Hello I'm George. I'm one of the nurses in A & E. I've looked at your daughter's
notes and I see that she has eczema. Yes, that's right. Can you tell me about your
daughter's eczema? What happens when she has eczema? Look, it's awful! It started
when she was about six months old. She just scratches most of the time. She
finds it hard to sleep, she scratches so much. I see. Yes, it is very unpleasant.
Where does she have the eczema? It's mainly behind her knees. She also has a
rash in her elbows. The problem is that it's easy to scratch there. Yes, it is.
Have you noticed anything that starts it off- anything that triggers it? Yes. I was
thinking about the things which might make it worse. I think it started when
she stopped breastfeeding. As soon as she started drinking milk, she got the rash.
I'm not sure but I think orange juice makes it worse too. Well both those
things are common triggers. We can talk about things to avoid later. I've got
some information for you that would be very helpful. I try to do things to help
her but I'm not really sure about eczema at all. I don't even know what causes it.
They are not sure. Actually it seems to be linked with
allergies, particularly allergies to foods like dairy products and citrus.
That makes sense - she can't drink milk or orange juice. Fortunately she likes
drinking other types of juice. Some children are sensitive to wool and do
better if they only wear cotton. There are several other common allergies which
are linked to eczema. For example pet allergies seem to go hand-in-hand with
eczema. Yes, I remember reading about that on the Internet.
Can you tell me about your daughter's current treatment? Does she use creams on
the eczema? Yes ...well sometimes. The GP gave me some cream to use everyday. it's
like a moisturIser. That's good. It's very important to use a moisturiser a
few times a day. When do you usually put the cream on? I put it on first thing in
the morning after she has a bath, then a couple of times during the day if she is
itching a lot. I try to put it on last thing at night before she goes to bed. It
sounds like you're doing the right thing with the moisturiser. Can you just tell
me again about her bath time - how often do you give your daughter a bath? I give her
a bath every morning so she is clean for the day. I use special soap - not perfumed
soap. OK. I understand. It might be better for the eczema if your daughter
did not have a bath every day. Baths tend to dry out the skin. Even if I use a
moisturiser afterwards? That's right. Try to wipe her hands and face with a
moist cloth instead. Can you tell me about any other creams you're using?
Well I'm supposed to use a steroid cream if her skin gets very red and inflamed.
The thing is that I don't want to use the steroid cream. I don't think it's
safe I can appreciate your concerns. Many people worry about steroid creams
because they think it's like the steroids that weightlifters use. Yes,
that's what I thought. No. The cream that your GP suggested that
you use is a very low dose of steroid medication. You only use the cream when
her eczema flares up. It's only a short-term treatment. I'm still not happy
about it. I've been reading about some natural creams which
are supposed to be good. I think I know the ones you mean. Some of these creams
can be helpful but it's important to remember that they are still
medications. Your GP has prescribed a cream that she thinks is right for your daughter
and only to be used now and then when the condition gets worse. We need to
stop your daughter itching so much that her skin bleeds.
Oh dear! Maybe that's why it happened! Her skin became very red and extremely itchy
last week. She was scratching all the time- then some of the areas on both her
arms started to bleed. Now they are weepy and I'm worried that it's infected. You
did the right thing coming in. If it is infected your daughter will be put on
some antibiotics. I see.. OK.. some antibiotics.. It is extremely important
that she takes all the antibiotics. Also make sure that she has the antibiotics
with some food. You could give her the antibiotics with a biscuit or a piece of
toast. That's a good idea. I'll try that. Right, I'll give you this patient
information leaflet now - we can go through the hints together. Oh yes this
is very helpful. Try to keep your daughter cool especially at night. That
may make it easier for her to sleep at night. It would also be better to dress
your daughter in clothes made of cotton or natural fibres. OK, that makes sense.
I'll try to keep her room a bit cooler. Try to cut down on the number of baths your
daughter has. I remember that you said that you use special soap to wash your
daughter - that's good. It's essential that you put on the
moisturising cream several times a day. Keeping the skin moisturised is one way
you can help to prevent skin infections. OK, so putting on the cream is very
important. Yes, it is. Using the steroid cream if necessary is also very
important. I'll just repeat the important information that using steroid cream is
not the same as using the steroids that body-builders use. Yes, I understand that
now. I can see that there are times when my daughter may need the steroid cream.
That's great. There are some hints in the leaflet to help with
the itching - keep your daughter's fingernails short so she can't hurt herself if she
scratches. It's a good idea to take her mind off it if she is starting to
scratch. Yeah, sometimes she scratches herself very badly.
I'll try those hints and see if it helps. The last hint is a reminder of the food
triggers of eczema. You already know that your daughter is sensitive to dairy and
citrus juices - just keep an eye on any other foods which cause any problems.
I'll do that. Thank you for the advice. I'll take this leaflet home with me too.