Getting Back On Track with Habit Reversal

author/source: DrB


For all ages, after success with The Combined Approach for chronic atopic eczema, whether clinic-based or self-help, the important follow-up phase needs on-going vigilance. Knowing how to recognise and deal with acute flare-ups with correct Level 1 and Level 2 treatment will keep persistent chronic eczema out of the picture. 

Just a few months of regular checking with appropriate responses can mean increasing resilience to eczema triggers. Wonderful!

But with the best will in the world the situation can sometimes revert to how things were! Then the eczema becomes again relatively resistant to topical treatment as habitual scratching starts again to complicate the situation. This chronic eczema looks and feels rough, thickened and damaged, as well as red and itchy. 


Perhaps a flare-up has not been treated properly, or perhaps use of emollients have been neglected. Such a return of persistent eczema is especially likely when stress is an issue. It happens also in particular in the winter, when the air is drier.

The good news is that it is easy to put things right. A short refresher of all three levels of The Combined Approach is needed. This may require only a short return to the full programme to get back on track!

First, think through what seems to have happened. Learning from experience means future set backs can be avoided. Commonly inadequate use of Level 1 and Level 2 - moisturisers and topical steroids: see diagram below - is the explanation. At follow-up, moisturising needs to be maintained to prevent the skin from drying. Short courses of topical steroids (or equivalent) need to be added at the correct strength and for long enough for acute flare-ups - remember the advice: ZAP the RELAPSE!

Second, prepare to add Level 3  - habit reversal - again to Levels 1 and 2.

  • Motivation: Consider again why the programme is important: being free of the complication of chronic eczema will allow both good control again, and getting on with life! These long-term benefits are well worth the effort required in the short-term.
  • Registration: Spend a few days - for Adults and Older Children with a hand tally counter - assessing the frequency of scratching, noting the typical circumstances again. During this period ensure supplies of the correct topical treatment are available for restarting the programme.

Third, only after these preparations, resume again all three levels of the full programme, as before.


Level three will be easier now as the lessons learnt the first time round are put into practice again. Remember even for adults how useful it can be to involve others.  Note how scratching reduces as habit reversal kicks in again. See how the chronic eczema melts away as topical treatment is able to work effectively alongside natural healing.

When all is clear again for long enough - at least for a week or so - stand down Levels 3 and 2 again. Continue as before with the follow-up regime:

Keep up with

  • Vigilance!
  • Prevent the skin drying! 
  • ZAP the RELAPSE!

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