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healed for a week or more, and during the last few days of this phase the steroid used can be applied once daily, or a reduced potency steroid can be used twice a day. Those steroids that are used once daily at first, can now be applied on alternate days. If an early relapse occurs, and becomes significantly complicated again by rubbing and scratching, it may be necessary to repeat the intensive programme of phase one. However, if the relapse is associated with the end of topical steroid treatment, the most likely explanation is inadequate 'hidden healing'. The remedy then is to reinstitute treatment as soon as possible at Level 2, continuing Level 1 throughout. If the relapse is treated in this way further intensive treatment at Level 3 can be avoided.

5.4 Follow-up: Phase Three Once healing has been thoroughly accomplished histologically, the most significant phase of management starts follow-up. With the discontinuation of treatment at Levels 3 and 2, only emollient therapy at Level 1 continues. Eventually, unless the patient has constitutionally dry skin, even moisturisers may prove unnecessary. The first two stages of healing of chronic eczema, cosmetic or obvious, which is superficial, and histological or hidden, which is deeper and involves the resolution of all inflammatory processes in the superficial dermis, is followed by two or three months when

Fig 5.13 The Healing Stages

1 . Obvious or cosmetic healing

The early stage of topical steroid effect

2. Hidden or histological healing

The later stage of topical steroid effect

3. Invisible or humoral healing

The final stage, without topical steroids

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