Habit reversal therapy is a useful adjunct to medical treatment for eczema. This blog has been written for those who may be considering this intervention as part of their treatment plan.
What is habit reversal therapy?
Habit reversal therapy is a type of intervention that focuses on changing a habitual behaviour that may be damaging (e.g. scratching itchy skin) into another competing behaviour that does not have undesirable effects.
What does scratching do to eczema?
Eczema is defined as a chronic itchy skin condition. Scratching the skin when feeling itchy can in some cases worsen or perpetuate eczema. This can happen in the following ways:
- The skin is damaged by the physical action of scratching, allowing bacteria in that can cause infection, driving inflammation and causing thickening of the skin
- Scratching drives further inflammation in the skin, which can intensify the feeling of itch, resulting in a vicious itch-scratch cycle
- People with eczema can get caught in the itch-scratch cycle, and scratching becomes a habit. The brain interprets scratching as a positive behaviour (as it ‘solves’ the itch) and the behaviour is more likely to be repeated (this is known as positive reinforcement). At some points people will scratch out of habit rather than in response to the feeling of itch (e.g. when anxious, bored or idle).
Even scratching skin without eczema can cause skin changes that look the same as eczema! In some people it can become difficult to tell how much of their eczema is due to the condition itself and how much is due to skin changes caused by scratching.
How does habit reversal therapy work?
This intervention has been championed in eczema by Peter Noren, Richard Staughton and Chris Bridgett. Habit reversal therapy centres around:
- Engagement – awareness of how much you scratch
- Behaviour modification – replacing a scratching behaviour with a more desirable behaviour (e.g. clenching fists or gently pinching the skin)
- Education – to understand eczema and the principles of treatment
It is usually also recommended to continue to treat eczema actively with emollients and medicated creams if required during the intervention period. There are limited studies in this area, but the results are encouraging and show improvements in the skin.
Where do I find out more?
Please visit www.atopicskindisease.com to learn about habit reversal therapy for eczema in adults, teens and children.
Daunton A, Bridgett C, Goulding JM. Habit reversal for refractory atopic dermatitis: a review. Br J Dermatol. 2016 Mar;174(3):657-9.
Tsakok T, Roberts E, Bridgett C, Staughton RCD. The effectiveness of habit reversal on treatment outcome and quality of life in patients with chronic eczema: a prospective observational study in the U.K. Br J Dermatol. 2017 Aug;177(2):554-556.