Positive change in hand care habits using therapeutic patient education in chronic hand eczema

Psychological burden, anxiety, depression and quality of life in patients with hand eczema: A systematic review and meta-analysis

BACKGROUND

Living with hand eczema (HE) has been associated with impaired quality of life (QoL), having anxiety and depression but the magnitude of association is not clear.

OBJECTIVES

The aim of this systematic review and meta-analysis was to determine the psychological burden in terms of anxiety, depression and quality of life in patients with HE.

METHODS

Several databases were systematically searched. Weighted means with standard deviation (SD) were calculated for disease severity, QoL, depression and/or anxiety scores among patients with HE. For studies presenting QoL, depression and/or anxiety scores in patients with HE and in controls the weighted means were compared with an unpaired t-test. In studies reporting Hand Eczema Severity Index (HECSI) and Dermatology Life Quality Index (DLQI), the correlation between HECSI and DLQI was estimated using Spearman's rank correlation (rs).

RESULTS

In total, 81 studies encompassing 17,835 patients with HE and 31,541 controls were included. The weighted mean DLQI was 10.66 (SD 8.93) corresponding to a moderate-to-large effect on QoL and a strong correlation (rs: 0.76, 95% CI:0.56-0.87) between DLQI and HECSI was observed. The mean EQ-5D-VAS was significantly lower in patients with HE compared with controls (68.03 (SD 10.52) vs. 80.63 (SD 1.17), p < 0.00001). Patients with HE had higher mean HADS (Hospital Anxiety and Depression Scale) anxiety score (7.4 vs. 5.8, p = 0.0008) than controls but not higher HADS depression score (6.5 vs. 5.7, p = 0.32). Only one study assessed risk of anxiety, depression and suicidal ideation showing an increased odds of all diseases among patients with HE compared with controls.

CONCLUSION

Hand eczema has a moderate-to-severe impact on quality of life with a strong correlation between disease severity and impact on quality of life. Patients with hand eczema have an impact on QoL comparable to other chronic diseases when measured with generic QoL scoring systems.

Assessing the Application of Large Language Models in Generating Dermatologic Patient Education Materials According to Reading Level: Qualitative Study

BACKGROUND

Dermatologic patient education materials (PEMs) are often written above the national average seventh- to eighth-grade reading level. ChatGPT-3.5, GPT-4, DermGPT, and DocsGPT are large language models (LLMs) that are responsive to user prompts. Our project assesses their use in generating dermatologic PEMs at specified reading levels.

OBJECTIVE

This study aims to assess the ability of select LLMs to generate PEMs for common and rare dermatologic conditions at unspecified and specified reading levels. Further, the study aims to assess the preservation of meaning across such LLM-generated PEMs, as assessed by dermatology resident trainees.

METHODS

The Flesch-Kincaid reading level (FKRL) of current American Academy of Dermatology PEMs was evaluated for 4 common (atopic dermatitis, acne vulgaris, psoriasis, and herpes zoster) and 4 rare (epidermolysis bullosa, bullous pemphigoid, lamellar ichthyosis, and lichen planus) dermatologic conditions. We prompted ChatGPT-3.5, GPT-4, DermGPT, and DocsGPT to "Create a patient education handout about [condition] at a [FKRL]" to iteratively generate 10 PEMs per condition at unspecified fifth- and seventh-grade FKRLs, evaluated with Microsoft Word readability statistics. The preservation of meaning across LLMs was assessed by 2 dermatology resident trainees.

RESULTS

The current American Academy of Dermatology PEMs had an average (SD) FKRL of 9.35 (1.26) and 9.50 (2.3) for common and rare diseases, respectively. For common diseases, the FKRLs of LLM-produced PEMs ranged between 9.8 and 11.21 (unspecified prompt), between 4.22 and 7.43 (fifth-grade prompt), and between 5.98 and 7.28 (seventh-grade prompt). For rare diseases, the FKRLs of LLM-produced PEMs ranged between 9.85 and 11.45 (unspecified prompt), between 4.22 and 7.43 (fifth-grade prompt), and between 5.98 and 7.28 (seventh-grade prompt). At the fifth-grade reading level, GPT-4 was better at producing PEMs for both common and rare conditions than ChatGPT-3.5 (P=.001 and P=.01, respectively), DermGPT (P<.001 and P=.03, respectively), and DocsGPT (P<.001 and P=.02, respectively). At the seventh-grade reading level, no significant difference was found between ChatGPT-3.5, GPT-4, DocsGPT, or DermGPT in producing PEMs for common conditions (all P>.05); however, for rare conditions, ChatGPT-3.5 and DocsGPT outperformed GPT-4 (P=.003 and P<.001, respectively). The preservation of meaning analysis revealed that for common conditions, DermGPT ranked the highest for overall ease of reading, patient understandability, and accuracy (14.75/15, 98%); for rare conditions, handouts generated by GPT-4 ranked the highest (14.5/15, 97%).

CONCLUSIONS

GPT-4 appeared to outperform ChatGPT-3.5, DocsGPT, and DermGPT at the fifth-grade FKRL for both common and rare conditions, although both ChatGPT-3.5 and DocsGPT performed better than GPT-4 at the seventh-grade FKRL for rare conditions. LLM-produced PEMs may reliably meet seventh-grade FKRLs for select common and rare dermatologic conditions and are easy to read, understandable for patients, and mostly accurate. LLMs may play a role in enhancing health literacy and disseminating accessible, understandable PEMs in dermatology.

Impact on quality of life of an intervention providing additional information to patients with allergic contact dermatitis; a randomized clinical trial

BACKGROUND

Allergic contact dermatitis can negatively impact an individual's daily life in terms of work and interpersonal relationships. Patch-tested individuals show an improved quality of life (QoL).

OBJECTIVES

We aimed to assess the impact on QoL after patch testing and what value an intervention would have on QoL.

METHODS

Dermatology Quality of Life Index (DLQI) were assessed in participants with positive patch test reaction. The participants were randomized, in parallel design, into two groups that received either standard information (controls, n = 70) or a reminder letter in addition to standard information (intervention group, n = 66), ClinicalTrials.gov NCT01953380.

RESULTS

The response rate was 74% (n = 136). The DLQI score was significantly lower 1 year after patch testing in comparison with baseline in the entire group (mean DLQI 6.3 and 4.5 respectively, 95% CI 0.93-2.72, P < 0.001). However, linear regression analyses showed no significant differences in DLQI score at follow-up between the intervention and control groups. Neither age nor gender had impact on DLQI score.

CONCLUSION

There was an improvement of QoL at follow-up in the entire group. However, the intervention performed did not show any significantly greater improvement concerning QoL. Further research is needed to understand what factors apart from patch testing and medical care may affect QoL in patients with contact dermatitis, and what interventions are needed to improve QoL.

Dermatology Life Quality Index as a Prognostic Tool for Predicting Need for Healthcare in Patients with Eczema: A Pilot Study

Abstract is missing (Short Communication)

The prevalence and year lived with disability of atopic dermatitis in China: Findings from the global burden of disease study 2019

Background

Atopic dermatitis (AD) is a chronic disease with growing prevalence and has become a global public health problem. However, little is known about the burden caused by AD in China.

Objective

To access the prevalence and burden of AD in China.

Methods

We estimated the prevalence and year lived with disability (YLD) of AD in China, by different age and sex groups. We also compared the burden of AD in China with other countries in the Group of Twenty (G20). We analyzed the changes in the number of AD patients and their YLDs by cause decomposition from 1990 to 2019.

Results

AD was the twenty-fourth leading cause of the burden of 369 diseases in China in 2019. From 1990 to 2019, the age-standardized prevalence and YLD rate of AD in China increased by 1.04% and 1.43% respectively, which were the second and the largest increase among the G20 and both higher than the global average (-4.29% and -4.14%). The number of patients with AD increased by 25.65%, of which 20.16% was due to population growth, 3.85% due to population aging, and 1.64% due to age-specific prevalence. Both the prevalence and YLD rate of AD were higher in 1 to 4 year-olds and 95+ years age group. Before the age of 10, the prevalence and YLD rate of AD in males were higher than those in females, while there was a marked sex shift at the ages of 10 to 14.

Conclusion

AD is a serious public health problem in China. Substantial variations exist in burden due to AD between male and female, and in age groups. Considering these findings will be important for developing preventive strategies and treatments to reduce the burden of AD.

Positive change in asthma control using therapeutic patient education in severe uncontrolled asthma: a one-year prospective study

Background

Severe asthma is difficult to control. Therapeutic patient education enables patients to better understand their disease and cope with treatment, but the effect of therapeutic patient education in severe uncontrolled asthma is unclear. We evaluated whether therapeutic patient education is effective in improving asthma control and decreasing the frequency of exacerbations in severe uncontrolled asthma.

Methods

This was a prospective, observational, and self-controlled study that enrolled 40 subjects with severe uncontrolled asthma. Patients were seen at a clinic four times (on day 1 and after 3, 6, and 12 months). After baseline data collection, the subjects completed a therapeutic patient education program and were also followed-up via telephone after 1, 2, 4, 5, 7, 8, 9, 10, and 11 months to monitor asthma medication adherence and collect asthma-related information.

Results

Within the 1-year study period, a total of 23 exacerbations were recorded in 14 patients, seven of whom required emergency treatment and two of whom were hospitalized. Twelve months after the standardized therapeutic patient education program, pulmonary function and fractional exhaled nitric oxide levels improved significantly in all 40 patients. Moreover, the scores from three standardized asthma questionnaires and indices suggested improved quality of life in these patients with severe uncontrolled asthma. Serum levels of biomarkers reflecting asthma immune responses did not change between baseline and the 1-year follow-up time point.

Conclusions

Therapeutic patient education is effective in improving asthma control and decreasing exacerbations in patients with severe uncontrolled asthma.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40733-021-00076-y.

Handekzem – Gleiche Therapie für alle Formen?

Es gibt nicht einen einzigen Typ des chronischen Handekzems (CHE) – weder morphologisch noch immunologisch. Schutz und Präventionsmaßnahmen können für alle Typen des CHE definiert werden. Die Therapie muss passen und zielgerichtet sein. Einige Therapien können jedoch für alle Typen des Handekzems angeboten werden wie topische Kortikosteroide, Calcineurinantagonisten, UV-Therapie und Alitretinoin, ggf. auch Dupilumab, was in größeren Studien untersucht werden sollte. Die Wahrnehmung des Handekzems sollte gerade in Zeiten der Irritation durch Desinfektion der Hände erhöht werden, damit Prävention und frühzeitige Therapie erfolgen können.

Nomenclature and clinical phenotypes of atopic dermatitis

Atopic dermatitis is a heterogeneous disease and resists classification. In this review, we discuss atopic dermatitis nomenclature and identify morphologic phenotypes, which will facilitate correct diagnoses and development of treatment strategies. We support using the term 'atopic dermatitis' rather than eczema, because it describes the allergic background and inflammation ('itis') as drivers of the disease. Atopic dermatitis has many morphologic manifestations that vary by topographic area affected, age, or race and require consideration in differential diagnosis. Different phenotypes based on morphology and topographic location, ethnicity, and age are discussed. A better-defined phenotype identification for atopic dermatitis will facilitate earlier and correct diagnosis of this complex condition and inform selection of the most appropriate treatment choice in an era in which targeted therapies may generate more individualized patient care.

Methods to improve quality of life, beyond medicines. Position statement of the European Academy of Dermatology and Venereology Task Force on Quality of Life and Patient Oriented Outcomes

The pharmaceutical approach to skin disease has been hugely successful, but despite effective drugs being available and used, there are still vast numbers of people who continue to have some level of persisting skin disease and continue to experience quality of life (QoL) impairment. So the question that needs to be answered, while we await further advances in our drug-based armamentarium, is how can we improve patients' QoL, beyond drugs? A working group was formed from members of the EADV Task Force on QoL and Patient Oriented Outcomes. Participants were asked to suggest all the ways in which they considered patients' QoL may be improved beyond medicines. Four groups of management approaches that may improve QoL in dermatology were identified: interventions within the dermatology service (hospitalization, multidisciplinary teams, patch testing and establishing relevant allergens and education), external services (corrective make-up, climatotherapy and balneotherapy), psychological (psychological intervention, cognitive therapy, hypnosis), lifestyle (lifestyle behavioural changes, religion and spirituality and music). The ultimate aim of therapy is to eradicate a disease in an individual and return the person's life to normal. But until the day comes when this has been achieved for every skin disease and for every patient there will be a need to support and assist many patients in additional non-pharmaceutical ways. These 'adjuvant' approaches receive too little attention while dermatologists and researchers strive for better pharmacological therapy. The different ways in which patients may benefit have been reviewed in our paper, but the reality is that most have a very poor evidence base. The research challenges that we have to meet are to identify those approaches that might be of value and to provide evidence for their optimal use. In the meantime, clinicians should consider the use of these approaches where QoL remains impaired despite optimal use of standard therapy.