Dr. Google may have too much to offer the detective mom scanning websites and blogs for medical advice, often after the kids are in bed and after many hours have already been spent on their devices. While their regular traditional docs may offer up the usual menu of pharmaceuticals, many parents are seeking more ‘natural’ (my least favorite word in the integrative lexicon) therapeutics.

We are there to help with our more diverse treatment options. However, I don’t throw the baby out with the bathwater (my favorite metaphor as you have probably guessed) and offer the least toxic, most effective, and hopefully somewhat affordable therapies based on pragmatism and common sense honed on the streets of my growing up on the Lower East Side. This approach is invaluable when it comes to the visible and often distressing issue of skin disorders. Who would have thought!

Rash Madness

The following cases have all presented over the past few months via Telemedicine.

Case 1. The Garcia family decided two new baby kittens would be just perfect companions for their three- and six-year olds during social isolation from COVID. They noted that the kittens had ‘dry patches’ on their skin which their own children were sharing and rubbing over their own faces. The three-year-old developed ring lesions with raised borders and central clearing on the neck and the six-year-old had a matching pair below her eye. Studies have shown that in 30-70% of households where a cat develops ringworm a minimum of one person acquires the infection.

This type of case would normally be a slam dunk; topical anti-fungals are quick, affordable and relatively non-toxic, such as clotrimazole. But the parents did not want pharmaceuticals. So, my easy fix became my Plan B, and I turned to Plan A, Sepia 30c two times a day for 14 days with 2 drops of tea tree oil in a carrier oil such as olive or coconut oil (with its own antifungal benefits work well), two times a day topically, with a few drops of vitamin E, carefully applied, since the location of the infection was near the eye. Allergic reactions can occur with potent essential oils as well as accidental introduction into the eye. The Garcia kids did great, although it did take almost three weeks to clear their tinea corporis infections. Their vet did prescribe clotrimazole along with diluted apple cider vinegar over the affected skin for the kittens. I was impressed!

Case 2. Josh is an active 16-year-old boy, bored during school closures from COVID, and spent a lot of time on his mountain bike. He was covered with an array of road rashes in various stages of healing from his biking adventures. One particular area on the shoulder was warm, erythematous, contained a few vesicles, some slight streaking towards his pectoral muscle and was painful with touch/showering. The mom was reluctant to bring him to the ER since he had a prior visit to the ER for road rash gone cellulitis which bought him two antibiotics (to cover for MRSA). My inclination was to begin cephalexin only since he wasn’t at a high risk for MRSA, but mom preferred a non-pharmaceutical approach, if possible.

Having a low threshold for bringing in pharmaceutical antibiotics if needed, the following regimen was created for Josh: Sulfur 30c three times a day (a great cellulitis remedy), topical homeopathic calendula ointment two times a day to be washed off in between since it can get crusty (another skin ointment must-have for kids), organic reishi mushroom powder (https://medicinal-foods.com/shop/reishi-mushroom-powder-organic/), doubling the dose (which boosts white blood cells and has beta-glucans activity; can activate macrophages and natural killer cells), topical Argentyn 23 gel (https://www.argentyn23.com/argentyn-23-silver-first-aid-gel/) and probiotics. Now this may seem like quite a bit to do for a teen, but the family was willing to try this creative concoction in order to avoid oral pharmaceutical antibiotics. I was contemplating the addition of an herbal antibiotic formula if necessary as well (https://biocidin.com/products/biocidin-capsules).

Within 24 hours, Josh stated that the pain resolved and the erythema was decreased. The evidence of lymphangitic red streak had disappeared (which was one of my big concerns), and I didn’t need to add anything to his treatment plan. Phew.

Case 3. Yasmin is a seven-year-old gal who loves hiking with her dog. After an afternoon of rolling down a hillside, Yasmin complained of a pruritic rash covering most of her legs and arms, in linear red streaks, with thickening of the skin, vesicular eruptions, and scattered weeping lesions. Within 24 hours, the rash covered most of her face as well and the parents were concerned that she had chicken pox.

Chicken pox was a good thought because of the vesicular component and extent of the rash, but the presentation of the rash wasn’t in the right order, wrong time of year, lack of exposure, and no systemic illness. (The patient was unvaccinated for chicken pox.) Only 20% of us do not react to the allergic oils of poison oak (poison ivy for the East Coasters), and every practitioner has at some time treated this common affliction. The extreme pruritus will have most adult patients begging for a steroid prescription such as prednisone since antihistamines (diphenhydramine) are only modestly helpful.

As an integrative practitioner, I try to avoid steroid usage since we have so many other tools to employ and I am concerned regarding the immune suppressive effects. I recommended an organic oatmeal bath (which contain avenanthramides and phenols, both anti-inflammatory) which can help soothe the itching. I prefer colloidal oatmeal, but that may be hard to find. Grinding the oatmeal and adding it to the bath and soaking in tepid water for 15-20 minutes can bring immediate itch relief. When the oatmeal bath doesn’t do the trick, apple cider vinegar can be dabbed on itchy lesions, more useful when the affected area isn’t too large. Aloe vera gel topically is soothing and I heavily prescribe topical homeopathic cardiospermum tincture 10% (http://www.florasone.org) for patients all summer long for itchy maladies such as eczema flares, insect bites, and allergic reactions. Apply frequently since its antipruritic effects last just a few hours.

For the non-homeopaths, prescribing a combination remedy (https://www.hylands.com/products/hylands-poison-ivy-poison-oak-relief) may be the easiest way to go, administer every few hours and the dosing can be tapered as the child becomes less symptomatic. I use Rhus tox 30c preventatively for those individuals that are extremely allergic to the sumac family of plants. Once the rash is in full bloom, I find the common rhus tox remedy not to be too effective. Calendula ointment, again, is a useful adjunct to calm the inflamed skin as well. It took almost two weeks for this case to resolve, but the intensity of the itch was better within two to three days; and we avoided superinfection from scratching with a bit of ice cream medicine. I’m not too proud to offer an occasional bribe!

Case 4. Sofia is a two year old, who presented with a rash on her foot for several days. The rash was serpiginous, raised, non-pruritic and approximately 10 cm in length. The mom denied travel history or exposure to animals, nor were any other family members affected. Mom did bring Sofia to the park to play in the sand box on a regular basis and Sofia may have enjoyed an occasional mouthful of sand. (And according to Murphy’s Law of Medicine, this patient was the last of the day. Smile.)

So, not your typical rash. For those practitioners that don’t treat children or people that work with animals frequently, may not be familiar with the cutaneous larva migrans rash of Toxocara canis (or T. catis). Infection is caused by the larvae of ascarid roundworms of mammals when ingesting the infective eggs or undercooked meat of infected hosts. The eggs can hatch and larvae can circulate through the body. The damage is caused mechanically and by local reactions. Many kids may not have any symptoms, or they may range from mild to severe. In countries where this infection is prevalent, children are often not treated since infection may clear spontaneously when the larvae die.

Trying to calm the mom who was freaking out was harder than treating the infection, which is quite straightforward. In this case, because of the potential organ involvement and the mom’s nervous system, I decided to use a pharmaceutical, thiabendazole (500mg/5ml), 250 mg two times a day for two days. Occasionally a second dose is recommended if active lesions are still present two days after the completion of the drug (which this patient did not require). However, the mom reported that Sofia had some mild diarrhea and gassy tummy starting before the rash began and increasing afterwards. I did several stool samples for ova and parasites to test for other potential uninvited guests and began the patient on homeopathic treatment for parasites (https://desbio.com/product/ver/) as well as probiotics. Her symptoms resolved completely within five days, and her stool tests did not reveal any co-infections.

The art and beauty of what we do lies within the experiential framework of our practices. There was a time 20 years ago when simple homeopathic remedies may have resolved a dermatologic issue. But our environment and our kids have changed requiring more complex therapies. Thus, when creating integrative treatment plans, I employ the judicious usage of pharmaceuticals, select various homeopathics to be administered both locally and systemically, protect and support the microbiota, and offer herbals/essential oils and whatever dietary interventions are required to eliminate a pathogen, calm a reactive immunologic response, and to regain the terrain. This strategy seems to work well, and most parents find comfort in an integrative approach. And it’s fun.