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Parent (Patient) Eczema Consultation Tips with Dr Susan J. Huang …

Dermatologist Susan Huang interview with EczemaBlues Eczema

Dr Susan Huang interview with MarcieMom,

It’s fairly common to hear eczema patients lamenting that their doctors seem to be just prescribing creams and not listening enough. It can be even more difficult for parents, particularly as we are not the one ‘experiencing’ the eczema but we’ve got the responsibility to learn as much from the doctor (while keeping our toddler quiet)! MarcieMom is privileged to know Dr Susan J. Huang, the chief resident at the Harvard Dermatology Residency Program, who works at multiple prestigious hospitals in the United States.

More on Dr Susan J. Huang – Dr Huang is the chief resident of Harvard Dermatology Residency Program, and works at many hospitals including the Massachusetts General Hospital, Brigham and Women’s Hospital, Beth Israel Deaconess Medical Center, Childrens’ Hospital of Boston, Boston VA Medical Centers, and the Lahey Clinic. She is also the author of, an online resource and blog on dermatology. Dr. Huang has written book chapters, published peer-reviewed articles, and presented at multiple national conferences on issues and topics in dermatology.

Marcie Mom: Thank you Dr Huang for last week’s pre-consultation preparation, this week we are focusing on the communication during consultation.

MarcieMom: Most parents would have heard about allergy testing and after supposedly sharing with the doctor various suspected food & non-food triggers, he/she may expect to have an allergy test conducted for the child. Is that a reasonable expectation? Are there justifiable circumstances when a doctor would say that an allergy test is not needed? And should a parent always insist to have one? (as to how doctors decide on what triggers to test, refer to Prof Hugo and Dr Liew Q&A)

Dr Susan Huang: The decision whether or not to allergy test is one that is based on your child’s particular situation.  During your consultation, your physician will ask you questions about triggers to your child’s eczema.  Triggers may include food & non-food triggers as you mentioned.

As we discussed in the last post, it’s important to have the details of these triggers ready in preparation for the visit.  The visit will also include a physical examination to see whether findings are consistent with a food allergy.  If certain foods or other exposures are suspected, your physician can then work to help confirm the trigger and come up with an appropriate panel of tests.  Testing may include skin prick, RAST, or oral challenge testing.  If a contact dermatitis is suspected, patch testing is performed (this is where small quantities of different contactants are placed on the skin).

The role of allergy testing in eczema is still a debated topic but we certainly do know that allergies, asthma and eczema run together, creating the “atopic triad.”  Now, studies have shown that 1 in 28 suspected food allergies are not true food allergies, but rather “intolerances.”  So, it’s important to know whether one truly has a food allergy or not, because you don’t want to limit your child’s diet unnecessarily (providing well-balanced nutrition is important for the growth of your child!)

MarcieMom: The prescription given by the doctor is typically moisturizing creams with topical steroid treatment and the instruction usually to moisturize frequently while steroid is to be used sparingly and not more than twice a day. What would you advice the parent to find out more from the doctor? For instance, asking how the eczema rash would appear after a week of application? And when it’d be cause to come back earlier than scheduled for another consultation? (I think doctors usually refrain from talking too much about specific creams, parents can refer to this Q&A with Dr Verallo to identify the top irritants in creams and also this Q&A with Dr Bridgett to learn how to apply topical cream and steroid, and this post on steroid strength and steroid-phobia.)

Dr Susan Huang: Great question.  Questions about the use of topical steroids frequently come up. Make sure you review an Eczema Action Plan with your physician before you and your child leave from your consultation.  Having this information written down is important so that you don’t forget the details. Action items may include non-medication therapies (e.g. moisturizing, bathing techniques include bleach baths, wet wraps or wet pajamas, etc) as well as medications (e.g. topical steroids).  It is important to clarify how much of the lotion/cream/ointment, to where is should be applied, and when it should be applied and for how many days.  As you mentioned, also ask what you should expect to see at the end of the treatment course that your physician has detailed to you.  It is important to have this information written down because it’s hard to remember all these details!  We provide these written eczema action plans in our clinics.

Absolutely clarify follow-up plans before you leave for your visit. Your physician may tell you when to come back or may say to come back if the rash does not get better. In addition, she/he may give you a list of warning signs to look out for, e.g. if your child’s rash doesn’t get better after the treatment course, develops fever/chills, the rash becomes crusty, weepy or ulcerated — showing signs of infection, etc.

MarcieMom: Thank you Dr Huang, it’s good to know your point of view as to what is acceptable to be asked during a consultation, as some parents may be too shy and leave promptly with many questions still unanswered and then (worse), not carry out the treatment as directed cos they are fearful of what has been prescribed!

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Coping with my Child's Eczema: The Creams … – A Dollop Of Me

One thing we’ve experienced with Bubbles’ eczema is that we get no shortage of advice and sharing of experiences by well-meaning people. Family, friends, and many strangers have taken time to approach us to share what has worked for either themselves, or people that they know.

I have been heartened by this, and appreciate the concern that we have received. I recall in particular one woman we met at a McDonalds. She felt so sorry for Bubbles (who was hurting from getting her hands washed), that she chatted with me for a long while, sharing about doctors, creams and eczema eliminating methods that she knows of.

Initially, I didn’t know if it was wise of me to share about the products that we have used. After all, I must state clearly that none of these products have cured Bubbles of her eczema. We have applied medications that have healed her rashes and wounds (I will share about those in another post), but so far, no product has helped prevent the rashes from recurring.

However, after being contacted several times about various products to help ease rashes cased by eczema – either as recommendations, or queries about what works, I decided that writing about the products we have tried could be useful for others.

In this post, I would like to share about the various moisturizing creams that we have used on Bubbles. People with eczema often have dry skin, with some having skin barrier conditions whereby the skin is unable to retain moisture well. Many of these creams were able to ease all symptoms of mild eczema, as attested by people who recommended the creams to us.

1. California Baby Calendula Cream
This was the first cream that we tried, and we used an entire tub. This is the cream that was recommended most often to us, especially when Bubbles was younger. From what I know, many babies with mild eczema only needed this to ease the rash. Unfortunately, while it provided moisturizing comfort to Bubbles, it did not stop the itch for her. If your child is young and the eczema is not serious, it may be worthwhile to try this cream out.

2. Physiogel Cream and Physiogel AI Cream
Physiogel as a brand was the next most recommended product to us. One of the doctors we saw prescribed the Physiogel AI Cream, as it has properties that help relive itch. For eczema sufferers, and in particular children, reliving the itch is a big part of the process to stop the eczema cycle. This is because scratching causes the skin to break, increasing the chance of bacteria to enter, and upping the itch factor in a vicious cycle. We used the Physiogel AI cream for quite a long time, but with Bubbles eczema being so bad that the cream did not stop enough of the itch, we switched to the cheaper option of regular Physiogel Cream just for the moisturizing properties. We still use this cream today, alternating with Cetaphil Cream, as I shall describe next.

3. Cetaphil Cream
With Bubbles needing to be moisturized 3-4 times a day, we were using out creams at a very fast rate. Roboman came home one day with a huge tub of Cetaphil Cream. We find its texture a tad lighter than the Physiogel Cream, and therefore perhaps a little less rich. However, since it is cheaper, we are able to be more liberal in applying this on her. Like the Physiogel Cream however, this also does not have itch-reliving properties.

Next, I’ll share about 3 newer products in the market that we have tried:

4. Atopiclair Cream/Lotion
This product claims to help relive the eczema itch, along with moisturizing properties. The cream was recommended to us by one of the doctors we saw. It does seem to relive some of Bubbles’ itch during the times when her flare-ups were not too serious. To save cost, we also tried the lotion, but found it too liquid and not moisturizing enough for her. However, I can imagine the lotion working for eczema sufferers who do not have as bad skin barrier a condition as hers.

5. Ceradan Cream
We received a tube of this from a doctor, and were told to try to see if it works on Bubbles. This cream is said to help “strengthen the skin barrier by restoring the skin’s natural compounds”. Bubbles’ skin has problems retaining moisture, so we were asked to use this along with a regular moisturizer. We only used one small tube, and it was along with a whole host of other products and eczema managing processes, so I cannot say if this produced clear results for Bubbles. If you are seeing a doctor regarding eczema, you may want to ask if the clinic has a sample for you to try.

6. Ezerra Cream
This cream was given to us from one of the doctors we saw. As we understand, different creams suit different eczema sufferers, and so we tried this as well to see if it works. This cream is stated to be suitable for mild to moderate cases of eczema, in particular in infants and children. Given that this cream was created with young ones in mind, it may be a good option to consider and to ask your healthcare practitioner about if you have a young eczema sufferer with you. Bubbles’ eczema was probably a little too severe when we tried this.

Finally, we used two other products that didn’t quite fall under “Creams” or “Lotions” but were certainly products that we applied on her skin:

7. Emulsifying Ointment BP

After spending tons of money on expensive creams, the price of this came a bit as a surprise for us. It is very affordable, and is basically a thick gel-like ointment. It is similar in texture to a block of petroleum jelly. It really helps retain moisture on the worse parts of skin, but its heavy texture means that it is uncomfortable for use in hot, humid weather. Given that we live in sunny Singapore, we only used this at nights, when air-conditioning is turned on. We also used this together with prescribed wet wraps, something that is tedious to do, and uncomfortable for Bubbles, but very effective.

8. Chlorhexidine Solution

This is basically an antiseptic solution. It also comes in little sachets. We applied these specifically on the areas of rash where there was broken skin, to prevent infection and bacteria growth. We were told that it is the bacteria that causes this itch, and therefore killing the bacteria would reduce the itch and scratching, and therefore aiding in the healing of the skin.


If you have landed on this post searching for products to help with yours or your child’s eczema, I hope you have found this useful. I will add to this list, if we try other products.

What other skin application products have you tried?

If you haven’t already, you may want to read this related post:
Coping with my Child’s Eczema – Our Story