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humoral rather than histological or structural changes occur. This extended convalescence can be called invis­ ible healing. As this last phase progresses the natural resilience of the skin returns, and some if not all of the hypersensitivities that can characterise eczematous skin will disappear (Fig 5.13). During follow-up, vigilance by the parents is most important. This applies even if, with the return of normal skin, emollients have been discontinued. Every day the skin needs inspection for signs of relapse and when diagnosed treatment should be started again immediately (Fig 5.14). In order to emphasise the importance of this prompt response the slogan, 'Zap the Relapse'

Fig 5.14 Relapse Recognition • Dryness • Roughness • Redness • Itchiness

Fig 5.15 Vulnerability and Provocative Factors Unavoidable

Avoidable

• Atopy

• Exhaustion

• Season

• Stress

• Climate

• Air con­ ditioning

• Illness • Allergies

is used, and each patient should have the necessary treatment available: the Zap Pack. For any relapse an effective topical steroid needs to be used for at least six days, for example three days twice daily, three days once daily, with the Look Good Point on day two, or three. If this point takes longer to achieve, the treatment period needs extending: the period taken for 'hidden healing' can be approximately equal the time taken for 'obvious healing'. Thus, treatment of an acute relapse, if started early and pursued vigorously, will be successful in a matter of days, rather than the weeks needed for chronic eczema. With the topical steroid, emollient therapy is essential, and initially is required frequently. Once healing has occurred moisturisers will be necessary for at least a week or two longer, if not more, depending on both skin and environmental factors. By returning to the experiences recorded at first assessment, discussion can usefully focus on the factors known to provoke eczematous reactions. Some of these will be given and therefore unavoidable. Some will be inter­ mittent and variable. Atopy itself is a given vulnerability factor which cannot be avoided. Seasonal changes are usually unavoidable. Intermittent factors include other climatic variations, episodes of stress and unhappiness, and periods of physical strain and exhaustion including perhaps concomitant physical illnesses (Fig 5.15). Parents can appreciate that when several factors occur together a relapse is more likely, and action can be taken. It may be possible to change arrangements to offset the possibility of a relapse. Emollient treatment can be reinstated, or

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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