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Teledermatology, habit reversal and atopic eczema
The coronavirus pandemic means consultations about skin disorders increasingly involve getting and giving advice “at a distance”. In place of hospital outpatient clinic visits, the “virtual” clinic with consultation using the telephone and the internet has become common practice. This includes when using The Combined Approach treatment programme for chronic atopic eczema.
Telemedicine poses problems, for both patient and practitioner, but can fortunately bring some advantages.
The problems can begin with a lack of opportunity to establish good rapport. This is easier to achieve with a face-to-face encounter. Next, for example, an electronic consultation does not allow the use of touch in physical examination. When chronic eczema is assessed, it is often easier to feel than it is to see the tell-tale thickened skin of typical lichenification.
However, getting and giving help for troublesome atopic eczema using The Combined Approach is not only very feasible online - it is after all a home based treatment programme, based on self-help, and it is supported both by a handbook and a website that can easily be shared electronically - it is also clear that the practice of teledermatology can make specialist help with habit reversal for chronic eczema accessible to many more people than before.
Our suggested programmes for both adults and older children, and younger children and their parents, involve several stages over just a few weeks, each involving a series of appointments. It is certainly feasible to have all these online, but there may be advantages if the first and last - the assessment, and the planning for aftercare and follow-up - can be face-to-face.
The protocols we set out in the practitioner’s handbook were established for face-to-face encounters, but the main components are included in the “virtual” appointments that are built into the self-help version of the programme for adults and older children in the book “The Eczema Solution”. As Sue Armstrong-Brown recommends in her talk, the self-help format is more likely to be successful with staged professional support. In practice this can be achieved successfully online, especially if both patient and practitioner have a copy of her book to refer to.
For younger children and their parents it is equally feasible to adapt the clinic programme into a virtual format. An example of this in practice is reflected in the account given here by website member Iman, who chose to work online with DrB when using The Combined Approach to treat her two year old son. Another account of this success story appeared subsequently in the journal Dermatological Nursing.
Have you had online experience using The Combined Approach? Please let us know.