Toddler Eczema

What started out as a suspect fungal infection on the toe, turns out to an outbreak of eczema over the whole body, appearing on the neck, back of the knees, wrists, between fingers and toes.

My 3 year old daughter had an early stage onset of the most common eczema Atopic dermatitis. The actual cause of her eczema remains a mystery. There were 3 theories. 

1. Dry skin

Since she started Nursery 2, she took her own bath and she loved using lots of body wash which perhaps have made her skin dry. And she took 2 baths a day (once in school, once at home), Besides over-showering, we slept in ac room and did not apply sufficient moisturizer has made her skin dry. 

2. Triggers

With the skin’s natural barrier weakened, it was susceptible to irritants and allergens. Heat, soap, dust were all possible triggers.

3. Food Allergy (least likely)

My daughter used to have allergies to eggs and we thought it could be either eggs or other food allergens which we have not discovered.

We visited polyclinic at first when it started from the toe (middle image, as above) and was given hydrocortisone (1%). But it didn't work. It became drier and my daughter scratches it a lot, making it swell. Soon, the rashes spread to some parts of the body beyond just the toes. At that time, I applied lots of moisturizers (including aloe vera), hoping to relieve her itch. Aloe Vera was effective to soothe the skin for a while but required constant application as my daughter started scratching again soon after.

As it didn't work, I thought I should go to a clinic that specializes in skin and I brought her to Niks Maple clinic at Vision (Jurong East). I have visited them before for my acne and it helped. We saw Dr Ong and was pointed out that it was eczema and that I wasn't doing enough in moisturizing my daughter. The consultation alone was about $25 but the cost of the medicine and products were expensive and I spent about $150+ in a single visit. The medicine/products given were as follow:

• Nizoral for her toes
• Fucicort for her rashes
• Anti-Itch Oatmeal Moisturizing Cream 150ml
• Aroma Shower & Bath Oil 750ml

As Fucicort had steroid, I was a little hesitant to apply for her. But the rashes still got worse, partially because my daughter scratches a lot and the skin became dryer despite moisturizing with the Anti-Itch Oatmeal Moisturizing Cream.

Just a week after CNY, her skin still doesn't improve. Rashes started to turn darker and patchy. There are more areas on her body and neck with rough skin. There were red spots forming sparsely over the sides of her body, thighs, arms and the face near the neck. We decided to visit a specialist, knowing that it will cost us a bomb to see them. 

First I called NUH on 31 Jan 2020 and was told that the nearest appointment I could get to see a paediatric dermatologist is in July (6 months gap???!!!) as the schedule was very packed. I asked the nurse over the phone if there was any way to expedite as the skin condition can get really bad even in a few weeks. I was advised to go to A&E if I think is urgent. My goodness... My husband was pretty mad as he said he could easily find a specialist in Korea and spend a lot less. He was surprised at the inefficiency of our public health system. 

Hence, I decided to call a specialist clinic despite knowing it will be relatively expensive. I have called about 3 clinics but most of them are not available on the day itself and will have to schedule one week later, except Chiang Children's Allergy and Asthma Clinic. We heading to Chiang Children's Allergy and Asthma Clinic which was at Mount Elizabeth. The clinic opens at 2pm and waited for my appointment time at 2.30pm. The consult with Dr Dr Chiang Wen Chin was about 10 mins. First she briefly looked at my daughter's skin condition. As my daughter could not sit still, she called in her nurse so that she could ask me questions without my daughter interrupting the conversation. She clearly stated that to "treat" eczema, there is a lot of "homework" for the parents to bring back moisture to the skin. There was a whole basket of creams and medication that I would need to apply at different stages. After the consultation, the nurse demonstrated to me which medication to use for which skin condition. When they mention that I should use moisturizer generously, I wasn't expecting such a huge layer of moisturizer (see image 6). My daughter wasn't very pleased to wear the wet wrap but she obediently followed instructions and sat there quietly as she was given video to watch.

Step 1: Bath Oil
Step 2: Medication
Step 3: Moisturizer
Step 4: Wet Wrap
Step 5: Antibiotics (not required unless no recovery after 2 weeks)

I recalled bringing my daughter to a paediatrician in Korea and I only spend $5 for consultation and around $10 for medication. I saw a skin specialist for my sudden skin allergy when I visited Korea, I only spend $20 (foreigner rate, without subsidy). Seeing a specialist in Korea is even cheaper than visiting a GP in Singapore.