Treatment Notes
From time to time Dr Aron posts messages on the Facebook page. Parents and patients who have recently joined may have missed some of them. Here they are, consolidated for your convenience.
8/3/2015 CLINICAL JUDGEMENT AND GUIDELINES
Anyone reading this post will have an interest in the treatment of atopic eczema (AE), usually reflecting a family member who suffers from the condition and whose therapy has not been successful in a consistent medium to long term manner, in spite of consultations with many therapists including PCPs, dermatologists, pediatric dermatologists, pediatricians, allergists, homeopaths and naturopaths. Information on therapeutics is widely available eg Steroid products, both oral and topical, antibiotics, both oral and topical, antihistamines, wet wraps, phototherapy and when all else fails, immunosuppressive drugs.
So what is used and how is it used in treatment? This is where clinical judgement comes in. The therapist needs to make a coherent, objective treatment decision. Having made this decision, arrange to see the patient in a regular follow up schedule (not at 3 month intervals) to see the outcome of the decision and adjust therapy according to the response.
In a worthy but flawed attempt to bring order to the management of AE, public authorities in some countries have established guidelines how to manage AE. It is clear, given the large number of patients who seek my help, that these guidelines fail many patients and the reason is that guidelines, at best, stifle clinical judgement. In AE one size most definitely does not fit all and lack of clinical judgement tacked onto flawed guidelines leads to many sleepless nights for families.
19/11/2014 MANAGING EXPECTATIONS
I am privileged to have been able to help so many patients and families who have been battling AE, very often for many years. Positive reports which have been posted on FB have been beneficial in encouraging parents/patients to follow the Aron Regimen.
However, the treatment of Atopic skin disease is not a straightforward challenge and the response to therapy varies significantly from patient to patient. The relief enjoyed by patients, often very rapid indeed, may lead to heightened expectations which may not be duplicable in other cases. Consequently, patience and perseverance may be needed in patients where progress is not as swift.
As everyone knows, eczema flares. This happens with the Aron Regimen as well, as my treatment approach, effective though it may be, is not a cure. There are many reasons for flares including teething, viral illness, inappropriate exposure to irritant materials at school, swimming, compromised compliance with treatment (usually by omission rather than commission), seasonal factors and dietary factors as well. So one may see that we are travelling a rocky road and that some setbacks along the path to comfort and healing are inevitable. This does not mean that you will necessarily return to that dark place from which you have escaped. It simply means that one needs to address the reasons for flare if possible and persist with the treatment advice which I will provide.
04/11/2014 STAPHYLOCOCCAL AUREUS INFECTION
There are understandable concerns about the use of topical antibiotics in the management of Atopic skin disease (AE). However, I have established that one of the most important triggers in AE is the presence of bacterial infection, specifically with a bacterium called Staphylococcus Aureus. It is essential that this infection be eradicated if one is to achieve a positive outcome and avoid recurrent flares, which I believe are triggered by undiagnosed and untreated staphylococcal infection. There is a possibility of individual cases of bacterial resistance, but given the severity of the AE in so many patients, the benefit of using topical antibiotics far outweighs any unquantifiable risk that there may be of resistance. When the eczema is under control or in remission, it is possible to proceed with a mixture without the antibiotic element. Remember that all treatments of whatever variety carry risk, the key decision is to balance risk against benefit which I consider in every patient.
03/04/2015 ECZEMA FLARES
Everyone knows that viruses and teething cause flares in children with atopic eczema (AE). However, what is less well understood, is that flares may be provoked by irritant factors, particularly when the skin is much improved or clear. Over confidence may lead to contact exposures which ordinarily would be avoided. Eg playing on an abrasive surface such as a carpet or sand may cause a friction flare and when this occurs it can lead to concerns that the eczema is about to lead everyone back into that dark place from which they escaped in the recent past. Remember that the skin retains its sensitivity and reactivity for many months after clearing and that caution remains the watch-word, essentially indefinitely. On a positive note, it is remarkable how many so-called allergies disappear when the bacterial infection has been eliminated by appropriate therapy via the Aron Regimen.
12/01/2015 TREATMENT OF THE HANDS
Certain areas, particularly the hands, prove may not respond as favourably as others.
This is because the cream does not remain on the hands for very long and in consequence frequent applications are required, often as six times daily. Secondly, it is very easy to scratch the hands, so trauma may be a factor in aggravating the condition. Contact factors act as triggers. These exposures are common in children who are in day care where they may touch materials such as paints and glues. These should be avoided and specific instructions may have to be given to daycare personnel in this regard. In some, my standard mixture may be too mild for resistant areas, in which case I prescribe a less dilute compound for localised use in the short term.