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Abstract: This child had severe eczema on his body for the last 3 months, all presenting large red patches of eczema with exudate, accompanied by diarrhea, sour-smelling stools, milk flaps in stools, resistance to eating milk, and slow weight gain. Both parents had an allergic basis, so he was diagnosed as having pediatric allergic eczema caused by protein allergy. The child’s symptoms were relieved by giving medication.
Basic information】Female, 7 months
Type of disease】Pediatric allergic eczema
Hospital】Shanghai Sixth People’s Hospital
Date of Consultation】September 2021
Treatment plan】Adjustment of formula feeding (deeply hydrolyzed protein formula) + medication (urea ointment + zinc oxide borate ice cream + mucopolysaccharide polysulfate ointment)
Treatment period】1 month of home treatment
Results】Eczema improved significantly, and the stool condition was significantly better than before
I. Initial consultation
The 7-month-old child started to develop eczema 2 months after birth, and the eczema on the child’s body has been getting more and more serious in the last 3 months, and he has applied many creams, such as Denide cream and hydrocortisone butyrate cream, but there is no improvement. On examination, a rash was seen all over the body, with widespread red flaky eczema on the head, face, trunk and extremities, with yellow exudate on the surface. Further questioning revealed that the child’s gastrointestinal condition was not good, with frequent stools 4-5 times a day, which were very thin, with milk flaps and a sour odor. The child’s growth curve had slowed down significantly since he was 3 months old, and he was not eating milk well and had great difficulty adding complementary foods. Further inquiry revealed that the child’s mother had allergic rhinitis and the father had chronic urticaria, so the diagnosis was pediatric allergic eczema caused by protein allergy.
II. Treatment
Firstly, we adjusted the feeding to deeply hydrolyzed protein formula and simplified the supplementary food, such as basic rice flour and rice paste, and suspended the others first. Oral probiotics were administered to regulate intestinal flora as well as topical eczema ointments, including urea ointment, boric acid zinc oxide ice cream and mucopolysaccharide polysulfate cream to astringent exudate in areas where exudation was particularly high, and the improvement of all symptoms was observed.
III. Treatment effect
After the child went home, he was given a full range of adjustments, not only in terms of skin and medication, but also in terms of feeding and oral medication. 1 month later, he came back to the hospital for a review, and the parents said that after the treatment, the eczema on his body had significantly improved, the red eczema was significantly lighter, and there was no longer any yellow exudate, the skin was significantly brighter than before, and the diarrhea had also improved. The weight gain in this recent month is still relatively satisfactory compared with the previous one, and the appetite has been improved, and the parents’ nervousness is also relaxed than before.
IV. Notes
We are glad that the child’s symptoms have improved after treatment, but since the child’s allergic eczema is caused by protein allergy, we suggest that parents should pay attention to the infant’s mental condition and other reactions of the child’s skin in daily life, and if eczema, diarrhea, feeding difficulties and other uncomfortable symptoms appear again, go to the hospital and follow the doctor’s instructions. Pay attention to opening the windows more often and avoid taking the child to crowded places.
V. Personal insight
By understanding the situation of the child in this case, we can see that since the proportion of eczema caused by protein allergy in pediatric eczema is not high, it is not recommended to make a hasty diagnosis at the beginning. Usually, when a child has eczema, he or she is first treated with topical skin medication and the results are observed. If topical medication is not effective, various other causes of eczema are then actively analyzed. If there are digestive symptoms and a family history of allergies in the parents, as well as feeding difficulties and lagging in the growth curve, a visit to the hospital is required for a comprehensive evaluation.