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Side-effects in long-standing atopic skin disease can be avoided if the aims of treatment rather than the fear of sideeffects dictate the behaviour of both doctor and patient. Hence the relevance of the discussion with every patient of the nature of atopy (p. 58) as an unavoidable constitutional vulnerability, compared with atopic skin disease as an eminently treatable condition. A vigorous treatment approach reduces the severity, length and frequency of relapse in atopic eczema, and eliminates chronicity for the great majority of patients (p. 83, Fig 4.37).

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The Combined Approach In practice we emphasise that it is essential that topical steroids are not used in isolation. For an acute relapse their use is combined with appropriate emollient therapy, and in the management of chronic eczema topical steroid and emollient therapy must be complemented by simultaneous attention to eliminating selfdamaging behaviour. Steroid use on different parts In the same way that topical steroids come in four potencies, the natural sensitivity of skin to topical steroids varies according to part treated. While the stronger steroids are sometimes required for the hands, feet and scalp, the weakest may be appropriate for the face, and genital area. Other parts are intermediate in sensitivity, though care should be taken with the thin skin on the inside of the thighs and upper arms. In disease, lichenification can make otherwise sensitive skin relatively resistant to topical steroids. Then even on the face the strongest steroids may be required, under close supervision and as part of a planned treatment programme. Apart from different strengths, some areas such as the scalp, and ears may pose practical problems. Suggestions for what to use are given in Appendix 4.

Fig 2.22 Key Message

Ensure appropriate topical steroid use by educating the patient and by providing a clear treatment schedule

Strengths, frequencies and amounts (Fig 2.22) It is invaluable to create with each patient a clear and strict schedule for them to follow. Simplicity will make this easier. There are disadvantages in providing a range of steroids in different strengths to use in sequence, and one or possibly two should be sufficient if varying the frequency of application is part of the programme. Most topical steroids are used on a twice daily basis. Some new preparations are used once daily. While there may

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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