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In order to keep discussion going, some members comments on articles are brought together here; if you are interested, and want to find out more, please go to the article - and then add your comment too!

On Article: Topical Tip #1 Apply Emollient sparingly

Jean Sheehan (Albany)
very good article, however, my daughter does apply cream lightly but several times a day yet her skin is still extremely dry and inflammed..any ideas on this.

DrB
Thank you for your comment.
On general principles - I cannot give a specific response - it is important to remember that inflammation dries the skin, and emollients are not anti-inflammatory. When there is active eczema an anti-inflammatory cream is needed also - usually a topical steroid.

Martina King (Clonee)
Very good article but I do everything it says in that article, but my son of 5, skin extremely dry and flakes. I use ointments and creams. Any advice would help.

Hannah Smith (Carmarthen)
As a dermatology Specialist Nurse, i suggest that patients depending on age/size aim to use at least 500g of emollient a week, applied in a downwards motion to avoid complications such as infection of the hair follicles(folliculitis).
But I think it is important to find an emollient that suits each individual as the best moisturisers is one that a person likes and will use. If people will not tolerate an ointment, then i suggest a cream as less greasy alternative throughout the day and a greasier emollient at night.
This is just the practice I adopt as i cannot give direct advice to individuals, as not seen in person.
In children creams can sometimes sting on application more than an ointment.

DrB
Getting the frequency of the application of moisturiser right is also important, and altering the frequency depending on need - aim to prevent the skin drying rather than treat dry skin!
But also if there is acute eczema ensure anti-inflammatory cream is used too, and if the eczema is chronic, add habit reversal! Hence The Combined Approach...

On Article: Jennifer talks to DrB

Anneliese Lacourse (Eganville Ontario)
I wish this kind of help had been more available when my daughter was small. She is 22 and still has bouts of eczema throughout her life. She is an Asthmatic and also suffers with, Hayfever and food Allergies.
I feel that more information should be provided for anyone wanting to start a family, especially those who have a history of any of the above problems. I had eczema and hayfever as a child but wasnt made aware of how important this is in relation to having children and how these genes can pass on and manifest in them.
I agree with all your comments, especially about food triggers. I feel that doctors should make it mandatory for all children with Atopic skin diseases to have food and allergy tests as soon as symptoms appear.
Also, to have follow up appointments closer together to keep home management in check. I have seen too many parents (myself included) give up on following through and completing medication and the subsequent relapse of the original problem. This was due to lack of time and not enough information given during appointments.
Now my daugheter is 22, she still doesnt help herself as soon as any symptoms recur (during prolonged stressful periods). Self help and management Courses and more websites like this one would be a godsend for people her age who have hectic lifestyles and are on the go most of the time.
Thank you for starting this site.

Anneliese Lacourse (Eganville Ontario)
I also want to add the benefits in having Hair analysis testing. It is very accurate for finding toxic substances but especially in finding deficiencies in minerals and other nutrients in the body. This test would be very useful alongside the food allergy tests and allow more accurate diagnosis and basis for planning specific diet and supplement regimes.

DrB
Thank you for sharing your experience

On Article: The Art of Conversation

Iman Ogoo (London)
I have been very lucky with the staff at the paediatric allergy/dermatology clinic I attend. They treated my 2nd son's eczema, and are currently treating my toddler. Over the years we have developed a relationship of understanding and have been receptive to each others ideas. They have been supportive in my development of natural emollients for my family and I in turn have backed down on my initial resistance to topical steroids after much discussion. I do NOT share the same practitioner/patient relationship with my family GPs, with whom I am dictated to and my concerns often dismissed hurriedly.

DrB
Some good news then...
Some of the problems in a busy general practice around allowing sufficient time for both understanding and being understood are obvious, but attitudes like old-fashioned paternalism need challenging. One way of improving things has been through "patient participation groups": see http://www.napp.org.uk/ for some ideas. What do other people find? Any good news from general practice?

On Article: Self-Help

Spanish Key (San Francisco)
Motivated patient groups can probably also provide a lot of information to doctors (dermatologists etc) about the range of subtypes & prevalence & success of various treatments for eczema. Otherwise, my experience is that doctors rely largely on their personal anecdotal history with patients to diagnose your issues. Of course, successes/failures they've seen themselves will always weigh more heavily than something they've heard or read about.

On Article: How Do You Scratch?

Iman Ogoo (London): As a young baby, my son would rub his face/hands/arms against relatives'beards/stubble as they cuddled him, in order to scratch his eczema.

Gnaan (Bangalore): My preferred means of scratching in different parts of my body are

face or around eyes - nails
nipples - palms
thighs - instruments such as hair comb, nail cutter handle or plastic ruler
back - hair comb as it has a long handle or towel if it is rough

I have one peculiar habit of scratching; I don't know whether others do it the same way. Whenever I change cloths or lie in the bed before sleep, my hands involuntarily moves and touches the skin around the inflammation. My fingers move around the skin in circular pattern and begin to move spirally inwards and destroy everything. In fact, I used to be addicted to scratching to such an extent that if I don't scratch in bed, I don't get a sound peaceful sleep. Moreover, once I scratch, my skin starts to ooze and in order to take the fluid of my skin, I use soft cotton cloth pieces. After I wipe off the fluid, I again feel itchy and so scratch. Therefore, at once I end up scratching for about 5 to 10 times. Immediately after that, I check the look of my skin in the mirror. The condition of my skin as seen in the mirror adds fuel to the burning fire and I get frustrated and sink in sorrow that I end up violently scratching.

90% of my scratching per day is when I lie in bed before sleep, i.e, from 09:30 pm to 11:30 Pm.
5% - while changing cloths or going for a shower after a long journey
5% - when I work on my research project especially while reading a "statistical mechanics" book.
0% - when I bat in a street cricket match (really! My skin never comes to my mind even involuntarily while my hands are on the handle of a cricket bat)

After reading your post about habitual reversal, I got to know that only 20% of my scratching is due to itching. Your emphasis on this is truly commendable.

On Article: Quality of life and atopic eczema

Guest

I would agree with Dr Bridgett that years after undergoing the combined approach treatment I have maintained an active optimistic attitude. I have woken this morning after a particularly long and stressful 3 days and my skin has broken down on my face and neck. I feel none of the "hideaway panic" that I used to get with a flare-up and feel totally confident that in a couple of days, with a little extra care of myself, I will be completely fine. In the past I would hide, wait and hope my eczema would go away.
I would say that the "can do" attitude with my skin took a lot longer to translate into my everyday life in terms of gaining confidence in myself and my abilities as a person. But I did get there and I am now not afraid to live an interesting and challenging life that 10 years ago would have been unthinkable because I mentally shut so many doors just in order to survive.

Christopher Bridgett (London): With The Combined Approach it is now possible for everyone with atopic dermatitis to learn how to minimize the difficulties caused by the condition, and to maximize the opportunities to enjoy life

On article: Food and atopic eczema

Guest: My son had severe eczema and so many foods seem to trigger his flare-ups. Milk, gluten, soy, and a few tree nuts were found to cause him hives, severe itching and horrible, severe flare-ups. Although he tested negative to these things in skin prick and blood allergy tests, they still are true allergies due to the symptoms they create in my son. There were also some foods that would make him really red and itchy, but not necessarily trigger eczema or hives - tomatoes, cantaloupe, red pepper, to name a few. Now that his skin is 95% better (since we removed the primary food triggers), he no longer reacts to to the tomatoes and red peppers if given in small doses and not every day. So, yes, totally agree with what you're saying.

Jennifer
itchylittleworld.wordpress.com

On article: Understanding acute atopic eczema

Yes, you call them "factors" we call them "triggers." Once you understand your triggers, eczema can be fairly easily controlled. The problem is identifying the triggers which can be almost anything - environmental allergies, food allergies, temperatures, stress, products applied or in contact with the skin - like laundry detergents, some creams, etc. The list goes on.

Many people find that when all the triggers are found and controlled, the eczema magically goes away - sometimes creams, medication are not even needed. Obviously, this is the best case scenario and one we all strive for.

Jennifer
itchylittleworld.wordpress.com

Iman Ogoo (London): I agree with Jennifer, but bearing in mind that some triggers are easier to control than others. The thing is, there are so many potential triggers that even when you try your best to avoid all know irritants, something or other will come along and kick-start an eczema flare up. So frustrating...

On article: How do you scratch?

Iman Ogoo (London): As a young baby, my son would rub his face/hands/arms against relatives'beards/stubble as they cuddled him, in order to scratch his eczema.

Karen Lynn (Bristol): I think I've been guilty of just about all the options over the years ... possibly not the beards or stubble though, but definitely the towels after washing ... or rubbing hands in and out of jeans pockets: in both cases I know I shouldn't, but ...!

On article: Mark Gets Better with The Combined Approach

Iman Ogoo (London): Nice and simple explanation of the 'Combined Approach'. Due to time constraints I haven't been able to follow the programme strictly as advised for my son, but I've started to implement the distraction strategies and feel more positve about steroid use. I am now scheduling a time over the next week when I can start the programme with the intense 4 days. It will mean sacrificing a lot of time from work (I work from home) But I believe it will be worthwhile, and I am willing to do whatever it takes to give my son relief from eczema.

Iman Ogoo (London): Update: I finally started the Combined Approach with my 2 year old son. First of all can I just say WOW!! It's been under 2 weeks and the results have been amazing. My boy hasn't scratched in over a week! This is a child who would scratch all day at every opportunity, especially when upset. His skin is almost completely smooth now. I believe this technique is actually working.

I think it's worthwhile pointing out that my decision to 'ease' into the process was a good one. By introducing the distraction techniques beforehand, there were no new surprises for my boy. He quickly became familiar with them, so the transition was smooth and the 4 intense days were nowhere near as difficult as I imagined (though admittedly I couldn't keep my eye on him at all times).

Before starting I also had to 'make peace' with topical steroids. After years of using them on my own skin I resented having to use them on my children. I felt they made the eczema word once I stopped applying them. This was the hardest thing to overcome. As the owner of a Natural Skin Care business, I also felt it contradicted my business ethos, but I had to get over it and give the Combined Approach a real attempt. Using my natural oils for the emollient part of the routine helped me to ensure that I was still giving his skin the best nourishment available. Also Dr.Bridgett's handbook explained about the hidden healing, which explained why the skin would flare up again quickly - I was stopping too early. It all made sense, and I became comfortable with the idea.

Life had become very difficult for the whole family as a result 2 of my children's eczema and severe allergies (my 8 year old also has eczema and allergies) and I was stressed beyond belief. This past week or so has been great. Aside from looking better, my 2 year old has been less miserable,and he is sleeping MUCH better which means I am actually getting some sleep too!! No tearing into his skin at night or blood on his pyjamas in the morning. The break from scratching has allowed his skin to heal nicely. I never expected the scratching to stop so quickly. I am so thankful to Dr. Bridgett for sharing his work. I have been trying to tell my Doctors for a while that I suspected a majority of the scratching was down to habit, but nobody could offer a solution.

I pray that this success continues, although I am aware that flare ups may arise from time to time. But I am now hopeful that the worst of our ordeal is over.

I will regularly record our progress on my blog: www.imanmade.tumblr.com

On article: Psychodermatology

Guest

I have been using Habit reversal in my nurse led clinics for a few months now (I'm a dermatology nurse practitioner [in London, UK - DrB]). It's been one of the most rewarding things I have ever done, some of the results have been amazing!

I have slightly adapted the technique to suit my practice; I have 45 minute slots in one of my clinics and find that this allows more than adequate time to go through everything. The start up costs were minimal and we will soon be advertising the service more aggressively to encourage referrals from outside our local area.

There is a real need for this kind of input into the care of patients, and so long as you have a willingness to give it a go, and reasonable negotiation skills, any dermatology nurse with experience in treating chronic eczema should find it straightforward and rewarding! Do it!

On article: Three-in-one: the hydrocolloidal gel dressing

David Haigh (London): Another benefit of hydrocolloid is that they can be worn in the shower or bath if applied properly.
Sometimes the dressings roll up and stick to bedclothes or clothing making a sticky mess. When applying the dressing to the skin make sure that you press it in place with your hand for a few minutes gently smoothing it down so that it melds it onto the skin. Try not to remove the dressing before 3 days as this may cause trauma to fragile healing skin.

On article: MarcieMom talks to DrB

Anna Pugh (Bedford)
I found the above interview fascinating and the idea of the "A to Z Animals are not Scratching!" is inspired. As an adult I call it "distraction therapy", my skin, health and happiness are always better the busier I am so I keep myself mentally and physically active. The downside is that I used to find it hard to focus so I've learnt to set aside periods of time for work-intense focus punctuated by regular breaks. Doing this I have learnt to be very productive in short bursts and have become more organised rather than a "headless chicken" of unproductive activity. My school reports were full of "if only Anna would concentrate" and "she's so easily distracted". Undergoing the combined approach in my early '20s definitely helped me understand more about myself and the way I work which has been transformed from mindlessly busy to constructively occupied! Marcie is extremely lucky to have such a proactive and dedicated mother. Anna Pugh

On article: Friday Facts #1 Atopic eczema, dermatitis and skin disease

Guest: Thanks for clarifying the Greek for us, Dr B.

Having never studied classics, I've always parsed "atopic" as "not topic" and assumed that "topic" (as used in "topical steroids") had something to do with physical location. Eczema as I experience it is not caused by contact irritation at a specific location. Thus "atopic" would mean "not caused by an agent acting at the location where the problem occurs".

In fact from what you say that IS what the original Greek means, but the medical profession has taken the word and made a broader, somewhat detached definition for it.

On article: Friday Facts #2 The Structure of Skin

Guest: Interesting to see. It seems safe to say that if the epidermis is damaged, that anything applied to the skin could penetrate the dermis. No?
Jennifer
http://www.itchylittleworld.wordpress.com

On article: A useful saying
Atul P (Reading): DrB,

I am grateful to you for your efforts in launching this website last year. I have been battling atopic eczema for the last 16 yrs and have been searching for material specifically on atopic eczema... hopefully can apply the techniques in the website to myself..

On article: VIDEO: A Behavioural Approach

On article at Ask DrB: Swimming Pools and atopic eczema: do they go together?

Guest:

Swimming may be fun but in my experience pools cause trouble. You just can't moisturize properly in a locker room. There's also an intense kind of itch I get afterward that's probably caused by the chlorine. The chlorine might helping in a way by killing off bacteria on my skin--but then it is killing beneficial bacteria as well as staph.

There's also the social aspect of being virtually naked in front of everyone. I have gone through phases where I couldn't stand the embarrassment. At the moment I go swimming when I have the time, because my eczema isn't particularly bad, and I'm at a stage of life where I don't care so much what others think. But it's completely different when you're a teenager or young adult.

Guest: While I'm not an avid swimmer, I have found that my skin is much better after swimming. After I get out, I definitely take a good shower to remove the chlorine and then moisturize accordingly. The difficulty I have is that as a woman, I'm expected to shave my legs in order to wear a swimming suit and that is very difficult on my skin. No matter what, I can't get around that social expectation. That is the main reason why I haven't pursued swimming, although it would be my ideal exercise.

Guest comment:

Can anyone recomend sun tan lotion to use if

they have Eczema.

Guest comment:

I guess like many other things there's an element of trial and error to find what suits each individual ... but I use the "Sensitive" version of Boots own brand (Soltan I think from memory), and it's usually OK. It did seem this year though that I was likely to get some irritation if I'd showered too soon before I put it on: showering the evening before was fine, though (which I did anyway to prevent leaving it on too long)

On Friday Fact #13 Antihistamines and atopic eczema

Guest: We use hydroxyzine for our four year old when he's beside himself with the itch. It really helps him and it's non-drowsy.
Jennifer
http://itchylittleworld.wordpress.com

Guest

As an adult, I occasionally use Piriton (chlorphenamine maleate). Possibly because I only use it occasionally, I find even 1/2 of (4mg) tablet is enough to relieve itching, but without making me too drowsy ... although when I do take it it's often at night so that I'll get to sleep anyway

On article: A useful saying

Atul P (Reading): DrB,
I am grateful to you for your efforts in launching this website last year. I have been battling atopic eczema for the last 16 yrs and have been searching for material specifically on atopic eczema... hopefully can apply the techniques in the website to myself..

On article: Why is it important to avoid saying "stop scratching"?

Karen Lynn (Bristol)

Whilst I agree that as general advice this might be appropriate, my personal preference now is that, at least certain trusted individuals DO tell me when to stop scratching! I'm much better at not scratching than I used to be (I think ... hope!), but I know there are occasions when I still do so, and don't realise that I am. As an adult, I now find it helpful when it's pointed out to me ... as long as it's done in the right way.

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