How I saved my skin

Sue Armstrong-Brown had such severe eczema that she was in constant pain, barely slept and even had to be hospitalised. That was until she discovered the therapy that changed her life
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Indy Lifestyle Online

I stretched to get a cup off the top shelf today. Last night I slept for seven hours without waking once. And on a warm day at the end of April, I happily donned a T-shirt and shorts and sprawled in the garden. All modest accomplishments, as I'm sure you'll agree. But as every severe eczema sufferer knows, these things can't be taken for granted.

I stretched to get a cup off the top shelf today. Last night I slept for seven hours without waking once. And on a warm day at the end of April, I happily donned a T-shirt and shorts and sprawled in the garden. All modest accomplishments, as I'm sure you'll agree. But as every severe eczema sufferer knows, these things can't be taken for granted.

For more than 10 years, I lived with the pain, disfigurement and misery of severe chronic eczema. Like all sufferers, I was told that the condition was incurable and I would just have to learn to live with it. But now I'm cured – just like every chronic eczema sufferer could be.

I have had eczema since I was six weeks old. It was never a major problem when I was a child. But throughout my teens it grew gradually worse, until I ended up in hospital when I was 18. It was a tremendous shock – I had always thought of eczema as something annoying and unpleasant, but not serious enough to merit hospital treatment. During my twenties my skin went completely out of control, and I had three more spells in hospital. I watched the eczema creep over the whole of my body, and it was actually a relief when it reached the soles of my feet. It couldn't spread any further after that.

Every movement hurt. As my skin lost its elasticity, stretching and sudden movements often resulted in painful splits. I remember being in tears over dropped objects, knowing how much bending down to pick them up would hurt. My skin was so dry that it came off in sheets, and I woke every morning looking as though I had been rolled in porridge oats. I dreaded being anywhere with dark furnishings, because it would quickly look as though it had snowed around me.

I scratched so much and so hard that my nails split across, and chunks of skin got rammed down behind them, setting off painful infections under the nail. My work and social relationships suffered, and in the end I became clinically depressed. I was exhausted, waking up three or four times a night to apply more cream, and I was a nervous wreck, jumpy and tearful. I hated my skin, and was obsessed by it.

Of course, I searched for cures. Like many chronic eczema sufferers, I became alarmed about the side-effects of the steroids prescribed to treat my eczema, and tried to cut down. That only made my skin worse. I tried numerous complementary therapies, always searching for a miracle cure: Chinese herbs, homeopathy, hypnotism, herbalism, magnetology, acupuncture, exclusion diets, meditation... Most of them appeared to help at first. I still don't know whether that was an illusion because I wanted them to work so much, or if feeling better because I was doing something positive helped, or indeed if the treatments were effective to some degree. Some of the treatments were valuable in helping me to recognise the damage that having severe eczema was doing to my personality, and provided techniques to calm me down. But eventually I had to admit that I was persevering with them only because I didn't want to admit that they had helped as much as they were going to. Now, I understand why the complementary treatments didn't work. They were all missing one vital ingredient – but we'll come to that later.

The crunch finally came when my parents saw that I could no longer cope with simple jobs without becoming frenzied and exhausted. My family ganged up on me and sent me off to my GP to ask for help. I asked to be referred to the Chelsea and Westminster Hospital in London, because its progressive treatment for eczema had helped one of my friends. Three months later my appointment came through – and I can honestly say that it changed my life.

The Chelsea and Westminster team have a secret weapon in the fight against eczema. They give all the power back to the patient. Instead of relying on mysterious ointments and potions, they simply teach you how to break the cycle of chronic eczema, allowing your skin to heal – and stay healed. It could not be simpler.

And it works. Within three months, my skin was better than it had been for 10 years. It has never returned to the chronically inflamed, flaking and painful state that I tolerated for a decade. And it never will.

There are three elements of chronic eczema: inflamed, eczematous skin, dryness and scratching. Conventional treatments treat the inflammation with steroids, and the dryness with emollients. But they don't address scratching. Habit reversal is based on a recognition of the role that scratching plays in chronic eczema. Scratching tears and damages the skin's surface, preventing conventional steroid and moisturising treatments from working. It causes the epidermis to become unevenly thickened, a condition known as lichenification, because it looks like lichen on rocks. Research with miniature scratching machines has shown that when healthy, non-eczematous skin is consistently scratched, it becomes lichenified, and it clears when the scratching stops.

So why does the scratching happen? People with eczema start scratching because their skin is itchy. But it quickly becomes a generalised habit, when they are stressed, tired or just doing something that they have come to associate with scratching: driving, talking on the phone, watching television – almost anything. Eczema sufferers often scratch almost non-stop, unaware that they are doing it.

This is where habit reversal comes in. By unlearning the scratching reflex and replacing it with another, non-damaging behaviour, eczema sufferers can break the cycle. Now, finally, the steroids and emollients can begin to work. When scratching, inflammation and dryness are addressed together, the condition can be cured.

The programme also teaches people how to use steroids correctly. Concerns about the side-effects of long-term steroid use often lead patients to cut down their dose. But skin doesn't respond to inadequate treatment, and more steroids end up being used for longer. With habit reversal, eczematous skin responds quickly to strong steroids, which can then be stopped earlier. The trick is not to stop too soon – full healing requires two weeks of treatment after the surface layers look clear. Sufficiently strong medicines used for the right length of time mean less steroids are applied overall.

Ten per cent of adults have eczema. A fraction of them can be treated by the leading dermatology clinics and GP surgeries that are taking up the Chelsea and Westminster's ground-breaking programme. But hundreds of thousands still have no access to the new approach. By making habit reversal into a self-help book, I hope that other people will take heart from my story and rediscover the joy of healthy skin.

Once you know what to do, the steps are easy. First, you register how much you are scratching, using a hand tally to log every time you scratch. I was amazed by the results of this exercise – I thought I was probably scratching about 20 times a day, but in reality it was over 600! Then you replace the scratching with new, non-damaging behaviour: clenching your fist for 30 seconds. The urge to scratch has usually passed by the time the 30 seconds are up. This breaks the habitual scratching cycle.

Finally, you identify the situations that are most likely to make you want to scratch, and write your own prescription to avoid doing it. Mine were as simple as holding the steering-wheel with both hands while driving, or keeping a jotter pad handy for doodling while I was on the phone. The whole programme takes six weeks, and people can start seeing an improvement as early as week three.

Breaking the scratching habit

The behavioural approach to treating eczema was developed by the Swedish dermatologist Dr Peter Noren. He discovered that the scratching of eczema sufferers could be treated with habit reversal. Dr Richard Staughton, a London dermatologist, heard about the technique and enlisted Dr Christopher Bridgett, a psychiatrist. They developed a programme to teach habit reversal to patients with long-standing atopic eczema. It is available in the UK through the Daniel Turner Dermatology Clinic at the Chelsea and Westminster Hospital, London.

"So far we have taught the technique in our clinics, and showed doctors and nurses how it can be taught in hospital clinics and in general practice," says Dr Bridgett. "It seemed important to find a way of making the treatment more generally available. If you have established eczema and are frustrated by the creams not working, the programme could change your life."

'The Eczema Solution' by Sue Armstrong-Brown is published by Vermillion (£7.99)