Article

Therapeutic Patient Education in Children with Atopic Dermatitis: Position Paper on Objectives and Recommendations

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

Poor adherence is frequent in patients with atopic dermatitis (AD), leading to therapeutic failure. Therapeutic patient education (TPE) helps patients with chronic disease to acquire or maintain the skills they need to manage their chronic disease. After a review of the literature, a group of multispecialty physicians, nurses, psychologists, and patients worked together during two international workshops to develop common recommendations for TPE in AD. These recommendations were structured as answers to nine frequently asked questions about TPE in AD: What is TPE and what are its underlying principles? Why use TPE in the management of AD? Who should benefit from TPE in AD? How can TPE be organized for AD? What is the assessment process for TPE in AD? What is the evidence of the benefit of TPE in AD? Who are the people involved in TPE? How should TPE be funded in dermatology? What are the limits of the TPE process?

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... Education of the patient/caregiver must be communicated in lay person language and should include regular discussions on short-and long-term goals of therapy [12,15,16,[27][28][29]. Therapeutic patient education is a patient-centered approach to AD management that entails acquiring skills, such as self-management and treatment adaptation, which have been shown to lead to better disease control [28,30,31]. ...
... The implementation of structured and multidisciplinary educational programs has led to significant improvements in subjective assessments of severity, itching and coping [29]. Educational programs differ in their type, content and organization [30]. Further studies are needed to determine the cross-applicability and cost-effectiveness of these programs in localities with different cultural norms [13]. ...
... · Educational programs that allow a patient-centered approach in AD management are recommended as an adjunct to conventional therapies. [Level 2+, C] · Patient information leaflets presented in a local language/dialect may be considered as a cost-effective educational measure [30]. Instructional videos may also be explored. ...
Article
Full-text available
Background Atopic dermatitis (AD) is a common skin condition among Asians. Recent studies have shown that Asian AD has a unique clinical and immunologic phenotype compared with European/American AD. Objective The Asian Academy of Dermatology and Venereology Expert Panel on Atopic Dermatitis developed this reference guide to provide a holistic and evidence-based approach in managing AD among Asians. Methods Electronic searches were performed to retrieve relevant systematic reviews and guidelines on AD. Recommendations were appraised for level of evidence and strength of recommendation based on the U.K. National Institute for Health and Care Excellence and Scottish Intercollegiate Guidelines Network guidelines. These practice points were based on the consensus recommendations discussed during the Asia Pacific Meeting of Experts in Dermatology held in Bali, Indonesia in October 2016 and April 2017. Results The Expert Panel recommends an approach to treatment based on disease severity. The use of moisturizers is recommended across all levels of AD severity, while topical steroids are recommended only for flares not controlled by conventional skin care and moisturizers. Causes of waning efficacy must be explored before using topical corticosteroids of higher potency. Topical calcineurin inhibitors are recommended for patients who have become recalcitrant to steroid, in chronic uninterrupted use, and when there is steroid atrophy, or when there is a need to treat sensitive areas and pediatric patients. Systemic steroids have a limited role in AD treatment and should be avoided if possible. Educational programs that allow a patient-centered approach in AD management are recommended as an adjunct to conventional therapies. Recommendations on the use of phototherapy, systemic drugs, and emerging treatments are also included. Conclusion The management of AD among Asians requires a holistic approach, integrating evidence-based treatments while considering accessibility and cultural acceptability.
... There is no evidence showing from what age therapeutic education should be offered to patients [25]. However, it is known that patient engagement in treatment is important for proper control of AD [3,25]. ...
... There is no evidence showing from what age therapeutic education should be offered to patients [25]. However, it is known that patient engagement in treatment is important for proper control of AD [3,25]. In the present study, educational intervention was directed not only to caregivers, but also to children of all ages, which may have been another factor contributing to the improvement of QoL and the reduction of disease severity. ...
Article
Full-text available
Background: Educational intervention (EI) could improve understanding of atopic dermatitis (AD) and adherence to treatment, decreasing severity, and improving quality of life (QoL). Objective: This study aims to evaluate the influence of an EI on the severity of the disease and on the QoL in children with AD. Methods: A controlled clinical trial was performed, including children up to 14 years of age with AD. Patients were allocated into control group (CG), which received usual guidelines on AD during the outpatient visit, and a study group (SG) that, in addition to the usual guidelines, participated in the EI. The severity of AD was assessed by Scoring Atopic Dermatitis (SCORAD) and Eczema Area and Severity Index (EASI). QoL was assessed by the Children's Dermatology Life Quality Index and the Dermatitis Family Impact Questionnaire. Results: Twenty-seven participants were included in the CG and 21 in the SG. There was a decrease in the median value for the QoL of children in the SG after the intervention (p = 0.04), as well as in the caregiver's (p = 0.04). In the CG, the median QoL of children and caregivers remained unaltered, for caregivers the median value for the QoL was equal throughout first and second evaluation (p = 0.32). In the SG, EASI values decreased after the intervention (p = 0.04), as well as SCORAD (p = 0.04). The CG did not show any decrease in the values of EASI (p = 0.88) scores nor of SCORAD scores (p = 0.82). Conclusion: The EI rendered a decrease in severity of the disease and improvement in the QoL of patients and their caregivers.
... Longer consultations and forming a good caregiver-patient relationship are the strongest predictors of adherence to skin-care treatment. Performing this role requires well-trained educators [60]. ...
... Distraction techniques are also helpful to parents to feel more relaxed, they improve the interaction with their child, transmitting greater security and managing the disease with less anxiety. The utility of learning techniques has also been documented in the parents of very young children [59][60][61][62]. ...
Article
Full-text available
Given the inadequate overall awareness of the main disease features and treatment modalities of pruritus in pediatric patients with atopic dermatitis, a multidisciplinary Italian expert group met with the major aim of increasing knowledge of the condition for improved diagnosis and better management among specialists involved in disease management. Herein, the overall features of the condition are reviewed, along with its etiopathogenesis and symptoms. Likewise, management options are summarized, emphasizing the need for a multidisciplinary approach, minimally composed of a management team that includes a pediatrician, dermatologist, psychologist, play assistant, and dedicated nurse. In addition to more traditional therapies such as emollients as highlighted by European guidelines, therapeutic patient education in a group or individually is highly encouraged as it helps patients and their parents to better understand the disease and provide practical guidance for dressing and bandaging. It can also aid in outlining coping strategies for itching and sleep disturbance. The utility of distraction techniques should also be stressed as such educational interventions involving the child and their parents can substantially improve the overall quality of life. All approaches should be tailored according to patient age and clinical features and requires individualized strategy to ensure good adherence by both children and their parents. Thus, a holistic approach embracing systemic, topical and psychological interventions is advocated in order to provide patients and their caregivers the best possible care.
... Since AD has a greater psychological burden than it is usually recognized, the assessment of disease has to be well structured to allow children and their parents to control the condition and reduce the psychological and economic burden of care. 10,11 In order to manage the disease of their child, many parents seek information from different sources. A number of people search information on the Internet, using different websites or discussion forums. ...
... The parents' knowledge can also affect attitudes and behavior toward AD, which further influence AD-related outcomes. The need for effective, consistent child-parent education could be the key to successful self-management of AD.10 Some studies pointed out the importance of educational programs on AD that might have a positive impact not only on the course of the disease but also on the family's quality of life by providing psychological support to the patients and their parents.33 ...
Article
Background: Successful control of atopic dermatitis (AD) in children depends on parents' knowledge on the disease and attitude toward ill child, but there is a lack studies exploring parental knowledge, attitude, and behaviors. The aim of this study was to investigate parents' knowledge, attitude, and behavior toward AD. Methods: A cross-sectional study was conducted at the Clinic of Dermatovenereology, Clinical Center of Serbia, Belgrade, between February 2015 and March 2016. Parents of children with AD were invited to complete the questionnaire, which was comprised of five parts: parental sociodemographic characteristics, demographic and clinical characteristics of children, knowledge, attitude, and behavior. To assess factors associated with a higher knowledge level on AD, stronger positive attitude, and more supportive behavior, we performed two multiple linear regression models. Results: The average parental knowledge score was 9.5 ± 1.9 out of 12. The level of knowledge did not correlate with parental conviction that they were well-informed on AD (ρ = -0.121; P = 0.319). Older (β = 0.08, 95% confidence interval [CI] 0.00-0.16, P = 0.040), married/partnered parents (β = -2.14, 95% CI -3.55 to 0.72, P = 0.004), and those who have had AD themselves were more likely to be more knowledgeable on AD. Older (β = 0.18, 95% CI 0.01-0.34, P = 0.036) and employed (β = 3.99, 95% CI 1.59-6.38, P = 0.002) parents had stronger positive attitudes toward their children with AD. More supportive behavior of parents of children with AD was associated with being older (β = 0.24, 95% CI 0.04-0.45, P = 0.020) and less educated (β = -0.76, 95% CI -1.24 to 0.28, P = 0.003). Conclusion: The importance of understanding AD and accounting for attitudes by family members is obvious for successful control of the disease.
... Se ha demostrado que la educación terapéutica contribuye eficazmente a prevenir complicaciones y a mejorar el cumplimiento del tratamiento, que aumenta la calidad de vida en numerosas enfermedades crónicas como la diabetes, el asma y las enfermedades cardiovasculares. [1][2][3] La dermatitis atópica es la enfermedad inflamatoria crónica de la piel más común en la infancia, se caracteriza por una piel seca y con bajo umbral al prurito. La integridad de la barrera cutánea está alterada y eso facilita la pérdida transepidérmica de agua y la entrada de antígenos ambientales a la epidermis con la consecuente activación del sistema inmunitario que genera inflamación. ...
... La evaluación de su eficacia es esencial en la educación terapéutica, puede realizarse mediante la medición de la gravedad de la dermatitis atópica con las escalas SCORAD o EASI, o con escalas que miden la calidad de vida del paciente. 2 Rolinck-Werninghaus y su grupo 6 demostraron que la educación terapéutica realizada por enfermeras especializadas aumenta la confianza de los padres para manejar el padecimiento y disminuye la gravedad y frecuencia de los síntomas. Por su parte, Mason y sus colegas 7 encontraron que después de la educación terapéutica se incrementó el uso de emolientes, lo que redujo los síntomas de la dermatitis atópica sin incrementar los costos de atención. ...
Article
Full-text available
Se ha demostrado que la educación terapéutica contribuye eficazmente a prevenir complicaciones y a mejorar el cumplimiento del tratamiento, que aumenta la calidad de vida en numerosas enfermedades crónicas.
... The potential of these interventions has been recognized by several stakeholders worldwide, making them a cornerstone of promotion, prevention, and treatment guidelines around the globe (8,(12)(13)(14). The field of patient education is a highly interdisciplinary area (15). ...
Article
Full-text available
Background Chronic disorders are highly prevalent and are a major contributor to death and disability worldwide. Evidence has shown that therapeutic patient education (TPE) interventions are effective in improving a range of biomedical and psychological outcomes for a variety of chronic disorders. This has been demonstrated in scores of randomized controlled and evidence-synthesis studies. However, no quantitative evidence has been published so far on the content and effective teaching strategies in TPE programs. The present systematic review and meta-analysis aim to bridge this gap by answering the who, what, and how of TPE programs.Methods Using a pretested search strategy, we searched the Web of Science, MEDLINE, CINAHL, PsycINFO, and the COCHRANE databases, from inception to August 2019. The search strategy was based on four comprehensive search concepts (patient education, chronic diseases, study design, and outcomes). After a careful screening for eligible studies, two reviewers extracted qualitative and quantitative data from the randomized controlled trials on the TPE interventions. We also developed a taxonomy of curriculum skills and intervention delivery techniques to aid the extraction of data in these domains.ResultsWe found that these interventions were effective in improving biological outcomes (SMD = 0.48; 95% CI: 0.38–0.57), adherence to the treatment regimen (SMD = 0.73; 95% CI: 0.46–1.002), knowledge (SMD = 1.22; 95% CI: 0.79–1.65), self-efficacy (SMD = 0.43; 95% CI: 0.30–0.56), and psychological health (SMD = −0.41; 95% CI: −0.53 to −0.29). This effectiveness was consistent across different delivery formats (individual, group, and electronic) and delivery agents (non-specialists vs. specialists).Conclusion The flexibility in the choice of mode of delivery and curriculum development gives stakeholders an opportunity to scale up TPE interventions in healthcare settings.Systematic review registrationIdentifier: CRD42019141294.
... Edukativni program u sklopu "Škole atopije" za pacijente i roditelje djece s AD-om predstavlja "zlatni standard" u pristupu i liječenju djece s ovom kroničnom bolesti kože. 32,35,36 Edukacija utječe na poboljšanje kontrole bolesti i poboljšanje kvalitete života za roditelje i oboljelu djecu. 37 ...
... e ideal model of intervention integrates different theoretical and operational models, with the participation of a multidisciplinary team composed of the specialist physician (pediatrician, allergist, and dermatologist), the psychologist/psychotherapist, and other professionals, such as nurses [56,86]. e specialist works as the expert in therapeutic education and first conducts a psychologically supportive educational interview, including evaluation of symptoms, such as itching and sleep disturbance, by quantitative tools, such as the Patient-Oriented SCORAD [87] and a Visual Analogue Scale of Pruritus and approaches for handling itching and sleep impairment [88,89]. e clinical assessment includes some psycho-diagnostic testing for parents and patients older than 4 years, which helps identify the most useful psychotherapeutic intervention. ...
Article
Full-text available
Atopic dermatitis (AD) is a chronic skin disease with increasing prevalence worldwide. It is characterized by pruritic eczematous lesions, affecting up to 20% of the children and negatively impacting their quality of life. Guidelines for AD management are available worldwide, but specific guidelines for pediatric AD in Saudi Arabia are lacking. This consensus document aims to identify the needs for the diagnosis and management of pediatric AD in Saudi Arabia by gathering the opinions and recommendations of key experts. We conducted a three-step modified Delphi method to develop the present consensus. The experts agreed that pediatricians and dermatologists commonly encounter AD; however, it is still under-recognized in its early stage in Saudi Arabia. The family physicians should be involved in assessing suspected children with a family history of atopy, particularly in patients with isolated lesions. Further, the experts confirmed that AD diagnosis should be documented, showing assessment criteria used, key morphological characteristics, and features used to ascertain the severity of the disease. There is still a need for simple validated diagnostic criteria suitable for daily practice for pediatric AD. The experts highlighted several medical conditions that pertain to the diagnosis and management of AD in Saudi Arabia.
... If the patients respond to the elimination diet, an oral food challenge should be done to confirm the relationship of food intake and AD. (140,141) Food allergy can be further evaluated by either skin prick testing or in vitro testing for food-specific IgE. Nonetheless, the results must be interpreted in the context of the patient's clinical history. ...
Article
Full-text available
Consensus statement on the treatment of Atopic Dermatitis among adult and pediatric dermatologist in the Philippines
... Patient educational programs, usually provided by multidisciplinary teams, have been successfully implemented in the management of several chronic diseases, including atopic dermatitis [37][38][39][40]. The literature describing educational programs for pediatric psoriasis is limited to small pilot studies, which reported high satisfaction from patients and their parents and promising results in terms of patient outcomes [36,41]. ...
Article
Full-text available
Introduction: Psoriasis affects children with a considerable burden in early life. Treating pediatric psoriasis is challenging also because of the lack of updated specific guidelines. With the recent approval of several biologics for pediatric psoriasis and the ongoing COVID-19 pandemic, the management of young psoriatic patients is facing major changes. A revision of treatment recommendations is therefore needed. Methods: In September 2021, a board of six Italian dermatologists convened to update treatment recommendations. The board issued evidence- and consensus-based statements covering relevant areas of pediatric psoriasis, namely: assessment of psoriasis severity, management of children with psoriasis, and treatment of pediatric psoriasis. To reach consensus, the statements were submitted to a panel of 24 experts in a Delphi process performed entirely via videoconference. A treatment algorithm was produced. Results: There was full consensus that psoriasis severity is determined by the extension/severity of skin lesions, site of lesions, and impact on patient quality of life. Agreement was reached on the need for a multidisciplinary approach to pediatric psoriasis and the importance of patient/parents education. The relevance of vaccinations, including COVID-19 vaccination, for psoriatic children was acknowledged by all participants. Management issues that initially failed to reach consensus included the screening for psoriasis comorbidities and early treatment with biologics to prevent them and the use of telemedicine to facilitate patient follow-up. There was full consensus that topical corticosteroids are the first choice for the treatment of mild pediatric psoriasis, while phototherapy and systemic therapy are used in children with moderate-severe psoriasis. According to the proposed treatment algorithm, biologics are the first line of systemic therapy. Conclusions: Targeted systemic therapies are changing the treatment of moderate-severe pediatric psoriasis, while topical corticosteroids continue to be the first choice for mild disease. Children-centered research is needed to further improve the treatment of pediatric psoriasis.
... Among the main findings of our research, the need for reliable pieces of information stands out. The evidence shows that education improves patient adherence to the treatment of AD [9]. In line with what is described in the bibliography, we decided to include in our AD community a section where specialists generate reliable pieces of information, elaborated for the therapeutic education of patients and their families. ...
Chapter
Full-text available
Atopic dermatitis is a common chronic dermatological disease in childhood that can affect people’s quality of life. The aim of this study was to inquire about the difficulties, needs and interests related to the disease that people with eczema and their caregivers have; in order to develop a tool that is useful for the follow-up of the illness. Electronic surveys were sent to potential users and interviews were conducted with professionals who are specialized on the subject. The main findings allowed us to understand the challenges and situations they face on a daily basis, such as the difficulties related to the family support, the queries on the eczema flare-ups, the struggles with the adherence to treatment and the needs of optimizing their quality of life. These results helped us design a tool that allows patients and their companions to better monitor their disease while optimizing communication with their health professionals.
... These programs have been shown to alter health behaviors positively, and thus improve biological, psychological, and quality of life outcomes for many chronic disorders [3][4][5][6]. Several stakeholders and international medical organizations have recommended their use in routine patient care [4,5,7]. ...
Article
Full-text available
Therapeutic patient education (TPE) aims to empower the patients and their caregivers to effectively care for and manage their conditions. Such educational programs have been shown to improve health behaviors, disease outcomes, and quality of life among different patient populations. The field of TPE has evolved extensively over decades, owing to interdisciplinary research. No study so far has been done to map this field, to identify the stakeholders and gaps requiring future research. By leveraging the theory of co-citation, CiteSpace was used to visualize the bibliographic data pertaining to TPE research. A total of 54,533 articles published in English language were analyzed to identify influential funders, regions, and institutes contributing to this field. Besides these, significant theoretical and empirical contributions that shaped this field were mapped. Our analysis revealed several important insights. Most of the important theories that helped shape TPE were inspired from the social sciences. Five important research themes were identified: disorders, study designs utilized in TPE research, the scope of the TPE literature and outcomes, and populations. The research focused on improving perceptions, behaviors, and attitudes toward health promotion, reducing stigma, self-management and medication adherence. Most of the research was developed in the context of high-income countries. Future research should involve patients and use digital technology. Meta-analytical studies need to be done to identify the effectiveness and moderators of TPE interventions across different disorders. Further research should involve low and middle-income countries (LMIC) to ensure knowledge and technology transfer.
... These programmes have been shown to positively alter health behaviours and thus improve biological, psychological, and quality of life outcomes, for many chronic disorders [3][4][5][6]. Recognizing the potential of TPE interventions, several stakeholders and international medical organizations have recommended their use in routine patient care [4,5,7]. ...
Preprint
Full-text available
Therapeutic patient education (TPE) aims to empower the patients and their caregivers to effectively care for and manage their conditions. Such educational programs have been shown to improve health behaviors, disease outcomes and quality of life among different patient populations. The field of TPE has evolved extensively over decades, owing to interdisciplinary research. No study so far has been done to map this field, to identify the stakeholders and gaps requiring future research. By leveraging the theory of co-citation, Citespace was used to visualize the bibliographic data pertaining to TPE research. A total of 54,533 articles published in English language were analyzed to identify influential funders, regions and institutes contributing to this field. Besides these, important theoretical and empirical work that has shaped this field has also been mapped. Our analysis revealed several important insights. Most of the important theories which helped shape TPE were inspired from the social sciences. Five important themes of research were identified including disorders, study designs utilized in TPE research, scope of the TPE literature, and outcomes, and populations. The research focused on improving perceptions, behaviors, and attitudes for health promotion, reducing stigma as well as self-management and medication adherence. Most of the research was developed in the context of high income countries. The future research should more involve patients and use digital technology. Meta-analytical studies need to be done to identify the specificities of TPE interventions across different disorders. More research should involve low and middle income countries (LMIC) to ensure knowledge and technology transfer.
... [24][25][26] Patient initial assessment is the first step of TPE from which individualized education can be operationalized and deployed. 22,[26][27][28][29] More generally, for Hawkins et al. 30 The principles of using tailored communication states that by tailoring content, superfluous information is eliminated. People pay more attention to information that they perceive to be personally relevant, and this information process is more likely to have an effect. ...
Article
Full-text available
Background Tailoring therapeutic education consists of adapting the intervention to patients' needs with the expectation that this individualization will improve the results of the intervention. Communication is the basis for any individualization process. To our knowledge, there is no guide or structured advice to help healthcare providers (HCPs) tailor patient education interventions. Objectives We used a data-driven qualitative analysis to (1) investigate the reasons why HCPs tailor their educational interventions and (2) identify how this tailoring is effectively conducted. The perspective aimed to better understand how to individualize therapeutic patient education and to disentangle the different elements to set up studies to investigate the mechanisms and effects of individualization. Design Individual semistructured interviews with 28 HCPs involved in patient education were conducted. The present study complied with the COREQ criteria. Results Why individualization is necessary: participants outlined that the person must be thought of as unique and that therapeutic education should be adapted to the patient's personality and cognitive abilities. The first step in the individualization process was formalized by an initial patient assessment. Several informal practices were identified: if needed, giving an individual time or involving a specific professional; eliciting individual objectives; reinforcing the relationship by avoiding asymmetrical posture; focusing on patients' concerns; leading sessions in pairs; and making the patient the actor of decisions. Conclusion From our thematic data analysis, a model for tailoring patient education interventions based on the Haes and Bensing medical communication framework is proposed. The present work paves the way for evaluation, then generation of recommendations and finally implementation of training for individualization in educational interventions. Short Informative Tailoring in therapeutic education consists of an adaptation to patients' needs. Communication is the basis for any individualization process. There is no model of patient-centred communication in educational interventions. From semistructured interviews with HCPs, we propose a patient-centred communication model for tailoring patient education intervention.
... In a position paper of "The Oriented Patient-Education Network in Dermatology," it was recommended that patient education "[. . .] should be offered to patients and parents with a history of therapeutic failures, with or without efficient and credible treatment, and to families who feel they have poor social support" and should be delivered by multidisciplinary teams (Barbarot et al. 2013). ...
Article
Allergic diseases are characterized by a complex complex chronic pathophysiology. Therapeutic patient education (TPE) programs are an important part of health care for allergic patients. These programs aim to increase the patient's adherence to evidence-based treatment and improve their ability to cope with the disease. TPE led by a multiprofessional team covers the complex pathogenesis of the disease, trigger factors, nursing and dietary issues, and the broad variety of treatment options available including psychological and behavioral aspects.Regarding atopic dermatitis (AD), randomized, controlled studies have demonstrated the beneficial effects of delivering structured group training to children, their caregivers, and adult patients with AD. Such intervention achieved substantial improvements in quality of life and objective clinical disease parameters. Besides AD, training programs have also been developed and evaluated for patients with anaphylaxis and asthma. This article provides an overview of the multitude of TPE concepts and their impact on subjective and objective outcomes. It focuses on AD but also sheds light on other allergic diseases such as anaphylaxis and asthma.
... If the patients respond to the elimination diet, an oral food challenge should be done to confirm the relationship of food intake and AD. (140,141) Food allergy can be further evaluated by either skin prick testing or in vitro testing for food-specific IgE. Nonetheless, the results must be interpreted in the context of the patient's clinical history. ...
Article
Full-text available
Consensus Statement about Atopic Dermatitis
... If the patients respond to the elimination diet, an oral food challenge should be done to confirm the relationship of food intake and AD. (140,141) Food allergy can be further evaluated by either skin prick testing or in vitro testing for food-specific IgE. Nonetheless, the results must be interpreted in the context of the patient's clinical history. ...
Article
Consensus Statement in the Management of Atopic Dermatitis of Dermatologist from the Philippine Dermatological Society
... Such educational measures in turn should be implemented by a multidisciplinary team within the context of well-defined and programmed sessions. 15 The present study has limitations, including its descriptive design, with evaluation being limited to parent satisfaction with regard to improved management of the disease and quality of life. The number of surveys was moreover limited, and no patient follow-up was carried out; as a result, the applicability of the therapeutic education strategy was not confirmed by clinical improvement of the disease. ...
Article
Full-text available
Introduction: Atopic dermatitis is a highly prevalent chronic disorder. Therapeutic education in diseases of this kind is essential in order to improve patient management and prognosis. A study was conducted regarding parent satisfaction following educational sessions in an Atopy School organized by a multidisciplinary team. Material and methods: E-mail surveys with variables scored by means of a Likert scale were administered among the parents participating in the workshops organized by the Atopy School. The educational program comprised four sessions with a duration of 4 hours. Results: Ninety-five percent of the parents were satisfied after participating in the workshops, and were of the opinion that the therapeutic education received was useful for improving control of the illness of their children. Likewise, 85% were satisfied or very satisfied with the help received in the sessions for control of the disease during flare-ups, and 90% considered the data and advice received in the sessions to be of use in improving quality of life of both the children and the family as a whole. Conclusions: The Atopy School afforded caregiver empowerment, and the parents were satisfied and felt more secure in dealing with the disease of their children-thereby improving the prognosis and quality of life.
... Adjuvant psychosocial programmes focused on itch are most effective in AD, and many randomized controlled trials have been published in the recent years. [295][296][297][298][299][300][301][302][303][304][305][306] Such programmes include strategies for breaking the vicious circle of itching and scratching, relaxation and stress management techniques as well as strategies for dealing with relapses. More than 10 randomized controlled studies 296,307,308 and a Cochrane review about psychological interventions showed slightly beneficial effects. ...
Article
Full-text available
Atopic dermatitis (AD) is a highly pruritic, chronic inflammatory skin disease. The diagnosis is made using evaluated clinical criteria. Disease activity and burden are best measured with a composite score, assessing both objective and subjective symptoms, such as SCORing Atopic Dermatitis (SCORAD). AD management must take into account clinical and pathogenic variabilities, the patient’s age and also target flare prevention. Basic therapy includes hydrating and barrier‐stabilizing topical treatment universally applied, as well as avoiding specific and unspecific provocation factors. Visible skin lesions are treated with anti‐inflammatory topical agents such as corticosteroids and calcineurin inhibitors (tacrolimus and pimecrolimus), which are preferred in sensitive locations. Topical tacrolimus and some mid‐potency corticosteroids are proven agents for proactive therapy, which is defined as the long‐term intermittent anti‐inflammatory therapy of frequently relapsing skin areas. Systemic anti‐inflammatory or immunosuppressive treatment is a rapidly changing field requiring monitoring. Oral corticosteroids have a largely unfavourable benefit–risk ratio. The IL‐4R‐blocker dupilumab is a safe, effective and licensed, but expensive, treatment option with potential ocular side‐effects. Other biologicals targeting key pathways in the atopic immune response, as well as different Janus kinase inhibitors, are among emerging treatment options. Dysbalanced microbial colonization and infection may induce disease exacerbation and can justify additional antimicrobial treatment. Systemic antihistamines (H1R‐blockers) only have limited effects on AD‐related itch and eczema lesions. Adjuvant therapy includes UV irradiation, preferably narrowband UVB or UVA1. Coal tar may be useful for atopic hand and foot eczema. Dietary recommendations should be patient‐specific, and elimination diets should only be advised in case of proven food allergy. Allergen‐specific immunotherapy to aeroallergens may be useful in selected cases. Psychosomatic counselling is recommended to address stress‐induced exacerbations. Efficacy‐proven 'Eczema school' educational programmes and therapeutic patient education are recommended for both children and adults.
... Because of this, their children can suffer in terms of inadequate and insufficient care and therapy, and children may also be confused, which may worsen the clinical picture for a sick child [22,23]. In contrast, for families with a higher standard of living, which may involve working every day in well-paid and demanding jobs, it is understandable that such parents may worry about their jobs, and may therefore manifest their behaviour through a constant critical attitude towards the child. ...
Article
Background: Atopic dermatitis is a frequent, chronic, pruritic, inflammatory skin disease that usually begins in early childhood. It is a somato-psychic disease which is influenced by the family environment and related emotional instability (neuroticism), however, relevant data are sparse. Objectives: To determine the impact of personality properties of affected children and parental styles of care on the severity of atopic dermatitis. Materials and methods: The study was conducted on 80 patients diagnosed with atopic dermatitis, treated at the Center for Dermato-venereology of the Pediatric Clinic, Clinical Center "Kragujevac", Central Serbia. The study included children aged 8 to 13 years, of both sexes, with a diagnosis of atopic dermatitis based on the SCORAD index. The EMBU scale was used to assess parental behaviour, and HANES1 and HANES2 scales were used to assess basic dimensions of personality (neuroticism and stability). The Student-t, Chi-square, ANOVA, and Cronbach's alpha coefficient were used for statistical analyses (p < 0.05 was considered significant). Results: A statistically significant difference in average score values for both mothers and fathers was observed for the scales, Overprotection (p = 0.007) and Emotional warmth (p = 0.001), but not for Rejection (p = 0.073), Favouring (p = 0.128) or Inconsistency (p = 0.083). Conclusion: We suggest that the therapeutic programme for atopic dermatitis requires improvement, with the addition of psychological testing and subsequent psychotherapy to standard diagnostic procedures.
... Treatment recommendations include non-pharmacological interventions such as therapeutic patient education (TPE) 2,9,10 which helps patients acquire or maintain the skills they need to optimally manage life with a chronic disease. 11 TPE has been well studied in atopic dermatitis (AD) 12,13 and CHE, mostly focusing on occupational hand eczema. [14][15][16] The objective of this study was to evaluate the effect of a standardised care program including TPE on negative hand care and washing behaviours in unselected CHE patients and to investigate the change in clinical severity, quality of life, and work productivity. ...
Article
Background: Chronic hand eczema (CHE) is a major burden for patients. Maintenance treatment involves prevention measures limiting detrimental behaviour and aggravating factors. Objective: To evaluate the effect of a standardised care program including therapeutic patient education (TPE) on hand care behaviours, clinical severity, quality of life and work productivity. Methods: A single-centre study was conducted prospectively. Together with the prescription of a topical steroid, patients participated in individual TPE sessions. Evaluations were performed initially and repeated three months after the therapeutic intervention. They included a structured analysis of hand care behaviours, the assessment of the mTLSS (modified Total Lesion Symptom Score), DLQI (Dermatology Life Quality Index) and WPAI (Work Productivity and Activity Impairment). Results: Seventy-one patients were included (30 men, 42.3%). Three months after completion of the standardised care program (n=58), hand care behaviours such as hand washing and rinsing, hand drying, wearing protective gloves, using moisturizing creams and following specific treatments and recommendations for CHE improved significantly and were associated with a significant improvement in the mTLSS, DLQI and WPAI scores. Conclusions: TPE helps patients to change hand care behaviours, adopt skin protection measures and may improve CHE severity, quality of life and work productivity. This article is protected by copyright. All rights reserved.
... 54 Therapeutic patient education can be carried out by doctors or nurses and can be conducted either through individualised one-to-one sessions or in group sessions. 53 Individualised sessions include treatment counselling, patient information leaflets and action plans (Appendix 1). Group sessions can be organised as lectures, workshops, camps or through support groups. ...
... The result of this study highlights the need for age related educational programs for the control of atopic dermatitis. Such programs have been shown to be effective in ameliorating the disease [11] and in improving the quality of life of eczematous children [12]. ...
Article
Full-text available
This review provides an overview of a remarkable number of significant studies in pediatrics that have been published over the past year in the Italian Journal of Pediatrics. We have selected information from papers presented in the Journal that deal with allergy, endocrinology, gastroenterology, genetics, immunology, infectious diseases, neonatology, nephrology, neurology, pulmonology. The relevant epidemiologic findings, and developments in prevention, diagnosis and treatment of the last year have been discussed and placed in context. We think that advances achieved in 2017 will help readers to make the future of patients better.
... 247 High-quality PE programmes should ideally be evidencebased, tailored to a patient's individual educational and cultural background (rather than being standardized in form and content) and have well-defined content and activities. 233,236,249 Educational service delivery models ...
Article
Full-text available
This guideline was developed as a joint interdisciplinary European project, including physicians from all relevant disciplines as well as patients. It is a consensus‐based guideline, taking available evidence from other guidelines, systematic reviews and published studies into account. This second part of the guideline covers antimicrobial therapy, systemic treatment, allergen‐specific immunotherapy, complementary medicine, psychosomatic counselling and educational interventions, whereas the first part covers methods, patient perspective, general measures and avoidance strategies, basic emollient treatment and bathing, dietary intervention, topical anti‐inflammatory therapy, phototherapy and antipruritic therapy. Management of AE must consider the individual clinical variability of the disease. Systemic immunosuppressive treatment with cyclosporine, methotrexate, azathioprine and mycophenolic acid is established option for severe refractory cases, and widely available. Biologicals targeting the T helper 2 pathway such as dupilumab may be a safe and effective, disease‐modifying alternative when available. Oral drugs such as JAK inhibitors and histamine 4 receptor antagonists are in development. Microbial colonization and superinfection may cause disease exacerbation and can require additional antimicrobial treatment. Allergen‐specific immunotherapy with aeroallergens may be considered in selected cases. Psychosomatic counselling is recommended especially in stress‐induced exacerbations. Therapeutic patient education (‘Eczema school’) is recommended for children and adult patients. General measures, basic emollient treatment, bathing, dietary intervention, topical anti‐inflammatory therapy, phototherapy and antipruritic therapy have been addressed in the first part of the guideline.
... Therapeutic patient education and a comprehensive approach to the treatment of AD are aimed at improving the therapeutic adherence of patients and their caregivers. 22,23 Many patients acquire indiscriminate or inadequate disease information through various forms of media, without expert supervision. 24 However, 70.1% of patients surveyed in a previous study demonstrated willingness to participate in an expert-led education program in a hospital. ...
Article
Full-text available
Purpose: There is an unmet need for the treatment of moderate-to-severe atopic dermatitis (AD), leading to variation in management strategies. To investigate distinct features and treatment modalities according to physicians' specialties, we collected data on the current treatment approach to moderate-to-severe AD among allergists, pediatric allergists and dermatologists in Korea. Methods: This questionnaire-based study was administered to physicians from the Korean Academy of Asthma, Allergy and Clinical Immunology (KAAACI), Korean Academy of Pediatric Allergy and Respiratory Disease (KAPARD), and Korean Atopic Dermatitis Association (KADA). Results: A total of 93 physicians participated in the study; 64.5% were pediatric allergists and 31.2% were dermatologists. The major patient age groups were "less than 5 years" for 100% of pediatric allergists and "6-12 years old" for 38% of dermatologists. The proportion of patients with moderate-to-severe AD was higher for dermatologists and allergists compared to pediatric allergists. Physicians agreed on the necessity of education including demonstration of basic skin care and application of topical therapies (88.2%), nutritional consultation (83.9%) and psychological counseling (75.3%). However, less than half were able to educate and counsel their patients in real practice. There were noticeable differences in first-line treatment among physician groups. For pediatric allergists, the order of preferred systemic treatment was wet wrap therapy, systemic corticosteroids and oral cyclosporin. Dermatologists ranked cyclosporin, phototherapy, and systemic corticosteroids as first-line treatment regimens. Major reported barriers to proper management were steroid phobia, unproven complementary and alternative medicine, lack of education, and the unreasonable insurance system. Conclusions: Our findings suggest there are distinct differences in moderate-to-severe AD treatment according to physicians' specialties. Medical policy changes along with governmental supports are required in order to implement the ideal approach in real practice. For moderate-to-severe AD, a consensus on the approach to optimal management should be reached for the best outcomes, based on further randomized controlled trials.
... These sessions can be conducted as large group demonstrations or, preferably, as smaller workshops, with more opportunity for practical individualized demonstrations [267]. ...
Article
Full-text available
The Italian Consensus Conference on clinical management of atopic dermatitis in children reflects the best and most recent scientific evidence, with the aim to provide specialists with a useful tool for managing this common, but complex clinical condition. Thanks to the contribution of experts in the field and members of the Italian Society of Pediatric Allergology and Immunology (SIAIP) and the Italian Society of Pediatric Dermatology (SIDerP), this Consensus statement integrates the basic principles of the most recent guidelines for the management of atopic dermatitis to facilitate a practical approach to the disease. The therapeutical approach should be adapted to the clinical severity and requires a tailored strategy to ensure good compliance by children and their parents. In this Consensus, levels and models of intervention are also enriched by the Italian experience to facilitate a practical approach to the disease.
... This education program aims at informing the families of pediatric patients about the disease course and at empowering them towards an autonomous therapeutic management of the disease [21]. The therapeutic education includes information on the appropriate modalities for applying topical products and on the use of distraction techniques aimed at creating a relaxing environment and at transforming the dressing moment into a pleasant interaction between the child and his parent [22][23][24]; no specific information is actually given on the safety profile of TCS. This may explain the lack of association between therapeutic education and TCS fear. ...
Article
Full-text available
Background Families of children affected with atopic dermatitis (AD) often report fear and anxiety regarding treatment with topical corticosteroids (TCS), which may lead to reduced compliance. The objective of our study was to measure, through a standardized questionnaire, fear of TCS in families of pediatric patients with AD and to identify items associated with fear. Methods Families of pediatric patients with AD were enrolled in 9 Italian centers of pediatric dermatology. Enrolled parents were invited to fill in a questionnaire including questions on sociodemographic and clinical characteristics and 3 sets of questions on corticosteroid phobia (general fear, specific fears, behaviours regarding TCS). Determinants of the level of general fear were investigated through multivariable analysis. ResultsA total of 300 outpatients with AD were enrolled. Most parents (80%) had a high instruction level. Eighty-one percent reported to have a certain amount of fear of TCS. At the multivariable analysis, fear of TCS was associated with the following items: believing that TCS treatment advantages do not overweight disadvantages (P = 0.011); believing that TCS may be dangerous independently from the specific side effect (P < 0.001). Moreover, TCS fear was associated with fear of applying too much cream (P = 0.001). ConclusionTCS phobia is widespread among Italian families of children with AD. Fear of TCS is associated with fear of applying too much cream, thus increasing the risk of poor compliance and treatment failure. Therapeutic education of families on the use of TCS should be implemented.
... Those patients with low self-efficacy will need the nurse to help them to master the skills they will require, slowly developing confidence and resilience. Problem-solving behavioural changes also result from personal experience (Barbarot et al 2013). ...
Article
Abstract Nurses who understand the philosophical concept of knowledge are able to deliver patient education more effectively. A framework that combines nursing, education and cognitive psychology elements helps to enhance nurses’ understanding of why this is needed for effective patient education. Patients need to gain and retain knowledge as they develop the practical skills and behaviour changes they need if they are to manage health conditions successfully. The framework discussed in this article was developed to assist specialist nurses providing education for children with eczema. However, it is also useful for nurses in other disciplines. After reading this article and completing the time out activities you should be able to: Discuss the essential elements of patient education for effective, long-term management of health conditions. Explain the distinction between declarative knowledge and procedural knowledge, and describe how knowledge is gained by the patient and his/her family. Describe how nurses can enable the behaviour changes that patients require to manage health conditions in the long- term. Outline the theoretical basis of successful patient education by nurses. Keywords: behaviour change, declarative knowledge, effective management, patient education, procedural knowledge, social cognitive theory
Article
Full-text available
Background: Paediatric atopic dermatitis (AD) can be burdensome, affecting mental health and impairing quality of life for children and caregivers. Comprehensive guidelines exist for managing paediatric AD, but practical guidance on using systemic therapy is limited, particularly for new therapies including biologics and Janus kinase (JAK) inhibitors, recently approved for various ages in this indication. Objectives: This expert consensus aimed to provide practical recommendations within this advancing field to enhance clinical decision-making on the use of these and other systemics for children and adolescents aged ≥2 years with moderate-to-severe AD. Methods: Nineteen physicians from Northern Europe were selected for their expertise in managing childhood AD. Using a two-round Delphi process, they reached full or partial consensus on 37 statements. Results: Systemic therapy is recommended for children aged ≥2 years with a clear clinical diagnosis of severe AD and persistent disease uncontrolled after optimising non-systemic therapy. Systemic therapy should achieve long-term disease control and reduce short-term interventions. Recommended are cyclosporine A for short-term use (all ages) and dupilumab or methotrexate for long-term use (ages ≥6 years). Consensus was not reached on the best long-term systemics for children aged 2-6 years, although new systemic therapies will likely become favourable: new biologics and JAK inhibitors will soon be approved for this age group, and more trial and real-world data will become available. Conclusions: This paper makes practical recommendations on the use of systemic AD treatments for children and adolescents, to supplement international and regional guidelines. It considers the systemic medication that was available for children and adolescents with moderate-to-severe AD at the time this consensus project was done: azathioprine, cyclosporine A, dupilumab, methotrexate, mycophenolate mofetil, and oral glucocorticosteroids. We focus on the geographically similar Northern European countries, whose healthcare systems, local preferences for AD management, and reimbursement structures nonetheless differ significantly.
Article
Atopic dermatitis (AD) is a chronic inflammatory skin condition that has a major impact on the quality of life of patients and their families. Therapeutic patient education (TPE) is recommended for all patients with this condition to improve disease management, adherence to therapy, and quality of life. Nurse‐led consultation, when performed by expert nurses, can be as effective as consultation by dermatologists in this field. This study aimed to examine the role of nurses in the management of patients with atopic dermatitis. A global survey was carried out to determine the current role of nurses in TPE for patients with AD. A 24‐item online questionnaire was sent to all members of the ISAD‐OPENED network. In total, 85 health care professionals from 20 countries answered the questionnaire. About 75% of the responding physicians and nurses reported effective interprofessional collaboration. The collaboration between nurse and physician was deemed to be excellent by 51% of the respondents. According to caregivers, a trained nurse could be helpful in many other fields, such as nurse consultations, patient care demonstrations, telephone follow‐ups between consultations, and patient workshops. The main obstacles preventing nurse involvement in TPE are insufficient training of nurses, lack of recognition, and lack of specific funding. This study emphasises the potential of the help provided by trained nurses throughout the TPE process. Doctor/nurse teams are very promising for TPE in the field of AD because of their potential to improve patient care.
Article
I applaud the long overdue ISAD/OPENED taskforce position statement on the nurses’ role in Therapeutic Patient Education1 (TPE). The algorithm provides nurses with a clear pathway when establishing a TPE program. However, I argue the position statement misses one critical point for TPE success – explaining to nurses and health professionals (HP) how learning takes place within TPE.
Chapter
Full-text available
Key Messages: • In acute urticaria, routine diagnostic procedures are not suggested except that the patient history renders a specific suspicion of underlying allergy, e.g., intake of food or drugs • In chronic spontaneous urticaria, recommended routine diagnostic tests are differential blood count and erythrocyte sedimentation rate and/or C-reactive protein levels • In patients who have wheals with or without angioedema, urticarial vasculitis is the main differential diagnosis. In patients with wheals only, autoinflammatory disorders including Schnitzler’s syndrome need to be ruled out • In chronic inducible urticaria (CIndU), provocation tests are used as a routine diagnostic workup to identify the subtypes of CIndU and to determine trigger thresholds
Article
In chronic skin diseases such as atopic dermatitis (AD), therapeutic failure due to poor patient adherence to treatment is commonly reported. Therapeutic patient education (TPE) is an approach to improve self-management and adherence. Several studies demonstrated that TPE programmes have positive effects on disease management resulting in decreased disease severity and improved quality of life in AD patients. Various healthcare professionals (dermatologists, nurses, psychologists, dieticians) have been involved. TPE performed by trained dermatology nurses are highly efficient and improve various health-related outcomes. The aim of this position paper is to analyse the aims, modalities and efficacy of TPE in AD, to identify specific roles of dermatology nurses, to assess qualification requirements, and to propose practical recommendations. Potential activities of nurses in ongoing and future TPE programmes for AD patients will be discussed.
Article
Background Atopic dermatitis (AD) is a chronic, relapsing, inflammatory skin disease. Therapeutic patient education (TPE) has been demonstrated to be effective in AD in reducing disease severity and improving coping and quality of life. Objectives To describe the sociodemographic and clinical characteristics of children and adolescents with AD who had attended TPE sessions, as well as the characteristics of their parents, and compare them with those who did not attend TPE. Methods Parents of children with AD aged 6 to 17 years old were recruited from a representative sample of the French population contacted by e-mail. Sociodemographic data and clinical information were collected in patients and parents. Clinical severity was assessed by parents using a proxy version of the Patient-Oriented Eczema Measure (POEM). Attendance to TPE sessions was assessed by the following question “did your child or one or both parents attended TPE for AD?”. Also, the number of sessions was recorded. Determinants of TPE attendance were evaluated by univariable and multivariable analyses. Results Data were collected on 1063 parents and children with AD. A total of 131 (12.3%) children and/or parents attended TPE sessions. Most of them attended 2 to 5 TPE sessions. In that group there were 85 boys (64.9%), and severity evaluated by POEM was mild in 29.8%, moderate in 52.7% and severe in 17.6% of patients. In the multivariable model, attending TPE sessions was significantly associated with sex of the child (boy vs girl), consultation with a dermatologist or a pediatrician, high clinical severity, and presence of AD in parents. Conclusions Despite recommendations, the use of TPE in children with AD is still low in France. There is a need for implementing such programs in the management of the disease, in particular when the disease is severe.
Chapter
Atopic eczema is a chronic itchy inflammatory condition that affects both children and adults. The symptoms can be debilitating and have a severe impact on the quality of life. This chapter discusses diagnosis, investigations and management of eczema, as well as psychological impact and the use of psychological interventions as an adjunct to medical management.
Article
Background/Objectives Patient education is important to families’ ability to manage and cope with pediatric atopic dermatitis (AD). We evaluated whether an educational handbook could improve AD symptoms, caregiver confidence in AD management skills, and AD‐related quality of life. Methods Caregivers of children with AD ages 1 month to 16 years were randomly assigned to the intervention arm (handbook in addition to standard AD management) or the control arm (standard management alone). Caregivers completed self‐report outcome questionnaires prior to a clinical visit for AD and at 3‐month follow‐up. Results 175 caregivers completed questionnaires at baseline and follow‐up. AD symptoms measured by the Patient‐Oriented Eczema Measure (POEM) improved in both the handbook and control arms. However, the decrease in the mean POEM score in the handbook arm (−4.4, 95% CI [−5.8, −3.0]) did not differ from that in the control arm (−3.4, 95% CI [−4.8, −2.03]; P = .343). Change in quality of life did not differ between study arms. Among caregivers attending a new patient visit for AD, mean confidence scores (measured from 0 to 100) increased more in the handbook arm (67 [95% CI {60, 74}] to 83 [95% CI {77, 88}]) relative to the control arm (74 [95% CI {65, 82}] to 75 [95% CI {67, 83}]; P = .012). The majority of caregivers rated the handbook as helpful in managing the child's AD. Conclusions Despite an adequate sample size, the handbook did not improve AD symptoms more than standard management alone. The handbook improved confidence in management skills for families attending new patient visits for AD.
Article
Zusammenfassung. Hintergrund: Die atopische Dermatitis (AD) ist eine chronische, rezidivierende Hauterkrankung. Jedes fünfte bis sechste Kind ist in der westlichen Zivilisation davon betroffen. Die Folgen der Erkrankung können gravierend sein: Chronische Entzündung der Haut und plagender Juckreiz verbunden mit Schlafstörungen. Für den Erfolg der Therapie ist die Edukation der Eltern von betroffenen Kindern zentral. Ziel: Entwicklung und Evaluation von evidenzbasierten Edukationsvideos für Eltern von einem Kleinkind mit AD. Methode: In den Videos wurde die Methode Storytelling eingesetzt. Ziel von Storytelling ist, Informationen durch den Einsatz von Geschichten einfach zu vermitteln. Anschließend an die Entwicklung wurden die Videos hinsichtlich der Verständlichkeit, der Wichtigkeit sowie der Nützlichkeit der Inhalte von einem multi-professionellem Team sowie von Familien mit betroffenen Kindern evaluiert. Ergebnisse: Es entstanden insgesamt sechs Videos, welche Themen wie Ursachen der AD, Symptome, Hautpflege, Behandlung sowie Leben mit AD beinhalteten. Storytelling wurde umgesetzt indem zwei Familien mit betroffenen Kindern von ihren Erfahrungen mit der Erkrankung erzählten. Fachinformationen wurden durch Spezialistinnen vermittelt. Die Evaluation ergab, dass die Informationen in den Videos einfach verständlich und relevant sind. Schlussfolgerungen: Mit evidenzbasierten Videos kann die Edukation auf innovative, kreative und moderne Art und Weise gefördert werden. Storytelling ist eine nutzerfreundliche Methode um komplexe Informationen einfach und verständlich zu vermitteln.
Article
Atopic dermatitis (AD) is a disease that can have a high impact on quality of life, especially due to itch and skin pain. This paper utilizes expertise from members of the International Society of Atopic Dermatitis (ISAD)/Oriented Patient‐Education Network in Dermatology (OPENED) task force to review the epidemiology, pathophysiology and exacerbating factors of itch and pain in atopic dermatitis. General principles of treatment are provided, as well as a more detailed evaluation of topical and systemic therapies. Educational and psychological approaches to itch and pain in atopic dermatitis are proposed, along with expert recommendations for the management of itch and pain in atopic dermatitis.
Chapter
Several dermatologic diseases put children and adolescents at a greater risk for low self-esteem, depression, anxiety, social isolation, and suicidal ideation. Proper treatment, flare prevention, and medication adherence lowers risk of long-term sequelae and can decrease the risk of psychologic morbidity associated with these conditions. Although the number of medications to treat dermatologic conditions in pediatric patients continues to expand, treatment is often hindered by poor medication adherence. Promoting adherence to treatment is particularly challenging in pediatric populations because of family dynamics and functioning, caregiver and child characteristics, and child health outcomes. Barriers may be specific to the child, to the caregiver, or shared between them. While interventions can be implemented for patients or caregiver factors independently, intervening with both caregivers and patients is ideal. Interventions to promote adherence should include fostering a strong patient-provider-caregiver relationship, family education including written action plans, simplification of treatment regimens, and motivation training to ensure patient compliance. By instilling proper adherence in childhood, young patients will be equipped to properly self-manage their disease as they age into adulthood.
Article
Resumen Introducción El objetivo de este trabajo consistió en determinar la percepción sobre el conocimiento que los padres de niños con dermatitis atópica (DA) tienen sobre la enfermedad y su manejo, y la repercusión que la educación terapéutica (ET) podría tener en ampliarlo. Metodología Encuesta no validada, realizada a padres de niños con DA en la Escuela de la Atopia (EA) de Pontevedra. El cuestionario estaba compuesto por 9 preguntas relacionadas con la repercusión de la DA en diferentes ámbitos de la vida, el consumo de tiempo de los cuidados tópicos, el conocimiento sobre la enfermedad y su tratamiento, y el efecto de la EA en la ampliación de dicho conocimiento. Resultados Se obtuvieron 61 encuestas procedentes de 5 sesiones de la EA. El 83,6% de los padres percibieron que la DA influía al menos moderadamente en la calidad de vida de sus hijos. Solo el 6,6% refería tener muchos conocimientos sobre DA con anterioridad a la EA, y en todos los casos la ET amplió dichos conocimientos. Conclusión Nuestros datos apoyan que la ET amplía los conocimientos sobre la DA. El impacto negativo de la DA en diferentes ámbitos de la vida apoya la importancia de estas sesiones formativas.
Article
Full-text available
Purpose of Review Demonstrate the need and objectives of patient education in atopic dermatitis (AD), provide an overview of the most recent studies regarding patient education, and propose new approaches to improve educational programs. Recent Findings Different models of patient education programs exist, and their structures depend on social and economic conditions. An active participation of patients is needed to improve new models of educational programs. Healthcare professionals who work with AD patients must have a comprehensive view of the many aspects involved in this disease, which includes psychological, environmental, social, financial, and cultural aspects. Summary AD is a complex disease and has a clear impact in patients’ quality of life. Patients are often frustrated and confused by the information they receive. This information can often be conflicting and overwhelming. Education for patients with AD is now being proposed as an important step in major treatment guidelines. Most studies of patient education demonstrate a positive impact in patients’ clinical outcomes, adherence, and quality of life.
Article
Full-text available
This guideline was developed as a joint interdisciplinary European project, including physicians from all relevant disciplines as well as patients. It is a consensus‐based guideline, taking available evidence from other guidelines, systematic reviews and published studies into account. This first part of the guideline covers methods, patient perspective, general measures and avoidance strategies, basic emollient treatment and bathing, dietary intervention, topical anti‐inflammatory therapy, phototherapy and antipruritic therapy, whereas the second part covers antimicrobial therapy, systemic treatment, allergen‐specific immunotherapy, complementary medicine, psychosomatic counselling and educational interventions. Management of AE must consider the individual clinical variability of the disease; highly standardized treatment rules are not recommended. Basic therapy is focused on treatment of disturbed barrier function by hydrating and lubricating topical treatment, besides further avoidance of specific and unspecific provocation factors. Topical anti‐inflammatory treatment based on glucocorticosteroids and calcineurin inhibitors is used for flare management and for proactive therapy for long‐term control. Topical corticosteroids remain the mainstay of therapy, whereas tacrolimus and pimecrolimus are preferred in sensitive skin areas and for long‐term use. Topical phosphodiesterase inhibitors may be a treatment alternative when available. Adjuvant therapy includes UV irradiation, preferably with UVB 311 nm or UVA1. Pruritus is targeted with the majority of the recommended therapies, but some patients may need additional antipruritic therapy. Antimicrobial therapy, systemic anti‐inflammatory treatment, immunotherapy, complementary medicine and educational intervention will be addressed in part II of the guideline.
Article
Education Gap Clinicians are often challenged in the primary care setting with children who present with moderate-severe recalcitrant atopic dermatitis. Many patients present at the subspecialist level grossly undertreated with topical medications and emollients. Recently, numerous clinical investigations have evolved our understanding of the pathogenesis of atopic dermatitis, and the American Academy of Dermatology released new atopic dermatitis guidelines in 2014. Understanding the groundbreaking discoveries in disease pathogenesis and implementing up-to-date management guidelines in clinical practice are critical for pediatricians. Objectives After completing this article, readers should be able to: 1. List the age-specific clinical features of atopic dermatitis (AD). 2. Understand the essential, important, and associated diagnostic criteria of AD. 3. Recognize the atopic and nonatopic clinical comorbidities associated with AD. 4. Understand the cutaneous infectious complications associated with AD. 5. Understand the disease pathogenesis and its relationship to therapeutic management. 6. Understand the state-of-the-art treatment guidelines, including the recent "proactive" maintenance therapy recommendations. 7. Recognize the importance of multidisciplinary management and clinical indications for subspecialty referral. 8. Understand effective strategies of therapeutic patient education and implement them into clinical practice.
Article
Full-text available
Over the last few decades, knowledge of the etiopathogenesis of atopic dermatitis (AD) advanced greatly. The main triggering and/or aggravating factors involved in the clinical expression of AD have been identified, and cutaneous barrier integrity has been found to be key for the maintenance of skin homeostasis. Thus, when treating patients with AD, in addition to avoiding triggering and/ or irritating agents, recommending the use of skin moisturizers is paramount – and believed to have a preventive action against acute outbreaks. Moreover, topical anti-inflammatory agents have allowed AD control in patients with mild to moderate forms of the disease. Although more restricted, systemic immunosuppressive agents have also been used in the treatment of patients with severe or refractory AD. Specific allergen immunotherapy is presented as a possible adjunctive treatment for AD in some patients, especially those allergic to mites and presenting associated respiratory manifestations. Finally, the use of new immunobiological agents is discussed in the light of the scientific and clinical evidence currently available. The objectives of this updated practical guide on atopic dermatitis – treatment approach were to review the treatment regimens available and used in the follow-up of patients with AD and to present new therapies (e.g., immunobiological agents) that will soon be available for the treatment of more severe and/ or refractory forms of AD.
Article
Introduction: Atopic dermatitis is a common, chronic pruritic condition affecting both children and adults, which has a negative impact on the quality of life. These guidelines were developed by an expert workgroup appointed by the Dermatological Society of Singapore, to provide doctors with information to assist in the management of their patients with atopic dermatitis. The workgroup members are experienced dermatologists with interest and expertise in eczemas. Materials and methods: Workgroup members arrived at a consensus on the topics to be included. Relevant studies from the literature were assessed for best evidence, supplemented by the collective experience of the workgroup. Results: For mild atopic dermatitis, emollients, mild potency topical steroids and topical calcineurin inhibitors are recommended. For moderate-to-severe atopic dermatitis, the use of emollients, moderate-to-potent topical steroids, topical calcineurin inhibitors, wet dressings, antimicrobials for secondary skin infection, phototherapy, and systemic therapy (e.g. prednisolone, cyclosporine, azathioprine or methotrexate) may be warranted. Patients with moderate-to-severe atopic dermatitis should be managed in conjunction with a dermatologist. Conclusion: Good outcomes can be achieved with an individualised therapeutic approach combined with adequate patient and parental education.
Chapter
The encounter of high levels of allergens via the skin, such as from house dust mite, may induce allergic dermatitis. Atopic individuals, both human and animal, are genetically predisposed for a deficient skin barrier function and have an inborn higher jeopardy for percutaneous allergy and infections. The atopic phenotype also has typically a higher risk for environmental allergies which is in humans termed the atopic march. Atopic dermatitis (AD) or eczema is clinically associated with chronic or recurrent, often persistent skin inflammation at typical body sites: head and face, neck, intertrigo areas, and bend and hollow sites of arms and legs. It often occurs from early age, may persist lifelong, and is complexed by the associated itch. The clinics in humans and animals are comparable in terms of the pruritic inflammation, and scratching bears a high risk for superinfections. Further symptoms may be thickening of the keratocyte layer associated with overall atrophy of the skin (lichenification); more rarely severe systemic courses may take place. The diagnostic criteria are the eczematous skin appearance, elevated total IgE levels, and occurrence of allergen-specific IgE associated with hay fever, asthma, and food allergies. Treatments of AD are based on skin repair and anti-inflammatory and immunomodulatory drugs, mostly local, in severe cases systemically. All treatments today are symptomatic. The great homology of human and veterinary AD should be recognized to speed up the understanding of the underlying pathophysiology and result in development of an improved generation of drugs with true healing potency.
Article
Treatment of children diagnosed with atopic dermatitis (AD) is an art. Age-dependent barrier function, skin physiology, body surface:weight ratio, the compliance of patient and caregivers, and legal considerations related to the license status of topical and systemic drugs must be considered. Mild to moderate AD can usually be treated sufficiently with a personalized regimen of emollients and topical anti-inflammatory therapy consisting of topical corticosteroids (TCSs) or topical calcineurin inhibitors. Emollients containing bacterial lysates, tailored wet wrap regimen, and proactive therapy with tacrolimus ointment or some TCSs are new developments in the field. Severe AD may need systemic therapy, but all currently available systemic agents for severe AD are either not licensed for children or not advisable on the long term, or both. Therapeutic patient education based on structured, interactive sessions with patients or caregivers and a multidisciplinary team is highly effective. This publication summarizes the current therapeutic options used in the pediatric AD population.
Article
Atopic dermatitis (AD) is the most prevalent dermatological disease in the pediatric population. It is a chronic, pruritic, and inflammatory skin disorder, with a complex etiology involving genetic predisposition, skin barrier defects, and immune dysfunction. AD can be a challenge for patients, physicians, and caregivers and has a clear impact in patients' quality of life (QoL). Educational programs for patients with AD and their caregivers are effective in improving adherence, QoL, and clinical outcomes. Different models of educational programs exist and their structures depend on cultural, social, and economic factors. To improve existing programs, the educational team should go beyond the disease and have a broader view of the many aspects involved in the pathological process. These include psychological, environmental, social, financial, and cultural aspects. Patients and their caregivers should have a more realistic expectation about the treatment. Innovative methods and approaches like design thinking can create new and effective solutions for patients with AD and their caregivers.
Article
Full-text available
The Internet is increasingly used as a medium for the delivery of interventions designed to promote health behavior change. However, reviews of these interventions to date have not systematically identified intervention characteristics and linked these to effectiveness. The present review sought to capitalize on recently published coding frames for assessing use of theory and behavior change techniques to investigate which characteristics of Internet-based interventions best promote health behavior change. In addition, we wanted to develop a novel coding scheme for assessing mode of delivery in Internet-based interventions and also to link different modes to effect sizes. We conducted a computerized search of the databases indexed by ISI Web of Knowledge (including BIOSIS Previews and Medline) between 2000 and 2008. Studies were included if (1) the primary components of the intervention were delivered via the Internet, (2) participants were randomly assigned to conditions, and (3) a measure of behavior related to health was taken after the intervention. We found 85 studies that satisfied the inclusion criteria, providing a total sample size of 43,236 participants. On average, interventions had a statistically small but significant effect on health-related behavior (d(+) = 0.16, 95% CI 0.09 to 0.23). More extensive use of theory was associated with increases in effect size (P = .049), and, in particular, interventions based on the theory of planned behavior tended to have substantial effects on behavior (d(+) = 0.36, 95% CI 0.15 to 0.56). Interventions that incorporated more behavior change techniques also tended to have larger effects compared to interventions that incorporated fewer techniques (P < .001). Finally, the effectiveness of Internet-based interventions was enhanced by the use of additional methods of communicating with participants, especially the use of short message service (SMS), or text, messages. The review provides a framework for the development of a science of Internet-based interventions, and our findings provide a rationale for investing in more intensive theory-based interventions that incorporate multiple behavior change techniques and modes of delivery.
Article
Full-text available
Evaluating complex interventions is complicated. The Medical Research Council's evaluation framework (2000) brought welcome clarity to the task. Now the council has updated its guidance
Article
Full-text available
To systematically evaluate the published evidence regarding the characteristics and effectiveness of disease management programmes. Meta-analysis. Computerised databases for English language articles during 1987-2001. Study selection: 102 articles evaluating 118 disease management programmes. Pooled effect sizes calculated with a random effects model. Patient education was the most commonly used intervention (92/118 programmes), followed by education of healthcare providers (47/118) and provider feedback (32/118). Most programmes (70/118) used more than one intervention. Provider education, feedback, and reminders were associated with significant improvements in provider adherence to guidelines (effect sizes (95% confidence intervals) 0.44 (0.19 to 0.68), 0.61 (0.28 to 0.93), and 0.52 (0.35 to 0.69) respectively) and with significant improvements in patient disease control (effect sizes 0.35 (0.19 to 0.51), 0.17 (0.10 to 0.25), and 0.22 (0.1 to 0.37) respectively). Patient education, reminders, and financial incentives were all associated with improvements in patient disease control (effect sizes 0.24 (0.07 to 0.40), 0.27 (0.17 to 0.36), and 0.40 (0.26 to 0.54) respectively). All studied interventions were associated with improvements in provider adherence to practice guidelines and disease control. The type and number of interventions varied greatly, and future studies should directly compare different types of intervention to find the most effective.
Article
Full-text available
To determine the effectiveness of educational programmes for the self management of asthma in children and adolescents. Databases of the Cochrane Airways Group, PsychINFO, reference lists of review papers, and eligible studies. Eligible studies were published randomised controlled trials or controlled clinical trials of educational programmes for the self management of asthma in children and adolescents that reported lung function, morbidity, self perception of asthma control, or utilisation of healthcare services. Eligible studies were abstracted, assessed for methodological quality, and pooled with fixed effects and random effects models. 32 of 45 identified trials were eligible, totalling 3706 patients aged 2 to 18 years. Education in asthma was associated with improved lung function (standardised mean difference 0.50, 95% confidence interval 0.25 to 0.75) and self efficacy (0.36, 0.15 to 0.57) and reduced absenteeism from school (-0.14, -0.23 to -0.04), number of days of restricted activity (-0.29, -0.33 to -0.09), and number of visits to an emergency department (-0.21, -0.33 to -0.09). When pooled by the fixed effects model but not by the random effects model, education was also associated with a reduced number of nights disturbed by asthma. The effect on morbidity was greatest among programmes with strategies based on peak flow, interventions targeted at the individual, and participants with severe asthma. Educational programmes for the self management of asthma in children and adolescents improve lung function and feelings of self control, reduce absenteeism from school, number of days with restricted activity, number of visits to an emergency department, and possibly number of disturbed nights. Educational programmes should be considered a part of the routine care of young people with asthma.
Article
Full-text available
The full benefit of many effective medications will be achieved only if patients adhere to prescribed treatment regimens. Unfortunately, applying terms such as “noncompliant” and “nonadherent” to patients who do not consume every pill at the desired time can stigmatize them in their future relationships with health care providers. This article on medication adherence (or compliance) reviews strategies to assess and enhance this important aspect of patient care.
Article
Full-text available
The Eczema Area and Severity Index (EASI) is used by dermatological investigators world-wide to assess eczema disease severity. EASI measures are, however, time-consuming and require trained personnel, thereby limiting its application to large-scale epidemiological studies. Additionally, the use of self-assessed severity indices in dermatology is restricted to adult subjects and conditions, thereby not addressing the needs of paediatric patients. To develop and validate an instrument for a caregiver's self-assessment of the severity of his/her child's atopic dermatitis (AD), the Self-Administered EASI (SA-EASI). Trained investigators performed a modified EASI assessment on the same day as an SA-EASI was obtained from 47 caregivers of children with AD. The SA-EASI was found to be a valid measure of the severity of AD. Total, acute and chronic SA-EASI scores predicted total, acute and chronic modified EASI scores (P < 0.0001). SA-EASI body surface area (BSA) scores predicted EASI BSA scores (P < 0.0001). SA-EASI pruritus scores correlated with the acute, chronic and total EASI scores (P = 0.0001). The SA-EASI may provide caregivers the means to report the severity of their child's skin disease objectively. The high correlation with the EASI score observed in this sample implies that statistical inferences with the SA-EASI will be valid for large populations. In future studies, this will permit analysis of the relationship of skin disease severity to such measures as quality of life, disability, patient satisfaction and the costs of various therapies. Moreover, this SA-EASI instrument may allow older children, over 12 years old, to assess the severity of their AD.
Article
Full-text available
One size does not fit all
Article
Full-text available
To determine the effects of age related, structured educational programmes on the management of moderate to severe atopic dermatitis in childhood and adolescence. Multicentre, randomised controlled trial. Seven hospitals in Germany. Parents of children with atopic dermatitis aged 3 months to 7 years (n = 274) and 8-12 years (n = 102), adolescents with atopic dermatitis aged 13-18 years (n = 70), and controls (n = 244, n = 83, and n = 50, respectively). Group sessions of standardised intervention programmes for atopic dermatitis once weekly for six weeks or no education (control group). Severity of eczema (scoring of atopic dermatitis scale), subjective severity (standardised questionnaires), and quality of life for parents of affected children aged less than 13 years, over 12 months. Significant improvements in severity of eczema and subjective severity were seen in all intervention groups compared with control groups (total score for severity: age 3 months to 7 years - 17.5, 95% confidence intervals - 19.6 to - 15.3 v - 12.2, - 14.3 to - 10.1; age 8-12 years - 16.0, - 20.0 to - 12.0 v - 7.8, - 11.4; - 4.3; and age 13-18 years - 19.7, - 23.7 to - 15.7 v - 5.2, - 10.5 to 0.1). Parents of affected children aged less than 7 years experienced significantly better improvement in all five quality of life subscales, whereas parents of affected children aged 8-12 years experienced significantly better improvement in three of five quality of life subscales. Age related educational programmes for the control of atopic dermatitis in children and adolescents are effective in the long term management of the disease.
Article
This comprehensive account of the genetic and environmental factors that cause atopic dermatitis reconciles two hypotheses concerning the origin of the disease - IgE-mediated sensitization, or an intrinsic defect in epithelial cells that causes dysfunction of the skin barrier - with evidence that both mechanisms contribute. Clinical implications are discussed.
Article
Atopic dermatitis (AD) is a skin disease which causes psychological distress to patients and their families. Patient education programs for childhood AD have positive effects on the severity of the skin disease as well as on psychological variables. So far it has not been determined whether particular patient characteristics lead to being interested in patient education programs. The aim of this cross-sectional study was to identify exploratory predictors of being interested in patient education programs in parents of children with atopic dermatitis. A severity index (SCORAD) as well as questionnaire data were collected from 73 parents of children with AD to measure satisfaction with medical care, quality of life, coping strategies, and the subjective benefit of former treatments as possible predictors. A regression analysis revealed that besides dissatisfaction with medical care, low social support and high active problem-solving behavior were significant predictors of interest in patient education programs (R(2) = 0.244). Our study gives a preliminary indication that participation in a patient education program for childhood AD should be offered to parents without sufficient social support, but who would like to gather more information on coping with AD. This could also enhance satisfaction with the medical care provided.
Article
In a randomized, controlled trial (RCT) on childhood eczema we reported that substituting nurse practitioners (NPs) for dermatologists resulted in similar outcomes of eczema severity and in the quality of life, and higher patient satisfaction. To determine costs and cost-effectiveness of care provided by NPs vs. dermatologists and to compare our results with those in studies from other countries. We estimated the healthcare costs, family costs and the costs in other sectors alongside the RCT. All the costs were linked to quality of life [Infants' Dermatitis Quality of Life Index (IDQOL), Children's Dermatology Life Quality Index (CDLQI)] and to patient satisfaction (Client Satisfaction Questionnaire-8) to determine the incremental cost-effectiveness ratio (ICER). We also examined all the reported studies on the costs of childhood eczema. The mean annual healthcare costs, family costs and costs in other sectors were €658, €302 and €21, respectively, in the NP group and €801, €608 and €0·93, respectively, in the dermatologist group. The ICER in the NP group compared with the dermatologist group indicated €925 and €751 savings per one point less improvement in IDQOL and CDLQI, respectively, and €251 savings per one point more satisfaction in the NP group at 12 months. The mean annual healthcare costs and family costs varied considerably in the six identified studies. Substituting NPs for dermatologists is both cost-saving and cost-effective. The treatment of choice is that provided by the NPs as it is similarly effective to treatment provided by a dermatologist with a higher parent satisfaction. International comparisons are difficult because the types of costs determined, the units and unit prices, and eczema severity all differ between studies.
Article
Topical corticosteroids remain the mainstay of atopic dermatitis therapy. Many atopic dermatitis therapeutic failures appear to be attributable to poor adherence to treatment due to topical corticosteroid phobia. To assess the facets, origins and frequency of fear of topical corticosteroid use among patients with atopic dermatitis. A questionnaire comprising 69 items, generated from information gathered during interviews with 21 patients and 15 health professionals, was given to consecutive patients consulting at the outpatient dermatology departments of five regional university hospitals or with 53 dermatologists in private practice. A total of 208 questionnaires were analysed (including 144 from parents and 87 from adult patients, 27 of whom were also parents); 80·7% of the respondents reported having fears about topical corticosteroids and 36% admitted nonadherence to treatment. A correlation was found between topical corticosteroid phobia and the need for reassurance, the belief that topical corticosteroids pass through the skin into the bloodstream, a prior adverse event, inconsistent information about the quantity of cream to apply, a desire to self-treat for the shortest time possible or poor treatment adherence. Topical corticosteroid phobia was not correlated with atopic dermatitis severity. Topical corticosteroid phobia is a genuine and complex phenomenon, common among French patients with atopic dermatitis, that has an important impact on treatment compliance.
Article
This study sought to identify barriers to treatment in children with chronic inflammatory skin disease, particularly those with atopic dermatitis, psoriasis, and acne vulgaris. Caregivers of 101 patients seen in the Children's Specialty Group Division of Dermatology, Children's Hospital of The King's Daughters, Norfolk, Virginia, completed an 11-item Likert scale questionnaire. This survey addressed complexity and time requirements for treatment, medication cost, vehicle formulation, perceived safety, and caregiver understanding of chronicity of skin disorders. Parents and caregivers indicated that adequate instructions for using the medications were provided but that they felt less comfortable with treating their child's skin disease during a severe flare. The complexity of treatment programs, time required to apply medications, and vehicle type were not considered prohibitive factors. Caregivers were concerned about the cost and safety of prescribed medications and had a less understanding of the chronicity of inflammatory skin disorders.
Article
BACKGROund: Patient-oriented medicine is an emerging concept, encouraged by the World Health Organization, to greater involvement of the patient in the management of chronic diseases. The Patient-Oriented SCORing Atopic Dermatitis (PO-SCORAD) index is a self-assessment score allowing the patient to comprehensively evaluate the actual course of atopic dermatitis (AD), using subjective and objective criteria derived mainly from the SCORAD, a validated AD severity clinical assessment tool. To validate the PO-SCORAD index in a large European population of patients exhibiting all forms of AD severity by assessing its correlation with the SCORAD index. Four hundred and seventy-one patients (185 adults, 286 children) consulting for AD in hospitals from 9 European countries were recruited. The investigators and the patients used the SCORAD and PO-SCORAD scales, respectively, to assess AD severity at inclusion (D0) and 28 ± 7 days later (D28). Patient-Oriented SCORing Atopic Dermatitis and SCORAD scores were significantly correlated at D0 [r = 0.67 (95% CI: 0.62; 0.72), P < 0.0001]. Consistency was confirmed at D28, with a stronger linear correlation between both scales [r = 0.79 (95% CI: 0.75; 0.83), P < 0.0001]. Absolute changes from baseline in SCORAD and PO-SCORAD scores were also significantly correlated [r= 0.71 (95% CI: 0.64; 0.76), P < 0.0001]. Although no specific intervention was investigated, AD improved over the study, with a decrease of PO-SCORAD and SCORAD scores from D0 to D28 by -19.19% and -24.39%, respectively. The consistency of the correlations was similar in the adult and children groups. This study validated the use of PO-SCORAD to self-assess AD severity and demonstrated its good correlation with SCORAD.
Article
The negative impact of skin disease on quality of life (QoL) has been described in many studies. Patient education as an adjunct to treatment, with the aim of improving QoL and reducing disease severity, is a relatively new technique in dermatology. The objective of this article is to analyse and summarise evidence concerning the effects of patient education on QoL and disease severity in patients with chronic skin diseases. All source material was identified through searches in MEDLINE and Embase. The CONSORT statement was used to assess the quality of reported randomised controlled studies. Ten of 254 studies met the inclusion criteria. In five of them, statistically significant improvements in QoL were reported. The severity of skin disease significantly improved in three studies. In conclusion, patient education appears to be effective in improving QoL and in reducing the perceived severity of skin disease.
Article
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.
Article
Background We hypothesized that a nurse practitioner would improve the quality of life of a child with eczema more than a dermatologist because of a structured intervention and more consultation time. Objectives To compare the level of care by nurse practitioners with that by dermatologists in children with eczema. Methods New referrals aged ≤ 16 years with a diagnosis of eczema were recruited. In a randomized, parallel-group study with a follow-up period of 1 year, 160 participants were randomized either to conventional care from a dermatologist or to care from a nurse practitioner. The primary outcome measure was change in quality of life at 12 months, as assessed by the Infants’ Dermatitis Quality of Life Index (IDQOL) for children aged ≤ 4 years, and by the illustrated version of the Children’s Dermatology Life Quality Index (CDLQI) for children aged 4–16 years. Secondary outcomes were changes in IDQOL and CDLQI at 4 and 8 months, family impact of childhood atopic dermatitis (Dermatitis Family Impact Questionnaire, DFI), eczema severity (objective SCORAD) and patient satisfaction (Client Satisfaction Questionnaire-8, CSQ-8) at 4, 8 and 12 months. Results The mean IDQOL in the dermatologist group improved significantly from 11·6 [SD 8·1; 95% confidence interval (CI) 9·0–14·2] at the baseline to 5·6 (SD 3·9; 95% CI 4·3–7·0) at 12 months with a mean change from the baseline of −6·5 (SD 6·6; 95% CI −14·2 to −8·9; P < 0·001). The mean IDQOL in the nurse practitioner group improved significantly from 10·7 (SD 4·9; 95% CI 9·1–12·3) at baseline to 5·7 (SD 5·4; 95% CI 4·0–7·5) at 12 months with a mean change from the baseline of −4·9 (SD 5·5; 95% CI −6·8 to −3·0; P < 0·001). The between-groups difference was (−)1·7 (95% CI −4·6 to 1·2; P = 0·26). The mean CDLQI in the dermatologist group improved significantly from 12·1 (SD 6·3; 95% CI 9·9–14·2) at baseline to 5·6 (SD 4·2; 95% CI 4·2–7·1) at 12 months with a mean change from the baseline of −5·9 (SD 6·0; 95% CI −8·0 to −3·9; P < 0·001). The mean CDLQI in the nurse practitioner group improved significantly from 10·0 (SD 4·4; 95% CI 8·5–11·4) at the baseline to 4·9 (SD 3·5; 95% CI 3·7–6·1) at 12 months with a mean change from the baseline of −5·2 (SD 4·0; 95% CI −6·6 to −3·8; P < 0·001). The between-groups difference was (−)0·7 (95% CI −3·3 to 1·7; P = 0·55). The between-groups comparison was not significant for the IDQOL and the CDLQI at baseline or 4, 8 and 12 months. Both treatment groups showed significant improvement in DFI and objective SCORAD at 12 months. The between-groups comparison was not significant at baseline or 4, 8 and 12 months. Significantly higher satisfaction levels were observed at 4, 8 and 12 months in the nurse practitioner group. Conclusions The level of care provided by a nurse practitioner in terms of the improvement in the eczema severity and the quality of life outcomes was comparable with that provided by a dermatologist. In addition, the parents were more satisfied with the care that was provided by a nurse practitioner.
Article
The diagnosis of atopic dermatitis (AD) is made using evaluated clinical criteria. Management of AD must consider the symptomatic variability of the disease. EADV eczema task force developed its guideline for atopic dermatitis diagnosis and treatment based on literature review and repeated consenting group discussions. Basic therapy relies on hydrating topical treatment and avoidance of specific and unspecific provocation factors. Anti-inflammatory treatment based on topical glucocorticosteroids and topical calcineurin antagonists is used for exacerbation management and more recently for proactive therapy in selected cases. Topical corticosteroids remain the mainstay of therapy, but the topical calcineurin inhibitors, tacrolimus and pimecrolimus are preferred in certain locations. Systemic anti-inflammatory treatment is an option for severe refractory cases. Microbial colonization and superinfection may induce disease exacerbation and can justify additional antimicrobial/antiseptic treatment. Systemic antihistamines (H1) can relieve pruritus, but do not have sufficient effect on eczema. Adjuvant therapy includes UV irradiation preferably of UVA1 wavelength or UVB 311 nm. Dietary recommendations should be specific and given only in diagnosed individual food allergy. Allergen-specific immunotherapy to aeroallergens may be useful in selected cases. Stress-induced exacerbations may make psychosomatic counselling recommendable. 'Eczema school' educational programmes have been proven to be helpful.
Article
Patients are remarkably nonadherent to medical treatment regimens across all diseases and classes of therapy, and it has been estimated that nonadherence to drug treatment is responsible for as many as 10% of all hospital admissions. Nonadherence to treatment also has significant negative effects on treatment outcomes across a wide range of diseases. Patient-related factors such as age, ethnicity, literacy (including health literacy), health beliefs, and socioeconomic conditions have been shown to influence adherence to oral therapy. Medication-related factors, such as regimen complexity and duration of treatment, also impact on adherence. Variables that significantly influence adherence to oral drugs have similar effects on adherence to topical therapy. Both educational and psychological interventions along with simplification of dosing regimens can significantly improve adherence to oral therapy and limited evidence indicates that these approaches are also effective in patients receiving topical therapy. There is very little information about the effects of dosing regimens on adherence to topical medical therapy. The advent of new drug formulations that permit once-daily or single-dose drug application will, however, permit evaluation of different topical treatment regimens on adherence and treatment outcomes in patients with dermatological disease.
Article
An intervention study was conducted to assess the effectiveness of a nurse-led eczema workshop in reducing the severity of atopic eczema in infants, children and adolescents. Ninety-nine new patients referred to the Dermatology Department of The Royal Children's Hospital in Melbourne, Australia, for the management of atopic eczema were randomized to receive care from an eczema workshop or a dermatologist-led clinic. Patients were followed-up 4 weeks after the intervention. The primary outcome was the severity of eczema as determined by scores obtained using the Scoring of Atopic Dermatitis (SCORAD) index at a 4-week follow-up visit. The secondary outcome was a comparison of treatments used in both clinics. At the 4-week review the mean improvement in SCORAD was significantly greater in those patients attending the eczema workshop than those attending the dermatologist-led clinic (-9.93, 95% confidence interval -14.57 to -5.29, P < 0.001). Significantly more patients from the eczema workshop improved from moderate severity eczema at baseline to mild at review. There was greater adherence to eczema management in the eczema workshop compared with the dermatologist-led clinic. In this study, patients attending the eczema workshop had a greater improvement in eczema severity thanpatients attending a dermatologist-led clinic, supporting collaborative models of service provision.
Article
The chronic course of atopic dermatitis is a problem for children and their families: it can be extremely disabling, and may cause psychologic problems for both child and family. As atopic dermatitis affects 10% of the pediatric population, pediatricians and dermatologists spend much time on the treatment of this disease, which requires a multidisciplinary approach. To improve the quality of life of children and families affected by atopic dermatitis we have offered an educational program to the parents of young children affected by the disease. The program consists of six meetings at weekly intervals involving a pediatric allergist, a dermatologist, and a psychologist. Our experience has been positive. This type of program may help to improve the quality of life of families with children affected by atopic dermatitis. Lower levels of anxiety were observed among parents at the end of the program. We believe that educational programs of this type, in association with conventional treatment, can be useful in the long term management of the disease. They may be considered to improve the quality of life of the family and children and to create more interaction and compliance between physicians, parents, and children.
Article
Atopic dermatitis, one of the most common skin disorders in young children, has a prevalence of 10% to 20% in the first decade of life. It is a chronic illness that requires a multifaceted treatment strategy in the setting of limited therapeutic options. Balancing safety concerns with efficacious treatment is of particular importance in the pediatric population. Parents of patients with atopic dermatitis turn to their primary caregivers for guidance regarding this physically demanding and psychologically stressful condition. In addition to serving as a review of atopic dermatitis, this article delves into the state-of-the-art therapeutic options and includes a detailed review of the differences between topical corticosteroids and topical calcineurin inhibitors. We also discuss new treatment strategies that are being used by atopic dermatitis specialists, such as comprehensive "education-as-intervention" models, wet wraps, bleach baths, and systemic immunomodulatory therapies.
Article
To evaluate the role of health education in the treatment of childhood atopic eczema, an eczema school was arranged for the parents. Fifty consecutive patients (aged 4 months-6 years 2 months) with atopic eczema of varying severity were randomly assigned into two groups; one group receiving routine information given by the physician during the medical visit, and the other group also visiting a trained nurse to receive further information on eczema treatment and practical training in controlling atopic eczema. The therapeutic effect was better in the group which had received extra guidance. We suggest that systematic training in eczema treatment should be organized as an important part of eczema treatment.
Article
Topical corticosteroids are widely prescribed by dermatologists caring for patients with atopic eczema. Patients' fears about using topical corticosteroids may have important implications for compliance with treatment. We carried out a questionnaire-based study of 200 dermatology outpatients with atopic eczema (age range 4 months-67.8 years) to assess the prevalence and source of topical corticosteroid phobia. We also questioned patients on their knowledge of the potencies of different topical corticosteroids. Overall, 72.5% of people worried about using topical corticosteroids on their own or their child's skin. Twenty-four per cent of people admitted to having been non-compliant with topical corticosteroid treatment because of these worries. The most frequent cause for concern was the perceived risk of skin thinning (34.5%). In addition, 9.5% of patients worried about systemic absorption leading to effects on growth and development. The most commonly used topical corticosteroid was hydrocortisone, yet 31% of patients who used this preparation classified it as either strong, very strong or did not know the potency. Only 62.5% of the 48 patients who had used both Dermovate (Glaxo) and hydrocortisone in the past were able to correctly grade Dermovate as being more potent than hydrocortisone. The most common source of patient information regarding topical corticosteroid safety was the general practitioner. Although skin thinning and systemic effects can develop very occasionally in people using topical corticosteroids, the concern expressed by people using them seems out of proportion in relation to the evidence of harm. This study highlights the need for provision of better information and education to patients and possibly general practitioners regarding the safety, potency and appropriate use of topical corticosteroids.
Article
Atopic eczema is mostly managed in primary care but there is often insufficient time for patient education; a nurse practitioner could help with this. To evaluate the effects of a single consultation with a primary care nurse on the quality of life (QOL) of children with atopic eczema aged 0.5-16 years and the impact of the disease on their families. Children with eczema were invited to join the trial. Volunteers were randomized to a control group or an intervention group who attended the nurse for a single 30-min session. Family impact was determined using the Family Dermatitis Index (FDI), and QOL was assessed using the Infant Dermatitis Quality of Life questionnaire (IDQOL) or, in children aged 4-16 years, the Children's Dermatology Life Quality Index (CDLQI). Baseline scores for family impact and QOL were compared with those at 4 weeks and 12 weeks post-intervention. Two hundred and thirty-five children were recruited over 12 months; 115 were aged 0.5-4 years and 120 were aged 4-16 years. Follow-up data were missing for 38 children (84% completion rate, n = 197). All measures of QOL or family impact at baseline were skewed. The median scores were IDQOL, 5, and CDLQI, 6. About 20% of children had zero scores for the FDI (no impact on family life); median FDI scores were 2 or 3. At baseline the FDI correlated with the IDQOL or CDLQI. In addition, the FDI and IDQOL were related to parental assessment of disease severity. Non-responders had, on average, worse QOL at baseline than those who provided complete data. In the children with complete data, the mean differences in CD < Q1 and 1DQO< scores between intervention and control children were small at 4 and 12 weeks (P > 0.05). The improvement in FDI at 4 weeks was slightly better in intervention than control children (P < 0.06). The impact on QOL of a single intervention by a dermatology nurse was marginal for family impact at 4 weeks and was not apparent for other measures, either in the short or longer term. The planned sample size was derived from data in hospital patients but in our population disease activity was milder and the effects on QOL were less. On this account the present study was of low statistical power for some measures. Further studies in larger populations using additional outcome measures are required before advocating the wider introduction of nurse specialists.
Article
Nurse follow-up clinics have become increasingly popular in recent years. Their impact on service delivery within dermatology may be useful in relation to chronic diseases, where education and treatment concordance are important factors in disease management. To assess the impact of providing a nurse follow-up clinic in addition to the normal service provided by the dermatology outpatient department at Queen's Medical Centre, Nottingham, and to obtain pilot data with which to inform future study design. Newly referred patients aged >/= 14 years and with a diagnosis of either eczema or psoriasis were identified. In a randomized, parallel-group study with a follow-up period of 6 weeks, participants were randomized either to normal care, or to receive an additional session with a dermatology nurse specialist immediately after their consultation with the dermatologist. The primary outcome measure was change in quality of life at 6 weeks, as assessed by the Dermatology Life Quality Index (DLQI). Secondary outcomes comprised a comparison of patient knowledge at 6 weeks and the number of consultations (in secondary and primary care) that occurred during the 6-week follow-up period. Both groups improved by approximately 3 points on the DLQI scale after 6 weeks. The between-group difference was 0.27 (95% confidence interval - 2.3 to 2.8, P = 0.83). Patients who had seen the nurse were more likely to know how long they should apply treatment (P = 0.05). There was also a marked difference in patients' understanding of how to obtain a repeat prescription (P = 0.01) and from whom they could receive further support (P < 0.001). Following the addition of this service, 33% of follow-up appointments with a doctor were cancelled in the nurse intervention group. Dermatology nurses can add to a dermatology consultation and provide effective patient education and support in managing a skin condition. With this added service nurses could help to free up dermatologists' time, thus allowing them to see more new patients. Cost-effectiveness studies are now needed.