Background: The article describes the development of a psychodermatological service for patients with atopic dermatitis at the Chelsea and Westminster Hospital, London. Methods: Since 1989 an approach has been offered for chronic atopic eczema combining habit reversal with optimal dermatological treatment. The programme aims to eliminate the chronic syndrome by reducing scratching and rubbing behaviour, and achieve control over the skin condition. First a distinction between itching and scratching is made, followed by behavioural analysis to heighten awareness of scratching. The programme then continues with training in habit reversal and explanation of the optimal use of emollients and topical steroids. Finally advice is given on how to predict, recognise and manage acute relapses. Results: About 250 patients have participated in the treatment programme. 60% of the participants were sucessfully treated, for 25% the results were satisfactory and 15% did not benefit from the programme. Conclusion: The conclusion can be drawn that the training helps a majority of the patients. Self-management can be encouraged by handbooks and materials and thereby reducing the professional input. The effectiveness of the combined approach has to be explored by further studies with a prospective randomized study design.

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