June 25, 2009


When I heard that the baby was 'thrashing around' and crying, I didn't know what to make of it. Her father said that she had a rash, and he wondered if this new behavior was related.

Here's a tip: don't ask the doctor, 'what could it be?' I have whole textbooks filled with awful diseases that your child doesn't have and won't get. Try to focus on what they do have. But an important part of my job is indeed to worry about what a problem could be. So during the phone conversation with the baby's father, I thought of the possibilities. These included everything from using the wrong detergent on her onesies to serious illnesses with seizures. Though I was reassured by some basic screening questions over the phone, I decided to see the baby in person that night. It was Saturday on a 3-day Memorial Day Weekend, and I didn't want to wait until Tuesday when the office was scheduled to open. The baby was only 2 months old.

When I got to the house, the baby's parents gave me more history. They said that this has been going on for about a week. She didn't have fever or any other symptoms of being sick. They noticed a couple of rough patches on her skin which they have been treating with a calendula cream. Over the week, despite more frequent treatment with the calendula cream, the rash has been getting much worse and more widespread over her body.

I felt the rash, which covered her forehead and cheeks, behind her ears, her elbows and lower legs, and had patches all over her body. She had eczema. In older kids, eczema typically affects different places on the body than it does on babies. Her places and the appearance and feel of the rash were characteristic of eczema for kids her age.

Eczema seems to travel genetically with allergies and asthma. Sometimes a parent will have one of these and the child will have another or some combination. In this case, the father said that he had eczema as a child and the mother had a little eczema now.

But I wondered what caused it to erupt so suddenly. Though eczema usually goes through times of improvement and worsening, these don't usually happen in just a few days. I had seen the baby in my office about 2 weeks earlier, and the parents didn't mention it and I didn't notice it. I asked them to tell me about absolutely everything they put on the baby's skin. It made my job a little easier when they showed me the product. It was very expensive, and from a very successful all-natural, organic, line of 'Natural Medicines.' (Except for removing the actual brand name, the following is an exact quote from the company's description of the product.)

"Brand Name® Calendula Cream is excellent for use on general diaper area, cradle cap, on cuts and scrapes, and may be used on face and body for extra-dry or sensitive skin. Botanically based, our light and fluffy Calendula Cream contains the active ingredient of Calendula, which has been used to heal the skin for centuries. Brand Name® Calendula Cream offers deep hydration, absorbs completely, and leaves skin feeling satiny smooth. Use daily for everyday protection and especially when the air is dry and baby's skin needs relief. Our customers have reported excellent results with Brand Name®'s Calendula Cream in their fight against eczema, perioral dermatitis, and other skin sensitivities. The entire family can benefit from this soothing, multipurpose cream. We suggest that you try Brand Name® Calendula Cream and/or Brand Name® Botanical Moisturizing Cream in combination with any of our Shampoos & Bodywashes. Also add Brand Name® Calming™ Soothing & Healing Spray, and any of our non-chemical sunscreens to your skin care regime.
  • Contains organic and sustainably grown ingredients
  • Active ingredient: Calendula officinalis is the common pot marigold and is well known for its skin healing properties
  • Safe, gentle and effective for cuts, sores and general skin abrasions
  • May be used around the diaper area for simple rashes
  • Hypo-allergenic
  • Works very well on cradle cap and chapped skin
  • Light and fluffy consistency"

What, exactly, does 'hypo-allergenic' mean? I certainly don't know in the context of any calendula product. Calendula is from marigold flowers. Marigolds are in the same family as ragweed, which is probably the most common pollen that people are allergic to, maybe as much as 10-20% of all Americans. This has been studied. In about 2% of people, using calendula on the skin causes an eczema-like rash.

The poor baby was suffering and itchy. I sent a parent out immediately to get some medicated cream that I hoped would start helping her feel better right away. Within a couple of days of stopping the calendula and starting some very low-strength medicated cream, the rash was nearly gone and the thrashing had stopped.

Except to instruct the parents to stop using the calendula and stick to the regular medicated cream right now, I didn't say anything about the product they had been using. It wasn't their fault that the label does more than imply—it states quite clearly—that the product is hypoallergenic and safe to use. And I wondered why they let this rash spread and grow along with their baby's discomfort as they used something, though with the best of intentions, that was clearly not working. If I had prescribed a cream for the baby which was clearly not working, and the baby was getting worse and worse, would they have continued using it for a week? Would they have called me after a day or two, concerned? What were their expectations for this product? Why did they wait until the baby had such a severe, extensive and obvious rash? What was there about this product that allowed them to tolerate its ineffectiveness much longer than I suspect they would have tolerated a prescription product?

The rapid worsening and extension of the baby's rash, I believe, was the result of a reaction to the calendula. It's common enough (about 1 in every 50 people) that I think it should be a caution on the label. Especially because it's intended use is for the very rash that it causes. Because it's sold as a natural supplement, the manufacturer doesn't have to do this.

This may or may not be related to the Bollywood version.

1 comment:

Please let me know what you think. Do you know a child or situation like this?