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Can anything help ease my daughter's eczema?

 Severe eczema is very distressing for both your daughter and you - I am sure you feel at your wit's end in asking what else can be done when you have tried so much already.

I am going to list all the treatments which can help eczema in case you have not come across some. Sorry if you've already been through them all. Your next step will be to ask your GP to refer her to a dermatologist for specialist advice.

1. Avoid irritants
• These include avoiding biological washing powder and soap both of which can irritate and dry her skin. Add bath oils (eg Balneum Plus) to her bath and use emulsifying ointment or a water dispersible cream such as aqueous cream or unguentum merck instead of soap. Your GP can prescribe all these
• Dress her in pure cotton or cotton mixtures instead of wool or synthetics.
• Consider whether contact with animal could be bringing on her eczema - do you have any new pets?
• Heat (including central heating ) and cold all stir up eczema - avoid over heating your house and protect her face from the cold when outside.

2. Treat skin infection
You may find that her doctors keep giving her antibiotics - this is because the dry scratched skin of eczema is much more likely to get infected. But this can produce flare-ups of her eczema.

If this happens her skin will look red and angry, she may have a temperature and seem unwell in herself. Doctors try to give antibiotics (usually by mouth) which act directly on the skin and therefore get to the root of the problem much quicker. If her skin is covered in wraps she will be less likely to get skin infections.

3. Steroids
I would imagine she has been treated with some form of steroid preparation rubbed onto her skin. These can be very effective in calming down flare-ups of eczema by suppressing her own over active immune reaction.

Unfortunately they can have side effects if not used properly but don't let this fear put you off using them. Steroids can be safe if used as creams or ointments directly on her skin at the weakest effective concentration needed to keep her eczema under control.

Apply using a thin smear over the worst parts - often around the wrist, elbow, knee and ankle joints. The best time is after her bath.

There are at least sixty different brand names of steroid creams all in different strengths which can make things quite confusing. One per cent hydrocortisone is most suitable for long term use on babies and for sensitive areas such as her face (where even 0.5 per cent may be effective).

Eumovate and Modrasone are slightly stronger but fine for longer term use in children over one if used on affected patches and not all over. Synalar, Betnovate, Propoderm, Metosyn and Dermovate are all strong steroids which I would avoid using at all on your daughter unless she was under the supervision of a dermatologist who might occasionally use them for a few days at a time in a diluted form.

If very strong steroids are used over large areas of skin for a long time, especially in a small child, they can stop the body producing its own supplies of steroids and slow down growth. They can make skin less elastic and thin allowing blood vessels to show through.

4. Antihistamines
These can help by making your daughter feel sleepy and night and reducing the itching sensation. Discuss this with your GP who may be happy to prescribe one for her.

5. Diet
If you breastfed your daughter this would have been is extremely helpful in giving her antibodies to fight skin infection and reducing her exposure to substances in her diet which might trigger her eczema. As she gets older she will need a fully mixed diet to ensure she has enough minerals, vitamins and nourishment for growth.

People often ask whether cow's milk could be triggering their children's eczema. You could try cutting out all dairy products in diet for a limited period - for example a month or two- to see if this made a difference to her eczema. If it did help and you wished to continue you would need to discuss this with your GP or health visitor your daughter would need vitamin and mineral supplements and might need to see the dietician for advice about a dairy free diet.

Depending on her age she could be prescribed a soya milk formula (if she is under two). If she is older you could buy soya milk and soya milk products from the supermarket or health food shops. If there was no difference after two months there would be no point continuing with cow's milk exclusion.

Some acid fruits and vegetables like tomatoes and citrus fruits can cause a reaction around her mouth and hands - if you notice this it is worth excluding them from her diet.

6. Natural Remedies
Some of my patients have found a natural cream called SK cream which helps with eczema. It is made from almond oil, beeswax, borage, camomile and lanolin, none of which are harmful so I am happy to mention it here.

Some people with eczema are allergic to lanolin and apparently there is a lanolin free version.(Order line : 01526 832491 for a 30 ml tub costing £9.95). As with all treatments it is worth trying for a month or two and if there is no improvement consider stopping.

Others have found a couple of drops of Tea tree oil in the bath help - this may be because its natural antiseptic properties stop the skin from getting infected.

For further advice try contacting the National Eczema Society at 163 Eversholt Street, London, NW1 1BU or contact them on 0870 241 3604 and www.eczema.org

We recommend readers seek personal medical attention in appropriate circumstances.