On Friday before Labor Day weekend we woke up to inflamed cheeks. We chased this flare for a couple days with the wet washcloths, lotions and wet wraps.
I felt trapped in a pre-National Jewish Health frenzy, when she would clear up for an hour or so, then go right back to red, bumpy areas increasing in size with no apparent triggers. Fridays are “Daddy Days” when her father watches her while I work. She wasn’t in preschool and this was supposed to be the most eczema-friendly environment.
Why wasn’t our new approach working? Was it going to all go back to how it was before we went for treatment at NJH? My heart fell at the thought that we only gained a temporary solution.
By Sunday I was frantically paging through our care plan to see what I might have missed. It turns out that while I was diligently following the skin hydration, moisturizer, daily baths and even wet wraps, I completely abandoned the “step-down” instructions for the mild steroids in the last week. I was so thrilled to see the simple and “natural” measures of wetting and moisturizing working for the last few weeks that I never kept up with these directions which were clear and underlined in my care plan.
Now we would end up having to move up to the “Moderate Atopic Dermatitis” portion of the plan and use Desonide, a stronger steroid before getting back into maintenance mode. This did the trick after about two days and we are back in “Mild” for a couple weeks, and hopefully onto Maintenance if we stick to the instructions.
Part of me is terrified that once we are stepped off of the mild steroid completely, that her eczema will kick back into gear completely. The logical part of me knows that there is a good reason for stepping down from steroids, and we saw what happens if we don’t taper down in the right order, and we need to use the topical steroid how they are intended.
The second trigger contributing to this recent flare was likely the lack of sunscreen last week during daycare.
I love that her preschool has the students outside for an hour each day. I was afraid to mess with any progress we’d made and didn’t apply the sunscreen.
Topical steroids + sun exposure is a recipe for a flare.
Though Zoey loves playing outside, she’s never been tolerant of warm temperatures. To make it worse, I dress her in long sleeves (lightweight cotton) which helps mitigate the effects of airborne allergens indoor and outdoors on her skin.
You just can’t win in the North Carolina summer.
Thankfully her daycare, Little Stepping Stones, is diligent about getting Zoey inside and cooled down when she turns beat red and feels uncomfortable. They cool her down with a wash cloth, change her clothes and re-moisturize.
She’s arrived home each hot day looking as clear as when she left NJH. While she eats with friends during lunch and snack, her teachers Ms. Joanne Ms. Alyssa work hard in the background with an eagle eye to observe the area is clear of allergens, sitting with students who are better than others at keeping their mess to a minimum, overseeing hand washing before and after and thoroughly scrubbing the tables.
This impossible task, happening pretty much all at once among 18 energetic kids is not an easy one but they do it somehow, singing throughout.