What should I do?

[camperdown9]

Hi

I had a rash that didn't hurt or cause any discomfort. However it was unsightly and didn't clear up, so I went to my GP. My GP was unsure what it was and arranged for me to see a doctor at the dermatology department of our local hospital.

When I first went to the dermatology clinic the doctor there never really said what the rash was. Just advised that its nothing to worry about and gave me "Dermol" to use in place of soap and "Dermovate ointment". Over the next 18 months there were maybe 5 follow up appointments. At one stage they changed the "Dermovate ointment for "Trimovate Cream". The rash would sort of come and go and never really clear up totally. A few months ago they sent me for a biopsy and finally said that its eczema. This time they gave me more Dermol to use and something called "Elocon".

They said use the "Elocon" everyday for two weeks and then don't use it again until the rash comes back. Then use it again for another two weeks. There is a follow up appointment booked for the end of September. But here is the issue........

When I use Elocon for the first day its fine, then after 2 or 3 days the area where I have used the cream goes red and a bit swollen. After 7 days the area goes slightly painful and a bit itchy. I just put up with this for the first two weeks, I couldn't tell if elocon was having any effect on the eczema because of the redness caused by the cream. A few days after I stopped using the cream the redness went away but the eczema was still there. I didn't use anything for two weeks then tried again with the elocon but this time I just went a few days and stopped as the effects of the cream were worse than the eczema.

Any advise about what I should do and what might happen next. As I said my follow up appointment isn't until the end of September. Should I try and contact the hospital and get this moved forward? Has anyone else had problems with Elocon and if so what happened?

Alex

[Marcie Mom]

Hi Alex,

Sorry to hear of the worsening rash Suggest that you call the doctor to ask and also work to bring forward the appointment. Don't scratch in the meantime.. scratching will lead to scarring and possibly, infection. Moisturize too, and from the sound of it, your doc didn't communicate much to you. An extract of what to expect during consultation from my interview with a dermatologist on my blog.

MarcieMom: The prescription given by the doctor is typically moisturizing creams with topical steroid treatment and the instruction usually to moisturize frequently while steroid is to be used sparingly and not more than twice a day. What would you advice the parent to find out more from the doctor? For instance, asking how the eczema rash would appear after a week of application? And when it’d be cause to come back earlier than scheduled for another consultation?

Dr Susan Huang: Great question. Questions about the use of topical steroids frequently come up. Make sure you review an Eczema Action Plan with your physician before you and your child leave from your consultation. Having this information written down is important so that you don’t forget the details. Action items may include non-medication therapies (e.g. moisturizing, bathing techniques include bleach baths, wet wraps or wet pajamas, etc) as well as medications (e.g. topical steroids). It is important to clarify how much of the lotion/cream/ointment, to where is should be applied, and when it should be applied and for how many days. As you mentioned, also ask what you should expect to see at the end of the treatment course that your physician has detailed to you. It is important to have this information written down because it’s hard to remember all these details! We provide these written eczema action plans in our clinics.

Absolutely clarify follow-up plans before you leave for your visit.

Take care,
Mei

[Dr Mary Judge]

Your story is unusual. It would help to know your age and any personal or family history of skin problems. You have been told you have eczema but it did not itch or irritate until you used Elocon. Eczema is itchy so could it be something else. We rarely biopsy typical eczema so that's another oddity. Eczema usually improves with Elocon and similar creams but they are not a cure and most people will use a strong steroid cream for a few days then a weaker one, as well as moisturizers. Beware miracle cures for eczema, they usually contain hidden steroid cream and cost you!