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given more often. Vigilance becomes even more important, in order that any relapse which proves unavoidable can be treated early and vigorously. Hence a further slogan for parents: 'Help stamp out chronic eczema!'. It is evident that managing the skin condition successfully in this way is worth accomplishing. The relatively continuous experience of skin disease in the chronic condition is replaced by intermittent episodes of acute relapse (p. 83). As these are managed appropriately they become less troublesome and less frequent as convalescence progresses. Now the skin is being managed by the family rather than the family being managed by the skin. They are living without, rather than with eczema.

5.5 Problems As in adulthood The three main types of difficulty preventing successful treatment of adults (p. 84, Fig 4.38) can be seen in their own form in young children and their families. Thus for families the practicalities of The Combined Approach for the very young patient can compete unsuccessfully with other priorities and considerations. Evidently the first phase of intensive treatment requires time and effort, and this needs commitment. Hopefully this is worthwhile for the majority of families, but this will not always be the case. Secondly, the ability of those involved to understand what is required will vary. The instructions can sometimes seem difficult for an individual parent to absorb. This becomes evident when the programme has not been followed, and review reveals that essential principles have not been appreciated. Often ways round these practical and educational problems can be found. More difficult for the younger child are the equivalents to the attitudinal problems of adulthood, and it is particularly in the adults of the family where these issues will be encountered. They range from an impervious resistance to using topical steroids properly, to an evident emotional investment in continuing illness. With the latter case, rarely and at its most extreme the situation for the child resembles an illness by proxy. Without the child continuing to need treatment, the parent would not have access to health centres

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