Missed our Wednesday Lunch Club with dermatology nurse Julie Van Onselen? Don’t worry, you can read all of the expert advice she shared here
Every week at Mother&Baby we bring you the Wednesday Lunch Club – a chance to get brilliant advice for your parenting questions from a top expert. This week, dermatology nurse Julie Van Onselen was on standby to answer your questions.
An independent dermatology nurse, Julie specialises in skin conditions and works for the National Eczema Society. She’s also a member of the British Dermatology Nursing Group and has extensive experience as an educator in this area.
If you missed the chat, here’s what happened…
My two-year-old daughter has small red blisters on her fingers and palms that crack and go dry and itchy. Any advice?
Julie: I am sorry to hear your child has problems sore hands. I wonder if her skin problem has been diagnosed. I suggest you take her to your GP, as she may need treatment creams prescribed. In the meantime do use bland moisturisers for washing (avoid soap) and moisturising.
My little girl has eczema and is 10 months old. We get prescription creams but is there anything else we can do to relieve itching?
Sometimes knowing how to exactly use prescription creams can make all the difference
Julie: I am sorry to hear your baby has eczema, itching is a difficult symptom to control but always worst when eczema is flaring. Also changes in season, especially going into to Autumn and turning on the heating is a trigger for most people with eczema. Do ask your health visitor to run through how to use all the creams, where to apply, how much to use and when to stop flare treatment creams.
Sometimes knowing how to exactly use prescription creams can make all the difference. You should use emollients everyday, several times a day for washing, bathing and moisturising and avoid all soap and bubble baths. If you would like more eczema advice, I highly recommend The National Eczema Society, they have a helpline where you can speak to an adviser on 0800 089 1122 and a website.
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My son has some dry spots on his skin. Not red or anything. What should I do?
Julie: If the spots are not red or itchy, your son probably has dry skin, so try some bland moisturiser and see if this helps. If he is a baby this may just be due to developing skin, if he is older and you want to reassure yourself, do discuss with your health visitor or take him to see your GP.
I have bad psoriasis on my elbows and knees. Is there anything you recommend I can use? The creams prescribed do nothing.
Julie: Psoriasis can be a challenging condition to manage. There are lots of treatments that help clear the plaques but it is very important you understand how to use your treatment, how much to apply, how long to use for and what to expect.
Remember to also use lots of emollients, as psoriasis treatments tend to be more effective on well-moisturised skin. Do look up The Psoriasis Association and contact them, they have lots of helpful information and can give you more support. If your prescribed creams are really not helping your psoriasis and you are seeing no effect from treatment, discuss with your doctor a referral to the local dermatologist, as there are more treatment options under dermatologist care.
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I am 35 weeks pregnant and I have had a very red itchy rash on my belly and breasts for almost three weeks now. It's incredibly itchy to the point it's preventing me from sleeping well. I have been to the doctors who have ruled out the liver related illness with a blood test, which came back clear. In the meantime I want to know which creams are recommended or is it best to air it and have loose clothing. One doctor prescribed piriton but I haven't take it as I've heard conflicting messages about whether it's OK to use while pregnant!
Julie: It’s good that you have been assessed and it is not liver related (a much rarer itchy condition of pregnancy). Do use lots of medical emollients, and apply liberally, creams are probably better and you can keep then in the fridge, which makes then more cooling.
Piriton is an antihistamine and generally a safe drug, but if you have any concerns, it would be best to discuss directly with your GP. If the rash is getting worst, you could also as your GP for an eczema treatment cream at a moderate potency, which is fine to use in pregnancy and may help reduce redness and itching. The good news is that once your baby is born the itch and the rash will resolve quickly.
I would love some tips on acne treatments and skin care products for acne/spot prone skin that are safe for pregnant and/or breastfeeding women.
Julie: This is a good question, as when you become pregnant or are breastfeeding, you sometimes need to adapt your skin treatments for a chronic skin conditions, such as acne. It is difficult to advise you without knowing the treatments you are currently using. Most topical treatments will only be advised for pregnancy and breastfeeding under medical guidance, so this is something you should discuss with your GP. If your acne is getting worst in pregnancy, I would discuss with your GP a referral to a dermatologist for assessment and specialist advice.
A midwife-led research study recently found no difference between water and a pH neutral baby cleanser
I’m not sure what is best for my newborn as I’d like to use a product to help clean her in the bath but I’ve heard you should only use water?
Julie: It is totally up to you. You can cleanse your baby with water alone but you can also use a pH neutral baby cleanser. A midwife-led research study recently found no difference between water only or a suitable pH neutral baby cleanser.
My baby has a little bit of dry skin on his forehead. What would you recommend to put on it?
Julie: The skin does sometimes change in pregnancy and common changes are usually pigment changes or itching. If you have developed small lesion, I would advise that you get these checked out with your GP, especially if they are itchy or weepy. I am sure there is nothing to worry about and yes they may be normal skin changes in pregnancy but you do need reassurance.
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My toddler has keratosis pilaris on the tops of his arms. Is there anything I can do to help that won't irritate his skin?
Julie: Keratosis pilaris causes dry skin but generally it doesn’t get too irritated (unless your son also has eczema). So the best way to help smooth out the skin and prevent dryness is to keep the skin well moisturised.
My 16-week-old daughter has a really sore looking rash under her neck. The doctor has prescribed eczema cream but I think it's from excessive dribbling – if she has a bib on this gets very wet and seems to run also. Any tricks to helping this dry up?
Julie: This is such a difficult area due to neck folds combining with dribble. A greasy emollient as a barrier would be my suggestion, perhaps try a medical moisturiser, such as Epaderm or Hydromol or plain white soft paraffin, as they are more waxy that Vaseline; and keep applying lots and keeping bibs dry.
If her neck is red and sore, do use the prescribed eczema cream, you will probably only need to use for three to five days but this will clear the flare, try to apply the cream with a gap between using the moisturiser. Don’t be afraid of using a prescribed cream, you need to treat the area and short bursts of treatment won’t do any harm, even to a delicate area. Your daughter’s neck will improve (and she will dribble less) when she has stopped teething, so her neck will improve in time.
My son is now 15 weeks old and over the last two weeks his arms, legs and cheeks have become so dry and tight. I'm not sure if it's eczema or just dry skin. We have put our heating on recently, but that is the only change. I currently use E45 Junior whenever I change his nappy on the above areas but it doesn't seem to help. Any product suggestions? Or just visit my GP?
Atopic eczema affects 20 per cent of children and is most likely to develop between three to six months of age
Julie: If he has atopic eczema, you will need to visit your GP for assessment and diagnosis. Atopic eczema affects 20 per cent of children and is most likely to develop between three to six months of age (although it can develop earlier/later), dry skin is usually the first symptom.
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You have made an excellent start using a bland emollient (E45 is one of many). There are lots of environmental triggers and change of season, especially going into autumn/winter and heating going on seems to affect most people with eczema. So, for now keep using lots of moisturiser, every nappy change and use for washing too, avoid all soaps and bubble baths.
Do discuss with your health visitor, who may be able to recommend some other emollients for your to try and yes, I agree take your son to the GP, as the earlier eczema is managed, the more likely it is that you will get on top of it and prevent flares. If you need anymore help with eczema, when your son is diagnosed do contact The National Eczema Society (see my reply to Becky below for contact details).
My six-month-old daughter has been diagnosed with eczema but it's so bad I'm not sure that's what it is. It sometimes looks like ulcers and she constantly scratches at it, poor thing always has to wear scratch sleeves! Otherwise nappy changes consist of her scratching her legs, chest or arms. If we don't stop her quickly enough she draws blood with her scratching. Does it sound like eczema or could it be something else?
Julie: Eczema can range in severity and skin is always dry and itchy, eczema flares can cause redness, soreness and blistering. If your daughter has eczema it sounds like she is having an eczema flare, so she needs prescribed eczema treatments. When the flare is treated and settles her frantic scratching should stop. Do discuss with your health visitor and take your daughter to your GP for assessment. Please do contact The National Eczema Society (NES) for more advice and support. The NES has a helpline open 08.00-20.00hrs on 0800 089 1122 where you can talk to an adviser and be sent information, the NES web site address is www.eczema.org
I have developed cellulitis on my abdomen from right above my C-section scar up to just above my belly button. It doesn’t touch the scar and is the size of two hands. I’ve had this infection since the start of June and it keeps flaring up. If you have any help that would be great.
Julie: This is usually an acute problem that resolves with treatment, so your case is unusual. I wonder who you have been referred to at the hospital? It sounds like your infection is not resolving and you need specialist and prompt assessment and treatment. I would suggest you discuss with your GP a referral to dermatology and ask your GP if you can have skin swabs taken and advice sought from microbiology. Do let your GP know how unwell and tired you are feeling too.
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I’d like to know how to treat my daughter’s constant nappy rash. I’ve tried every cream, every powder, every type of nappy on the market, frequent changing, diet changes, free airtime. Nothing seems to work.
Julie: If she has constant sore nappy rash and you can not improve it with nappy rashes creams bought form a pharmacist, it’s possible your daughter has a skin infection (most likely to be a fungal infection) and needs some prescribed treatment. Please do discuss with your health visitor and book an appointment with your GP.
My daughter gets really sore nappy rash when she is teething, so much so she doesn't want her bottom wiped at all, even with water. What's the best cream I can use and are there other things I can do in order to help her?
Julie: If your daughter’s nappy rash is very sore and problematic, do check with your GP or health visitor, as it is possible that she may need some prescribed treatment. Try and wash/clean her bottom with a bland moisturising cream and put this on before her bath, which may help stop the water from stinging. Do ask your pharmacist to recommend a bland moisturising cream. Avoid all soap (you can use pH neutral baby cleansers) and any perfumed moisturisers or ones containing SLS.
My four-month-old girl has cradle cap on her head only, just where hairline starts at forehead. What is best way to clear this up?
Julie: Firstly cradle cap will generally resolve by six months. In the meantime use a bland emoillient (moisturiser) on her forehead several times a day, to help reduce scaling.