I have to admit that I had not heard of Dr Bernhoft before. I was alerted to him through the discussions about him on this blog. So, I had a look. What I found amazed me.

On his website, Bernhoft states the following:

Dr. Bernhoft is one of the nation’s leading practitioners in the field of environmental medicine. He comes to his expertise not only through extensive academic and professional training and decades as a practicing physician and surgeon, but also from the uniquely motivating perspective of having been a patient himself who had to fight desperately for his life and was literally forced to find a way to heal himself from an illness that left his MD colleagues at a loss for diagnosis and treatment…

His personal quest for survival carried him into cutting-edge advanced medicine, including gene-environment interactions. He found out that his gene which codes for an enzyme called MTHFR was hypoactive, and a second, which produces GSTM1 was absent, leaving him susceptible to poisoning by a wide range of metals and chemicals…

Because of his unique personal experience, combined with his outstanding professional credentials, he is one of the most effective spokespeople in the cause of environmental healing.

His ‘outstanding professional credentials’ consist of amongst others ‘28 peer reviewed medical articles‘, he claims. My Medline search located just 11:

  1. Cadmium toxicity and treatment. Bernhoft RA.ScientificWorldJournal. 2013 Jun 3;2013:394652. doi: 10.1155/2013/394652. Print 2013.PMID: 23844395 Free PMC article. Review.
  2. Mercury toxicity and treatment: a review of the literature.Bernhoft RA.J Environ Public Health. 2012;2012:460508. doi: 10.1155/2012/460508. Epub 2011 Dec 22.PMID: 22235210 Free PMC article. Review.
  3. Clinical detoxification: elimination of persistent toxicants from the human body.Genuis SJ, Sears ME, Schwalfenberg G, Hope J, Bernhoft R.ScientificWorldJournal. 2013 Jun 6;2013:238347. doi: 10.1155/2013/238347. Print 2013.PMID: 23844383 Free PMC article. No abstract available.
  4. Incorporating environmental health in clinical medicine.Genuis SJ, Sears M, Schwalfenberg G, Hope J, Bernhoft R.J Environ Public Health. 2012;2012:103041. doi: 10.1155/2012/103041. Epub 2012 May 17.PMID: 22675371 Free PMC article. No abstract available.
  5. Cholangitis after endoscopic sphincterotomy in patients with stricture of the biliary duct.Kracht M, Thompson JN, Bernhoft RA, Tsang V, Gibson RN, Blumgart LH.Surg Gynecol Obstet. 1986 Oct;163(4):324-6.PMID: 3764637
  6. Composition and morphologic and clinical features of common duct stones.Bernhoft RA, Pellegrini CA, Motson RW, Way LW.Am J Surg. 1984 Jul;148(1):77-85. doi: 10.1016/0002-9610(84)90292-7.PMID: 6742333
  7. Pigment sludge and stone formation in the acutely ligated dog gallbladder.Bernhoft RA, Pellegrini CA, Broderick WC, Way LW.Gastroenterology. 1983 Nov;85(5):1166-71.PMID: 6618107
  8. Vesicular transport of horseradish peroxidase during chronic bile duct obstruction in the rat.Renston RH, Zsigmond G, Bernhoft RA, Burwen SJ, Jones AL.Hepatology. 1983 Sep-Oct;3(5):673-80. doi: 10.1002/hep.1840030508.PMID: 6618434
  9. Peritoneovenous shunt for refractory ascites: operative complications and long-term results.Bernhoft RA, Pellegrini CA, Way LW.Arch Surg. 1982 May;117(5):631-5. doi: 0.1001/archsurg.1982.01380290081014.PMID: 7073482
  10. Biliary stricture.Way LW, Bernhoft RA, Thomas MJ.Surg Clin North Am. 1981 Aug;61(4):963-72. doi: 10.1016/s0039-6109(16)42492-8.PMID: 7280936
  11. The effects of a low level of dietary cadmium on blood pressure, ’24Na, ’42K, andwater retention in growing rats.Doyle JJ, Bernhoft RA, Sandstead HH.J Lab Clin Med. 1975 Jul;86(1):57-63.PMID: 1151143
Few, if any of them identify him as a leading expert in anything. Confused by this contradiction, I re-consulted Bernhoft’s website and found this:
We carry a wide selection of physician grade supplements, from beneficial probiotics, trace minerals, fish oils and other multivitamins that help detoxify and support the immune system. 
That puzzled even more. As far as I am aware, the term ‘physician grade’ is not a officially recognised qualifier; it seems to be a meaningless word that misleads consumers. More importantly, I can find no good evidence that probiotics, trace minerals, fish oils and other multivitamins help detoxify and support the immune system. Could this be another invented myth?
But my confusion was about to increase even further when I noticed that Bernhoft has another website; and on this one he no longer is an expert in in environmental medicine, but ‘an Ojai California Bioidentical Hormones Specialist‘. Is this another invented term?, I asked myself.
Now, I was understandably keen to learn more and discovered that Bernhoft makes many claims on his website:

The following are typical symptoms of hormone imbalance in both men and women:

  • Hot flashes and night sweats
  • Fatigue
  • Anxiety, depression, and irritability
  • Low libido
  • Memory lapses and trouble concentrating
  • Weight gain
  • Headaches
  • Insomnia and sleep apnea
  • Lack of muscle tone

Regardless of your age, gender, or specific symptoms, you can find relief with Bioidentical Hormone Replacement Therapy (BHRT).

Naturally, I am keen to learn what conditions Bernhoft’s BHRT can cure. Brace yourself, the list is long:

Women’s Conditions Treated With Bioidentical Hormones

Robin A. Bernhoft, M.D. at the Bernhoft Center for Advanced Medicine specializes in Bioidentical Hormone balancing for women, which includes addressing the symptoms of hormonal imbalance and customizing individual treatment programs using Bioidentical Hormone Replacement Therapy. Robin A. Bernhoft, M.D. will test each woman’s hormone levels to determine deficiencies, dominances, and imbalances, and he will work closely with each woman to find the correct dosages to restore optimal health. Some of the conditions that Doctor Bernhoft uses Bioidentical Hormone Replacement Therapy to treat in women include:


When you suffer from chronic or poorly managed stress, your adrenal glands do not release the level of cortisol you require to remain healthy and emotionally stable. You may struggle with anxiety, depression, insomnia, fatigue, cravings for sweets, and several other symptoms due to adrenal fatigue. Along with proper nutrition, balancing your hormones with Bioidentical Hormone Replacement Therapy helps you manage stress better by bringing your cortisol levels in balance.


Having too much of the estrogen hormone or an underactive thyroid may cause you to lose hair on your head, arms, legs, or pubic area. If you are diabetic, poor blood sugar control can also cause this problem. Robin A. Bernhoft, M.D. can take a quick blood test to determine if hormonal imbalance is causing this issue. If so, replacing your body’s lost hormones with Bioidentical ones can help you re-grow scalp and body hair.


When feelings of anxiety and depression are unrelated to a specific life event, they are often the result of unbalanced levels of estrogen, progesterone, and cortisol. You may feel weepy, irritable, nervous, guilty, and many other troublesome emotions. Having a hysterectomy or going through menopause tends to increase your risk of anxiety and depression. When anti-depressant medication doesn’t work, it’s more likely you’re experiencing hormonal depression that is treatable with Bioidentical Hormone Replacement Therapy.


Women who are approaching middle age complain of chronic headaches more often than younger women do. This is often because of pending menopause or being at a certain point in their menstrual cycle. An unbalanced amount of the hormone progesterone may also be the cause of this misery. If Robin A. Bernhoft, M.D. discovers a problem with your progesterone, he may recommend that you start Bioidentical Hormone Replacement Therapy along with a daily dose of the vitamin B12.


It’s normal to feel tired when you are under stress or don’t get enough sleep, but chronic fatigue lasting throughout the day is probably a sign of hormonal imbalance. Unfortunately, it causes other problems such as irritability, depression, and lowered resistance to illnesses. Low estrogen levels are often the cause of severe fatigue in women. Balancing your hormones with Bioidentical Hormone Replacement Therapy gives you the energy you need to meet everyday responsibilities and enjoy satisfying relationships.


Cystitis, or bladder infections, occurs when bacteria from outside of the body enter through the urinary tract and cause an infection. Hormonal changes that begin in perimenopause may also cause recurring bladder infections. This is because the bladder, urethra, and vagina lose muscle tone and strength as levels of estrogen slowly decline. Fortunately, you can correct this imbalance by receiving Bioidentical Hormone Replacement Therapy. When the muscles near your bladder are stronger, it’s harder for bacteria to invade.


Uterine fibroids are masses of tissue that grow within the wall of your uterus, in it, or on it. It can result in irregular menstrual bleeding or uterine cancer in rare cases. Normally, estrogen stimulates cell growth in your body while progesterone balances it. Fibroids may be the result of unbalanced levels of estrogen, cortisol, xenoestrogens, and progesterone. Bringing all of these necessary hormones in balance with Bioidentical Hormone Replacement Therapy can help to reduce the risk of fibroids.


Insomnia, which is the consistent inability to fall or stay asleep, is both a cause and an effect of hormone imbalance. The hormonal changes of PMS, perimenopause, and menopause can all cause sleeplessness. Chronic insomnia can also make hormone imbalance worse. When your hormones are balanced through Bioidentical Hormone Replacement Therapy, it has a less inhibiting effect on your ability to fall asleep and stay asleep throughout the night.


IBS is a term that describes pain with bowel movements, urge frequency, a feeling of incomplete bowel emptying, abdominal distension, and several other symptoms. Many women report worsening IBS symptoms just before their period starts. This may occur due to the fluctuation of estrogen and progesterone in the second half of the cycle. Having unbalanced levels of estrogen and progesterone can slow motility in the gut. However, balancing these hormones can greatly alleviate IBS.


Lack of desire for physical intimacy is due to an imbalance in the amounts of estrogen, progesterone, and testosterone in your body. When the latter two hormones start declining, it may cause estrogen dominance. This problem is also associated with weight gain, mood swings, and painful intercourse, all of which further decrease your libido. Balancing estrogen in your body so it doesn’t dominate other hormones is essential to restore your desire for sex.


Menopause is the clinical term for 12 consecutive months without a menstrual period. As you start menopause, your estrogen, progesterone, and testosterone hormones may fluctuate wildly. Although there are dozens of symptoms associated with menopause, the most common ones include hot flashes, night sweats, low libido, mood swings, and weight gain. Replacement therapy with Bioidentical Hormones can help eliminate or reduce multiple symptoms at the same time.


Although the average age of menopause is 51, you may begin perimenopause as early as your mid 30s. Common symptoms include breast tenderness, changes in the menstrual cycle, skin changes, sexual dysfunction, and loss of bone density. These problems occur due to decreasing levels of estrogen and other essential hormones as you age. If your blood work confirms hormonal imbalance, Bioidentical Hormone Replacement Therapy can help you feel more comfortable.


In a normal menstrual cycle, estrogen rises for the first two weeks and then begins to fall. During the second half of the cycle, this process repeats itself with progesterone. If you’re highly sensitive to hormonal changes, you may experience worsening symptoms of PMS. Some of these include bloating, irritability, fatigue, tension, and weight gain. If your PMS symptoms are severe enough to interfere with your quality of life, consider Bioidentical Hormone Replacement Therapy with Doctor Robin A. Bernhoft.


You have a thyroid imbalance when your thyroid, which is a small nodule at the base of your neck, produces too little or too much of this hormone. When you go to a traditional doctor complaining of fatigue or difficulty losing weight, he or she may test your TSH level. However, this may not be enough to determine hormone imbalance. Robin A. Bernhoft, M.D. conducts several medical tests to see if you are a good candidate for Bioidentical Hormone Replacement Therapy.

Men’s Conditions Treated With Bioidentical Hormones

Robin A. Bernhoft, M.D. also specializes in Bioidentical Hormone Replacement Therapy for men, which includes addressing symptoms of hormonal imbalance and customizing individual treatment programs using Bioidentical Hormones. Robin A. Bernhoft, M.D. will apply the newest and most effective methods for restoring optimal hormone balance using Bioidentical Hormone Replacement Therapy. He offers medically supervised programs, which include the most advanced delivery methods to help bring hormone levels back into balance. His programs can also treat the symptoms of andropause, helping men regain their health and confidence. Some of the conditions Robin A. Bernhoft, M.D. uses Bioidentical Hormone Replacement Therapy to treat in men include:


Your adrenal glands release the hormone cortisol in response to stress, exercise, excitement, and low blood sugar. As you age, your body has a harder time balancing your cortisol levels. This can cause unrelenting fatigue, anxiety, sexual problems, and a wide range of other symptoms due to cortisol imbalance in your adrenal glands. Hormone restoration through Bioidentical Hormone Replacement Therapy can help speed up sluggish adrenal glands and provide you with more energy.


Dihydrotestosterone (DHT), which is part of the testosterone hormone, is responsible for hair loss on your scalp, face, chest, back, arms, legs, and groin area. When this hormone is unbalanced, it causes the follicles of your hair to regress and die. High levels of DHT can result in premature balding or thinning hair. If a full head of hair is important to you, remember that Bioidentical Hormone Replacement Therapy can stimulate hair growth.


By the time men reach age 70, they may have only 10 percent of the testosterone hormone they had at age 25. This explains why many men begin experiencing symptoms associated with low testosterone around age 40. Andropause is a term that describes the many physical and emotional changes that occur due to the imbalance of hormones. Testosterone replacement is essential to help you experience long-term symptom relief.


Low levels of testosterone cause an overall feeling of discontent in some men, which is the hallmark characteristic of hypogonadism. Balanced levels of this hormone are so essential that men with hypogonadism receive a diagnosis of clinical depression 400 times more often than men with normal hormone levels do. If you feel hopeless, low on energy, and irritable, ask Robin A. Bernhoft, M.D. to check your testosterone level. Bioidentical Hormone Replacement Therapy can help balance your hormones and improve your outlook on life.


When fatigue is chronic, you lack the energy to focus or keep up with everyday responsibilities. Declining levels of testosterone are often to blame for this problem. Chronic fatigue is also worsened by other symptoms of andropause, including night sweats, insomnia, sleep apnea, increased stress, and irritability. It’s important to note that all-day fatigue is different than feeling tired. Fortunately, balancing your testosterone and other hormones with Bioidentical Hormone Replacement Therapy helps to improve fatigue and all of its associated symptoms.


Cortisol, the stress hormone, can go into overdrive when you are under constant, unrelenting stress. This can cause daily headaches of varying intensity. The drop in testosterone starting at age 30 can also play a role in chronic headaches; Robin A. Bernhoft, M.D. can pinpoint an exact cause with a simple blood test. If your hormones are unbalanced, treatment with Bioidentical Hormone Replacement Therapy can help alleviate headache pain.


You have erectile dysfunction when you can’t get an erection at all or maintain one long enough for satisfying sexual activity. A diminished level of testosterone is the typical cause. This also happens when the brain fails to signal the release of nitrous oxide, which is responsible for blood flow to the penis. Too much of the stress hormone cortisol also plays a role in erectile dysfunction. Balancing testosterone and cortisol with Bioidentical Hormone Replacement Therapy can eliminate or improve this problem.


Gas, bloating, constipation, diarrhea, heartburn, belching, and slow digestion may all be related to imbalanced hormones in your body. Specifically, these problems could originate due to problems with normal thyroid functioning due to too much cortisol or estrogen. Many traditional doctors don’t treat digestion problems correctly because they don’t understand the connection to hormones. When diet, exercise, and medication aren’t working, consider replacing lost hormones through Bioidentical Hormone Replacement Therapy with Doctor Bernhoft.


Because testosterone normally replenishes itself while you are sleeping, struggling with insomnia lowers your testosterone production. This causes a vicious cycle because low testosterone levels cause many sleep disturbances, including insomnia and sleep apnea. While difficulty falling or staying asleep and decreased testosterone production are both normal signs of aging, you don’t have to allow them to affect your quality of life. Providing your body the testosterone it needs through Bioidentical Hormone Replacement Therapy can greatly improve restful sleep.


Elevated stress levels and a weakened immune system can both cause IBS, which may present itself as abdominal pain, gas, bloating, or frequent diarrhea. In many cases, both stress and immune system deficiency are related to unbalanced levels of hormones. This can trigger an attack of IBS. Determining what triggers your symptoms, including certain foods and hormone imbalance, is the first step to helping you feel better. Bioidentical Hormone Replacement Therapy helps to balance the hormones responsible for triggering IBS symptoms.


The desire to have sex less often and erectile dysfunction are often related, but it’s possible to have one without the other. Testosterone stimulates the nerves in the brain to become sexually aroused, so this sensation naturally diminishes as you age. Smoking, drinking too much alcohol, and a poor diet are additional reasons your libido may be low. When combined with a healthy lifestyle, therapy with Bioidentical Hormones helps to improve your sexual desire and functioning.


Low testosterone, which your doctor may also refer to as male menopause, hypogonadism, or andropause, is the term used to describe the multitude of symptoms many men experience as they approach middle age. Your testosterone production actually starts declining one percent every year at age 30. Sexual dysfunction, mood problems, weight gain, and low energy are common problems associated with low testosterone that are correctable with Bioidentical Hormone Replacement Therapy.


Low thyroid levels in men can cause cold intolerance, fatigue, hair loss, weight gain, dry skin, and constipation; as many as one in seven men struggle with hypothyroidism. When the thyroid produces an excess of hormones, hyperthyroidism is the result. This condition has many additional symptoms, including muscle weakness, trembling hands, insomnia, and heart palpitations. Having your thyroid level checked by a hormone specialist such as Robin A. Bernhoft, M.D. and completing Bioidentical Hormone Replacement Therapy are essential to help you feel better.

Ojai, California Bioidentical Hormone Replacement Therapy specialist, Robin A. Bernhoft, M.D. at the Bernhoft Center for Advanced Medicine has helped countless men and women to overcome conditions related to hormonal imbalance or decline. Before beginning a Bioidentical Hormone Replacement Therapy program, Robin A. Bernhoft, M.D. tests the levels of all essential hormones in order to get to the root of patients’ imbalances. He then designs a personalized program using dosages that are unique to each patient. Vast numbers of men and women have been able to achieve peak levels of health with Doctor Bernhoft’s specialized Bioidentical Hormone Replacement Therapy programs.

Yes, I did try to find evidence for these claims. It’s a big job and a frustrating one too, as I was less than successful.

Now I am positively exhausted! Maybe I too need some of Bernhoft’s BHRT ?


13 Responses to Dr. Robin A. Bernhoft and his ‘Bioidentical Hormone Replacement Therapy’ (BHRT)

  • I love the nebulous concept of “Physician Grade”. It reminds me of a current toothpaste (or is it toothbrush – I forget) advert on UK television which recommends using the product so as to “Brush like a professional”. It made me wonder how you brush your teeth like an amateur. And where we find tooth brushing professionals. I had never heard of that profession.

    Electronic components are (or used to be) made in three grades: Domestic, Commercial, and Military, with Military being the highest quality, since lives depend on military equipment working reliably. Maybe medicines are made in different grades too, with the best kept for doctors – it’s (another) conspiracy!

    • I remember seeing a TV advert that said, “after eating, dentists agree that acid causes tooth decay.” I always wondered if they had taken a bunch of dentists out to a restaurant, bought them a really good meal, and then asked, “do you agree that…”

  • Bernhoft. Yet another brass-necked supplement-touting profiteering quack to add to the list.

    Of course Sandra thinks he’s a genius but we know how acute her powers of observation are.

  • Thank you for your website. I am not a physician or medical expert in any way, but I am very curious and love to seek out skepticism if I am presented with something that sounds too good to be true. But in this instance, I am truly worried… My PCP specializes in hormones… I am a woman heading into menopause and she has me on “bioidentical hormones”… I am very interested to find out more about the legitimacy of the treatment. This is the first I have heard of with regards to hormone therapy. I received a “pellet” with testosterone due to being a little low… I was actually on your website trying to find truthful information because there is so much out ther on the web and it is so overwhelming. Normally, I trust my physician, but with the hormone therapy and the endless vitamin/supplement suggestions and recently being told I had “candida overgrowth”.. I just don’t know who to trust anymore. It’s very frustrating. I look forward to reading all of your articles and appreciate that you are here shedding light on all of the trickery going on in “alternative medicine”. THANK YOU!

  • Kristen, I am not a medic either. As a layperson, one or two things you wrote, are causing alarm bells to ring, and I think you could well investigate further.

    The mention of ‘candida overgrowth’ is one of the bell-ringing things. It’s a characteristic (from what I’ve read) of quacks, to diagnose candida overgrowth. How was it diagnosed, if one may ask?
    Genuine candiasis is generally associated with a severely compromised immune system, as found, for example, in patients whose HIV+ status has progressed to AIDS.

    HRT is of course a well-established part of the medical armamentarium for managing menopause. But as for the claims of “bio-identical”, do the claims of benefit really have merit?

    Another alarm bell is ringing because of your mention of “endless vitamin/supplement suggestions”. Do you buy those from the physician?

    Is this physician in fact a genuinely qualified Doctor, with MD and/or MB ChB degrees?

    I stress again that I am not a medical person, and am not giving medical advice. What I have written here is absolutely subject to correction by suitably qualified persons!

    • David,

      FYI,localised candidiasis is very common in anybody undergoing treatment with steroids, and quite common in poorly-controlled diabetics. It is usually easy to diagnose on the basis of clinical appearance, and can readily be confirmed by a microbiological sample. Systemic candidiasis is a different matter entirely, and is as you say a life-threatening problem in individuals who are severely immunocompromised. I am not sure that candida overgrowth is a meaninful term at all, however. The late Professor Frank Odds, who regularly posted wise and well-informed comments on this Blog, devoted much of his career to researching candida and explained all this in some detail on another thread; it was about a year ago, shortly before his death.


      The main component of HRT is some sort of oestrogen, as it is a lack of oestrogens that cause the symptoms of the menopause. Oestrogens on their own can increase the risk of endometrial (uterine) cancer, and are therefore usually combined with progestagens which prevent this risk, though this is not necessary if the woman has had a hysterectomy. The main naturally-occurring oestrogen is oestradiol, and the main progestagen is progesterone, but there are a number of others, both naturally-occurring and synthetic. Mimicking the body’s own production of sex hormones would involve giving a mixture of these, the proportion and dose varying over the course of the menstrual cycle, and quite possibly mimicking gonadotrophin levels as well (these are produced by the pituitary gland and control the secretion of sex hormones by the ovaries). This would be excessively complicated and would require blood tests at least daily if not more often, and is clearly completely impractical as treatment for anything.

      Bio-identical in this context clearly means something else, though I don’t know what. I only know it as a marketing term used by manufacturers of vitamins and various other unnecessary dietary supplements.

      There are many HRT preparations available containing different oestrogens and progestagens. This is not my area of expertise and I won’t pretend to know the differences between them. I would, however, expect any mainstream preparation to be formulated for reliable and consistent absorption. I would also expect there to be a lot of data available concerning safety and efficacy, including short-term and long-term benefits and risks. If the bio-identical formulation is something new then this data may not yet exist.

      Although testosterone is widely known as the male sex hormone, it is also present in women in lower concentrations and is necessary for a normal sex drive. Too much, though, would cause masculinisation (body hair, muscular development etc.). Most of what I know about testosterone comes from treating men with cancer, in whom I am either trying to suppress it (prostate cancer) or restore normal levels after surgery (testicular cancer); my experience in women is limited to rare intersex cases of testicular cancer, and I have only managed a handful of these. It isn’t absorbed very well by mouth and has to be given either by depot injection every few weeks or trans-dermally in the form of a gel. I would expect that testosterone levels vary from one woman to another just as almost every other thing you can measure does, though I don’t know how low it needs to be for there to be a benefit from supplements. I imagine that your pellet was something along the lines of Testopel, which is a slow-release pellet injected into the subcutaneous fat to provide a normal level of testosterone for 3 – 6 months. As far as I know these are only licensed for use in men, however, and would provide a much higher level of testosterone than would be normal in women, but perhaps it is a different preparation that I am not aware of.

      Obviously I can’t give you medical advice as you are not my patient, I have never met you, and I am an oncologist, so this isn’t even my specialist area. If you are unsure about your current management I would suggest that you see an endocrinologist or a gynaecologist with an interest in HRT; your primary care physician ought to be happy to refer you for a second opinion, and I would be a bit suspicious if she weren’t.

      • Thank you for the clarifications about fungal overgrowth. I was woolly, or incomplete!

        While not being so much aware of the risk in diabetes, I am well aware of fungal overgrowth as a complication of atopic eczematous skin, and have on occasion over the decades suffered from intertriginous fungal complications myself. A dead giveaway is when application of topical steroid makes things worse instead of calming things down. Time for the anti-fungal cream instead!

        No response from Kristen Long…..

        • Actually topical steroids can make bacterial and viral infections worse, too. I had a scaly itchy rash on my feet for many years. I was convinced that it was fungal, but it never seemd to respond very well to antifungal creams. Eventually it flared up to the point that I diagnosed a superadded bacterial infection; I think that was after I put an antifungal / steroid cream on it. I got a course of flucloxacillin (a specific antibiotic against staphylococcal infections). The rash vanished completely within 24 hours, never to return.

          • Differential diagnosis!

            Persons (like me) with a moderate atopic tendency expressing (for reasons yet to be fully understood) as, among other things, atopic eczema, have to be extra-vigilant regarding the possibility of either bacterial or fungal infection.

            The compromised barrier function of atopic skin is apt to favour the tipping-over of colonisation into infection. Weeping with golden crusting is a sure indicator that there is an S aureus infection as well as eczema. I got caught out years ago with a scalp infection because I had not paid sufficient attention to emollients and topical steroids there. I eventually self-diagnosed and went with an extremely red face (literally and metaphorically) to the Health Centre where happily I was seen the same day, my diagnosis confirmed, and antibiotics and a scalp application of Potent group topical steroid prescribed. Since then I have been more careful about my scalp, as well as looking after the rest of my skin.

            I do understand that used inappropriately, steroids including topical applications, can make bacterial and fungal infections worse. But used appropriately, to help in repairing or maintaining the barrier function, topical steroids (I have read) can actually help in making the skin less susceptible to bacterial/fungal overgrowth, because the barrier function is better and is not compromised by inflammatory chemicals.

          • On viral infections, steroids and eczema:

            Years ago I was able to help a parent of a 9 year old in the USA. The Mum, on our Internet Eczema Mailing List (remember email mailing lists?) described a very particular set of symptoms her little girl was experiencing. She had taken her daughter twice to A&E, and doctors were unsure what kind of flare-up was happening, and put the child on oral Prednisone.

            The child’s skin seemed to be getting worse, however. The Mum gave a very clear description, saying that it was now night-time there, and her daughter was in bed.

            Of course I am not a medic and am completely unqualified to diagnose anything. But I can recognise a set of symptoms. I immediately emailed the List contributor, saying “Don’t be alarmed, your daughter will be OK, but first thing in the morning, I think you should take her straight back to A&E, ask directly if it could be Eczema Herpeticum and if so whether they should take her off Prednisone and put her on oral Acyclovir”.

            She did, and it was, and they did.

            Eczema Herpeticum can kill a baby in hours, but in a 9 year old, there is a bit more leeway before things get truly dangerous. Nowadays it might be more quickly recognised, but this was over 15 years ago, and dermatology is still a bit of a medical Cinderella sector in some areas!

            (For those interested, Eczema Herpeticum is a condition in which a Herpes virus spreads very rapidly in eczematous skin. Babies with eczema should never be hugged or kissed by anyone with a coldsore).

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