Emily - the dermatological atlas (update with graphic pics!)

Sorry I haven't posted an update about Emily... We went to see Dr. Vanderhooft at Primary Children's Dermatology on Monday, September 8th. She is the head of the Hemangioma team on the dermatology end of things. Dr. Grimmer (the hemangioma surgeon) wanted us to go see her to get her take on what to do with Emily. We came away from the appointment a little more confused than when we went...

Dr. Vanderhooft told us that she didn't think that surgery was an option because it would leave a huge scar because of the size of the hemangioma. She was more leaning towards steroid injections to shrink it. Dr. Grimmer had said surgery but no steroid injections (sigh...). The biggest concern at this point is obviously the ulcerations. Dr. Vanderhooft gave us a new cream to try - Biafine. She hadn't used it much (as it's new to the market) but she had read good things about it. She also wanted us to use a Tegaderm/bioclusive dressing (it's semi-permeable but promotes healing).

Well, it took us a few days to get the Biafine, as the pharmacy had to order it. In the meantime, I thought that the ulcerations were looking really bad and Emily also had a horrible diaper rash, so I took her into Dr. Gould (our AWESOME pediatrician). He has been such a great advocate for Emily and a good friend as well.

After looking at Emily and talking to us for over an hour, he declared that Emily is a walking dermatological atlas. She has her ulcerations, ezcema on her arms and legs, and a yeast diaper infection. Poor little thing - her skin looks horrible. He gave us some more suggestions for the ulcerations, Nystatin for the yeast, hydrocortisone for the ezcema, Tylenol with codeine for when the pain gets really bad. He was also going to talk to Dr. Vanderhooft to clarify what the plan was.

To make this long story a little shorter, after talking to some wonderful nurses at the hospital where I work, we have changed the dressing that we are using on the ulcerations, changed the way we are cleaning them, and have been using the Biafene for over a week now. I think that the ulcerations are finally looking better. If you look at the previous pictures of the ulcerations, you wouldn't believe it, but I didn't post pictures when they were looking really bad. She doesn't scream quite as bad when we are doing the dressing changes.

Unfortunately, the yeast diaper rash got worse on the Nystatin and it spread down her legs to her knees and up to her chest. She is now on Diflucan orally for 10 days. She also has some unknown rash on her arms and legs. We are hoping that whatever the Diflucan doesn't clear up, we can treat with a lot of moisture (Aquaphor).

We go back to Dr. Vanderhooft on Monday to follow-up. Below are current pics of the ulcerations with the dressing and medication on, without the dressing and after cleaning, and all of the skin supplies that we are currently using on Emily.