Chronic intractable atopic eczema. Its occurrence as a physical sign of impaired parent-child relationships and psychologic developmental arrest: improvement through parent insight and education.

Atopic eczema of infancy and childhood responds readily and predictably to treatment; only a small percentage remains intractable. Lack of therapeutic response in a proportion of these patients can be attributed to dysfunctional parent-child relationships that lead to physical and emotional developmental arrest. Improvement in parent-child relationships following parental insight into their conflicted feelings permits acceptance of educational recommendations from the physician; it also allows normal development to be resumed and eczema to improve. Eight illustrative cases are reported in which aggressive dermatologic measures were combined with an approach that helped parents recognize conflict and provided education that permitted more appropriate behavioral limit setting. Rapid and sustained improvement in skin, emotional development, and social adjustment resulted.