The Nightmare That Is Not Knowing – Eczema, HFMD, & GCS

It has been a crazy few weeks. For those who don’t know, Noah developed an extremely bad rash that has only gotten worse the past 3 weeks. We’ve been going back and forth to a GP, his PD, and even once to a hospital emergency room to find answers. But now, 4 diagnoses later, I think we’ve gotten our answer and can finally look forward to Noah’s recovery.

The First Rash

His first rash appeared on 23 June. We were on a cab on the way to a lunch appointment when I noticed small pinkish bumps on his right wrist. There were no more than 10 bumps cluttered together, but because he had a fair bit of contact with plants and had tried new fruits during the week, I was worried it was an allergy. As you can see from the picture below, it was hardly visible but still warranted a visit to the GP by my standards.

Eczema

We brought him to the GP and was told that it was just an eczema flare. I felt it was a little weird, considering that his last eczema flare was when he was a month old. But I guess because he had a history, it was possible. We were told to keep him moisturized and dressed in cool clothing since perspiration can contribute to skin irritation and eczema.

The Fevers

On 27 and 28 June, Noah developed a low grade fever on both evenings. We gave him Paracetamol and the fever was gone almost immediately. We also noticed that his appetite was poor, which was a pretty big deal for my little foodie. His rash was also starting to spread because they were now on both his wrists.

Eczema

Just to be sure, I brought him back to the GP only to be reassured again that it was still his eczema. The GP gave a slightly stronger steroid cream to help with the itch.

Getting a Second Opinion

By 2 July, it seemed like the steroid cream wasn’t helping because the rash was still spreading. We decided to make a visit to his PD to seek a second opinion. His PD also confirmed that it was eczema and gave a third steroid cream that was apparently stronger than the first two given by the GP.

Side Complication

On 5 July, an insect bite on Noah’s right leg had become red, swollen, and had small blisters surrounding the bite.

Eczema

He had gotten this once before so I knew it was infected. I brought him back to the GP where he confirmed the infection. We were asked to use the steroid cream given by Noah’s PD on his infected bite and to monitor for red flags such as fever or lethargy.

During this period, his rash was also worsening. The bumps on his wrists were growing bigger and there were now bumps on his knee as well. Again, the GP assured it was still the eczema at work.

Eczema

Eczema

HFMD?

Apart from the two low grade fevers Noah had on 27 and 28 June, Noah had regained his appetite and was his usual active self. But by the night of 7 July, I had an inkling that Noah’s rashes were definitely not just an eczema flare because they started to look like this.

Eczema

Eczema

And by the morning of 8 July, this appeared on the sole of his feet.

Eczema

We were now convinced that Noah had Hand, Foot, and Mouth Disease (HFMD). It was a Sunday so we rushed him to Mount Alvernia’s A & E. During triage, the nurse spotted an ulcer at the back of Noah’s throat which further convinced us that it was HFMD. Strangely enough, the doctor told us it was an eczema flare of moderate intensity! I was on the brink of pulling my hair out right there and then. I asked why, if it were really an eczema flare, there were red spots on Noah’s palms and soles. Or why the nurse said she spotted an ulcer at the back of his throat. We also asked about the possibility of chicken pox, seeing how the bumps were raised and looked like little blisters. But the doctor assured that it was not HFMD and, even more so, not chicken pox. He shared that children with chicken pox are often lethargic. And there in his room was a little energizer bunny, running around and trying to type on his computer. We were sent home with two bottles of antihistamines and told to continue to keep Noah cool and moisturized.

Still unconvinced, we brought Noah back to his PD on 9 July. By now, his rashes looked like this.

Eczema

Within 2 minutes of being in the room, his PD confirmed that Noah had a combination of HFMD and a bad eczema flare. He shared that Noah seemed to have contracted an uncommon strain of the HFMD virus and that his eczema has caused the HFMD spots to present as bigger, raised bumps instead. As with all other straightforward HFMD cases in children, there isn’t much a doctor can do. HFMD is considered a self-limiting disease where the body fights off the virus on its own without treatment. Instead, the doctor provides medication or cream to relief symptoms of HFMD such as itching.

Downhill

Unfortunately, things didn’t improve. We woke up to Noah’s legs looking like this on 11 and 12 July respectively.

Eczema

Eczema

During his visit to the PD, we were told that the rashes would peak within the next few days. So while we were extremely worried, we gave Noah’s body time, thinking that this was the period where the rashes were peaking. But seeing how the red bumps were now merging to form big red patches, I couldn’t just sit by and watch.

I emailed these pictures to his PD, asking if this was what he meant by “peaking”. His PD told us that while the smaller red bumps still look like HFMD, the bigger red patches don’t. We were referred to a skin specialist for a second fourth opinion. We made an appointment for the very next day.

The Final Diagnosis

After meeting with the skin specialist on 13 July, we were told that Noah has a condition called Gianotti Crosti Syndrome (GCS). GCS is a rare childhood skin condition that typically affects children as young as 6 months old. GCS may first present as small red bumps which then merge to form bigger red patches or blisters. The doctor shared that in Noah’s case, his GCS may have been a response to his body fighting off a virus. And while it sounds scary, the doctor assured us that GCS is neither dangerous to Noah nor contagious to anybody else. In fact, like HFMD, GCS typically does not require treatment and will go away on its own. Bad news is, it would take between 1 – 3 months for a full recovery. We were given a stronger steroid cream to help with his itch and told to bring him back after 4 weeks if his condition doesn’t show signs of improvement.

Recovery

As of today, Noah’s skin has shown a huge improvement. The redness has faded to a nude pink and the big patches have also shrunk in size. Most importantly, Noah is still as active as ever and is eating extremely well. He’s got a slight hint of a runny nose and cough because we have been keeping him confined in an air-conditioned environment as advised by his PD. But we will deal with that if and when it comes. I’m just glad this worrisome guessing game is finally over and we know exactly what is causing his skin to react this way and how to help him.

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