Consultant Psychiatrist

Being creatures of habit is usually useful, but nature can get the better of us.

Anything that is done on a regular basis can become a habit. A habit is a behaviour that we lose conscious control over. Sometimes then it can become excessive. Too much of anything can cause problems. Consider the basics. Too much oxygen can be a bad thing. The same goes for water.

Habitual over-breathing, or hyperventilation, a complication of anxiety states, can lead to faints and fits. Water, another essential for life, needs to be taken in moderation – not too little, not too much. Too little, and we can dehydrate. Too much, and we can get water intoxication.

Each of the three levels (see below) of The Combined Approach for treating chronic atopic eczema involve getting things right to achieve success. At level 1, using moisturisers appropriately, neither too little, nor to excess, is important. Habitual scratching, the cause of lichenification, or thickening of the skin, in chronic eczema, needs tackling with habit reversal at Level 3.

Three Levels of Treatment for The Vicious Circle of Chronic Eczema

Three Levels of Treatment for The Vicious Circle of Chronic Eczema ©ckbridgett1996

At Level 2, getting it right with the use of topical steroids is also important for success with The Combined Approach. Using them too much can certainly cause problems. But so can using them too little. The risk of steroid side effects need not become steroid phobia, when they are avoided altogether. On the other hand, over-use, or abuse, of topical steroids can lead not only to skin thinning and easy bruising, but also it seems, perhaps after prolonged, inappropriate use, to a troublesome state called Topical Steroid Addiction, also known as Red Skin Syndrome or Steroid-Induced Eczema.

Following The Combined Approach for atopic eczema allows topical steroids to be used without the complications of either under-use or over-use.Topical steroids need to be used under medical supervision, at the correct strength and for the right length of time. When used in this way, topical steroids are both safe, and very effective.




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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