Identify the Aggravating Factors
The first thing to determine
is whether there are any obviousaggravating factors that the patient
Do particular foodstuffs make the condition worse?
The argument about cow's milk has not been settled as yet but if
either patient or parent is convinced that milk makes the condition
worse then a trial should be made of a milk-exclusion diet.
The same is true of any other foodstuff that is accused. Some find that
eggs or fruit bring on attacks or aggravate the condition. If strict
avoidance of the suspected allergen does little for the disease
then there is not much point in persisting, but it is certainly
worth making the attempt at exclusion from the diet. If dietetic
treatments are contemplated it is important to 'build in' as much
objectivity and absence of bias into a preliminary trial as possible.
An unequivocal negative is just as important as a positive. When
suspected foodstuffs are subjected to trials which are evaluated
critically it is quite uncommon for the suspicion to be sustained.
Woolen clothes are tolerated badly by many atopies and
now that there are cheap smooth synthetic garments there seems little
point in persisting with the older fluffier ones.
Stress and anxiety
Although stress or anxiety does not cause the disease they certainly
seem capable of making it worse. The accounts of children's dermatitis
getting worse before examinations at school are too frequently heard
to be ignored.
However, although recognition of this sort of problem
is important, it is much more difficult to know what to do about
it. The worsening of the dermatitis before exams or some other stressful
event should be anticipated and if possible guarded against. If
the worsening that stress produces cannot be prevented, it is probably
better to put up with it than avoid the stress. A voidance of this
type of stress inevitably generates other problems - and examinations
are still important.
When children scratch their way through the
night and cry with the discomfort it inevitably causes anxiety and
guilt in the parents. Eventually this may lead to a very unpleasant
atmosphere within the family where no-one sleeps and everyone is
bad-tempered. In these circumstances a temporary separation of the
affected child from the family may be the best answer. If necessary
a few days of intensive treatment in hospital can be arranged.