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Singleton H, Hodder A, Almilaji O, Ersser SJ, Heaslip V, O'Meara S, Boyers D, Roberts A, Scott H, Van Onselen J, Doney L, Boyle RJ, Thompson AR. Educational and psychological interventions for managing atopic dermatitis (eczema). Cochrane Database Syst Rev 2024; 8:CD014932. [PMID: 39132734 PMCID: PMC11318083 DOI: 10.1002/14651858.cd014932.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
BACKGROUND Atopic dermatitis (eczema), can have a significant impact on well-being and quality of life for affected people and their families. Standard treatment is avoidance of triggers or irritants and regular application of emollients and topical steroids or calcineurin inhibitors. Thorough physical and psychological assessment is central to good-quality treatment. Overcoming barriers to provision of holistic treatment in dermatological practice is dependent on evaluation of the efficacy and economics of both psychological and educational interventions in this participant group. This review is based on a previous Cochrane review published in 2014, and now includes adults as well as children. OBJECTIVES To assess the clinical outcomes of educational and psychological interventions in children and adults with atopic dermatitis (eczema) and to summarise the availability and principal findings of relevant economic evaluations. SEARCH METHODS We searched the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, APA PsycINFO and two trials registers up to March 2023. We checked the reference lists of included studies and related systematic reviews for further references to relevant randomised controlled trials (RCTs) and contacted experts in the field to identify additional studies. We searched NHS Economic Evaluation Database, MEDLINE and Embase for economic evaluations on 8 June 2022. SELECTION CRITERIA Randomised, cluster-randomised and cross-over RCTs that assess educational and psychological interventions for treating eczema in children and adults. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods, with GRADE to assess the certainty of the evidence for each outcome. Primary outcomes were reduction in disease severity, as measured by clinical signs, patient-reported symptoms and improvement in health-related quality-of-life (HRQoL) measures. Secondary outcomes were improvement in long-term control of symptoms, improvement in psychological well-being, improvement in standard treatment concordance and adverse events. We assessed short- (up to 16 weeks after treatment) and long-term time points (more than 16 weeks). MAIN RESULTS We included 37 trials (6170 participants). Most trials were conducted in high-income countries (34/37), in outpatient settings (25/37). We judged three trials to be low risk of bias across all domains. Fifteen trials had a high risk of bias in at least one domain, mostly due to bias in measurement of the outcome. Trials assessed interventions compared to standard care. Individual educational interventions may reduce short-term clinical signs (measured by SCORing Atopic Dermatitis (SCORAD); mean difference (MD) -5.70, 95% confidence interval (CI) -9.39 to -2.01; 1 trial, 30 participants; low-certainty evidence) but patient-reported symptoms, HRQoL, long-term eczema control and psychological well-being were not reported. Group education interventions probably reduce clinical signs (SCORAD) both in the short term (MD -9.66, 95% CI -19.04 to -0.29; 3 studies, 731 participants; moderate-certainty evidence) and the long term (MD -7.22, 95% CI -11.01 to -3.43; 3 studies, 1424 participants; moderate-certainty evidence) and probably reduce long-term patient-reported symptoms (SMD -0.47 95% CI -0.60 to -0.33; 2 studies, 908 participants; moderate-certainty evidence). They may slightly improve short-term HRQoL (SMD -0.19, 95% CI -0.36 to -0.01; 4 studies, 746 participants; low-certainty evidence), but may make little or no difference to short-term psychological well-being (Perceived Stress Scale (PSS); MD -2.47, 95% CI -5.16 to 0.22; 1 study, 80 participants; low-certainty evidence). Long-term eczema control was not reported. We don't know whether technology-mediated educational interventions could improve short-term clinical signs (SCORAD; 1 study; 29 participants; very low-certainty evidence). They may have little or no effect on short-term patient-reported symptoms (Patient Oriented Eczema Measure (POEM); MD -0.76, 95% CI -1.84 to 0.33; 2 studies; 195 participants; low-certainty evidence) and probably have little or no effect on short-term HRQoL (MD 0, 95% CI -0.03 to 0.03; 2 studies, 430 participants; moderate-certainty evidence). Technology-mediated education interventions probably slightly improve long-term eczema control (Recap of atopic eczema (RECAP); MD -1.5, 95% CI -3.13 to 0.13; 1 study, 232 participants; moderate-certainty evidence), and may improve short-term psychological well-being (MD -1.78, 95% CI -2.13 to -1.43; 1 study, 24 participants; low-certainty evidence). Habit reversal treatment may reduce short-term clinical signs (SCORAD; MD -6.57, 95% CI -13.04 to -0.1; 1 study, 33 participants; low-certainty evidence) but we are uncertain about any effects on short-term HRQoL (Children's Dermatology Life Quality Index (CDLQI); 1 study, 30 participants; very low-certainty evidence). Patient-reported symptoms, long-term eczema control and psychological well-being were not reported. We are uncertain whether arousal reduction therapy interventions could improve short-term clinical signs (Eczema Area and Severity Index (EASI); 1 study, 24 participants; very low-certainty evidence) or patient-reported symptoms (visual analogue scale (VAS); 1 study, 18 participants; very low-certainty evidence). Arousal reduction therapy may improve short-term HRQoL (Dermatitis Family Impact (DFI); MD -2.1, 95% CI -4.41 to 0.21; 1 study, 91 participants; low-certainty evidence) and psychological well-being (PSS; MD -1.2, 95% CI -3.38 to 0.98; 1 study, 91 participants; low-certainty evidence). Long-term eczema control was not reported. No studies reported standard care compared with self-help psychological interventions, psychological therapies or printed education; or adverse events. We identified two health economic studies. One found that a 12-week, technology-mediated, educational-support programme may be cost neutral. The other found that a nurse practitioner group-education intervention may have lower costs than standard care provided by a dermatologist, with comparable effectiveness. AUTHORS' CONCLUSIONS In-person, individual education, as an adjunct to conventional topical therapy, may reduce short-term eczema signs compared to standard care, but there is no information on eczema symptoms, quality of life or long-term outcomes. Group education probably reduces eczema signs and symptoms in the long term and may also improve quality of life in the short term. Favourable effects were also reported for technology-mediated education, habit reversal treatment and arousal reduction therapy. All favourable effects are of uncertain clinical significance, since they may not exceed the minimal clinically important difference (MCID) for the outcome measures used (MCID 8.7 points for SCORAD, 3.4 points for POEM). We found no trials of self-help psychological interventions, psychological therapies or printed education. Future trials should include more diverse populations, address shared priorities, evaluate long-term outcomes and ensure patients are involved in trial design.
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Affiliation(s)
- Heidi Singleton
- Bournemouth University, Department of Nursing Science, Bournemouth, UK
| | - Andrew Hodder
- Department of Dermatology, University Hospitals Dorset, Christchurch, UK
- Yell Health Centre, NHS Scotland, Shetland, UK
| | - Orouba Almilaji
- Department of Health Service Research and Policy, LSHTM, London, UK
| | - Steven J Ersser
- Bournemouth University, Department of Nursing Science, Bournemouth, UK
| | - Vanessa Heaslip
- Department of Nursing and Midwifery , University of Salford, Salford, UK
| | | | - Dwayne Boyers
- Health Economics Research Unit, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Amanda Roberts
- Nottingham Support Group for Carers of Children with Eczema, Nottingham, UK
| | - Helen Scott
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Julie Van Onselen
- Dermatology Education Partnership, Oxford, UK
- National Eczema Society, London, UK
| | - Liz Doney
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Robert J Boyle
- National Heart & Lung Institute, Section of Inflammation and Repair, Imperial College London, London, UK
| | - Andrew R Thompson
- South Wales Clinical Psychology Training Programme, Cardiff and Vale University Health Board & Cardiff University, Cardiff, UK
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Barbarot S, Aubert H, Vibet MA, Leray M, Foureau A, Elan F, Menneron L, Stalder JF, Mazereeuw-Hautier J, Phan A, Droitcourt C, Bursztejn AC, Boralevi F, Chiaverini C, Raison-Peyron N, Lasek A, Misery L, Abasq C, Mallet S. Effectiveness of a nurse-led one-to-one education programme in addition to standard care in children with atopic dermatitis: a multicentre randomized control trial. Br J Dermatol 2024; 191:177-186. [PMID: 38863109 DOI: 10.1093/bjd/ljae111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 03/08/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Therapeutic patient education (TPE) is recommended for children with atopic dermatitis (AD), but no consensus has been reached on the optimal tailoring of delivery. While repeated multidisciplinary group education sessions have shown effectiveness, the benefits of one-on-one educational interventions led by nurses for children with AD have not yet been assessed. OBJECTIVES To assess the benefits of additional, well-structured, 1-h nurse-led individual TPE interventions in children with AD and their families compared with standard care alone. METHODS Children with moderate-to-severe AD and their parents were randomized to receive a 1-h nurse-led education session in addition to standard care vs. standard care alone. The primary outcome was the area under the curve (AUC) of the SCORing of Atopic Dermatitis index (SCORAD) from baseline to week 24 (lower AUC values represent better long-term control of the disease). RESULTS In our study, 176 patients were randomized across 11 centres, and 153 were included in the full analysis set. The mean (SD) age was 4.47 (4.57) years. By week 24, there were no significant differences in the AUCs of the SCORAD between the two groups (P = 0.3). Secondary outcomes including patient-reported severity and quality of life [AUCs of the patient-oriented SCORAD (PO-SCORAD) and Infants' Dermatitis Quality of Life Index (IDLQI), Children's Dermatitis Quality of Life Index (CDLQI) and Family Dermatitis Quality of Life Index (FDLQI)] were not significantly different between the two groups. The only significant change observed in the intervention group, when compared with the one receiving standard care, was a decrease in topical steroid phobia, as assessed by the topical corticosteroid phobia (TOPICOP) score. Prespecified subgroup analyses showed that disease severity in the intervention group was significantly lower throughout the study, compared with the standard-care group when participants had moderate AD at baseline (n = 47); while participants with severe AD at baseline (n = 106) did not show benefit from the intervention. Participants showed no additional benefit from the intervention regardless of age group. CONCLUSIONS This study did not show any additional effectiveness, in long-term severity control, of a 1-h nurse-led TPE intervention in children with AD treated with standard care, compared with those treated with standard care alone. However, it should be noted that the intervention reduced the fear of using topical steroids and may be beneficial for patients in the subgroup with moderate AD.
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Affiliation(s)
- Sebastien Barbarot
- Department of Dermatology, Nantes Université, CHU Nantes, INRAE, UMR 1280, PhAN, Nantes, France
- Departments of Dermatology, Nantes Université, CHU Nantes, Nantes, France
| | - Helene Aubert
- Departments of Dermatology, Nantes Université, CHU Nantes, Nantes, France
| | - Marie-Anne Vibet
- Research and Innovation Department, Nantes Université, CHU Nantes, Nantes, France
| | - Maëlle Leray
- Research and Innovation Department, Nantes Université, CHU Nantes, Nantes, France
| | - Aurore Foureau
- Departments of Dermatology, Nantes Université, CHU Nantes, Nantes, France
| | - Francoise Elan
- Departments of Dermatology, Nantes Université, CHU Nantes, Nantes, France
| | - Laëtitia Menneron
- Departments of Dermatology, Nantes Université, CHU Nantes, Nantes, France
| | | | | | - Alice Phan
- Department of Dermatology, CHU Lyon, Lyon, France
| | | | | | | | | | | | - Audrey Lasek
- Department of Dermatology, Saint Vincent de Paul Hospital, GHICL, Lille, France
| | | | - Claire Abasq
- Department of Dermatology, CHRU Brest, Brest, France
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Jaklitsch EL, Lin AJ, James AJ. Community-engaged education and evaluation of an acral lentiginous melanoma awareness initiative. J Natl Med Assoc 2024; 116:252-257. [PMID: 38336534 DOI: 10.1016/j.jnma.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/08/2024] [Accepted: 01/13/2024] [Indexed: 02/12/2024]
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Andrade LF, Abdi P, Mashoudy KD, Kooner A, Egler A, Urbonas R, Smith A, Yosipovitch G. Effectiveness of atopic dermatitis patient education programs - a systematic review and meta-analysis. Arch Dermatol Res 2024; 316:135. [PMID: 38662127 PMCID: PMC11045580 DOI: 10.1007/s00403-024-02871-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 01/20/2024] [Accepted: 04/07/2024] [Indexed: 04/26/2024]
Abstract
Patient education in atopic dermatitis (AD) has worked in parallel to the gold standard of pharmacological treatment as a foundational component of therapeutic regimens. In addition to improving patient education, past investigations of educational interventions have demonstrated profound reductions in disease severity for patients living with AD. However, prior meta-analytical work has focused mostly on comparing in-person interventions, and thus the need to determine the effectiveness of virtual methodologies in the current post-COVID era remains. In this study, we conducted a systematic review of the literature to determine the effectiveness of online programming in AD education compared to in-person interventions. A comprehensive search was conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions 2019. Studies were retrieved based on articles published up to 04 April 2023. Adherence to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Statement guided the reportage process for this systematic review and meta-analysis. The primary outcome of our meta-analysis was the effect of various educational modalities on atopic dermatitis severity as measured by multiple scales across the studies, the most common including SCORAD, Dermatology Life Quality Index (DLQI), Patient Oriented Eczema Measure (POEM), and Eczema Area and Severity Index (EASI). Most studies were randomized controlled trials, primarily from North America and Western Europe and focused on patient and/or caregiver education about disease management, self-care techniques, avoidance of triggers, and comprehensive understanding of the disease process. Our pooled analyses showed that targeted educational programs in understudied adult populations can be as impactful as those in pediatric groups. Moreover, virtual interventions can be employed as constructive tools for reducing barriers of access to patient education. Future research on educational interventions should utilize various methodologies to encourage individual learning preferences with a focus on adult cohorts.
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Affiliation(s)
- Luis F Andrade
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1150 NW 14th Street, Miami, FL, 33136, USA.
| | - Parsa Abdi
- Faculty of Medicine, Memorial University of Newfoundland, 300 Prince Philip Dr, St. John's, NL, A1B 3V6, Canada
| | - Kayla D Mashoudy
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1150 NW 14th Street, Miami, FL, 33136, USA
| | - Amritpal Kooner
- Chicago College of Osteopathic Medicine, Midwestern University, Downers Grove, IL, 60515, USA
| | - Ashley Egler
- Indiana University School of Medicine, 340 W. 10th Street, Fairbanks Hall 6217, Indianapolis, IN, 46202, USA
| | - Rebecca Urbonas
- Charles E. Schmidt College of Medicine, Florida Atlantic University, 777 Glades Road BC-71, Boca Raton, FL, 33431, USA
| | - Aaron Smith
- University of Virginia School of Medicine, 1340 Jefferson Park Ave, Charlottesville, VA, 22903, USA
| | - Gil Yosipovitch
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1150 NW 14th Street, Miami, FL, 33136, USA
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Brunner C, Theiler M, Znoj H, Holzer S, Seliner B. The characteristics and efficacy of educational nurse-led interventions in the management of children with atopic dermatitis - An integrative review. PATIENT EDUCATION AND COUNSELING 2023; 116:107936. [PMID: 37598585 DOI: 10.1016/j.pec.2023.107936] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 08/06/2023] [Accepted: 08/08/2023] [Indexed: 08/22/2023]
Abstract
OBJECTIVE This integrative review investigates the modalities, characteristics, and efficacy of educational nurse-led interventions for parents of children with atopic dermatitis (AD). METHODS We conducted an integrative review with the following inclusion criteria: Quantitative, qualitative and mixed-method studies written in English or German and published between 1 January 2000 and 31 December 2021. We searched for entirely nurse-led interventions. RESULTS Four RCTs, three pre-post studies without control groups, and one post-test study without control group met the inclusion criteria. Nurse-led interventions were found to have medium to large positive effect sizes on disease severity, and none to large positive effects on quality of life. There was significant heterogeneity across study designs with a wide variety in educational interventions and outcome measures used. The quality of most included studies was low. CONCLUSION Nurse-led educational interventions for parents of children with AD are beneficial in reducing disease severity. However, it remains unclear, which main components of the nurse-led intervention are most effective. PRACTICE IMPLICATIONS Based on the results of this review, we think that trained and qualified nurses who are part of the entire treatment of children with AD and do as well educational interventions have the greatest potential to improve outcomes.
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Affiliation(s)
- Corinne Brunner
- Pediatric Skin Center, Skin, and Wound management, University Children's Hospital of Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Zurich, Switzerland; Graduate School for Health Sciences, University of Bern, Switzerland.
| | - Martin Theiler
- Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Zurich, Switzerland; Pediatric Skin Center, Dermatology Department, University Children's Hospital of Zurich, Zurich, Switzerland
| | - Hansjoerg Znoj
- Department of Health Psychology and Behavioral Medicine, Institute of Psychology, University of Bern, Bern, Switzerland
| | - Sarah Holzer
- Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Zurich, Switzerland; Department of Nursing Science, University Children's Hospital of Zurich, Zurich, Switzerland
| | - Brigitte Seliner
- Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Zurich, Switzerland; Department of Nursing Science, University Children's Hospital of Zurich, Zurich, Switzerland
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Mostafa N, Smith SD. Improving Psychological Health Outcomes in Children with Atopic Dermatitis. Clin Cosmet Investig Dermatol 2023; 16:2821-2827. [PMID: 37841063 PMCID: PMC10576503 DOI: 10.2147/ccid.s393254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 10/03/2023] [Indexed: 10/17/2023]
Abstract
Introduction Atopic dermatitis (AD) is a chronic inflammatory skin disease that usually develops in early childhood. AD has a significant impact on quality of life and psychological health outcomes in both adults and children. There are increased reported rates of psychiatric comorbidities including anxiety, depression, ADHD and suicidal ideation compared to the general population. Primary caregivers of children with pediatric eczema and their families may also have derangements in psychological health and quality of life. A number of interventions exist for AD and address wellbeing outcomes as an important aspect of effective treatment. Methods A comprehensive literature search was conducted using PubMed/Medline, Embase, the Cochrane Central Register of Controlled Trials in February 2023. Published studies up to April 2023 were included related to interventions for childhood AD that included psychological health or quality of life outcomes. These interventions were stratified according to type and evidence quality. Results Search strategy revealed a wide variety of interventions with demonstrated improvements in quality of life or wellbeing of patients with pediatric AD or their families. Both pharmacological and non-pharmacological interventions demonstrated effectiveness in improving disease outcomes. Conclusion A variety of both pharmacological and non-pharmacological interventions may be employed to improve psychological health outcomes in children with AD.
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Affiliation(s)
- Niyaz Mostafa
- Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia
| | - Saxon D Smith
- ANU Medical School, ANU College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
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Caffarelli C, Giannetti A, Giannì G, Ricci G. Anti-inflammatory and biologic drugs for atopic dermatitis: a therapeutic approach in children and adolescents. Front Med (Lausanne) 2023; 10:1214963. [PMID: 37654660 PMCID: PMC10466416 DOI: 10.3389/fmed.2023.1214963] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 07/27/2023] [Indexed: 09/02/2023] Open
Abstract
Atopic dermatitis (AD) is a chronic inflammatory disease with a heterogeneous pathogenesis correlated with dysregulation of the immune system and a prevalence of the T2-mediated immune pathway. Recent understanding of the pathogenesis of AD has allowed the development of new drugs targeting different mechanisms and cytokines that have changed the treatment approach. The aim of this review is to update knowledge on the standard of care and recent advancements in the control of skin inflammation. In light of recent guidelines, we report on the clinical efficacy of novel treatments, with special attention to situations where biologics and small molecules are involved.
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Affiliation(s)
- Carlo Caffarelli
- Clinica Pediatrica, Azienda Ospedaliero-Universitaria, Department of Medicine and Surgery, Università di Parma, Parma, Italy
| | - Arianna Giannetti
- Paediatrics Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giuliana Giannì
- Clinica Pediatrica, Azienda Ospedaliero-Universitaria, Department of Medicine and Surgery, Università di Parma, Parma, Italy
| | - Giampaolo Ricci
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
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Brunner C, Schlüer AB, Znoj H, Schwieger-Briel A, Luchsinger I, Weibel L, Theiler M. Video-Based Education with Storytelling Reduces Parents' Fear of Topical Corticosteroid Use in Children with Atopic Dermatitis: A Randomized Controlled Trial (The EduDerm Study Part II). Adv Skin Wound Care 2023; 36:414-419. [PMID: 37471446 DOI: 10.1097/asw.0000000000000002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
OBJECTIVE To investigate the efficacy of educational videos using storytelling to reduce parents' fear of topical corticosteroid (TCS) use in children affected by atopic dermatitis (AD). METHODS Children aged 0 to 5 years who had AD were included. The primary outcome measures were parental fear of TCSs, as determined by Topical Corticosteroid Phobia score, and quality of life according to the Family Dermatology Life Quality Index. Disease severity, assessed by the Scoring Atopic Dermatitis tool, served as a secondary outcome measure. Assessments were performed at baseline (T1), 1 to 4 weeks later (T2), and at 3-month follow-up (T3). The intervention group was exposed to the videos between baseline and T2. RESULTS Forty patients were recruited: 21 in the intervention group and 19 in the control group. A statistically significant decrease in parental TCS fear was found in the intervention group at T2 after video education as compared with the control group (P < .0001); this was maintained at T3 (P = .001). The groups did not significantly differ in FDLQI or SCORAD scores at any point. CONCLUSIONS These findings suggest that video education based on the method of storytelling is effective in reducing TCS fear. Although the education did not impact disease severity or quality of life, effectively reducing TCS fear remains an important aspect for AD management.
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Affiliation(s)
- Corinne Brunner
- Corinne Brunner, MScN, RN, is Advanced Practice Nurse, Pediatric Skin Center, University Children's Hospital of Zurich, Switzerland, and PhD Student, Graduate School for Health Sciences, University of Bern. Anna-Barbara Schlüer, PhD, MScN, RN, is Scientific Researcher, Department of Health Sciences, ZHAW Zurich University of Applied Sciences, Winterthur. Hansjoerg Znoj, PhD, is Emeritus Professor, Department of Health Psychology and Behavioural Medicine, Institute of Psychology, University of Bern. Also at University Children's Hospital of Zurich, Pediatric Skin Center, Agnes Schwieger-Briel, MD, and Isabelle Luchsinger, MD, are Consultants for Pediatric Dermatology; Lisa Weibel, MD, is Head of the Department of Pediatric Dermatology; and Martin Theiler, MD, is Consultant for Pediatric Dermatology. Acknowledgments: The authors thank all of the patients and parents who participated in this study. They are grateful to Samuel Roselip and Doris Kunz for support in data collection and Marianne Müller for statistical support. Lisa Weibel, MD, received honoraria from Pfizer, Sanofi, Eli Lilly, and Novartis for consultancy services. Martin Theiler, MD, received honoraria from Pfizer and Eli Lilly for investigator services, and from Sanofi-Aventis and Pfizer for participation in advisory boards and consultancy. The EduDerm study was supported by the Nursing Science Foundation Switzerland (ID 2242-2019) and the Children's Research Center, University Children's Hospital Zurich, Switzerland. The authors have disclosed no other financial relationships related to this article. Submitted April 13, 2022; accepted in revised form October 20, 2022. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website ( www.ASWCjournal.com )
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Kobusiewicz AK, Tarkowski B, Kaszuba A, Lesiak A, Narbutt J, Zalewska-Janowska A. The relationship between atopic dermatitis and atopic itch in children and the psychosocial functioning of their mothers: A cross-sectional study. Front Med (Lausanne) 2023; 10:1066495. [PMID: 36873862 PMCID: PMC9978477 DOI: 10.3389/fmed.2023.1066495] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/27/2023] [Indexed: 02/18/2023] Open
Abstract
Atopic dermatitis is a chronic inflammatory skin disease significantly affecting patients' and their parents' lives. Mothers are mostly responsible for the long-term treatment and their wellbeing is essential. The major objective of this cross-sectional study was to investigate the relationship between atopic dermatitis in children, especially concomitant itch, and the quality of life, stress, sleep quality, anxiety, and depression of their mothers. The study included 88 mothers of children with atopic dermatitis and 52 mothers of children without atopic dermatitis. All mothers completed sociodemographic questionnaire, the Perceived Stress Scale, the Athens Insomnia Scale and the Hospital Anxiety and Depression Scale. Additionally, mothers of children with atopic dermatitis filled in the Family Dermatology Life Quality Index. The severity of atopic dermatitis and pruritus intensity were evaluated by the Scoring Atopic Dermatitis Index and the Numerical Rating Scale, respectively. The severity of atopic dermatitis and itch significantly correlated with the quality of life, insomnia, and perceived stress of the mothers. Mothers whose children had had atopic dermatitis for more than 6 months had significantly higher scores of anxiety and depression. The results highlight the importance of screening mothers for functional impairment to provide adequate support. More attention should be directed to the standardization of stepped care interventions addressing factors resulting in the impaired functioning of mothers.
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Affiliation(s)
- Aleksandra K Kobusiewicz
- Psychodermatology Department, Pulmonology, Rheumatology and Clinical Immunology Chair, Medical University of Lodz, Lodz, Poland.,Department of Dermatology, Pediatric Dermatology and Dermatological Oncology, Medical University of Lodz, Lodz, Poland
| | - Bartlomiej Tarkowski
- Psychodermatology Department, Pulmonology, Rheumatology and Clinical Immunology Chair, Medical University of Lodz, Lodz, Poland
| | - Andrzej Kaszuba
- Department of Dermatology, Pediatric Dermatology and Dermatological Oncology, Medical University of Lodz, Lodz, Poland
| | - Aleksandra Lesiak
- Department of Dermatology, Pediatric Dermatology and Dermatological Oncology, Medical University of Lodz, Lodz, Poland
| | - Joanna Narbutt
- Department of Dermatology, Pediatric Dermatology and Dermatological Oncology, Medical University of Lodz, Lodz, Poland
| | - Anna Zalewska-Janowska
- Psychodermatology Department, Pulmonology, Rheumatology and Clinical Immunology Chair, Medical University of Lodz, Lodz, Poland
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Unmet Medical Needs and Early Referral of Pediatric Atopic Dermatitis: An Expert Modified Delphi Consensus from Saudi Arabia. Dermatol Res Pract 2022. [DOI: 10.1155/2022/5636903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
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.
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Galli E, Fortina AB, Ricci G, Maiello N, Neri I, Baldo E, Berti I, Bonamonte D, Capra L, Carboni E, Carello R, Caroppo F, Cavagni G, Chinellato I, Cipriani F, Comberiati P, Diociaiuti A, Di Lernia V, Duse M, Filippeschi C, Giannetti A, Giovannini M, Licari A, Marseglia GL, Pace M, Patrizi A, Pajno GB, Peroni D, Villani A, Eichenfield L. Narrative review on the management of moderate-severe atopic dermatitis in pediatric age of the Italian Society of Pediatric Allergology and Immunology (SIAIP), of the Italian Society of Pediatric Dermatology (SIDerP) and of the Italian Society of Pediatrics (SIP). Ital J Pediatr 2022; 48:95. [PMID: 35701810 PMCID: PMC9195338 DOI: 10.1186/s13052-022-01278-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/10/2022] [Indexed: 02/06/2023] Open
Abstract
Currently, there are a few detailed guidelines on the overall management of children and adolescents with moderate-severe atopic dermatitis. AD is a complex disease presenting with different clinical phenotypes, which require an individualized and multidisciplinary approach. Therefore, appropriate interaction between primary care pediatricians, pediatric allergists, and pediatric dermatologists is crucial to finding the best management strategy. In this manuscript, members of the Italian Society of Pediatric Allergology and Immunology (SIAIP), the Italian Society of Pediatric Dermatology (SIDerP), and the Italian Society of Pediatrics (SIP) with expertise in the management of moderate-severe atopic dermatitis have reviewed the latest scientific evidence in the field. This narrative review aims to define a pathway to appropriately managing children and adolescents with moderate-severe atopic dermatitis.
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Affiliation(s)
- Elena Galli
- Pediatric Allergology Unit, Department of Pediatric Medicine, S.Pietro Hospital Fatebenefratelli, Roma, Italy
| | - Anna Belloni Fortina
- Pediatric Dermatology Unit, Department of Medicine, University of Padua, Padova, Italy
| | - Giampaolo Ricci
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Nunzia Maiello
- Department of Woman, Child and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Iria Neri
- Dermatology Unit, IRCCS of Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola Hospital, Bologna, Italy
| | - Ermanno Baldo
- Giovan Battista Mattei" Research Institute, Stenico, Italy
| | - Irene Berti
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Domenico Bonamonte
- Department of Biomedical Science and Human Oncology, Section of Dermatology, University of Bari, Bari, Italy
| | | | - Elena Carboni
- Unit of Paediatrics, Maggiore Hospital, ASST-Cremona, Cremona, Italy
| | - Rossella Carello
- Pediatric Allergology Unit, Department of Pediatric Medicine, S.Pietro Hospital Fatebenefratelli, Roma, Italy
| | - Francesca Caroppo
- Pediatric Dermatology Unit, Department of Medicine, University of Padua, Padova, Italy
| | - Giovanni Cavagni
- Allergology Service European Diagnostic DRP Centre Parma, Parma, Italy
| | | | | | - Pasquale Comberiati
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy
| | - Andrea Diociaiuti
- Dermatology Unit and Genodermatosis Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Vito Di Lernia
- Dermatology Unit, Arcispedale Santa Maria Nuova, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Marzia Duse
- Pediatrics, Sapienza University, Rome, Italy
| | - Cesare Filippeschi
- Dermatology Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Arianna Giannetti
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti, 11, 40138, Bologna, Italy.
| | - Mattia Giovannini
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Amelia Licari
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy, University of Pavia, Pavia, Italy
| | - Gian Luigi Marseglia
- Clinica Pediatrica Università di Pavia - Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Manuela Pace
- Department of Pediatrics, S. Maria del Carmine Hospital, Rovereto, Italy
| | - Annalisa Patrizi
- Dermatology Unit, IRCCS of Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola Hospital, Bologna, Italy.,Dermatology, Department of Specialistic, Diagnostic and Experimental Medicine (DIMES), Alma MaterStudiorum University of Bologna, Bologna, Italy
| | | | - Diego Peroni
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy
| | - Alberto Villani
- Emergency and General Pediatrics Department Bambino Gesù Children Hospital - IRCCS, Rome, Italy
| | - Lawrence Eichenfield
- Department of Dermatology, University of California, San Diego and Rady Children's Hospital, San Diego, USA
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12
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Butala S, Paller AS. Optimizing topical management of atopic dermatitis. Ann Allergy Asthma Immunol 2022; 128:488-504. [PMID: 35288275 DOI: 10.1016/j.anai.2022.03.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/03/2022] [Accepted: 03/03/2022] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Provide a review of atopic dermatitis management, focusing on optimizing topical therapy, creating a stepwise approach for treatment plans, and providing guidance on when to start systemic therapy. DATA SOURCES PubMed search of articles in the English language regarding atopic dermatitis in all ages. STUDY SELECTION Articles on the subject matter were selected and reviewed. RESULTS Topical corticosteroids are the first-line treatment for managing atopic dermatitis. Topical nonsteroidal agents, calcineurin inhibitors, crisaborole, and recently, ruxolitinib, which cause no cutaneous atrophy, are options for reducing the use of topical corticosteroids, including on sensitive sites. Emerging topical agents are in clinical trials. Proactive management, with continued application 2 to 3 times weekly of a midpotency topical corticosteroid or tacrolimus, may maintain control for clear (or almost clear) localized sites of dermatitis that rapidly recur when topical anti-inflammatory medication is stopped. If topical therapy alone cannot control disease and quality of life is impacted, reevaluation to confirm the diagnosis, manage comorbid conditions, address compliance and patient-specific concerns, and optimize topical therapy must be undertaken before deciding to advance to systemic medication. Dupilumab, an interleukin-4 receptor inhibitor, has become first-line systemic therapy given its efficacy and safety, allowing long-term treatment without laboratory monitoring. Other biologics and Janus kinase inhibitors are emerging as alternatives that could eliminate the need for immunosuppressants with their higher risks. CONCLUSION Several options are now available for topical treatment. A stepwise approach is needed to consider alternative therapies and diagnoses before advancing to systemic treatment, but the safety of newer immunomodulators will lower the threshold for more aggressive intervention.
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Affiliation(s)
- Sneha Butala
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Amy S Paller
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
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13
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Psychological Interventions Are More Effective Than Educational Interventions at Improving Atopic Dermatitis Severity: A Systematic Review. Dermatitis 2022:01206501-990000000-00002. [PMID: 35481826 DOI: 10.1097/der.0000000000000868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT We determined which educational and/or psychological interventions were most effective in atopic dermatitis (AD). A systematic review of published studies evaluated the effectiveness of educational and/or psychological interventions in MEDLINE, Embase, SCOPUS, LILACS, Cochrane, China National Knowledge Infrastructure, Taiwan Electronic Periodical Services, and CiNii. Two reviewers conducted title/abstract, full-text review, and data extraction. Twenty-four prospective studies were included, including 20 randomized controlled trials. Educational (4/7 studies) and combined educational and psychological (5/6 studies) interventions reduced AD severity; psychological (10/11 studies) interventions showed the greatest benefit. The most commonly studied psychological intervention was habit reversal training (8/11 studies), which was most frequently incorporated in studies that reduced AD severity (8/10 studies). The most commonly studied educational interventions were education on AD triggers (7/7 studies) and skin care (7/7 studies); they were incorporated in all studies that reduced AD severity. Different psychological and/or educational interventions successfully reduced AD severity, especially habit reversal training.
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Zhao M, Liang Y, Song F, Ma L, Wang Y, Gao W, Tian J, Ying X, Shen C, Wang S, Jiao L, Wang Y, Sun X, Ma L, Ma X. Preventive Antenatal Educational Program on Allergic Diseases (PAEPAD) versus standard antenatal care for prevention of atopic dermatitis: study protocol for a single-centre, investigator-blinded randomised controlled trial. BMJ Open 2022; 12:e048083. [PMID: 35078832 PMCID: PMC8796218 DOI: 10.1136/bmjopen-2020-048083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Patient education serves an essential purpose in the long-term management of allergic diseases as a secondary prevention approach. However, evidence on using education for primary prevention is limited. This study aims to evaluate the effect of an educational intervention, that is, the Preventive Antenatal Educational Program on Allergic Diseases (PAEPAD), on infantile allergic disease incidences compared with the standard care. METHODS AND ANALYSIS This is a single-centre randomised controlled trial of expecting mother-children dyads in Daxing Teaching Hospital of Beijing, China. A total of 2266 expecting mothers will be recruited. Expecting mothers enlisted in the birth registry of Daxing Teaching Hospital of Capital Medical University and intend to give birth at this location will be screened for eligibility. Women aged≥18 years with less than 14+6 weeks of pregnancy who intends to remain resident in Daxing district for at least 2 years postpartum will be entered into the run-in phase. Randomisation will take place at 30 weeks of gestation. Women at high risk for miscarriage or intend to have abortions will be excluded. The participants will be allocated into two groups (ie, the PAEPAD and the standard care group) by random allocation (1:1). The PAEPAD group will receive a multidisciplinary education of neonatal care, including standard education as the control group and additional information on skincare of infants, sun protection, topical corticosteroids and an overview of atopic dermatitis (AD), whereas the standard care group will receive the standard neonatal care education carried out by obstetricians. Participants will be followed for 2 years. The primary outcome will be infantile AD cumulative incidence at 2 years postpartum. Secondary outcomes will include other AD outcomes, atopic march outcomes, knowledge outcomes and other maternal and neonatal outcomes. Data collection will be carried out using both electronic and paper questionnaires. Biological samples will also be collected longitudinally. ETHICS AND DISSEMINATION The study design was approved by the ethical committee of Capital Medical University Daxing Teaching Hospital, Beijing, China. The trial results will be published in peer-reviewed journals and at conferences. TRIAL REGISTRATION NUMBER ChiCTR registry (Trial ID: ChiCTR2000040463).
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Affiliation(s)
- Mutong Zhao
- Dermatology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Yuan Liang
- Dermatology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Fengli Song
- Obstetrics and Gynecology, Beijing Daxing District People's Hospital, Daxing Teaching Hospital, Capital Medical University, Beijing, China
| | - Lili Ma
- Obstetrics and Gynecology, Beijing Daxing District People's Hospital, Daxing Teaching Hospital, Capital Medical University, Beijing, China
| | - Ying Wang
- Obstetrics and Gynecology, Beijing Daxing District People's Hospital, Daxing Teaching Hospital, Capital Medical University, Beijing, China
| | - Wanli Gao
- Obstetrics and Gynecology, Beijing Daxing District People's Hospital, Daxing Teaching Hospital, Capital Medical University, Beijing, China
| | - Jing Tian
- Dermatology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Xiangji Ying
- Gastrointestinal Cancer Center, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Chunping Shen
- Dermatology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Shan Wang
- Dermatology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Lei Jiao
- Dermatology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Yang Wang
- Dermatology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Xiaoyan Sun
- Obstetrics and Gynecology, Beijing Daxing District People's Hospital, Daxing Teaching Hospital, Capital Medical University, Beijing, China
| | - Lin Ma
- Dermatology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Xiuhua Ma
- Obstetrics and Gynecology, Beijing Daxing District People's Hospital, Daxing Teaching Hospital, Capital Medical University, Beijing, China
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15
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Muzzolon M, Imoto RR, Canato M, Abagge KT, de Carvalho VO. Educational intervention and atopic dermatitis: impact on quality of life and treatment. Asia Pac Allergy 2021; 11:e21. [PMID: 34007831 PMCID: PMC8103006 DOI: 10.5415/apallergy.2021.11.e21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/26/2021] [Indexed: 01/02/2023] Open
Abstract
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.
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16
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Cheng NS, Chau JPC, Lo SHS, Choi KC, Hon KLE, Lam PH, Leung TF. Effects of a self-efficacy theory-based parental education program on eczema control and parental outcomes. Pediatr Allergy Immunol 2021; 32:535-543. [PMID: 33274772 DOI: 10.1111/pai.13421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/06/2020] [Accepted: 11/16/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Eczema is the most common childhood skin problem worldwide. Education that enhances parental self-efficacy in carrying out appropriate eczema management is crucial to controlling eczema symptoms of their children. However, the lack of such a structured education program hinders everyday lives of eczematous children and their families. This study evaluated the effects of a self-efficacy theory-based parental eczema education program in controlling eczema of Chinese children at three months after commencement of intervention. METHODS An assessor-blind, 2-arm, randomized controlled trial was conducted at an outpatient clinic of a regional hospital. One hundred and thirty-six Chinese children aged 3 months to 12 years with physician-diagnosed eczema, and their parents were recruited. The intervention was underpinned by the Social Cognitive Theory. Children's disease severity, parental self-efficacy, treatment adherence, and quality of life of family members were assessed by validated tools. Generalized estimating equation model was employed to compare differential change in each outcome across time between different groups. RESULTS Eczema severity of children and parental self-efficacy in the intervention group were found to show greater improvement at 3-month follow-up with regression coefficient (β) -16.98 (95% CI, -21.04 to -12.92; P < .001) and β 29.39 (95% CI, 22.64-36.14; P < .001), respectively. Nearly all parents (97%) receiving the intervention rated this program as useful and helpful. CONCLUSIONS This program is effective in enhancing parents' self-efficacy in managing their children's eczema and improving their adherence to eczema treatment and quality of life.
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Affiliation(s)
- Nam Sze Cheng
- Faculty of Medicine, The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Janita Pak Chun Chau
- Faculty of Medicine, The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Suzanne Hoi Shan Lo
- Faculty of Medicine, The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kai Chow Choi
- Faculty of Medicine, The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kam Lun Ellis Hon
- Faculty of Medicine, Department of Pediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Pok Hong Lam
- Faculty of Medicine, Department of Pediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ting Fan Leung
- Faculty of Medicine, Department of Pediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China.,Hong Kong Hub of Pediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
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17
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LeBovidge JS, Timmons K, Delano S, Greco KF, DeFreitas F, Chan F, Jeong T, Rosen M, Rea C, Schneider LC. Improving patient education for atopic dermatitis: A randomized controlled trial of a caregiver handbook. Pediatr Dermatol 2021; 38:396-404. [PMID: 33486817 DOI: 10.1111/pde.14519] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/14/2020] [Accepted: 01/02/2021] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- Jennifer S LeBovidge
- Division of Immunology, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Karol Timmons
- Division of Immunology, Boston Children's Hospital, Boston, MA, USA
| | - Sophia Delano
- Division of Immunology, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Kimberly F Greco
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, USA
| | | | - Felice Chan
- Division of Immunology, Boston Children's Hospital, Boston, MA, USA
| | - Tiffany Jeong
- Division of Immunology, Boston Children's Hospital, Boston, MA, USA
| | - Melissa Rosen
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Corinna Rea
- Harvard Medical School, Boston, MA, USA.,Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Lynda C Schneider
- Division of Immunology, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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Ezzedine K, Shourick J, Merhand S, Sampogna F, Taïeb C. Impact of Atopic Dermatitis in Adolescents and their Parents: A French Study. Acta Derm Venereol 2020; 100:adv00294. [PMID: 33021321 PMCID: PMC9274931 DOI: 10.2340/00015555-3653] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2020] [Indexed: 11/17/2022] Open
Abstract
Atopic dermatitis has a negative impact on quality of life in patients and their families. However, there have been very few studies of the impact of atopic dermatitis on adolescents and their relatives. The objective of this study was to evaluate the impact of atopic dermatitis in the daily lives of adolescents between 12 and 17 years of age in the French population and to assess the burden of the disease on their families. Quality of life was measured in 399 parents of adolescents with atopic dermatitis and in the adolescents themselves. Impairment of quality of life in the adolescents was associated with disease severity. Moreover, in children aged 12-14 years, quality of life was worse with increasing age, with decreasing disease duration, and when parents had atopic dermatitis. In children aged 15-17 years quality of life was worse when the parent who answered the questionnaire was male and when the parent was < 45 years old. The burden of atopic dermatitis was higher in parents of older children, in parents with children with higher disease severity, with shorter disease duration, in male parents, and in parents aged <45 years. The burden of atopic dermatitis in adolescents and their parents is considerable and should be taken into account in the management of atopic dermatitis.
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Affiliation(s)
- Khaled Ezzedine
- Department of Dermatology, Hôpital Henri Mondor, FR-94000 Creteil, France
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