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Column originally published Apr 26, 2005

Treatment Of Severe Eczema Can Be Complicated

Question: Our son is fourteen months old. He has had eczema for the past ten months, and it is getting worse instead of getting better. He is covered with these red raised patches from head to toe. In the past week, some of these patches are oozing fluid. He is more irritable and not eating well. We took him to the emergency room. The doctor told us that his eczema is infected and gave him an antibiotic, but it is not helping. We have tried many creams and baths, with little or no result. He is scratching all the time, and he cannot sleep at night. We would welcome any suggestion from you.


From your description, your son has severe eczema which is infected by bacteria.  The treatment is fairly complex, and you need to work together with your doctor.  I will give you some suggestion after I discuss briefly about eczema in general for the benefit of other readers.

Eczema is an allergic condition of the skin.  Children who develop eczema almost certainly have inherited the ‘allergy genes’ from one or both sides of the family.  These children are also very prone to other allergic conditions like hayfever and asthma.

Although we don’t completely understand how eczema develops or progresses in the body, we do know that eczema sufferers produce special antibodies called immunoglobulin E (IgE) in response to the things that they are allergic to.  The IgE then reacts with some skin cells to release histamine.  Histamine is the cause of redness, swelling, and itchiness.  The same histamine in bronchial tubes gives rise to symptoms of asthma (coughing and wheezing).

The most frequent cause of eczema is food allergy.  In infants, the most common foods that trigger eczema is dairy products, which include cows’ milk, cheese, and yogurt.  It is the cows milk protein that is the cause of allergy, and not lactose intolerance.  Sometimes dairy products are hidden as ingredients (like whey and casein) in many processed foods.  Unless one is familiar with those words on the labels, it is often easily overlooked.

Other foods that can cause eczema include soy, wheat, eggs, nuts, fish, shellfish, and many others.  Careful observation is necessary to see which are the foods triggering a child’s eczema.  Sometimes blood tests can help to pinpoint the offending foods.

In your particular situation, I would suggest that you eliminate all dairy products from his diet as much as possible, if you haven’t already done that.  This is because dairy is by far the most common trigger of eczema.

Your son’s eczema is very serious, and most likely infected by bacteria which he implanted into the skin from scratching.  This is not uncommon at all, and it requires treatment with antibiotics by mouth as well as antibiotic cream applied directly on the infected skin.  If one antibiotic doesn’t work, then your doctor has to change to another one.  His eczema likely will not improve much unless the infection is brought under control.

At the same time, it is important to downgrade the allergic reaction in the skin.  The most common treatment for eczema is topical steroids (like 1% hydrocortisone), in the form of cream or ointment.  They are generally very safe.  The only caution is that if it is used too much on the face, it can lead to thinning of the skin there, exposing fine blood vessels underneath.

If eczema is more severe, stronger topical steroids are necessary.  When strong topical steroids are used, there is a chance that some medicine is absorbed through the skin, and suppresses the adrenal glands.  That is why it is important for your doctor to monitor your son’s progress, and watch for possible complication as a result of treatment.

On occasion, if the eczema is very severe (which seems to be the case in your son), it is necessary to give steroids by mouth for a short time.  This is very similar to a child with an asthma attack and requires oral steroids.  Again, this is generally safe, but the decision should be made with the help of your doctor.

In the last few years, a new treatment option has become available.  There is a new class of cream and ointment that can modify the skin’s immune response by suppressing a kind of immune cells called T-lymphocytes in the skin.  Two of them, called Elidel and Protopic, have been approved in Canada.  They are very safe for the treatment and prevention of eczema, but they are rather expensive.

Your son likely needs a combination of these medications.  However, no treatment is complete unless you work on eliminating some of the foods that he may be allergic to.  This will be a slow process, and while you are doing it, you will have to make sure that he gets a balanced diet.  If he cannot drink cows’ milk, but can tolerate soy milk, then you don’t have to worry about calcium in his diet.  If you are uncertain, it is best to consult a dietitian.

I hope this information is helpful for you to take care of your very allergic child.