Consultant Psychiatrist




In 2013 NursingTimes.Net reported a survey that showed one in five eczema patients scratch “at least 10 times” a day, and of the 500 questioned, a third said they go to “extreme lengths” to hide their symptoms.

Our experience in clinic treating atopic eczema suggests this reported rate of scratching is only the tip of the iceberg.

Moreover, the full significance of the behaviour needs understanding. Scratching in itself does highlight the suffering and distress of having eczema, and the need for effective treatment. But habitual scratching causes longstanding, treatment resistant eczema. Habitual scratching needs treatment before standard topical treatment can be completely effective.

Scratching begins as a conscious reaction to itch. As it is repeated, like any behaviour, it becomes also an unconscious reflex. People with atopic eczema scratch much more than they think. That is why our Combined Approach to atopic eczema begins with a week’s homework.

Using a hand tally counter each episode of scratching is registered, and the daily totals recorded. The process of doing this makes the behaviour much more conscious: our patients then report an average 200 scratching episodes a day, with 60% of this being due to itch – the rest is habit.

Becoming more aware of what is happening is a crucial step towards successful treatment with habit reversal.

Scratching is not only an important symptom of atopic eczema.

Scratching is also a cause of chronic eczema, and needs treatment!



Dr Christopher Bridgett (DrB) is a specialist in Adult General Psychiatry who has also worked in Dermatology since being first introduced to Psychodermatology by Arthur Rook in 1971. Together with dermatologists Richard Staughton (London) and Peter Norén (Uppsala) he co-authored Atopic Skin Disease - A Manual for Practitioners, which sets out a behavioural approach for the successful management of atopic eczema. Now retired from both NHS and private practice, he continues to teach and advise at Chelsea & Westminster Hospital, London and runs an online community for both practitioners and patients interested in The Combined Approach to the treatment of atopic eczema:

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