Poor compliance with topical corticosteroids for atopic dermatitis despite severe disease

University of Massachusetts Medical School, Worcester, Massachusetts.
Dermatology online journal 02/2008; 14(9):13.
Source: PubMed


Electronic monitoring of adherence provides opportunities for new insights into the relationship between adherence and treatment outcomes. We report a patient who was non-adherent to treatment despite a high degree of atopic dermatitis severity. Such patients may be better managed by measures that increase adherence rather than use of more potent, potentially toxic medications.

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    • "For example, an appreciable number of AD patients/parents believe that animal-derived proteins such as milk, meat and eggs, are aggravating factors and erroneously consider that these foods should be restricted in the diet9-12. Furthermore, patients with AD and/or their parents commonly misunderstand the use of corticosteroids (corticosteroid phobia), especially for topical corticosteroids13,14. Corticosteroid phobia frequently leads to the worsening of symptoms and prompts the consideration/use of unproven alternative medicines, such as Chinese herbal therapies15. "
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    ABSTRACT: Providing an educational program as part of a health care program for the management of atopic dermatitis (AD) patients has rapidly become popular. AD educational programs can be of benefit in measured outcomes for both dermatology specialists and patients. To determine the effects of programmed education delivered by dermatology specialists on the management and knowledge of AD, we assessed the effectiveness of patient/parental education at improving AD knowledge, and determined the usefulness of the education. The program consisted of five, 20-minutes sessions which were prepared, discussed, reviewed, and delivered by professors of dermatology. At the end of the program, AD knowledge was assessed using a standardized questionnaire. A total of 148 people were included. Fifty-eight patients/parents received the programmed education and the remaining 90 did not receive the programmed education. The mean questionnaire scores from both groups were compared. Mean knowledge scores were significantly higher for those who received the education (p=0.00). We analyzed the knowledge score according to factors such as gender, education level, marital status, and occupation. The data indicated that education level influences the subjects' knowledge level of AD, but gender, occupation, and marital status do not. An educational program can be an effective tool to improve patient quality of life and treatment compliance by providing psychological support to the patients and their parents.
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    ABSTRACT: Atopic dermatitis (AD) is a chronic inflammatory skin disorder characterized by intense pruritus that causes significant disease and psychosocial burden in patients. Patient education has the potential to improve clinical outcomes and patient knowledge of this condition. We sought to assess the effectiveness of online video education at improving AD knowledge and disease severity compared with a written pamphlet, and to determine the usefulness and appeal of the two educational delivery vehicles. In a randomized controlled trial, 80 participants were randomized to receive either online video-based patient education or written pamphlet education about AD and its management. We assessed AD disease severity using the patient-oriented eczema measure (POEM) scale. AD knowledge was assessed with standardized questionnaires at baseline and after the 12-week intervention. All participants had similar baseline knowledge and AD severity at the beginning of the study. On study completion, improvements in AD knowledge assessed by questionnaire were significantly greater in the video group than the pamphlet group (3.05 vs 1.85, P = .011). Online video-based education resulted in greater improvement in clinical outcome, as measured by POEM, compared with pamphlet-based education (POEM score reduction of 3.30 vs 1.03, P = .0043). Finally, although the usefulness of both interventions was rated equally (P = .77), the online video was significantly more appealing than the pamphlet (P = .0086). This study is limited to AD in adults. Online video for patient education is an effective and appealing tool for improving clinical outcomes in adult patients with AD.
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