Katie talks to DrB
Using the self-help programme for The Combined Approach to atopic eczema
Katie is thirty. She grew up in New Zealand, and now lives in London, U.K.. Her eczema started in her early teens and she is not sure what causes it. She does not have asthma or hay fever, but her sister has asthma. Katie’s eczema became more widespread and troublesome last year, especially on her face and hands, so she went to see a dermatologist.
DrB: Was it when you went to see your dermatologist about your chronic atopic eczema that you first heard about The Combined Approach?
K: Yes, and then a friend recommended the book called “The Eczema Solution” by Sue Armstrong-Brown.
DrB: Sue wrote the book after The Combined Approach helped her so much with her chronic eczema. Now there are also many extra tips about The Combined Approach on this website.
K: For me “The Eczema Solution” has been really very helpful. I have worked my way through the programme, following the instructions on how to use my steroid creams and my emollients. I identified when I scratch, and have become much more aware of this. By following the programme I feel I have really cut out habit scratching. Certain patches of skin do still feel quite itchy at times, but instead of scratching, I just try to press my fingertip onto the area, as suggested. Will the itching just diminish, as the patches of eczema improve?
DrB: Itching has many causes, including the healing process itself, unfortunately! But the answer is yes, the programme aims to clear all chronic eczema in about 6 weeks, sometimes less. Acute flare-ups are itchy of course, and they will continue to happen, at least to begin with.
K: I have had a lot of success, especially with the eczema I had on my eyelids, forehead, cheeks, and neck. Now those flare-ups are definitely diminishing, in frequency and in duration. But my hands are still prone to more frequent and prolonged flare-ups. These clear within a few days of starting steroids but seem to come back a few days later. Some days they will be completely completely eczema free, and you would never know that I had eczema on my hands - except perhaps for the thin skin. I am hoping that my hands will also improve with time. It has been three months since I first started the programme.
DrB: With three months using The Combined Approach, first of all successful habit reversal with the correct use of emollients and topical steroids will clear uncomplicated chronic eczema. Then habit reversal is no longer required. After that, it is the correct use of emollients and topical steroids that is important. The steroids must be strong enough, and must be used for long enough. Once a flare-up has cleared - this should take a only a few days - the steroid needs to be continued for another few days more, for the “hidden healing”. These short courses of topical steroids need to treat the flare-ups as soon as they appear, to prevent the eczema getting out-of-hand again.
K: Is it possible that there is a complicating irritant or other factor that hasn't been identified, that is causing my hands to continue to flare up like this? If that is the case, and the dermatitis is being triggered by something still in my environment, will this programme ever work for my hands?
DrB: Yes, that it can. With the programme, some sensitivities disappear, as the skin recovers. This takes a few months of regular use of our follow-up advice. The hands are however a special case, because they get such a hard time, with all they get asked to do. If they can be given a holiday from house-work, that can really help! And “patch testing” can be done for possible "contact dermatitis”: there may be something you are in regular contact with that your hands are reacting to. If you suspect something in particular, try avoiding it.
K: All in all, I am so much happier, with my face so much better now: no more weeping forehead or eyelids. I will refer back to “The Eczema Solution” over the coming months, to make sure that I am staying on track, and I will keep visiting this website for extra tips.
DrB: How has the book particularly helped you?
K: I found it excellent to use in more ways than one. Putting everything together - the steroids, the emollients, the habit reversal - was a very satisfying, positive experience for me. It is a really practical book, right down to how to apply the steroids correctly, covering with emollient afterwards - something that hadn’t been suggested to me before. And the suggestion in the book to take one chapter at a time was really good. It meant that it didn’t become too overwhelming.
DrB: Did you involve your family doctor?
K: No, I did not involve my GP. I had recently seen the dermatologist who had reviewed my creams, and had advised about which emollients and topical steroids to use. Also, I didn’t feel that my practice had taken my eczema very seriously on previous occasions. In hindsight it probably would have been useful to see a doctor though, especially to monitor my progress, and to suggest changes in treatment when necessary. I would definitely recommend involving a doctor for anyone using The Eczema Solution - just as the book suggests!
DrB: How has the programme changed things for you?
K: I must admit I was pleasantly surprised that The Combined Approach worked for me! I was so used to having eczema, I did think that I would just have to live with it. Now, with the flare-ups getting shorter and less often I am hopeful over time they can stop altogether!
DrB: You are atopic of course, and this means you will always prone to get eczema - the atopy doesn’t go away, but the eczema can. The Combined Approach aims to help this to happen. That is why we talk about learning “to live without eczema”.
K: Having used the programme I now feel in control of my skin. I can have a positive influence on it. Before, it was like I was just slathering steroids over the eczema. Now the skin on my face is no longer bright red, scaly or weepy, and I feel so much less self conscious about my appearance.
DrB: You are happy that your friend recommended “The Eczema Solution”?
K: Yes, I am very happy. I will definitely be keeping this book to refer to again should needs be, and will be sure to recommend it to anyone with chronic eczema. And thank you for your support, and for all the extra helpful tips on this website!