Habitual scratching causes chronic childhood eczema
The Combined Approach to childhood atopic eczema is indicated when the eczema has become chronic, or longstanding.
There are acute flare-ups that come and go, but between these the skin remains rough, thickened and dry – this chronic eczema is called lichenification, and it is caused by regular scratching. Scratching prevents healing between acute flare-ups.
Some of the scratching is itch related, but some is not – it has now partly become a habit, and linked to other factors, including circumstance, and frame of mind.
Chronic eczema flares up much more easily than healthy skin. Once chronic eczema is successfully treated, less acute eczema occurs.
The Manual for Practitioners details The Combined Approach for younger children. As for Adults and Older Children, the approach has three levels:
Habit reversal is usually rapidly effective when it is part of The Combined Approach for the youngest patient. It then becomes first less important, and later unnecessary, as the treatment programme focuses on the first two levels of treatment, once the chronic eczema is successfully treated.
This first part of the programme can be accomplished in four weeks, with habit reversal being very important in the first part of this period – the first few days especially.
No habit can be successfully treated until awareness has been accomplished. In older children and adults preliminary registration by the patient is required. In the youngest patient the parents and others are needed to observe behaviour and need to become aware of the situations that are most likely to be triggers for scratching.
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