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Jon Goulding talks to DrB
On the importance of a holistic approach to the treatment of skin disease
Jon Goulding is a Consultant Dermatologist in the NHS at Solihull and Good Hope Hospitals, and in private practice at Little Aston Hospital, Sutton Coldfield, near Birmingham, UK. With a BSc from Edinburgh University, he qualified in Medicine at Oxford University in 2001 and gained his membership of the Royal College of Physicians of London in 2005.
DrB: Did you specialise in Dermatology straightaway after qualifying?
JG: I deliberately sampled a range of different specialties in my junior doctor years, and I particularly enjoyed 6 months in General Practice, where the focus on how to communicate with patients took centre stage.
DrB: What are your particular interests in Dermatology?
JG: I enjoy all aspects of general dermatology, but I do have a particular interest in psychodermatology, and also in male genital skin disease, where psychology often plays an important part.
DrB: What are your thoughts about psychodermatology?
JG: Perhaps it shouldn’t really be viewed as a sub-specialty in its own right – psychodermatology is relevant to every patient who comes to the clinic, whether they or their doctor realise it or not! It is also not complicated – in my view it boils down to ensuring that doctors ask their patients how they feel about their skin problem, and how they feel generally, as well as what is going on at home: taking account of the whole person. Unfortunately this is rarely given time or credence in general dermatology clinics, and specialist psychodermatological clinics of the type I run are inexplicably thin on the ground in the UK, despite a colossal unmet patient need.
DrB: What is your approach to the treatment of atopic eczema?
JG: Atopic eczema is of course very common and most people respond very well to standard topical treatment, as long as they can persuade their GPs and themselves to use adequate quantities of moisturisers and topical steroids. Most people who don’t respond are not using enough of either, or are not using sufficiently strong topical steroids for long enough. Side-effects from even super-potent topical steroids are relatively uncommon. In many people habitual scratching complicates eczema, over and above the inevitable itch-derived scratching. Habit reversal can be incredibly useful for these patients, and it makes absolute sense.
DrB: The Combined Approach fits the bill?
JG: Yes indeed - I think it is the perfect paradigm of the holistic approach to the treatment of skin disease that should be in use routinely in all dermatology clinics. Habit reversal is simple and the results are palpable. It dovetails perfectly with standard topical and other treatment strategies. Most importantly it empowers patients to take control of their skin problem and work out their own personal strategies for success. Patients have to be open-minded, willing to give it a proper go, and willing to change their habits – a half-hearted attempt does not succeed. For those that are keen and engaged I have had very good results indeed, with the potential to impart a lifelong change in their experience of eczema. I am also keen to apply a modified approach to other skin conditions with habitual elements, such as the skin picking syndromes, and lichen simplex chronicus.
DrB: Do you refer to atopicskindisease.com with your patients?
JG: Certainly. The website is an invaluable one-stop shop where doctors and patients can find a wealth of information to enhance and refine their experience using The Combined Approach. It is well worth spending time scrolling through the different pages and links to acquire the knowledge and real-life tips of others.
Jon Goulding: Presentation - "Habit reversal: a non-toxic, cost-effective intervention for chronic eczema"
Jon Goulding: Book review - "The Eczema Solution" by Sue Armstrong Brown