UNC pediatric dermatology appoint, take 1

Two weeks ago Ben and I headed to Chapel Hill for him to see an expert in pediatric dermatology.  The reason for the visit was to discuss his aplasia cutis, but I figured I would ask about his eczema as well.


The visit started with a medial resident meeting with us first.  The medical resident had been a pediatrician for years and was now doing a residency in dermatology.  Her reaction to the eczema and advice was consistent with pediatricians we have seen (use steroid cream Elidil as triamcinolone does not work). We have been using Elidil though and he was raw and bleeding at the appointment. She talked about using Zyrtec which he already takes daily.  In addition, her reaction to the aplasia cutis was similar, she knew of it in theory but had never seen one and seemed confused that I thought a doctor could do anything about it.


Enter Dr. Dean Morrel, the director of the residency program and professor of pediatric dermatology.  He addressed the eczema first and asked the resident what she thought.  He waved at her answers and pointed out that focusing on changing the over the counter cream or allergy medicine was not going to work.  He pointed out that eczema that does not respond to triamcinolone or Elidil is very bad eczema indeed.  He prescribed the strongest steroid ointment on the market--clobetasol.  He said that he would not need to use it daily (unlike anything else) as it would knock a eczema flare out.  This is good news as I hate using the steroid creams and hate the idea of using it daily.  Guess who currently has NO eczema on his skin?  I don't know when that last happened.  He told me today that his ankles don't hurt anymore.


Then addressed the aplasia cutis.  Based on my research (http://emedicine.medscape.com/article/1110134-overview), I was concerned that Ben's aplasia cutis might be associated with another condition. Dr. Morrell did not think so.  He also thinks Ben is a good candidate for surgery.  We had been told that we needed to wait until his head stopped growing, but Dr. Morrell explained that is not correct.  With Ben so young, his skin has a lot of flexibility.  As he gets older, his skin will be less flexible.  He said the surgery would have to be before his teenage years. Dr. Morrell does not do surgeries, so Ben will need to see Dr. Craig Burkhart (https://www.med.unc.edu/derm/the-department/craig-burkhart-md).  Dr. Burkhart will be able to answer more questions about the surgery.  We see him on February 12th. He will be able to tell us how many surgeries will be required to fix it, as well as give another opinion about whether we should operate at all.