Behavioural treatments for eczema

Educational and psychological interventions are invariably provided in conjunction with conventional therapy. Such interventions may be directed towards adults or the parent or child with eczema, with parents tending to be the primary focus of the educational approaches and children the main target of psychological interventions. This section builds on principles from Helping patients make the most of their treatment but applies and extends them to the field of eczema, addressing and largely focusing on key issues such as education and support for parents of children with atopic eczema. Such interventions provide considerable scope to nursing staff to approach the assessment and management of educational and support needs in a systematic way.

The importance of education, as a basis for improving adherence to treatment, is highlighted in the NICE (2007) guidance on atopic eczema in children. It highlights the importance of educating both child and parent or carer and reinforced at every consultation, both in written and verbal forms, with practical demonstrations covering:

• how much treatment to use,
• how often to apply treatments,
• when and how to step treatments up and down and
• how to treat infected atopic eczema

Such interventions may be illustrated with the application to children, as in the case of atopic eczema. The suitability of the intervention will depend on the age and developmental stage of the child and, therefore, the child’s ability to participate effectively in an educational and psychological intervention will vary.

Since atopic eczema affects children and can be disabling for whole families, it is generally agreed that psychological support and education of the parent/carer are a crucial component of disease management. Little is known, however, of the measurable effects of such interventions and the most recent systematic review of the treatments for atopic eczema to date (Hoare et al., 2000), which found only limited evidence to support psychological treatments or educational interventions, although more recent evidence has been found of the value of some planned educational approaches (Ersser et al., 2007). Psychological interventions are being incorporated into management strategies to reduce scratching behaviours that exacerbate eczema (Horne et al., 1989; Giannini, 1997). Despite the fact that parents are the primary carers for children with atopic eczema, very limited attention has been given to the psychological support of parents (by educational or psychological intervention). As such, the caregiver’s ability to manage their child’s eczema is an important outcome and therefore the educational or psychological support given to parents is required. It could be argued that the general case for psychosocial intervention to improve clinical outcomes in chronic organic disease such as eczema is established and in related areas such as asthma (Guevara et al., 2003).


The literature refers to a range of psychological interventions that have been used in atopic eczema, such as behavioural management (Noren 1995; Bridgett et al., 1996) and cognitive behavioural therapy (Ehlers et al., 1995). Clinical observations suggest that behavioural techniques can be a useful adjunct to topical therapy and breaking the itch–scratch cycle is argued to be a primary clinical aim (Hagermark and Wahlgren, 1995). However, evaluative research has been limited (Simpson- Dent et al., 1999; Bridgett, 2000), especially with children.