The dreaded bleeding bum...

As parents of HD babies we all know about the diaper rashes. I didn't think it would be that bad when Deacon had his bag. I thought, ya I've seen "bad" diaper rash. Not a big deal. Except that it is.

He had his stoma closure and 4 days later the horrid red blotches sprang up, like little angry men. The nurses and doctors kept telling me before his surgery that after I would have to keep applying the barrier cream. There was nothing there and they kept saying, "You MUST apply it EVERY time!!!" I thought ya I will thanks. But nothing prepared me for those angry men. No body told me what to do AFTER the rash appeared. I threw out the barrier creme and started a LLLOONNGG battle with the baby aisle in the grocery store. We spent alot of money trying out everything under the sun. Everybody who had HEARD of a thing called a baby had an opinion on what cream was the only one to buy. Weeks of trying anything that promised any sort of bum cream, came around to me taking him to the clinic. First visit - try Nyastain. Yeast cream. Try for 1 week. The rash will go away in 2 days. Riiiiight. I used it for 2 weeks and nothing. There was a gizzilion little angry men on my baby's bum and 1 SUPER angry baby on his face while I wiped the poop off his toosh. So the 2nd trip to the clinic, the doctor took one look at his bum and prescribed a cream that she had to call 2 other doctors to make sure it was okay to give him. Sorry I threw it out so I dont know what it is. But I used it and there was NO sign of any change good or bad. Then he got the flu and was addmitted to BC Children's Hospital. When we were in there a Dr. Rothstein told me that gastrointestinal patients had been given a special mixture cream. We tried it, and since he wasnt eating (therefore not pooping) his rash went away!! When we left the hospital we got a HUGE tub of this cream and we love it! Its Nyastatin cream, Zinc Oxide cream and 2% Hytrocortizon. We have been using it for a month now. The rash did come back but that was to be expected. It has been the only cream that has worked at all. The only thing is that I know Hytrocortizon is very bad. Im going to the doctors office on Friday and Im going to ask her about it. Weird white skin patches have started to appear on his rash. I've reaserched it abit and have found some interesting articles about it. One thing that Im going to try after Im finished tonite is putting Tea Tree Oil on it. Iv'e heard that it works amazing. But Iv'e heard that sooo many times...

Topical steroids
Topical steroids have revolutionized the practice of dermatology since they were introduced in the late 1950s. They are effective anti-inflammatory preparations used to control eczema/dermatitis and many other skin conditions.
Like all medications, topical (cortico)steroids are associated with potential adverse effects (side effects) especially if they are used incorrectly.
The topical steroids can be divided up into four groups according to their strength. As a general rule, use the weakest possible steroid that will do the job. However, sometimes it is appropriate to use a potent preparation for a short time to make sure the skin condition clears completely.

Class 1
Very potent (up to 600 times as potent as hydrocortisone)
Clobetasol propionate (Dermol™ Cream/Ointment
Betamethasone dipropionate (Diprosone™ OV Cream/Ointment)

Class 2
Potent (I50-100 times as potent as hydrocortisone)
Betamethasone valerate (Beta™ Cream/Ointment/Scalp Application, Betnovate™ Lotion/C Cream/C Ointment, Daivobet™ 50/500 Ointment, Fucicort™)
Betamethasone dipropionate (Diprosone™ Cream/Ointment)
Diflucortolone valerate (Nerisone™ C/Cream/Fatty Ointment/Ointment)
Hydrocortisone 17-butyrate (Locoid™ C/Cream/Crelo Topical Emulsion/Lipocream/Ointment/Scalp Lotion)
Mometasone furoate (Elocon™ Cream/Lotion/Ointment)
Methylprednisolone aceponate (Advantan™ Cream/Ointment)

Class 3
Moderate (2-25 times as potent as hydrocortisone)
Clobetasone butyrate (Eumovate™ Cream)
Triamcinolone acetonide (Aristocort™ Cream/Ointment, Viaderm KC™ Cream/Ointment, Kenacomb™ Ointment)

Class 4
Mild
Hydrocortisone 0.5-2.5% (DermAid Cream/Soft Cream, DP Lotion-HC 1%, Skincalm, Lemnis Fatty Cream HC, Pimafucort Cream/Ointment)

Topical steroids are also available in combination with salicylic acid to enhance penetration, and with antibacterial and antifungal agents.

Skin absorption of topical steroids
Steroids are absorbed at different rates from different parts of the body. A steroid that works on the face may not work on the palm. But a potent steroid may cause side effects on the face. For example:
Forearm absorbs 1%
Armpit absorbs 4%
Face absorbs 7%
Eyelids and genitals absorb 30%
Palm absorbs 0.1%
Sole absorbs 0.05%

Side effects of topical steroids
Internal side effects
If more than 50g of clobetasol propionate, or 500g of hydrocortisone is used per week, sufficient steroid may be absorbed through the skin to result in adrenal gland suppression and/or eventually Cushing's syndrome.
Adrenal Gland Suppression. Topical steroids can suppress the production of natural steroids, which are essential for healthy living. Stopping the steroids suddenly may then result in illness.
Cushing's Syndrome If large amounts of steroid are absorbed through the skin, fluid retention, raised blood pressure, diabetes etc. may result.

Skin side effects
Local side effects of topical steroids include:
Skin thinning (atrophy) and stretch marks (striae).
Easy bruising and tearing of the skin.
Perioral dermatitis (rash around the mouth).
Enlarged blood vessels (telangiectasia).
Susceptibility to skin infections.
Disguising infection e.g. tinea incognito.
Allergy to the steroid cream.

The risk of these side effects depends on the strength of the steroid, the length of application, the site treated, and the nature of the skin problem. If you use a potent steroid cream on your face as a moisturiser, you will develop the side effects within a few weeks. If you use 1% hydrocortisone cream on your hands for 25 years, you will have done no harm at all (except for having wasted a lot of money!)
Bruising
Skin thinning
Prominent capillaries
Stretch marks
Adverse effects of topical steroids

How to use topical steroids
Ask for specific instructions how to use your topical steroid(s). See DermNet's information about fingertip units. Which one, where, when, how often and for how long? Cream, ointment or lotion? This is particularly important if:
You are using strong steroids over large areas of your body.
You have been asked to use plastic to cover treated areas (occlusion).
Your skin condition persists for more than two or three weeks.
You are a child.
Topical steroids are very effective medications. They work by reducing inflammation, and when used correctly are very safe. They should not be used as bleaching creams.
Apply topical steroids only to the areas affected by the skin disease, and generally only once or twice daily. If your skin is dry, apply an emollient frequently.

This is a part of an article on Rxlist.com about topical steriods.

General
Systemic absorption of topical corticosteroids has produced reversible hypothalamic-pituitary-adrenal (HPA) axis suppression, manifestations of Cushing's syndrome, hyperglycemia, and glucosuria in some patients.
Conditions which augment systemic absorption include the application of the more potent steroids, use over large surface areas, prolonged use, and the addition of occlusive dressings.
Therefore, patients receiving a large dose of a potent topical steroid applied to a large surface area or under an occlusive dressing should be evaluated periodically for evidence of HPA axis suppression by using the urinary free cortisol and ACTH stimulation tests. If HPA axis suppression is noted, an attempt should be made to withdraw the drug, to reduce the frequency of application, or to substitute a less potent steroid.
Recovery of HPA axis function is generally prompt and complete upon discontinuation of the drug.
Infrequently, signs and symptoms of steroid withdrawal may occur, requiring supplemental systemic corticosteroids.

Children may absorb proportionally larger amounts of topical corticosteroids and thus be more susceptible to systemic toxicity (See PRECAUTIONS-Pediatric Use).
If irritation develops, topical corticosteroids should be discontinued and appropriate therapy instituted.

In the presence of dermatological infections, the use of an appropriate antifungal or antibacterial agent should be instituted. If a favorable response does not occur promptly, the corticosteroid should be discontinued until the infection has been adequately controlled.

Laboratory tests
The following tests may be helpful in evaluating HPA axis suppression: Urinary free cortisol test; ACTH stimulation test.
Carcinogenesis, Mutagenesis and Impairment of Fertility
Long-term animal studies have not been performed to evaluate the carcinogenic potential or the effect on fertility of topical corticosteroids.
Studies to determine mutagenicity with prednisolone and hydrocortisone have revealed negative results.

Pregnancy
Teratogenic Effects-Pregnancy Category C. Corticosteroids are generally teratogenic in laboratory animals when administered systemically at relatively low dosage levels. The more potent corticosteroids have been shown to be teratogenic after dermal application in laboratory animals. There are no adequate and well-controlled studies in pregnant women on teratogenic effects from topically applied corticosteroids. Therefore, topical corticosteroids should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Drugs of this class should not be used extensively on pregnant patients, in large amounts, or for prolonged periods of time.

Nursing Mothers
It is not known whether topical administration of corticosteroids could result in sufficient systemic absorption to produce detectable quantities in breast milk. Systemically administered corticosteroids are secreted into breast milk in quantities not likely to have a deleterious effect on the infant. Nevertheless, caution should be exercised when topical corticosteroids are administered to a nursing woman.

Pediatric Use
Pediatric patients may demonstrate greater susceptibility to topical corticosteroid-induced hypothalamic-pituitary-adrenal (HPA) axis suppression and Cushing's syndrome than mature patients because of a larger skin surface area to body weight ratio.
Hypothalamic-pituitary-adrenal (HPA) axis suppression, Cushing's syndrome, and intracranial hypertension have been reported in pediatric patients receiving topical corticosteroids. Manifestations of adrenal suppression in pediatric patients include linear growth retardation, delayed weight gain, low plasma cortisol levels, and absence of response to ACTH stimulation. Manifestations of intracranial hypertension include bulging fontanelles, headaches, and bilateral papilledema.
Administration of topical corticosteroids to pediatric patients should be limited to the least amount compatible with an effective therapeutic regimen. Chronic corticosteroid therapy may interfere with the growth and development of pediatric patients.