Can severe childhood eczema be safely controlled?

Question

Hello doctor,

I am writing to you about my 7-year-old daughter, who has been having a lot of trouble with severe atopic dermatitis that is very hard to control. It has been heartbreaking to see her in pain. She scratches a lot, especially at night, and her bedding is regularly ruined. Sometimes she even bleeds. This has been going on since she was six months old, and I am getting more and more worried about scarring as she gets older.

Her doctor has tried a lot of different therapies, like Hydrocortisone, Triamcinolone, Tacrolimus ointment, and oral antihistamines, but none of them have worked for more than a few days. Her skin is still quite dry and damaged, especially behind her knees and inside her elbows. Her eczema seems to get worse around the time of her period, which started around six months ago.

We have tried cutting out dairy, gluten, and eggs from our diet, but it has not helped. She finds bleach baths incredibly upsetting, even though they do not help much. Her allergist said that her IgE level is 890, which is very high.

The issue is now impacting her emotionally as well. She is being bullied at school and has started to avoid going. Because of the extreme itching, she usually only sleeps three to four hours a night. Her pediatrician talked about the idea of Dupixent shots, but our insurance would not pay for them because she was too young.

Right now, I feel hopeless and am willing to try anything that could work.

Should we look at other ways to cure eczema this badly?
Is there a chance that she will get better, or is this something that will last her whole life?

Thank you for your guidance.

Answer 1

Hi,

Welcome to icliniq.com.

I am so sad to hear about what your daughter is going through. I know this must be hard for her and your family. Severe atopic dermatitis can make it hard to sleep, go to school, feel confident, and feel good emotionally.

Based on what you said, your daughter's symptoms when she was a baby, her very high IgE level, and the fact that her flares got worse when she had her period, it sounds like she has a powerful and long-lasting form of atopic dermatitis that does not always react well to topical treatments alone.

To answer your question about the prognosis: in many kids, atopic dermatitis gets better as they get older, especially as they hit puberty. But kids who get the condition relatively early, have continuously high IgE levels, or have a lot of flare-ups are less likely to totally outgrow it. The good news is that even bad eczema can be kept under control with the correct therapy, which will let her live peacefully.

This means that her eczema has gotten to the point where she needs systemic therapy to treat the underlying inflammation because topical medicines like hydrocortisone, triamcinolone, tacrolimus ointment, and antihistamines have not worked. Things she can talk about with her dermatologist include:

Phototherapy.
Biologic therapy like Dupixent, which is safe and effective for kids six months and older, is one of the best therapies for severe childhood eczema. Insurance companies often deny claims based on age, but your dermatologist can appeal by pointing out how bad her disease is, how it affects her sleep, how it makes school harder, and how previous therapies have failed. This usually leads to approval.

In the meantime, supportive care can help with itching and bleeding at night:

Therapy with wet wraps.
Heavy moisturizers every day.
Baths that are warm but not hot.
Quick treatment of any skin illness that is causing problems

It might also help to work with her school to give her emotional support, since teasing, obvious skin changes, and trouble sleeping can all have a big effect on her health and confidence.

Please do not give up hope. Kids with very bad atopic dermatitis can get a lot of relief with a mix of systemic medicine, supportive care, and changes to their daily lives. This could help her sleep better, go to school, and enjoy life again.

Please feel free to share your valuable feedback for improved patient care.

Thank you.