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Fig 5.7 Scratching Becomes an unconscious habit

Associates with general stimuli

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w Accessible areas especially damaged

May be non-verbal communication

Fig 5.8 Emollients: Questions to Answer

92

For the child a reference to 'bees busy making honey' may be helpful, i.e. 'when you feel the buzzing of the bees, busy making honey, don't disturb them — else they 'II get cross and no healing, or honey, will come'. If the child has been apparently engrossed in play or drawing up to this point in the interview, discussion of 'the scratching machine' and the effects of turning it off will often provoke a contribution from the patient. It is clearly important to discuss how scratching is, over time, an increasingly habitual behaviour and as such all may have become relatively unaware of its occurrence (Fig 5.7). Although originally provoked by a particular stimulus, it tends later to generalise. Then it becomes linked to a variety of situations and circumstances, such as being bored or frustrated. The accessibility of skin for scratching, and the distribution of chronic eczema are important to review. The way scratching can become used, consciously or unconsciously, in family interpersonal communication is of particular importance. The testimony of some adult patients clearly endorses the notion that scratching for the child can be a powerful communication signal. That scratching can establish itself as a habit before the child can communicate through speech is clearly relevant. For the child, as for the adult, scratching can connect eczema to the rest of life.

Level 1: emollients (Fig 5.8) Anyone treating a child should understand as much as possible about the treatment being used. It is relevant therefore to review with the parents the basis for drying of the skin in eczema (pp. 15-17) and to consider the phenomenon of constitutionally dry skin. How emollients correct dryness needs explanation, i.e. by moisturising and lubricating. The balance between body fluids and relative humidity of surrounding air helps explain how need for moisturising varies according to circumstances. thinly, gently, quickly How to apply emollients (p. 65) can then be understood, as can the and frequently principle that use of emollients is optimal as a preven­ tion rather than a treatment of dry skin. The best results are achieved by anticipating that the skin will otherwise dry, and applying a fresh layer of moisturiser proactively. The range of products available (Appendix 4) can be usefully considered, together with the different

Profile for Christopher Bridgett

Atopic Skin Disease - A Manual For Practitioners  

An account of a new behavioural approach to the treatment of atopic eczema, written for practitioners, but also for patients

Atopic Skin Disease - A Manual For Practitioners  

An account of a new behavioural approach to the treatment of atopic eczema, written for practitioners, but also for patients