I wanted to make a visual record of Sam's eczema and how it has progressed over time. I could not explain the progression then but I feel I can explain it better now in light of AJ Lumsdaine's detergent theory.
October 2010 : baby eczema around 4 months. The problem started initially at bout two weeks old as pretty bad cradle cap which "crawled" down to settle on his face (mostly cheeks) and neck. It presented as a scant, spotty rash of individual rough pink patches.
The next stage of progression or "worsening" came at about 5 months when Sam started crawling. It was winter so he was still wearing pants but just the tops of his feet exposed and dragging on the carpet and also he was spending more time closer to our carpet in general. So not only did the tops of his feet develop large bright red patches but also all other areas such as face, arms and hands that had previous only been exposed to less serious detergent sources like bed sheets, now worsened also when exposed more frequently and for longer periods of time to harsher detergents in our carpet. Sam was 5 months old when we filled our first prescription for topical steroid creams. Until the time he became mobile on the carpet his eczema had been quite manageable.
When springtime came and Sam traded pants for shorts, he was now crawling with bare shins and knees, and I next noticed large bright red patches just under his knees, then on his knees, with smaller spots of lighter irritation in between. As summer came and the months got even warmer, I let him go without clothing all together. In just a diaper, now crawling, walking, rolling, and rubbing his body all over our carpet and furniture, the eczema worsened still with growing number of eczema patches all over, covering him from head to toe. Here are some photos to show what this worsening and spreading detergent-related eczema looked like:
Clear on steroids in October 2011:
Off Steroids in November 2011:
First dose oral steroids Prednisolone (as opposed to topical cream) in Nov 2011:
When Sam was just over a year his eczema worsened markedly, and he was starting to break out randomly at mealtimes. We thought he was allergic to everything. We started working with an allergist and I started putting Sam and myself on strict elimination diets to try and uncover hidden diet triggers. During this time the allergist put him on several doses of oral steroids. I remember feeling so hopeful when his skin seemed to heal but now I understand how that was just an immuno-suppressing effect, masking the damage. Steroids can never heal chronic eczema. In fact, knowing what I know now, I believe the detergents in steroid creams (most contain them!) play a huge role in worsening eczema. Literally we were taking the very thing causing Sam's eczema (although we didn't know it at the time) and slathering it into his skin.
Off Steroids in March 2012: This is the stage when I first became alarmed because of the growing number of red patches, closer together. From this point on we saw less and less healthy skin and more red each time coming off medication. I didn't know what to think of it at the time but now I think it was probably a growing bacteria or yeast on the skin. (Read my post about how the overuse of topical steroid creams can lead to nasty widespread infections like this one, as I believe was the case in Sam's situation after having used TS for over 16 months.)
April 2012: Below is Sam's eczema at its worst, completely inflamed and infected. I didn't let him run around naked much anymore at this time (except for photos like this one) so he would normally be wearing short sleeves and shorts and you can see how his eczema follows the clothing lines almost exactly, with total inflammation beginning exactly where the clothing ends. My theory for why his exposed skin looked so much worse in his second year than exposed skin in his first is that continual accumulation of detergents just made the skin barrier more and more broken down over time so that where he may have had intermittent weakened areas before, the whole surface of skin was now more easily susceptible to break outs and irritation from even the slightest exposure. I think the topical steroid creams we use (most of which contain detergents themselves!) further increased barrier permeability, increasing both detergent absorption and skin irritation tenfold.
(As an aside, I am familiar with ITSAN.org and while I agree that steroids can seriously worsen a child's baseline eczema, I disagree with their interpretation and understanding of this problem. I especially disagree with the suggested approach to healing I will address this at a later time.)
Early May 2012: This rash is not budging! I thought it was so odd that his earlier eczema, back in the fall, had shifting and changing spots, but now all the irritations seemed to be "stuck" and worsening. Again, I had no idea at the time that Sam's eczema was infected. In fact multiple pediatricians and dermatologists assured me this was a normal eczema presentation.
Mid-May 2012: This is what a viral infection on top of previously-existing infection on top of eczema looks like! All 3 kids got Hand, Foot & Mouth and this is what happened to Sam's eczema during that week. Not fun!
June 2 2012, after last oral dose of Prednisolone: Sam came off this last dose with fully red arms and legs. I was very unsettled by this as around this time I shifted from focusing on his diet to focusing on our environment, and was discouraged to see things seemingly getting worse instead of better:
June 13, 2012: Wow! This mommy is smiling today! This is seriously the best Sam's skin has ever looked in the past 8 months while completely steroid free. After finally being tipped off that Sam likely had an infection, I was able to start addressing that issue with a combination of bleach baths and ACV baths (apple cider vinegar is a natural anti-fungal) At the same time, following the council of solveeczema.org we removed all detergent products from our home, switched over to only pure soap products for washing, and kept Sam's skin covered at all times to protect it from environmental detergent residues beyond our control.
He is not fully healed by any means but I am so encouraged to see that stubborn angry redness fading a little more noticeably each day. I think he looks at least 60% better than he did last week or even two days ago. His face and arms in regular daylight look almost normal. The timing of this correlates exactly with the last week of dilute bleach baths which I am guessing have helped with infection on the skin, presumably allowing his skin to finally respond to our environmental changes. This remains to be proven but it is my guess.
This hypothesis would make chronological sense because our first big dust/detergent removal following the steps outlined on SolveEczema.org was about a week and a half ago, and within 3 days I was seeing similar healing. Then bam, two days later, all inflamed again. BUT, in those two days we had been away from home, visiting Grandma and then the hospital which would have huge amounts of detergent residues from the cleaning and sanitizing chemicals. I wasn't positive the rash was due to those outings, or that the previous healing was due to our clean-up, so to be sure I kept Sam home from church on Sunday and we've stayed close to home the past couple of days. Sure enough the previous healing repeated itself after 4 days of being at home in our newly cleansed environment of greatly reduced dust and detergent levels. Today he looks great.
If this healing continues long enough to prove the correlation, my work is obviously not done. We will need to maintain the safe environment, which I am told is so much easier once the soap switch is fully complete. Then it is just a matter of continuing to use the right products and dealing with breakouts that occur from exposures, which I've also heard is much easier once the skin is healed and often a matter of "washing" the eczema away in the bath with a true soap. I know that sounds crazy and I was hesitant to believe it but AJ has not steered me wrong yet so until she does I will trust her experience with contact eczema. To me it is more productive to follow an optimistic voice even if remains to be proven 100%, as opposed to the countless other voices that preach "No Cure. No Answer. No Solution."
Will update in a few days and let you all know if he is still looking good. Hopefully he will be even better!