Adults and Older Children
Chapter Four of Atopic Skin Disease - A Manual For Practitioners brings together, for Adults and Older Children, the conventional treatment of emollient and topical steroid therapy with habit reversal: The Combined Approach. The key messages are activate involvement, encourage realistic optimism, promote biological understanding and increase behavioural awareness. The protocol used at Chelsea & Westminster Hospital is set out in Appendix 1. Initial assessment includes a review of attitudes to illness and treatment, and the relevance of stress. Emphasis is placed on subjective measures - self rating is used throughout the programme, which typically is split into four clinic visits. Assessment at first visit is followed by the important registration week, where the patient's use of the hand tally counter enables the measurement of scratching frequency. At the second visit a behavioural analysis is completed, and the Three Levels of Treatment are introduced. The chapter details the content of the discussion required, supported by the content of Live Without Eczema - The Patient Handbook. The third visit allows for trouble-shooting and programme reinforcement. The three additional dimensions of stress management, attitudes of the patient and attitudes of others are relevant for many patients. Vital for all are the points to consider at follow-up. The chapter closes considering why some patients are unsuccessful.