Wednesday, January 25, 2012

More on habit-reversal for eczema treatment

After meeting Mei and CK Bridgett on Twitter I have done a little bit of research on the "habit-reversal" technique Bridgett is so keen on for eczema patients.

I like the idea very much. Through my entire life the only attitude I have gotten from doctors (GPs and dermatologists) about my eczema is that there's nothing you can do for the patient except prescribe topical corticosteroids. Nobody has ever addressed nervous or compulsive behavior, which is certainly a component.

In his website/book, Bridgett, a psychiatrist, refers to a number of the original papers on the habit-reversal technique. I printed them out and read them, and you can too.

A 17-patient study, finding that behavioral change (clenching hand into fist, or grasping an object) plus hydrocortisone cream improves skin quality twice as much as hydrocortisone cream alone (but did not affect bouts of intense itchiness).

A 45-patient study, where behavior training (fist-clenching &/or pinching the itchy area to cause pain) + steroid reduced scratching by 90% compared with 75% for steroid alone.

A conversational speech by Peter Noren, very readable, in which he explains how parents can apply the technique to children. Noren rightly laments the poor attitude of many doctors and insists on a positive outlook by both doctor and patient, and deeper involvement by the doctor.

I have to say that these studies are pretty small in size. I wonder whether anyone's ever conducted a study of, say, 200 or 1000 patients, which would give you more confidence in the results. Soon I hope to conduct a very small study (one patient: me) and publish the results on this blog. What's stopping me? I have to get psyched up to make little marks on a piece of paper each time I scratch, and to poke my skin with my fingernail in public.

Last year I spoke to Martin Steinhoff about his plans for an integrated itch center at the University of California, San Francisco (where I work). At the time Steinhoff did not mention behavioral coaching, but I'd like to ask whether he would consider a psychiatrist or behavioral coach as an essential member of such a center.

2 comments:

  1. In fact--duh--there have been a few more recent papers published on this topic. See http://www.ncbi.nlm.nih.gov/pubmed?term=habit%20reversal%20eczema

    But only five of them. You'd think there would be so many more.

    I'll have a look at these and see if there are any new insights.

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  2. Eczema is a common non infectious skin condition. It is a chronic and itchy rash that affects the skin causing grief and pain if it is very severe. Inflamed skin conditions result in Eczema.
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