I’m Dorota, a health psychology student at the University of Nottingham volunteering with the Rapid Eczema Trials project. Being diagnosed with a skin condition myself, I am very interested in what could be done about scratching. It can not only cause damage to the skin but also worsen the inflammation on the skin, thus creating a vicious cycle known as the “Itch-Scratch cycle”. I think it’s extremely important to find alternative ways to help patients maintain and manage skin conditions and not only focus on medical treatments.
An important research question
Eczema is a non-contagious skin condition that causes the skin to become dry, inflamed and itchy. The itch can be very uncomfortable (1).
© Emil Alce. Reproduced with permission.
Scratching is a natural response to the itch sensation which tends to feel good in the moment but can make the skin more irritated. If scratching continues over a long period, it can cause long-term inflammation in the skin that is hard to treat.
Most recommended treatments focus on moisturisers and flare-control creams, which are important to help manage eczema, but additional support to cope with intensely itchy skin is needed. Breaking the itch-scratch cycle is one way of helping with this. In 2012, a priority exercise, conducted by James Lind Alliance, highlighted an important question for people living with eczema: “What is the best psychological treatment for scratching and itching in eczema?” which is still important to this day! (4). Despite the importance of this issue, there is a lack of research in this area. Only two small randomised controlled trials have investigated the effectiveness of what the researchers call ‘habit reversal therapy’. Habit reversal is rooted in what we psychologists call ‘cognitive behavioural therapy’ – an approach all about changing what people do (for example, their scratching behaviour) (5,6).
One of the small randomised controlled trials, only included 45 participants. It focused on the “Combined Approach”, where topical treatments were used alongside techniques to reduce scratching. They discovered improvements in both scratching frequency and skin status in just four weeks, as opposed to the use of just topical treatments (7). So, there is a hint that this approach might just work – but we need a larger study with more people involved to know for sure!
This is where Rapid Eczema Trials come in. Our community told us they want a high-quality randomised control trial to test out whether support to reduce scratching really makes any difference to people living with eczema. Citizen scientists from the Rapid Eczema Trial community are busy helping us design this trial. It will be ready to launch within the next year.
But watch this space if you would be keen to take part!
“This approach won’t completely eliminate eczema or itch. It’s important to remember Itch is the sensation. Scratching is the response. There will always be flare-ups, but how you respond to them, that is the key.”
Dr Liz Steed, a Health Psychologist in the Rapid Eczema Trials Community.
References:
1.NIAMS. (2022). Atopic Dermatitis. National Institute of Arthritis and Musculoskeletal and Skin Diseases. https://www.niams.nih.gov/health-topics/atopic-dermatitis
2.Bridgett, C., Noren, P., & Staughton, R. (2015). Atopic Skin Disease: A Manual for Practitioners. Noren, P,.
3.NICE Guidence CG57 – Updated June 2023. https://www.nice.org.uk/guidance/CG57/chapter/Recommendations#emollients
4.James Lind Alliance (JLA). (2012). Generating research questions from treatment research priorities in eczema. British Association of Dermatologists, London. https://www.jla.nihr.ac.uk/priority-setting-partnerships/eczema
5. Daunton, A., Bridgett, C., & Goulding, J. M. R. (2016). Habit reversal for refractory atopic dermatitis: a review. British Journal of Dermatology, 174(3), 657-659. https://academic.oup.com/bjd/article/174/3/657/6617166?login=true
6. Azrin, N., & Nunn, R. (1973). Habit-reversal: A method of eliminating nervous habits and tics. Behavioural Research and Therapy, 4, 619-628. https://www.sciencedirect.com/science/article/abs/pii/0005796773901198
7. Noren P, & Melin L. (1989) The effect of combined topical steroids and habit-reversal treatment in patients with atopic dermatitis. Br J Dermatol; 121:359–66