kept them on for a week straight.  Now, I wash them with the rest of her clothes in the sanitary cycle and change them every day or two.  Not only do they help to keep the lube in place and provide a third layer of skin for holding in moisture, but they also prevent abrasion from pants on legs, grass, fingernails, etc.

And she has healed.  Not only have the bumps gone away, but so has the redness and her desire to itch herself when I remove her leggings.  Her arms and legs have healed and as long as I stick to this routine, she has not required any medication.  At this point she only has one small red spot on her arm (and the spots on her hand and cheeks which are exposed and therefore difficult) and that's the first spot that popped up on her arms and legs ten months ago.  I suspect there is bacteria in there and so I apply a vinegar soak, which is a sterile dressing soaked in vinegar and boiled water, twice every day to her arm and cheeks for ten minutes while she falls asleep as I feed her.  Our dermatologist recommended this as an alternative to prescribed topical antibiotics, because both gram negative and gram positive bacteria have trouble thriving in an acidic environment.

The allergy testing seemed to be a dead end road, for now.  She didn't react to any foods or any of the environmental allergens that we tested.  Although that may have simplified things, it is good she does not have an allergy (that we know of).  We see a great dermatologist regularly.  She is very good at answering my many, sometimes scientific and sometimes grasping, questions.  After seeing our daughter's skin, our dermatologist wrote up a hand-out for other parents to do what we are doing with the leggings.  I learned to do this from three other local moms who independently do the same thing.  I met them through three different local Facebook Groups.  Sometimes they have to apply them wet but so far we do not.  Wet wrapping is a common remedy for eczema but usually with gauze or special dressings or tights or cotton pajamas (all under something warm and synthetic), not necessary with something as simple as leggings.  Leggings are practical for babies and toddlers because you can actually get them on in a reasonable amount of time, while the child is squirming and fussing, they are affordable, and they do not interfere with diaper changes like tights do.

There's more to this story that has to do with nutrition and the immune system and other systems, too, I am sure.  I'll write about that conundrum another time once I have a better handle on it.  But, basically, you have to deal with the inflammation both outside and inside of the body and that is why I started with an elimination diet.  Eliminating my inflammation for many months did not seem to eliminate hers but on the bright side it cured my tinnitus temporarily until I reintroduced the foods so I solved a problem of my own without intending to do so.  Our daughter takes Nordic Naturals fish oil daily, which can cut inflammation in the body up to 30%, and various types of probiotics to boost her immune system and aid in digestion.  She doesn't eat any of the common allergens.  She has also taken homeopathic regimens to reduce any systemic yeast that may have been present.  As a 5 day old baby, she had seborrhea that persisted but was not generally bothersome once every couple weeks in her armpits or neck or belly button but that has been gone now for a couple of months.  My hope is that as her immune system matures, she will outgrow this fully instead of it progressing into something else that is worse.

I think, in many ways, we are making progress.

Back to School

It was recently time to go back to school.  And for our younger son, it was the first time.  He has been through two years of dropping his brother off at preschool and picking him up from preschool, twice a week, so I think that, along with everyone asking him all of the time if he's excited for preschool, helped to prepare him.

The night before the first day of preschool, our older son removed all of his little brother's clothes on hangers and laid them out for him and announced, "Here are your school clothes.  Pick what you are going to wear tomorrow."  I was impressed!  Instead of picking the usual clothes he begs for when dirty, like his button up red airplane shirt or his superhero tights, undies, and shirts, he happily picked a nice sweater and new-to-him jeans.  He, without any input from anyone else, chose a wool jacket, like his dad wears to work, and brown leather shoes.  I knew at this point that emotionally these boys have everything under control and that this was going to go alright.  He had some trouble going to sleep, which is not unusual for him, but when I awakened him in the morning, talk of what I was going to put on his oatmeal (whole milk, blueberries, and maple syrup--the usual) got him in the mood to wake up and let me dress him.  Yes, I dressed a preschooler that morning.  He is still my baby, always will be, and quite frankly I'd like someone to dress me each morning.  He announced that he was going to pour the milk and add the syrup.  His older brother cried while he did this out of jealousy, but preschoolers get to do new and challenging things, and he knew this!

We all ate breakfast at the table together.  I took a photo of him and drove him to school.  He entered the school with confidence, put his coat and backpack in his cubby, attached his name-tag to it, and sat down in a circle with the other kids in his class.  It was a full class of 9 children, mostly boys.  I took another photo and left, fighting my instinct to go back in and peek at him.  When I arrived to pick him up, he gave me the look that he always gives me when I pick him up at his babysitter or his grandparent's house:  a squinty-eyed shrug of the shoulders.  He didn't quite want it to end and he was still a little unsure of how to proceed at this point, but once we went inside to say goodbye to all of the animals (turtle, fish, anole, etc), he was confident again.  The teacher said he didn't want to say his name during introductions, but later told her that he wanted to be called by his middle name, which is his grandfather's first name.  He also talked to her about his favorite part of the day, which was snack time:  goldfish and cheese sticks.  The teacher by chance is one of the best friends of one of my close friends.  The preschool director is the teacher that our older son had last year.  And the nephew of our next door neighbor is also going to the school.  I know he appreciates those familiarities as much as I do.  And I hope that he makes new friends at school.  He already told me there aren't any bad kids in his class.  Whew!  By the third day, he was talking to his teacher more openly, although still quietly.  By the second or third week, he had become quiet comfortable speaking his mind and playing with the other children.

For our older son, Kindergarten is definitely welcomed change.  I'd like to keep him home, but he is more than ready to tackle something new.  We have been biking to this Elementary School to play on the playground since he was two.  It's where my husband went to school.  In fact, there are large photos of him and his classmates, the first years the school opened, all over the walls of the school.  We had been to Kindergarten Round-up, Meet the Bus day, and finally when we went to Meet the Teacher / Ice Cream Social day, he marched up to the school, found his name on the Kindergarten list (4 classes), went straight to his teacher's classroom through hoards of people, waited in line to meet her and said, with his hands in his pockets and his hood up, "So, it looks like I'm in the morning class."  She replied, "Well, it looks like you're all grown up."  His grandmother, who had gone with us nodded.  He has a thing with teachers.  She asked questions about him and our family and in two minutes, before I had completely the paperwork, he was bored with the classroom and wanted to meet the Librarian and Principal.  He was happy to do the assessment because he had all of the teacher's attention, and when school started and he was able to bring his backpack with his snack, lunch, and finally meet the other kids, he was ecstatic.  The teacher says he will not be bored, so all I can do is hope she is right ... and volunteer my help once a week during the reading, writing, and math curriculum.  Elementary School has been going on for several weeks now and I have been volunteering for four.  The personality types of the students are very interesting and the way my son portrayed the other students is very much like it is.  He has a great class of ten students.

While our older son is off in the world having new experiences with his new classmates, his little brother is the big brother of the house.  I can already see the bond between he and his little sister growing.  The play very well together as the boys always have.  But, now that there is school for both of the boys their time together is less frequent and I can tell more precious to them.