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Review usefulness of focal attention worked out in third visit. Consider 'three dimensions': 1. Relevance of stress, and techniques of coping. 2. Attitudes to illness before, and now. 3. Attitudes to illness, from others. Review follow-up procedures: 1. Graph of healing curve with three levels of treat­ ment: show how treatments are discontinued sequentially. Review of importance relapse recog­ nition. List symptoms and signs of relapse. 2. Discuss reasons for relapse. Discuss relevance of 'continuous' compared with 'intermittent' causes of relapse. 3. Give instructions for treatment of relapse — refer to vicious circle and Levels 1 and 2 — explain level 3 usually unnecessary. 4. Remind principles emollients and topical steroid treatment. 5. Discuss 'convalescent phase': increasing resilience of skin. 6. Emphasise importance of continuous vigilance for relapse — versus discontinuing steroids, discontin­ uing emollients. 7. Review need for skin to heal completely: ensure standards appropriate.

Subsequent Visits • •

Review six measures (see third visit). Review progress since last visit — has skin cleared? For how long? • Review signs of relapse. • Review use of emollients. • Review use of steroids. • Review relevance of habit reversal. • Review quality of life. • Review stress management, attitudes of self, attitudes of others. • Consider future strategies: ensure availability of Zap Pack for relapses. • Discuss follow-up arrangements — further contacts.

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