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assessment enables the making of an appropriate treatment plan that suits the needs of the individual patient. As these explicit purposes are worked through, implicit in assessment is a review of attitudes to illness and treatment, with the identification of any attitudes that are negative and therefore counterproductive. The fuller the assessment, the more clearly one can understand how the patient has used treatment to date. Early discussions in assessment set the scene for heightening awareness through registration of scratching behaviour, and for a complete analysis of all self-damaging behaviour. As The Combined Approach programme is clearly different to other treatments the patient will have experienced, its main characteristics need introduction. It is particularly relevant to take into account that some patients with long-term atopic skin disease have tried many different treatments in the past, and have been very disappointed with the results. The patient can be advised that more time will be spent in consultations than they are used to, and attention will be especially paid to what happens between consultations. An early start is made towards achieving a positive and optimistic alliance with the patient. Occasionally doubts will be expressed about the rationale of the programme. If nevertheless the procedures involved can be accepted at face value and followed for long enough, changes in attitude follow.

History of presenting complaint

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Overview By going back to the first experience of eczema, even though it is often remembered second hand, as reported to the patient by parents, the way atopic dermatitis is often entangled with psychosocial factors can become an early topic for discussion. Especially when the illness begins in the first year of life, the involvement of the patient's mother in caring for the condition is relevant. It is worth asking whether the mother also had eczema, and if siblings suffered from the same condition. This information, together with the quality of the child-parent relationship, illuminates subsequent developments in the history and informs both management and estimation of prognosis. Occasionally patients with chronic atopic dermatitis in adult life are found to have established an emotional investment in keeping the condition, and the origins of this may be found in early childhood experiences.

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