Iman talks to DrB

author/source: DrB



 DrB (@ckbridgett) met Iman (@imanmade) through Twitter. A mother of 3 from London, UK, Iman is the owner of Imanmade Natural Skin Care, a range of handmade products for dry, sensitive skin made with gentle, natural ingredients. Here she talks with DrB about how she first heard about The Combined Approach, and then used it, with help from her family and her son's nursery, to successfully treat the atopic eczema of her 2 year old son.

DrB: Please tell me how you became interested in atopic eczema and its successful treatment.

Iman: I suffered from allergies, eczema and sensitive skin since early childhood. I was the only person in my family with these issues, and information on eczema skin care was very limited back in the eighties. Throughout childhood to teenage years, my eczema was treated with topical steroids and petroleum based moisturisers. Over-use of the steroid creams caused my skin to thin, especially on my face and I felt the moisturisers just sat on my skin as a barrier rather than healing and keeping it healthy.
In early adulthood I discovered that my skin responded well to plain, unscented skin care products, especially natural oils, and once I kept to this regime, my skin condition was stable and eczema flare ups became a rarity.
I am a mother of three boys, and the youngest two have eczema and life-threatening allergies. My youngest son (almost 3 years) has had a particularly difficult time with both aspects of his health. He endured constant eczema flare-ups, and I often felt he would scratch for no reason, especially when stressed, e.g. if he didn't get his own way. Bedtime was very traumatic on a daily basis: he would wake throughout the night screaming and clawing at his skin until he bled. This happened every night for 2 years. The constant sleep deprivation affected the whole family, and my son was often grumpy and tearful throughout the day. It was all very upsetting and stressful for me to deal with constantly.

DrB: How did you discover The Combined Approach (TCA)?

Iman: I caught a conversation between yourself and MarcieMom, a mother of a child with eczema whom I was following on Twitter. When read further about The Combined Approach here on, it confirmed my suspicion that my toddler was often scratching out of habit. So, I quickly decided to try TCA with my son.

DrB: Before TCA, had you had experience with other treatment approaches?

Iman: I hated steroid creams with a passion. I grew up using them regularly and believe my skin is much thinner as a result (my own tears can cause ‘burns' on my face). I also believed that the steroids made my eczema worse, as flare-ups would escalate once the recommended usage period was over (this was before learning about Hidden Healing).
My boys were under the care of a specialist allergy and dermatology team. The older of the two has since been discharged due to drastic skin improvements. Under their care I reluctantly used steroid creams/ointments on my sons but would also go for long periods without them.
I tried zinc bandages for a while, which helped to soften the rough patches, but this took a long time to apply, and skin would revert shortly after. I also tried bandage style clothing, which helped to protect his skin, but he would find ways to access his skin and scratch.
Antihistamines were used regularly to suppress the itching, with a stronger antihistamine (Phenergan) prescribed to aid sleep on difficult nights. But he grew dependent on them and they began to lose effectiveness until after a long break.
I mainly focused on moisturising and nourishing their skin with my own handmade natural skin care products. I had started making my own skin care after a prescribed moisturiser burned my son's skin when he was only 4 months old. I was very pleased with the results of using my butters and oils, and the use of natural techniques like
oat baths to soothe itching. The specialists noted the improvements, but my toddler still had regular flare ups, and would even scratch intensely when his skin was completely clear.

DrB: How did you go about preparing to use TCA?

Iman: First of all I had to I had to let go of my dislike for topical steroids and convince myself that they could be a part of the solution. This wasn't easy as I also felt that it conflicted with my natural skin care business. But as a mother I was willing to try anything to help my son to live comfortably.
Although I was willing to try the steroid approach, I still wanted to keep the skin care as natural as possible. So, I continued to use my handmade body butter as my son's emollient to heal and nourish his skin, unlike the synthetic options available.
Aside from preparing myself mentally, I also had to clear time in my busy schedule to give the constant attention needed for the first few days of the programme. While waiting for a time when I would be free to focus on implementing the first 4 intense days, I slowly introduced my son to distraction techniques such as holding his hands while watching TV, and using toys to occupy his hands, I'm glad that I introduced these distraction techniques to my son beforehand, as when we started TCA properly, he was familiar with them and was able to transition smoothly. I did my best to refrain from saying ‘stop scratching!', which is easier said than done, and to use positive reinforcement instead.

DrB: Once you got going, what was the first thing that you did using TCA?

Iman: My son attends nursery part time, so I started TCA on a Friday so we could make full use of the weekend. We stayed at home during this period to minimise disruptions. Although I was already moisturising heavily, I began use of the steroid creams/ointments and utilized a few different distraction techniques to combat the habitual scratching. I was creative with distraction techniques - I would invent songs to sing with my son as I moisturised him, making up the words as I went along, but ensuring it involved a lot of clapping/actions to keep his hands busy. Other times, I would just hug him so his hands were wrapped around me. New and exciting items such as felt tip pens were fantastic ways to divert his attention when he was being stubborn with scratching. I'd help him to colour in pictures and hand a new colour to him when he went to scratch. Simple ball games were great for when we were out  in the garden.

DrB: Did you get others to help?

Iman: In the intensive stage, his father and older brothers (aged 8 and 9) were the only others helping me to care for him. I taught my sons the basics of TCA and got them to help with distraction techniques. I also had to tell them not to tell him to ‘stop scratching' or make a fuss if they saw him scratching, but to quietly hold his hands and play with him. Their involvement was invaluable as he looks up to them and often mimics what they do.

Dr B: Then, what came next: how long did it take to get results?

Iman: I notified my son's nursery of TCA so that they could help me to implement the strategies when he was in their care the following week. My sons' grandparents were also informed for weekend visits.
I also sped up his moisturising/getting dressed process as I usually took a long time to do so. I learned from TCA that it was better to keep the process short. Within a few days he was hardly scratching. It was quite remarkable. Although his skin cleared up very quickly, I continued to use the topical steroids to complete the hidden healing period. His first post-TCA flare up happened within the 1st month, but I persevered with the programme and all further flare-ups were minor.

DrB: With initial good results, what seemed important afterwards?

Iman: Maintaining my son's healthy skin with natural skin care products and preventing him from slipping into his old habit of constant scratching.  I continued to use topical steroids when he had further flare ups, but it wasn't necessary to use them for prolonged periods. I hardly use them now and I'm aiming to get to the point where I do not use them at all.

DrB: What has been the best thing for you about TCA?

Iman: Habit reversal. The absence of constant scratching allows the skin to heal and stay healthy.  And habit reversal was not as difficult as I thought it would be. I had geared myself up for a battle and it was actually quite a smooth transition

DrB: Do you have any special tips for others interested in doing the same thing?

Iman: Yes, of course. Here are a few -

  • Read the info here on to get a full understanding of TCA, then just go for it! It's worth a try.
  • Prepare yourself mentally and keep an open mind.
  • Involve others: make other family members, nursery staff and school staff aware of TCA - it helps for times when you are not around.
  • Moisturise skin as often as needed, keeping skin care and bath products as gentle and natural possible. Ingredients in some commercial products can cause irritation. Try natural oils such as olive oil, coconut oil and shea butter
  • Expect flare-ups to still occur, but in time you will notice that they are less often and not as bad as before.
  • Get help: don't be afraid to ask for emotional support/counselling. Caring for a child with eczema can be very stressful the whole family.

DrB: Overall, what changes have you achieved in quality of life using TCA?

Iman: My son's skin is much better. No more scratching until he bleeds. His eczema is hardly even noticeable now. He is happier, the constant crying has improved, and he sleeps much better, meaning I sleep much better too. I am happier too. I was really feeling the strain of coping with all of my son's skin issues as well as the multiple conflicting allergies in the family. It's still a struggle, but life is definitely easier now. It's lovely to watch my son enjoy activities with other children without having to stop and scratch all the time!

DrB: Thank you Iman, it was a pleasure talking with you!



Habit reversal for habitual scratching in younger children with atopic eczema
Bridgett,C & Ogoo,I (2013) Dermatological Nursing 12 (3): 28-30 

The positive effects of habit reversal treatment of scratching in children with atopic dermatitis: a randomised controlled study