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most cases. When it becomes lengthy, issues may be highlighted that may well be relevant either to achieving successful treatment, or to understanding poor prognosis. Thus, understanding the relevance of both the parents and children of the patient also having atopic skin disease will often help the patient appreciate entrenched attitudes and behaviour patterns, and a review of personal history and personality traits may begin to show for a particular patient what may prove to be a vested interest in continuing illness behaviour (p. 85).

Objective findings A preliminary objective assessment of the skin and if appropriate full physical examination, is clearly relevant to assessment though throughout the programme itself greater emphasis is placed on subjective reports of skin condition, as the patient's view is emphasised. Towards the end of the first phase of the programme, when follow-up is being planned, there may be a need to confront subjective assessment with objective findings (p. 81). Review of mental state is primarily useful for considering issues of attitude, general intelligence, rapport with the therapist, and broad behavioural characteristics best summarised as personality traits. Such observations will sometimes suggest the need for a particular approach, if good outcome is to be achieved.

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Other procedures Objective assessment of the skin condition can be supplemented usefully by photography. Furthermore biological markers, including assessment of immune status, may be useful requiring appropriate laboratory investigations (p. 9).

Prognosis It is always valuable as part of any clinical assessment to make a firm statement of likely prognosis. In order that vague terms are avoided, a score out of 10 can be useful 10 being the best result possible. Thought given to the justification of prognosis is particularly helpful in formulating an appropriate management plan. If difficulties are anticipated early, they will cause less frustration

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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