Getting ready to go with The Combined Approach

When it is seen that skin with atopic eczema has become thickened by habitual scratching, and is therefore not responding well to conventional topical treatment, it isn't necessarily plain sailing to immediately start habit reversal and The Combined Approach - assessment should anticipate possible difficulties.

Success with the treatment programme requires understanding, motivation and ability to commit to a few weeks of self-help homework.

As Dr Peter Norén says: "When starting habit reversal for atopic eczema, BE AWARE - there is a cost involved: your own work and effort. You will do the work, but you will get the credit!"

Assessment can use this simple system:

◉ Red: Hold off, for now?

The programme requires spending time, first of all understanding what is involved, and then putting it all into practise: there are no short cuts. If there are competing commitments that will prevent the full programme from being followed, it may be best to wait until the time is right. Good examples would be if there is a need to study for an examination, or a need to make a particular trip away from home. After the exam, or once back from the trip, can be better times to start the programme. If a child has chronic eczema, seeing if the same goes for a parent first may be a shrewd move!

◉ Amber: Proceed, with caution! 

Usually there is the required time for the programme - it is not so much really - but with adults in particular there may be an understandable scepticism about yet another remedy to try, perhaps recommended by someone else. Previous efforts over the years with novel treatments have been disappointing. Established habitual scratching can be linked to an acceptance of "living with eczema" - and the suggestion that one's own behaviour needs to change can seem hard to accept. Time therefore is needed to find the necessary can-do attitude - often special attention to this in a routine clinic discussion is all that is required, but occasionally extra preparatory discussions are worth considering before starting the The Combined Approach itself.

◉ Green: Go for it! 

Often the first explanation of The Combined Approach making so much sense, perhaps together with encouragement from others who have been successful with the programme, is all that is needed to get going. The self-help format is supported by the excellent, short, and easy-to-read book "The Eczema Solution". Also recommended are regular reviews of progress using this website, plus also getting appropriate support from others when needed.

The clinic-based format is also supported by this website, and by the relevant "Live Without Eczema" handbook. The appointments with the practitioner ensure the programme is followed in the recommended way, and liaison between all involved should ensure that, after the first two stages of the programme have been completed successfully, the important follow-up stage is also followed correctly.

Let us know how it goes for you. Comments welcome below.

See also

• Getting treatment 
• Ten Tips for success using The Combined Approach to atopic eczema
• Coping with difficulties: Adults & Older Children
• Coping with difficulties: Younger Children and their Parents
• Why some practitioners fail with habit reversal for chronic atopic eczema
• Why do you recommend treating the parent before treating the child?