... and we have a diagnosis!

The baby has had these little bumps and rash around her mouth off and on for the last month or so.

It gets worse, then it gets better.

And then it gets worse again.

And then it gets better.

No tweaking of diet, changing detergent, or using different shampoo has worked.  After a bad reaction to some frozen yogurt, we pulled her off dairy for five days, only to give her a big bottle of cow's milk last night and to see NO REACTION whatsoever.  Same with gluten.  And eggs.  And so on.

It was very frustrating.

Two different primary care doctors weren't able to help us.  "Sometimes babies just get rashes.  I wouldn't worry about it."  Well, I was worrying about it, and so I didn't listen to them.

Thankfully our insurance doesn't require these primary care doctors to refer us to a specialist; we just went ahead and made an appointment with a pediatric dermatologist ourselves. 

And after visiting with two specialists today, we now know that the baby has Perioral Dermatitis. 

It's not alarming, and it's not terribly uncommon (though the specialists weren't surprised that the primary care doctors weren't able to diagnose it correctly) and we can treat it with topical antibiotics for six weeks and see how she responds to them.  We're not crazy about giving her low doses of antibiotics for extended periods of time, but since it's the standard of care for this condition, we're okay trying it for six weeks and re-evaluating in the fall.  She may have problems off and on for a few years, and we may have to periodically use the topical antibiotics to correct it again.  But the specialists assured me that it wasn't anything that would scar or lead to other problems, and it would likely be gone in a few years.

It's odd she has it: we done use flouride toothpaste for her, and that can trigger this.  And we don't use steroid creams for her either, which can also trigger it.  It's also especially common in children with darker skin, and our baby is about as white as they come.  So you can't blame the average doctor for not thinking of it.  But the specialists said they had seen cases where a baby had been very sick with something else (like the roseola we had back in June) and when their immune system is compromised (like with the strep we had last week) sometimes it just happens.

Saliva and food getting on her face can make it worse almost instantly, which is why we thought that perhaps the oatmeal/yogurt/anything else she was eating and getting on her face was causing the problem.  It makes it worse, yes.  But thankfully it's not the root of the problem.

I can stop freaking out about food allergies, because they said that it would be freakishly bizarre if what the baby had turned out to be a food allergy and NOT Perioral Dermatitis.  They didn't say "freakishly bizarre" -- I think they said something like "extraordinarily unlikely" -- but in any case, the Google calendar for all the foods she was eating can be safely ignored now.

We're still learning and reading about this, and I suspect we will have a LOT of follow-up questions for our follow-up visit with the specialists.  But for right now, we're just happy to have an answer from two rock-star, top of their field specialists.

Living in the Boston area certainly has some perks, and solid medical care is definitely one of them.  We have some of the highest concentrations of some of the best trained doctors in the world, and seeing specialists like the ones I saw today really is reassuring. 

We're all going to be okay.  If anything, when things like this happen, I just remind myself that we're ever so blessed that our biggest concern right now is a slight skin rash.