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Forty-six patients with chronic atopic skin disease used hand-counters to 'register' their daily scratching frequency, and after one week they were randomly allocated to one of four groups. Two groups used topical hydrocortisone for four weeks, the other two used topical betamethasone-17valerate for two weeks followed by hydrocortisone for two weeks. One group from each different topical steroid schedule were taught the new habit reversal procedure. Reduction in scratching frequency and improvement in eczema score were statistically significant for the habit reversal patients, compared with those using topical steroids alone. It was important to note however no patients showed complete healing at four weeks, and use of a potent steroid for two weeks, followed by hydrocortisone for two weeks led to several examples of relapse. Although scratching could be diminished by 90% in three days by habit reversal, healing then required longer periods of effective topical treatment.

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3.4 Habit reversal in practice

Fig 3.2 Habit Reversal in Practice

1. Registration to increase awareness

2. Instruction to change behaviour

3. Follow-up to maintain change

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The above research studies generated ideas that have since been modified and improved upon in continuing clinical practice. The programme initially consisted of two parts registration, then active treatment. From the start integral to the treatment was an educational element using written material. Later it was realised that followup was very important (Fig 3.2). Habit reversal is not usually involved at follow-up. Adequate topical treatment of subsequent relapses of atopic eczema, once the chronic syndrome has been successfully treated, is the essential intervention. The risk of the re-emergence of chronic eczema must always be guarded against however, largely by the patient being proactive and aware of how the syndrome develops. More than anything, clinical experience has confirmed many times over the results of research: habit reversal offers the clinician a potent treatment opportunity in the management of atopic skin disease, but only when it is combined with adequate conventional topical treatment: it is not a treatment that stands on its own. Clinical practice has also highlighted how much more can be achieved by enabling the patient to manage their own condition. Changes in attitude are associated with improved prognosis. When difficulties in achieving a

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