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

Abstract

Summary Background Scratching and itch are common clinical signs of atopic dermatitis (AD). Studies of adult patients have shown that a decrease in scratching behaviour results in regression of inflammation and improved healing of the skin. Objectives To investigate whether a modified habit reversal (HR) treatment protocol could be used for the treatment of scratching in children to improve skin status. Methods The study is a single‐blind, randomized controlled trial of 39 patients who started with registration a week before randomization into one of two groups (intervention or control). The participants in the intervention group received a habit‐breaking therapy of their scratching behaviour (i.e. HR) in addition to a potent steroid (mometasone furoate), whereas the patients in the control group received the steroid alone. The patients were assessed by an independent dermatologist after the first week of registration (baseline assessment) and then after 3 and 8 weeks of treatment. The primary efficacy variable was a change in objective Scoring Atopic Dermatitis (SCORAD). Results At the end of the 3‐week treatment period, the change in mean objective SCORAD was significantly (P = 0·027) higher in the intervention group (−31·9 ± 9·5) than in the control group (−23·8 ± 10·1). After the 8‐week follow‐up, the change in mean objective SCORAD was significantly (P = 0·0038) higher in the intervention group (−31·7 ± 10·4) than in the control group (−19·7 ± 9·4). Conclusions The treatment of scratching with the HR method in combination with a potent steroid was found to improve skin status significantly after 3 and 11 weeks.

Stress and Skin: An Overview of Mind Body Therapies as a Treatment Strategy in Dermatology

“…In 1 trial, use of HR in conjunction with standard therapy led to clinically significant reduction in eczema severity and improved quality of life for up to 1 year [29]. In another, use of HR with potent topical steroids for 3 weeks resulted in significantly improved skin severity in atopic dermatitis as compared to controls [30].…”

A position paper on the management of itch and pain in atopic dermatitis from the International Society of Atopic Dermatitis (ISAD)/Oriented Patient‐Education Network in Dermatology (OPENED) task force

“…Therapeutic patient education and psychological approach would complete the caring patient‐doctor relationship based on reciprocity. In any case, it is beneficial to break the itch/scratching cycle 107,113 …”

Integrated behavioral health care for management of stress in allergic diseases

“…16 Habit reversal training has also been used successfully to reduce scratching and improve outcomes in individuals with atopic dermatitis. 50 Combined educational and psychological interventions also can be beneficial. In 1 study, patients with atopic dermatitis who received education and cognitive behavioral therapy had sustained improvements through the 1-year posttreatment follow-up, in atopic dermatitis severity, behavioral responses, illness cognitions, and quality of life, and they reduced their use of histamine agonists and corticosteroids.…”