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scratching, which starts out as a normal, understandable behaviour in response to the feeling of itch. If scratching is thus provoked for a sufficient length of time, and increases in frequency, awareness is reduced and the behaviour becomes automatic. At the same time it links to circumstances, situations and activities over and above the original itching stimulus. In the skin the result is the lichenification of chronic eczema. Thus in long-term atopic skin disease much scratching is habitual, whereas the scratching of acute eczema can be all in response to itch. Melin and his colleagues in the earlier study (1986) arranged for patients to be taught habit reversal by two psychology students. After an initial period of registration of scratching frequency without treatment, the patients were divided into two groups. Both groups used topical hydrocortisone for four weeks, but only one group was instructed in habit reversal. Instead of scratching they learnt to grasp an object, or clench their fists. Both groups improved, but the scratching frequency after four weeks was reduced by 90% in the habit reversal plus hydrocortisone group, against 60% in those using hydrocortisone alone. The eczema score showed an improvement of 70% using habit reversal compared with 30% without. As these results seemed promising, the technique was developed. In contrast to nail-biting, scratching can be provoked by a physical stimulus: itching. If itch could be diminished at the same time by habit reversal, a more successful treatment might be expected. Although scratching can provoke itch, part of the eifect of scratching is to relieve itch. Experimentally pruritus in a particular dermatome can be diminished by pricking a needle into the skin of the same dermatome. Furthermore, some patients volunteer the knowledge that they can pinch, or press a nail into an itching area and experience relief. Some use the technique as a remedy for the discomfort caused by insect bites. Based on these observations the later study (Noren and Melin, 1989) used

5a

Âť-M

H

i

clenching the fists and counting to 30 as an alternative to the habit of scratching, then (b) pinching the skin where it was itching as an alternative to itch-provoked scratching

(a)

as the new, desirable behaviours to replace scratching in atopic eczema.

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Profile for Christopher Bridgett

Atopic Skin Disease - A Manual For Practitioners  

An account of a new behavioural approach to the treatment of atopic eczema, written for practitioners, but also for patients

Atopic Skin Disease - A Manual For Practitioners  

An account of a new behavioural approach to the treatment of atopic eczema, written for practitioners, but also for patients