Second opinion?

I am debating seeking a second opinion about Amy’s current rash / skin irritations. I’ve never done that before — I don’t even know the etiquette. Do you ask your doctor directly, go behind him on your own initiative, or some other way?

Anyway, here’s the deal.

About a month ago, she developed some spots of the kind of impetigo that looks like blisters, which pop and form a dull crust. It’s all healed except one spot, which is probably no longer impetigo, although it still has one tiny bit of dull scab.

Next, yeast developed in all those areas.

After the yeast went away, what remains are some sore spots on the butt cheeks and vulva, tough red skin on the inner thighs, and a few red bumps in the center front near the top of a diaper or underwear.

At the first appointment — we saw the nurse practitioner — for the impetigo, she also had an ear infection. Oral antibiotics for that (and to help the impetigo) and a corticosteroid cream (triamcinolone 0.1%) for the rash. I think we used the cream for two weeks, maybe three.

Next appointment, with our family doctor (gp, not pediatrician), mainly for her two-year well visit, we were informed of the yeast and advised to start the corticosteroid again and add Lotrimin. He also said to quit using regular diaper creams. Unsurprisingly, next time she woke up poopy, there was new rash. Of course I started using diaper cream again — this time, A+D, because I think the Desitin Original was not only drying, but stayed on the skin forever and masked the yeast symptoms.

Next appointment, last Wednesday, again with the doctor, we learned the yeast was gone (no more Lotrimin, woo-hoo!), likely no more skin infection either, and that it’s very surprising that the corticosteroid cream hasn’t cleared it up yet. We upped to three times a day for another two weeks, cut back baths to twice a week (another diaper rash we’d had to do soaks twice a day — I guess warm water is good for some kinds of rash but not others), and slather on the A+D — and moisturizer.

I think I need to be more aggressive with the moisturizer — I thought A+D, which has so much lanolin in it, was moisturizing, but maybe not enough.

It’s interesting that the rash looks best when she wakes up from bed and nap — after being in a wet diaper and under warm covers. That seems weird — unless it’s like cuts — you know, how they look all red and dry and irritated unbandaged, but under a band-aid they stay soft and just a little pink. Is it really better, or just an appearance thing?

If it is really better, perhaps I should also decrease her naked time — keep underwear and pants on, or even return to diapers?

Who knows…

I don’t want to experiment with different butt creams yet — at least without a doctor’s input. But whether to call or visit our doctor again midweek, or wait the full two weeks, or call or visit someone else… hmmm…

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4 thoughts on “Second opinion?

  1. Would it be possible, instead of a ‘second opinion,’ to seek a specialist’s opinion? To say to your regular doctor that since Amy has had so many varied and confusing skin issues, that you might like to consult with a dermatologist? That sort of bumps it up a notch in importance, rather than implying you want to see a peer of the doctor’s for another opinion?
    I know doctors can be touchy (which is a whole separate subject), but I would think that the dermatologist route might be a delicate way to approach it. Plus it might be a good route to go anyway.
    Good luck. This stuff can be so challenging.

  2. Ros had a bunch of ick when she was younger, most of which I was able to resolve on my own thankfully-the yeast rashes I just used the canesten cream which you could buy OTC-the icky, excema looking stuff she gets all winter-a combo of something thick and greasy and when it’s really bad, Aveeno in the bath since it gets SOOOO dry here. I just wish the cradle cap would go away. It’s STILL on her head.

    I think a specialist might be a good idea though, as Amy said. Could even be some sort of reaction to something…

  3. I was going to say the same as Amy said. I’d call the doctor and say that since it isn’t getting better, you’re wondering if they’d be so kind as to refer you to a dermatologist.

  4. Thanks, all; we’ll see what happens with what the pediatrician said.

    Thor — have you ever tried olive oil on Ros’s head? Or T-gel shampoo? I used to get eczema on the back of my neck, and T-gel helped clear that up — I still use it every other shower. Then again, I bet you’ve tried everything. And, while annoying, it’s not like cradle cap hurts or leads to anything worse, and is probably nicely hidden under her lovely hair.

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