Fig 2.30 Hypnotherapy
Aims to achieve behavioural change, and stress reduction
Evidently effective in skillful hands
and minimising ambient anxiety. The technique would appear to have few side-effects but, like habit reversal, currently suffers from a severe limitation of availability (Fig 2.30).
Future avenues Genetic research may be able to further localise the genes which confer the potential to atopic allergies. However, it would currently seem unlikely that genetic engineering could reduce this immunological response without prejudicing other important defence mechanisms. Less toxic analogues of Cyclosporin A could be valuable suppressive medicines. Elucidation of the active principles in Chinese herbs might open many new therapeutic doors, and allow better toxicological evaluation. A more immediate and achievable prospect would be an easy and safe way of controlling the vastly increased population of house dust mites in the modern house. The new comfortable and effective covers for bedding are a crude but excellent first step forwards minimizing exposure to the 20th century midden within the home.
2.4 Complications During Conventional Treatment Treatment of atopic eczema with emollients and topical steroids can be frustrated by two complications in particular: hypersensitivity reactions and infections.
Hypersensitivity reactions Hypersensitivity can occur as contact reactions to both emollients and topical steroids. There is both inflammation and an unexpected lack of response to treatment. The inflammation may only show itself when topical steroid treatment is discontinued (Fig 2.31). Emollient hypersensitivity Reactions to moisturisers are relatively rare, and given the wide range of preparations and products available, it is invariably possible to find alternatives when necessary. Hypersensitivity is usually due to an added preservative or perfume. Amongst the oils and fats used in emollients, only lanolin (sheep sebum) is notorious as a sensitiser.