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Sunday, April 19, 2015

Our Asthma Journey

Please note- We have a wonderfully supportive pediatrician.  He knows Bo well and has his best interest at heart.  Please do not take this as medical advice.  See your doctor and ask him/her to help you find options.

Bo has asthma.  He has had about 4 acute attacks in his life.  We treated the first three with oral steroids.  The third was in month 9 of TSW.  After that, I started researching and working with our pediatrician to develop a non-steroid acute plan.



This is what we came up with-

Medical treatment-

Singular daily during allergy season

Xopenex inhaled through the nebulizer every 4 hours (this works better than Albuterol for Bo)

Cromolyn Sodium inhaled through the nebulizer every 6 hours.

Serevent inhaler 2 times, 12 hours apart.  (This one is a little controversial because it is only supposed to be used with a steroid.)

Ibuprofen every 6-8 hours, especially during the first 24 hours.

The doctor told me to count Bo's breaths per minute.  He said often children can maintain a high pulse ox even when in distress.

Homeopathic Treatment in addition to medical treatment-

sovereign silver every 4 hours

feed him pineapple to reduce inflammation

diffuse RC oil in his room while sleeping



This protocol diffused his last acute attack.  Please talk to your doctor about your plan!  This is a good article with a chart at the bottom that gives treatment options. http://www.nytimes.com/health/guides/disease/asthma/print.html

Why TSW Was Right for Us

Bo's first eczema appeared when he was only four months old.  At the onset the pediatrician asked us to watch it and treat his skin with moisturizers.  After two months of unsuccessful treatment, the pediatrician prescribed a low potency steroid cream.  Upon using the cream, the rash continued to spread and worsen.  The pediatrician referred us to a dermatologist when Bo was about a year old.  The dermatologist continued to treat the eczema with steroid creams.  By the age of 14 months, Bo was on numerous medications.  The treatment continued for about six months eventually leading to the dermatologist asking us to seek a pediatric specialist.  He stated that our case was more than simple eczema and required more specialized attention.



I would never wish this journey on anyone, especially this sweet baby!


See the tiny spot on eczema on his left cheek?  That is what started this all!


We also saw several allergist seeking a cause for the eczema.  At about 9 months, Bo was found to be allergic to soy via a blood test.  We eliminated all soy products from his diet, but his eczema continued to rage out of control.  At about 14 months old, he was tested for allergies by subcutaneous prick tests and live food test.  He did not show an allergy to any food or environmental trigger.  Even with these results, we did a complete food elimination diet with the support of an allergist and nutritionist. 



First birthday party.  We coated him head to toe with steroid creams the night before so that he would look good for his party. :(


Notice the red spots in his eyebrows and cheeks.  That was the beginning of the stubborn "eczema".



At the age of 18 months we visited a pediatric dermatologist.  Bo's skin was particularly inflamed when we visited.  The Pediatric dermatologist prescribed oral steroids to clear his skin.  Within a week he had perfectly clear, smooth skin.  I felt like the pediatric dermatologist was a miracle worker, until...   


This was taken in the pediatric Dermatologist's office


This was 3 days later on oral prednisone.



With the prescription of oral steroids, the doctor warned us that rebound would most likely happen.  He encouraged us to increase the frequency and amount of topical steroids as we decreased the oral steroids.  He also prescribed a tapering dose of oral medication.  Throughout the next 6 months we were on a continual cycle of oral steroids, strong topical steroids, and horrendous flares.  His skin was continually declining, as was his overall health.


Bo's medication list for the first two years of his life.



During this time, he maintained his weight, even though his was at an age where growth would be expected.  I vividly remember his weight was 27 pounds.  He maintained that weight from 18 months to 3 years old.  During the 18 months on steroids and 18 months of Topical Steroid Withdrawal, Bo's height dropped from the 75th percentile to the 6th percentile.


Near his second birthday, I knew that something more than "eczema" was going on with Bo.  He began to get other complications, like thinning hair, skin thinning, and fungal infections.  He was being prescribed medication to sleep, fungal infections, and itching.  I knew that his health was declining and felt we needed to take a different course.



The pediatric derm told us to moisturize using Crisco cooking shortening.  Proof we tried EVERYTHING!





Bo's second birthday party.  He had just had a full body application of Fluocinolone Oil and Elidel on his face.



Throughout this process, I read medical journals, looked at articles and communicated with our pediatrician.  Our pediatrician also felt that this was a complicated situation that was beyond "eczema".  Because of that, he ordered a series of tests including Celiac Panel, IEg readings, vitamin and mineral panels.  Overall, the tests were normal.  The IEg readings were high, but not high enough to indicate an immune disorder.  


One day, in a desperate search, I search "severe facial rash".  A blog about a little boy’s journey was in the results.  I read the supporting documentation and watched the YouTube videos about Topical Steroid Withdrawal.  I knew instantly that Bo had been over medicated and his body was addicted to the medication.  I immediately took the information to my pediatrician.  He looked into the process and agreed that we had exhausted all traditional treatment measures for eczema.  He agreed to consult with an expert doctor and support us through the process.


This was while on steroids!  As far as I know, this is the last picture of Bo on steroids.



The first 16 months of withdrawal were pure hell.  Bo had many symptoms including burning, itching, oozing skin, temperature regulation issues, shaking, nerve pain, insomnia, and overall discomfort.  We maintained close communication with an expert on the condition throughout the first nine months and our pediatrician the entire time.  


Bo's third birthday.  One year withdrawal.


Potty training during withdrawal.


No face painting, only a hand.  14 months withdrawal



To date, Bo has been off steroids for 25 months.  He had a huge breakthrough around month 16.  His skin began to clear, stopped oozing, stopped shaking and he began sleeping most of the night.  In months 16-20 he has begun to grow! We were on a long waiting period to see and endocrinologist. She ran several blood tests and everything came back normal! He grew 1.5 inches in 4 months.   He feels and acts like a normal 4 year old.






20 months withdrawal



While on steroids, he was not healthy.  His skin was broken out all over his face and his knees and feet were thinned from the medication.  While on oral steroids, he experienced behavior changes and was often lethargic when he was tapered off.  We were headed down a scary path, I'm afraid.  I can honestly say, the 16 months of hell were worth the healthy child I now have.  I do not consider him 100% healed, as he still has an eczema like rash in some areas particularly on his ankles and elbows.  However, his overall life quality is 100%.  We are able to schedule life activities without his skin being the number one concern.


I know TSW may not be for everyone.  It was right for my family because our goal was overall health.  I know using steroids long-term is against the FDA recommendations and the medication was not tested or approved for the way it was used in our case.  We saw behavioral and growth changes that were beginning to take a long-term effect on Bo's life.  TSW is a family commitment.  We spent thousands of dollars seeking the help of doctors prior to and during TSW.  Once we decided to endure TSW my husband changed jobs so he would not have to travel out of town.  I sacrificed promotions at my job.  Our daytime caregiver agreed to help so that we could both work full-time.  We took turns sleeping with Bo to give him care throughout the night.  Overall, our entire family committed to caring for him.  The sacrifice was steep, but the reward is a healthy, happy child who no longer has to suffer.



Bo's 4th birthday- 2 years steroid free- Hooray!




Please seek medical care if you are considering TSW. Endocrinologists seem to be the most informed about the side-effects of topical steroids.

Seeing the Light(s)

This post has been floating in my head for 4-5 months.  In December when we were happily driving around looking at Christmas lights, I was reminded of much darker times.  Two years before in December of 2012, I was alone driving the children around because my husband, Larry, was working out of town.  His job at the time required him to travel to areas with catastrophic events.  In December of 2012 he was in New York because of Super Storm Sandy.

All of this is very vivid because the night I took the kids to see the lights was the proverbial straw that broke the camel's back.  Bo was 20 months old.  His eczema was consuming our entire family.  He was using Predicarbate and Triamcinolone (.25% on his face and 1% on his body).  He also was on Amoxicillin for infecton.  During our tour around the neighborhood to look at lights, he began scratching his knees and feet and screaming.  I pulled over in a shopping center and wrapped his legs. This was a common occurrence at this point.  I kept a roll of gauze and tape in the car door.  The first time he scratched until he bleed in the car was in July of 2012.  What a horrible, helpless feeling.  He only worsened during those 6 months.


Christmas 2012- He was on oral steroids.  Notice how red his little face looks.


The week between Christmas and New Year 2012.  Steroids beginning to wear off.


Our bag of prescriptions. 


Doctor's visit for asthma mid-December 2012 that prompted the prescription for oral steroids.

This was a pivotal time because it was when I began to realize that Bo wasn't going to heal with conventional treatments.  Larry realized that he had to be home to help with Bo's care.  Therefore, he began looking for a job that did not require overnight travel.


Christmas 2013- 9 months TSW

Fast forward to Christmas 2014.  Bo is 21 months into TSW.  The four of us go out looking at Christmas lights, listening to Christmas music and Bo is wearing clothes.  He did not even scratch or get uncomfortable!  As we passed by the shopping center where I wrapped him two years before, tears filled my eyes,  We have come so far and we are seeing the light.  The lights of healing and enjoying life.



Cooking with Mimi- Christmas 2014



Cute little elf!  Notice those beautiful feet!






Monday, November 24, 2014

Thanksgiving

An update on Bo's progress is long overdue.  Over the past five months we have experienced tremendous healing.

June- The month of June was more of the same.  Bo continued to suffer with sleepless nights and red burning skin.  The oozing did subside some.  We spent two weeks at the beach.  Bo did not get in the ocean or the pool while we were there.  He had fun doing the activities and overall, his energy began to improve.  We began using some new products during the month including Young Living Lavender Essential Oil and pure zinc/ shea butter mix.





When we got home at the end of June, we had a huge breakthrough.  Bo decided to get in the pool!


July- Throughout July Bo continued to swim and take baths.  He suffered with water prior to now.  We continued treating him with the zinc/shea cream and lavender essential oil.  We also began to eliminate red food dye.  His skin healing during July was magnificent!  However, during his three year check-up we found that his height dropped to the 6th percentile.  His height has continually dropped since 9 months old.  The pediatrician recommended scheduling an appointment with an endocrinologist.  



August-October- More healing! Bo's skin continued to heal, but the amazing this was the internal healing that was evident.  Bo had swollen lymph nodes for years.  They were the size of a marble at the largest.  During this time, they shrunk to normal size!  He also began feeling well enough to do things other three year old boys do!  I was so worried as we entered the school year and Bo went back to the sitter's house.  He also started pre-school at our church.  I met with his teacher and the director prior to school starting.  They are familiar with Bo and had an idea of his skin troubles, but we talked and made sure a care plan was in place.  Overall, he did well starting school.  During the hot months he did get itchy on the playground and had to put on his pajamas after recess.  When the weather cooled down, he was able to wear clothes all day long.  During this time he also began sleeping more!  Sleep, glorious, sleep!  Remember, this child had not slept through the night since he was twelve months old.  He began sleeping through some nights and waking up once or twice others.  A huge improvement!
First day of pre-school

Florida game with dad Labor Day weekend

Enjoying a park in September

Visit to a farm in October

Dressed as a doctor for Halloween

November-  Everyday, I wake up and pray for Bo's health. This is not new.  I have spent countless sleepless hours holding him, crying, and praying.  The difference now is that we have experienced health and I'm fearful of regression.  I know another flare is probable.  Many people have clear skin for months and then flare.  I am also very concerned with Bo's asthma. Every November of his life he has had an asthma attack that resulted in emergency care.  We are living on a prayer... thanks Bon Jovi.  


Bo getting his hand painted.  His skin is finally well enough!


Sweet little healed face!
November 24, 2014

During this month, we also visited a pediatric endocrinologist concerning his growth.  Yes, it took five months to get a new patient appointment.  She asked the normal questions to rule out genetics for Bo's growth delay.  She also ordered a panel of tests.  (I do not want to ever have to take him for blood tests again!  He did really well, but it was traumatic for both of us.)  Overall, she said that the results of the blood test would rule out a hormone issue.  If the tests come back normal, she is prepared to conclude that the steroid treatment for eczema stunted his growth.  If that is the case, he should catch up with time.  He has already grown 1.5 inches since his July appointment!


November 24, 2014


The last 20 months have taught us so much.  We are Thankful for healing.  Our church family, friends, and community have been a huge support in this season.  Pastor Chris spoke on seasons of life a few months ago.  Until then, I had not considered how long this winter season of life was for us.  For three years we have been slaves to Bo's skin.  Worse, the poor baby has never felt well.  Kate has learned patience and sacrifice.  One night when Bo was crying, she asked me to sleep in his bed because he might itch and need help.  She sincerely cares about him and knows the treatment plan.  We are thankful for Ms. Pam.  She has cared for and loved Bo even though he has been very sick and required more time than a normal child.  We are thankful for my parents.  They have kept the children a few nights so that we can get a full night sleep.  We are thankful for our pediatrician who has supported us through our out-of-the-box treatment.  Also, we are thankful for our online support community.  The other families going through this are the only ones who understand completely. It is amazing that something as awful as Topical Steroid Withdrawal can help us see our many blessings, but as this season ends, we are thankful for a "spring" of new beginnings.





Several have asked how we are treating Bo.  Currently, we are using olive oil sparingly on extremely dry areas, zinc/shea balm from www.thehomeapothecary.etsy.com on the red broken spots, lavender and RC essential oil in a diffuser at night, melrose essential oil with dead sea salts in his bath, and a humidifier for cold, dry nights.  Of course, NO STEROIDS!!!


Sunday, June 8, 2014

This consumes me and helping others

This weekend we were visiting with some neighbors.  One neighbor is expecting her first grandchildren- twin girls.  As we sat and talked about the sale cycle of Gymboree and Carter's coupons, she said she was consumed with the twins.  They are all she can think about.  I just paused and looked at her.  I said, "I know, Bo's skin consumes me.  It's all I can think about."

During the last 15 months he has been itching, oozing, scratching, crying, and shedding some days non-stop. Most people in TSW have to take a year or more off from work.  Many parents have to adjust work schedules so that one parent is always home with the child going through TSW.  We are very lucky.  Bo has a wonderful daytime caregiver, who has fully supported us and cared from him during TSW.  Ms. Pam is a God sent!

So you may be thinking, "How did this happen?"
The long and short of it is that Bo had a small spot of eczema on his cheek.  He was treated with a low dose hydro-cortisone and it would not go away.  In fact, his eczema spread.  We were referred to a dermatologist who put him on stronger steroids.  On these medicines, his skin only worsened.  Looking back, I don't know why I didn't suspect the steroid creams.  Mostly because EVERY doctor (3 derms and 4 allergists) all said they were the only treatment.

We stopped steroids in March of 2013.  The past 15 months have been really hard.  Bo has trouble sleeping.  I've found from researching that it is probably because the body produces less natural cortisone at night.  He has an intense itch that can not be stopped.  Because of this, he scratches himself until he bleeds.  Therefore, he wears footed pajamas most of the time.  We have had a huge break through in the last month because he is able to wear pants and short sleeves.  During itching fits he begs for his pajamas.

His goes thought what are called flares in the TSW world.  This is where he itches, sheds and oozes more intensely than other times.  He is never 100% comfortable, but he has better times than others.  In the beginning, his flares were almost all the time and all over his body.  Now he flares every few weeks, and his flares are localized to his face, neck, and legs.  His arms and trunk are mostly healed.  During a flare, his only comfort is to be held and rubbed or scratched.  ALL THE TIME.  This is where we are so lucky to have Ms. Pam.  When we are at work, she holds and scratches him.  A true labor of love.  At home, we have sacrificed many things to sit and hold him.  Dinner goes uncooked, floors go un-swept, we go without sleep and Kate has to be very patient.  Many times as I'm scratching and rubbing, I'm also researching.

Here is the major problem.  This condition is not recognized by 90% of dermatologist.  However, It's very real.  We've lived this nightmare for 15 months and counting.  I am in a facebook group with 1500+ members, all suffering from TSW.  Another group for caregivers has 600+ members, not all the same and the 2000 member group.  The ITSAN forum has 2000+ members and is growing at the rate of 5 members per day.  Doctors continue to prescribe steroids and give off-label instructions.  The inserts clearly state that the drug should be used for only 5-7 days.  People are using them for years.  My pediatrician was the only doctor who properly warned us about the use of steroids. Still, he had no idea that the skin could become addicted and cause this type of withdrawal.  The other doctors we saw assured me they were safe.

We used topical steroids for an 18 month period.  Some people in the group were addicted in as little as 10-11 doses of OTC cortisone.  These drugs as not harmless!  I am currently working with a group of mothers to hopefully bring awareness to these side effects.  We are not ready to release our action plan yet, but I hope it will change the treatment of eczema for other children.

The past few days have been especially emotional.  Bo is registered for Bible School at our church this week.  I'm not sure that he is going to be able to participate.  He is very uncomfortable when we are not around.  I'm not sure if it's separation anxiety or if he is afraid he will itch or hurt and others will not know how to care for him.  Either way, it makes me a mess worried about him.  I really want him to go and be successful because I have signed him up for preschool in the fall.  He needs to be with other children his age and get used to being part of the group.  I pray that he will heal enough to experience VBS and preschool.

Also, I think the stories of others are taking a toll on me.  When Bo was so sick, all we did was function to make it from day to day.  We slept very little (and still don't sleep some nights) and literally just made it through the day- one day at a time. The only way I have made it though is to keep telling myself, this is not life threatening, he will heal, it's only temporary, he is too young to remember it, and other positive self talk. I feel that this journey is one that needs to be shared and that I need to help other moms.  Prevention is the ultimate goal, but support for others suffering is also a priority.  As I read the desperate posts of other moms, it breaks my heart knowing what they are going through.  Emotionally, I may have been better off when I thought we were alone.  On a positive note, I have made several friends through this.  We chat on the phone or facebook about symptoms, remedies, and how to help others.

At this point, we need prayers for Bo's healing, guidance for the mom's group (for change and support), and strength as we finish this long fight.  Also, if you know anyone that you think is going through this, please let me know!

Friday, June 6, 2014

Where are we now, 15 months TSW

First of all, blogging is not something I think I am good at.  I am only doing this to spread the word about TSW and hopefully prevent other children from suffering like Bo.  I'm sorry this is not a pretty and cutesy, buy honestly, this is not a pretty topic.  I hope I can at least pique your interest enough to read the whole post and tell a friend.  


We are currently in month 15 of TSW.  We stopped using steroids in March of 2013.  Bo is about 80% healed with his face and legs being the most stubborn areas.  The last 15 months have been very difficult, to say the least.  Each day, we anxiously wake up hoping, praying that it is the day he is healed.  On most days I do truly believe that he will be healed.  The road has been long, full of sleepless nights, tears, prayers, ooze, shedding skin, itching, burning, scratching, rubbing, and questions from everyone.  I don't mind answering questions, especially if the person is truly concerned.  Here are some common questions with the answers.

How did we find ITSAN?


Bo suffered from eczema from 6 months to 2 years old.  It increasingly got worse with each passing week.  We sought the advice of many prominent doctors in the Atlanta area and none seemed to know what was going of with his skin.  The one that we held out as our last hope at Emory proclaimed that he had "typical eczema".  Throughout all the visits and prescriptions for stronger steroids, my mama gut was yelling "NO!"  I knew it was not just eczema and something was spiraling our of control.  After the much awaited appointment at Emory, I began praying and searching for the answer.  On day, I went into my office and cried and prayed.  I asked God to please lead me to an answer for this baby's healing.

Obviously, I had conducted many Google searches in the past.  I even used my university library privileges to search medical journals for answers.  This time was different.  I Googled "severe facial rash".  For some reason, I clicked on images.  Until this point, I avoided blogs and personal stories because I wanted the medical facts. (Rolling my eyes at myself!)  As soon as I clicked on images, little Kline's face popped up.  I looked at several pictures of his little body and clicked to read his blog.  As soon as I read the words Loren wrote, I knew I had found the answer to Bo.  I clicked on ITSAN and the opening page asked a list of questions similar to, Have you tried everything to cure your eczema?  Have you been on elimination diets, removed pets from the home, tested for allergies, removed carpet, tried every cream on the market... if you answered yes, you may have steroid induced eczema.  I continued to read and watch the videos of Dr. Rapaport.  I knew I had our answer!

What is the difference between eczema and steroid induced eczema?


There is more information about this in the ITSAN Q and A page, but for me it was not typical eczema because we were "chasing" it.  It began on his trunk and spread to his face.  Before we stopped steroids, he had spots that would not clear on his face, knees, feet and fingers.





These pictures were taken in March 2013.  He was on Dermasmoothe Oil on his full body and Desonide 0.05% on his face.

Have your tried Aveeno, coconut oil, shea butter, Crisco...?


Yes, yes, yes, yes, I really do appreciate people's concern, but yes if it is sold on Amazon, or in Publix, CVS, Walmart, or Target and is marketed to help eczema we tried it.

On this topic, many of the products marketed for eczema contain steroids.  Baby Isaiah became addicted in 10-11 applications of OTC hydro-cortisone. See his blog link for more details.

How long will it take for Bo to heal?


This is the million dollar question.  We wish we knew.  We did consult with Dr. Rapaport and Bo is taking longer than he predicted.  I personally feel that the long withdrawal is due to using Dermasmoothe oil.  This is labeled as a weaker steroid and was prescribed to us to be used from neck to toes to keep Bo's body from breaking out.  It worked for the most part on his body, but it is stronger than originally thought (again my opinion).  There is currently a mislabeling and false advertising law suite against the pharmaceutical company.

If I can't use topical steroids for eczema, what should I use?


Dr. Rapaport has been practicing dermatology for 40+ years.  According to him (in a video on youtube) eczema was a short term problem that children often grew out of until the first line of treatment became steroids about 35 years ago.

Therefore, I say, wait it out.  These things have helped other moms I have met and we have used some-
Dye Free/ Scent Free detergents
Dove Sensitive bar soap
Cotton clothing
Vanicream or any other moisturizer the child can tolerate
Apple Cider Vinegar baths (1 cup in a full tub)
Probiotics
Elimination diets
Wet and dry wraps 
Zinc cream (diaper cream)
Oatmeal baths
Epson Salt baths
Dead Sea Salt baths

Basically, read all labels and be sure you are not applying steroids, especially as a first line of treatment!

If you or someone you know may be going through TSA or TSW, please check out ITSAN.org.

Thanks for supporting our journey!

Monday, June 2, 2014

History of Bo's Condition



This is an excerpt for an e-mail to Dr. Rapaport in July of 2013.  It outlines the history of Bo's Topical Steroid Addiction.


History of Bo's condition-
At about 3-4 months old Bo developed a fine rash on his stomach and back.  We used moisturizers to help it. Eucerin and other OTC lotions marketed for eczema.  At about 6 months his face began to break out.




First eczema on cheek and eyebrow



We used the same lotions and Aquaphor.  At that point the pediatrician prescribed a cortisone cream and changed his formula to Alimentium (sp?), Bo's eczema worsened over the next few months.  When he was about 11 months old the pediatrician ordered blood allergy test and a soy allergy was detected.  We began to feed him a soy free diet.  We also took him to a dermatologist.  The derm prescribe Desonide and Fluocinolone body oil. Bo's body cleared, however his face got increasingly worse.  All of this also corresponded with him weaning from breast feeding at a year old.




When he was about 18 months old (October of 2012) we were referred to two pediatric derms.  One at Emory had a 4 month waiting list .  I made an appointment for January of 2013.  With the other ped derm, we had an appointment at the end of October.  We also began seeing an allergist about this time.




Steroid withdrawal, October 2012 (I didn't know it.)




The pediatric derm (Caputo) continued topical steroids and prescribed Flopred orally.  Bo's eczema cleared significantly with the Flopred.  However, it returned quickly and worsened.
At this point blood work showed no allergies and he was given allergy prick tests for common food and environmental allergies.  He was also given a fresh food test to milk and soy.  All negative.




We saw Dr. Spraker at Emory in January 2013.  She said it sounded like "typical eczema".  At this point we had applied topical steroids for almost a year, visited 2 allergist and she was our third Derm.  I knew it wasn't "typical eczema".

Our ped ordered more test to rule out a genetic iron disorder.  Everything come back in the normal range.

In February 2013 we saw another allergist who put him on a food elimination diet.  He ate only pears, apples, green beans, broccoli, chicken, beef, white rice, and potatoes for a month.  His skin did not look better.

Bo also developed a fungal infection in his scalp and was treated for that for 7 weeks in February/ March.

In March I began looking online and found your work through Kline's blog.  I showed a YouTube video to Dr. Kim and Tanya.  I took Bo off all steroids in March 2013.

His skin looks better, but has some places that are bad.  He itches constantly.  He is also shedding.  He hasn't slept through the night since he was about a year old.













The social impact- older children always ask what is wrong with him.  Several moms have even taken toys from their children because Bo touched them and they fear he is contagious.

His sensory well being- I worry that the constant itching/ burning will cause sensory issues.

Long term impact of meds- the anti fungal medication is very dangerous, along with prolonged steroid use.  In addition, the anti itch causes dry mouth which is a concern for his oral health.

Also, we bath him with Dove sensitive skin soap, use dye/ scent free detergents, and moisturizer him with Vaniply cream.  Currently we are using Epsom salt baths.  We have used bleach baths in the past.