Consultant Psychiatrist




Atopic eczema easily becomes chronic, or longstanding, in early childhood, partly because of inadequate use of conventional topical treatment, and partly because of habitual scratching. The skin becomes thickened, or lichenified. Chronic eczema is established.

What to do about this dry, rough and thickened skin is usually overlooked in treatment guidelines. Only treatment instructions for acute flare-ups are given. These are treated with emollients or moisturisers, and topical steroids or other anti-inflammatory applications.

Once chronic eczema is present, acute flare-ups can become more frequent and more troublesome. The skin is now more sensitive, more reactive. The flare-ups become less responsive to the usual, recommended topical treatment. This then is understandably used with less enthusiasm, and less attention to recommendations.

More itching and scratching, and more lichenification or thickening of the skin can follow.

The Combined Approach to early childhood atopic eczema deals with this situation. Optimal topical treatment and habit reversal for habitual scratching make an ideal treatment programme that clears up any acute eczema and the chronic eczema, in just a few weeks.

Then the approach of treating acute eczema early and thoroughly with only topical treatment leads to fewer and fewer flare-ups, more and more healthy skin…

.. and extra time for fun!




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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