Consultant Psychiatrist


Eczema Scratching


The itch-scratch cycle is familiar to everyone who knows about atopic eczema.

When eczema flares up, it itches – a feeling, which leads to scratching – a behaviour. The scratching irritates the skin further, then there is more itching, and more scratching.

Hence, the famous itch-scratch cycle.

But with eczema, unlike with some other skin problems, not all scratching behaviour is due to itch. Especially when eczema is longstanding or chronic, scratching (including rubbing and picking) is due to habit as much as to itching. Habit scratching is something special about having atopic eczema that needs thinking about and dealing with. If not, it continues as a secret cause of chronic eczema.

This is the less well-known habit-scratch cycle that causes and maintains chronic eczema despite the correct use of conventional treatment.

Habitual scratching has certain characteristics:


  1. It is done “without thinking” – automatically or unconsciously
  2. Usually there is no itch-feeling involved
  3. It tends to be triggered by certain circumstances: the traffic light phenomenon
  •     Being held-up
  •     When running late
  •     Boredom
  •     Trying to think
  •     Embarrassment
  •     When on the phone
  •     Being in the bathroom
  •     Getting tired

Each of us tends to have a personal method for habit scratching that has its origins in the distant, forgotten past. My patient in the picture above showed me how she uses her favourite necklace to rub the eczema on her fingers. How it started was not so important, but realising that it happened all the time, and was causing chronic eczema on her fingers, was very important.

These special ways of scratching, rubbing and picking at the skin need adding to the usual ways of scratching, for discussion and understanding, before habit reversal can be completely successful.

Otherwise healing using The Combined Approach can be incomplete – favourite areas that are targets for such habit scratching will remain, until they too can be given habit reversal protection!

Find out more at


Do you have a favourite habit scratching method?

Do you remember how it started?




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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