1
|
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.
Collapse
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
| |
Collapse
|
2
|
Muzzolon M, Morgan M, Reis I, Imoto R, Carvalho VOD. Let's Play? A Board Health Game Development and Validation for Children with Atopic Dermatitis. Games Health J 2024. [PMID: 39069963 DOI: 10.1089/g4h.2023.0218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024] Open
Abstract
Objective: Several health games have been developed for pediatric patients in recent years but few for children with atopic dermatitis (AD). As this chronic disease requires changes in daily habits, this study aimed to develop and validate the content of a board health game for children with AD. Material and Methods: This is a content development and validation study of DermatrilhaTM, a board health game about AD. The instrument aims to promote interactions between children with AD and health care providers and offers the exchange of experiences, feelings, and knowledge about the disease in a playful way. The five stages of development of the board game were (a) planning, (b) development, (c) preparation of content validation questionnaires, (d) evaluation by a committee of experts, and (e) pretest with the target audience. Results: The expert committee group consisted of 20 professionals: 5 physicians specialized in pediatric dermatology, 5 psychologists specialized in health psychology, 5 designers with experience in illustration, and 5 early childhood educators. The target audience consisted of 25 children aged 7-12 years with AD. The evaluation of the expert committee found 0.95 in the general content validity index and 0.92 in the target audience, thus exceeding 0.80 in all items. Conclusion: The board health game Dermatrilha has proven to be a psychoeducational tool for the therapeutic education of children with AD, enabling the exchange of experiences, feelings, and knowledge about the disease among peers and health care providers.
Collapse
Affiliation(s)
- Mariana Muzzolon
- Postgraduate Program in Child and Adolescent Health, Federal University of Paraná-Clinical Hospital, Curitiba, Brazil
| | - Mariana Morgan
- Postgraduate Program in Child and Adolescent Health, Federal University of Paraná-Clinical Hospital, Curitiba, Brazil
| | - Izabella Reis
- Postgraduate Program in Child and Adolescent Health, Federal University of Paraná-Clinical Hospital, Curitiba, Brazil
| | - Renata Imoto
- Postgraduate Program in Child and Adolescent Health, Federal University of Paraná-Clinical Hospital, Curitiba, Brazil
| | - Vânia Oliveira de Carvalho
- Postgraduate Program in Child and Adolescent Health, Federal University of Paraná-Clinical Hospital, Curitiba, Brazil
| |
Collapse
|
3
|
Nummak P, Techasatian L, Uppala R, Sitthikarnkha P, Saengnipanthkul S, Sirikarn P. Parental Attitudes and Practices regarding Atopic Dermatitis: A Cross-Sectional Study among a Thai Population. CHILDREN (BASEL, SWITZERLAND) 2024; 11:870. [PMID: 39062319 PMCID: PMC11276138 DOI: 10.3390/children11070870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 07/05/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Atopic dermatitis (AD) is a chronic inflammatory skin disorder common in children. Successful pediatric AD therapy requires parental assistance. Thus, evaluating parental knowledge, attitudes, and behaviors regarding childhood AD may lead to more educational recommendations to help children control AD in the future. This study examined parents' knowledge, attitudes, and conduct concerning AD in families with and without children with AD. METHOD The Pediatric Department, Faculty of Medicine, Khon Kaen University, Thailand, conducted a cross-sectional study from June to December 2023. Parents of children who visited the dermatology clinic with or without AD were asked to complete a Google form questionnaire. RESULTS A total of 372 parents answered a questionnaire about AD pathophysiology, knowledge, attitudes, and practices. The participants were 293 (78.8%) female participants and 79 (21.2%) male participants. The average age was 29.79 (SD 4.91). Most parents (319, 85.8%) did not work in the medical field, and more than half (228 instances, 61.29%) had children diagnosed with AD. CONCLUSIONS Parents of children with AD understood AD causes and triggers better than parents of children without AD. But, "exposure to furry toys" that may contain dust and allergies and "infection" that may cause AD flare-ups were the most common triggers, regardless of the group. Appropriate information should be supplied because both the parents of children with AD and those of children without AD reported immediate food avoidance without confirmatory testing, which might lead to malnutrition. Clinicians and families handling patients with AD require further education.
Collapse
Affiliation(s)
- Phurithat Nummak
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand; (P.N.); (R.U.); (P.S.); (S.S.)
| | - Leelawadee Techasatian
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand; (P.N.); (R.U.); (P.S.); (S.S.)
| | - Rattapon Uppala
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand; (P.N.); (R.U.); (P.S.); (S.S.)
| | - Phanthila Sitthikarnkha
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand; (P.N.); (R.U.); (P.S.); (S.S.)
| | - Suchaorn Saengnipanthkul
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand; (P.N.); (R.U.); (P.S.); (S.S.)
| | - Prapassara Sirikarn
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen 40002, Thailand;
| |
Collapse
|
4
|
Ying G, Koch K. General practitioner prescription patterns for atopic eczema in children-Are they affected by telemedicine advice? Australas J Dermatol 2024; 65:369-372. [PMID: 38480998 DOI: 10.1111/ajd.14225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 02/04/2024] [Indexed: 06/07/2024]
Abstract
Traditionally, patients presenting to primary care with severe eczema would be referred to a dermatology clinic for an in-person specialist appointment. With the rise of teledermatology, dermatologists are instead dispensing tailored written advice based on information provided in the referral. However, there is currently minimal literature assessing whether this advice translates into relevant prescriptions. This clinical audit examines GP prescribing practices and how they correlate to dermatologist recommendations with the objective of assessing whether this form of teledermatology is a viable method of providing care to paediatric eczema patients.
Collapse
Affiliation(s)
- Geoffrey Ying
- University of Auckland Medical School, Auckland, New Zealand
| | - Karen Koch
- Department of Dermatology, Waikato Hospital, Waikato, New Zealand
| |
Collapse
|
5
|
Williams E, Lakkiss S. Supporting children, young people and families to self-manage atopic eczema. Nurs Child Young People 2024:e1478. [PMID: 38247728 DOI: 10.7748/ncyp.2024.e1478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2023] [Indexed: 01/23/2024]
Abstract
Atopic eczema is common in childhood and can continue into adulthood. Adherence to treatment is a significant factor in its effective management, but the complexity of treatment regimens can make adherence challenging. Additionally, living with the condition can have adverse psychosocial consequences for young people in particular. This article discusses treatment regimens for moderate-to-severe atopic eczema and some of the challenges encountered by children, young people and families in self-managing the condition. The authors discuss strategies that can support families to achieve optimal self-management, namely online support tools, written action plans and nurse-led eczema clinics.
Collapse
Affiliation(s)
- Emma Williams
- School of Health and Social Care, Swansea University, Swansea, Wales
| | - Samantha Lakkiss
- Singleton Hospital, Swansea Bay University Health Board, Swansea, Wales
| |
Collapse
|
6
|
van Halewijn KF, van der Most F, Bohnen AM, Pasmans SGMA, Bindels PJE, Elshout G. Atopic Dermatitis in Children in the General Population: Baseline Characteristics, Medication Use, and Severity Measures in the Rotterdam Eczema Study. Dermatitis 2024; 35:61-69. [PMID: 37015063 DOI: 10.1089/derm.2022.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
Background: Real-life data on severity and treatments in children with atopic dermatitis (AD) are needed to evaluate self-management. Objectives: To determine severity and use of topical treatments in children with AD in the general population. Furthermore, we aim to determine agreement and correlation between objective and subjective AD severity measures. Methods: Data were used from the Rotterdam Eczema Study, an observational prospective cohort study with an embedded pragmatic open-label randomized controlled trial. Descriptive statistics were used for baseline characteristics, medication use, and severity. Strength of agreement and correlation were determined using kappa analysis and Pearson correlation. Results: In total, 367 children (mean age 5.7 years) were recruited. The mean eczema area and severity index (EASI) score was 2.1 (±3.2) and mean patient-oriented eczema measure (POEM) score was 10.3 (±6.1). The majority applied emollients on a daily basis (54.9%) and had not used topical corticosteroids (TCSs) over the past week (51%). Based on severity banding of POEM and EASI, 49.9% and 24.9% of the children were undertreated, respectively. No evidence was found for an agreement between EASI and POEM (kappa 0.028, n = 178, P = 0.451). A moderate correlation between POEM, EASI, infants' dermatitis quality of life index, and children's dermatology life quality index was found. POEM showed higher correlation with quality of life (QoL) than EASI. Conclusion: Emollients were used sufficiently in the study population. Based on signs or symptoms, 24.9% and 49.9% of children are undertreated, respectively. POEM scores correlated better with QoL than with EASI scores. We argue that EASI underestimates severity of AD, and treatment based on EASI scores may lead to undertreatment of AD. Treating physicians should be aware of suboptimal use of TCSs.
Collapse
Affiliation(s)
- Karlijn F van Halewijn
- From the Departments of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Floor van der Most
- From the Departments of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Arthur M Bohnen
- From the Departments of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Suzanne G M A Pasmans
- Dermatology-Center of Pediatric Dermatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Patrick J E Bindels
- From the Departments of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Gijs Elshout
- From the Departments of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
7
|
Brown H, Singleton HJ. Atopic eczema and the barriers to treatment adherence for children: a literature review. Nurs Child Young People 2023; 35:21-27. [PMID: 37066679 DOI: 10.7748/ncyp.2023.e1459] [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] [Accepted: 09/02/2022] [Indexed: 04/18/2023]
Abstract
Atopic eczema is a chronic, non-contagious, relapsing inflammatory skin condition commonly seen in children and adults. Children with atopic eczema often endure complex skincare regimens that can keep the condition under control when managed effectively. Nonadherence, particularly to topical treatments, is one of the most common causes of treatment failure in atopic eczema. This literature review aimed to explore the barriers that influence treatment adherence in children and young people with atopic eczema and identify recommendations for practice. Six studies were included in the literature review and three themes were identified: relationships, medicines concerns and information deficits. Healthcare professionals should strive to develop trusting relationships with parents and understand the barriers to treatment adherence. Individualised conversations and education about medicines concerns, understanding the psychosocial effects of atopic eczema on children and families, and providing clear, consistent advice can be beneficial.
Collapse
Affiliation(s)
- Hayley Brown
- Dorset County Hospital, Dorchester, England and former student, Bournemouth University, Bournemouth, England
| | | |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Ridd MJ, Wells S, MacNeill SJ, Sanderson E, Webb D, Banks J, Sutton E, Shaw AR, Wilkins Z, Clayton J, Roberts A, Garfield K, Liddiard L, Barrett TJ, Lane JA, Baxter H, Howells L, Taylor J, Hay AD, Williams HC, Thomas KS, Santer M. Comparison of lotions, creams, gels and ointments for the treatment of childhood eczema: the BEE RCT. Health Technol Assess 2023; 27:1-120. [PMID: 37924282 PMCID: PMC10679965 DOI: 10.3310/gzqw6681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2023] Open
Abstract
Background Emollients are recommended for children with eczema (atopic eczema/dermatitis). A lack of head-to-head comparisons of the effectiveness and acceptability of the different types of emollients has resulted in a 'trial and error' approach to prescribing. Objective To compare the effectiveness and acceptability of four commonly used types of emollients for the treatment of childhood eczema. Design Four group, parallel, individually randomised, superiority randomised clinical trials with a nested qualitative study, completed in 2021. A purposeful sample of parents/children was interviewed at ≈ 4 and ≈ 16 weeks. Setting Primary care (78 general practitioner surgeries) in England. Participants Children aged between 6 months and 12 years with eczema, of at least mild severity, and with no known sensitivity to the study emollients or their constituents. Interventions Study emollients sharing the same characteristics in the four types of lotion, cream, gel or ointment, alongside usual care, and allocated using a web-based randomisation system. Participants were unmasked and the researcher assessing the Eczema Area Severity Index scores was masked. Main outcome measures The primary outcome was Patient-Oriented Eczema Measure scores over 16 weeks. The secondary outcomes were Patient-Oriented Eczema Measure scores over 52 weeks, Eczema Area Severity Index score at 16 weeks, quality of life (Atopic Dermatitis Quality of Life, Child Health Utility-9 Dimensions and EuroQol-5 Dimensions, five-level version, scores), Dermatitis Family Impact and satisfaction levels at 16 weeks. Results A total of 550 children were randomised to receive lotion (analysed for primary outcome 131/allocated 137), cream (137/140), gel (130/135) or ointment (126/138). At baseline, 86.0% of participants were white and 46.4% were female. The median (interquartile range) age was 4 (2-8) years and the median Patient-Oriented Eczema Measure score was 9.3 (SD 5.5). There was no evidence of a difference in mean Patient-Oriented Eczema Measure scores over the first 16 weeks between emollient types (global p = 0.765): adjusted Patient-Oriented Eczema Measure pairwise differences - cream-lotion 0.42 (95% confidence interval -0.48 to 1.32), gel-lotion 0.17 (95% confidence interval -0.75 to 1.09), ointment-lotion -0.01 (95% confidence interval -0.93 to 0.91), gel-cream -0.25 (95% confidence interval -1.15 to 0.65), ointment-cream -0.43 (95% confidence interval -1.34 to 0.48) and ointment-gel -0.18 (95% confidence interval -1.11 to 0.75). There was no effect modification by parent expectation, age, disease severity or the application of UK diagnostic criteria, and no differences between groups in any of the secondary outcomes. Median weekly use of allocated emollient, non-allocated emollient and topical corticosteroids was similar across groups. Overall satisfaction was highest for lotions and gels. There was no difference in the number of adverse reactions and there were no significant adverse events. In the nested qualitative study (n = 44 parents, n = 25 children), opinions about the acceptability of creams and ointments varied most, yet problems with all types were reported. Effectiveness may be favoured over acceptability. Parents preferred pumps and bottles over tubs and reported improved knowledge about, and use of, emollients as a result of taking part in the trial. Limitations Parents and clinicians were unmasked to allocation. The findings may not apply to non-study emollients of the same type or to children from more ethnically diverse backgrounds. Conclusions The four emollient types were equally effective. Satisfaction with the same emollient types varies, with different parents/children favouring different ones. Users need to be able to choose from a range of emollient types to find one that suits them. Future work Future work could focus on how best to support shared decision-making of different emollient types and evaluations of other paraffin-based, non-paraffin and 'novel' emollients. Trial registration This trial is registered as ISRCTN84540529 and EudraCT 2017-000688-34. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (HTA 15/130/07) and will be published in full in Health Technology Assessment; Vol. 27, No. 19. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Matthew J Ridd
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sian Wells
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | | | | | - Douglas Webb
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jonathan Banks
- National Institute for Health and Care Research Collaborations for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Eileen Sutton
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Alison Rg Shaw
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Zoe Wilkins
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Julie Clayton
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Amanda Roberts
- Nottingham Support Group for Carers of Children with Eczema, Nottingham, UK
| | | | - Lyn Liddiard
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tiffany J Barrett
- South West Medicines Information and Training, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - J Athene Lane
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Helen Baxter
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Laura Howells
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Jodi Taylor
- Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Alastair D Hay
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Hywel C Williams
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Kim S Thomas
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Miriam Santer
- Primary Care Research Centre, University of Southampton, Southampton, UK
| |
Collapse
|
10
|
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.
Collapse
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 )
| | | | | | | | | | | | | |
Collapse
|
11
|
Emmett ER, Allen M, Crownshaw S, Ridd MJ. How and what adverse events are reported and captured in randomized control trials of emollients in the treatment of eczema? Clin Exp Dermatol 2023; 48:889-894. [PMID: 37075240 PMCID: PMC10359396 DOI: 10.1093/ced/llad137] [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: 12/17/2022] [Revised: 03/20/2023] [Accepted: 04/10/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Emollients are universally recommended for atopic dermatitis/eczema ('eczema'), to improve the skin barrier and reduce symptoms. However, our knowledge of the frequency and nature of adverse effects associated with their use is limited. OBJECTIVES We sought to determine how well adverse events are reported in randomized controlled trials (RCTs) of emollients for eczema. METHODS MEDLINE was searched from inception (1946) to May 2022. Inclusion criteria were RCTs of moisturizers or emollients used as a leave-on treatment (as the intervention or control) in adults or children with eczema. Exclusion criteria were non-RCTs; patients with other diagnoses included; use of emollient as bath additives, soap substitutes or as preventative; and not published in English. References of eligible papers were reviewed for any additional, relevant research. Data were extracted into an Excel spreadsheet and analysed descriptively. An assessment of study quality was carried out using the Joanna Briggs Institute tool for RCTs. RESULTS From 369 potential papers, 35 papers (reporting on 34 studies) were included. Most research was conducted in research centres or hospitals (unclear in 34%). In total, 89% reported collecting data on adverse events related to emollient treatment use but the methods used were poorly reported (40% unclear). Four papers used patient questionnaires/diaries. However, it was unclear how and what was collected as only two studies showed the questionnaires used. CONCLUSIONS Reporting of adverse events related to emollient use in trials of patients with eczema is poor and inconsistent. Agreement should be reached on how and what adverse events should be collected, to standardize reporting across studies.
Collapse
Affiliation(s)
| | - Megan Allen
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Matthew J Ridd
- Bristol Medical School, University of Bristol, Bristol, UK
| |
Collapse
|
12
|
Dantuluri KL, Bonnet KR, Schlundt DG, Schulte RJ, Griffith HG, Luu A, Charnogursky C, Perkins JM, Whitmore CC, Banerjee R, Howard LM, Grijalva CG. Antibiotic perceptions, adherence, and disposal practices among parents of pediatric patients. PLoS One 2023; 18:e0281660. [PMID: 36758043 PMCID: PMC9910628 DOI: 10.1371/journal.pone.0281660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/30/2023] [Indexed: 02/10/2023] Open
Abstract
Antibiotics are frequently prescribed for children in the outpatient setting. Although sometimes necessary, antibiotic use is associated with important downstream effects including the development of antimicrobial resistance among human and environmental microorganisms. Current outpatient stewardship efforts focus on guiding appropriate antibiotic prescribing practices among providers, but little is known about parents' understanding of antibiotics and appropriate disposal of leftover antibiotics. To help bridge this gap, we conducted a qualitative study to assess parental understanding of their children's antibiotics, their adherence to antibiotic instructions, and their disposal practices. We conducted a semi-structured interview with parents of 13 children diagnosed with acute respiratory illnesses and prescribed antibiotics in an urban outpatient clinic. We found that parents had limited understanding of how antibiotics work. Although they received instructions about antibiotic use during the healthcare visit, adherence to the prescription and appropriate disposal of antibiotics was suboptimal. Limited baseline understanding of antibiotics, their prior experiences with antibiotics, perceptions about their social networks' antibiotic use, and information provided to them by healthcare providers may influence these behaviors. Our findings can inform educational efforts of outpatient stewardship programs to help optimize parental understanding of how to use and dispose of their children's antibiotics.
Collapse
Affiliation(s)
- Keerti L. Dantuluri
- Division of Infectious Diseases, Department of Pediatrics, Levine Children’s Hospital at Atrium Health, Charlotte, North Carolina, United States of America
| | - Kemberlee R. Bonnet
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, United States of America
| | - David G. Schlundt
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Rebecca J. Schulte
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Hannah G. Griffith
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Alexandria Luu
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Cara Charnogursky
- Division of Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Jessica M. Perkins
- Department of Human and Organizational Development, Peabody College, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Christine C. Whitmore
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Ritu Banerjee
- Division of Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Leigh M. Howard
- Division of Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Carlos G. Grijalva
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| |
Collapse
|
13
|
Devasenapathy N, Chu A, Wong M, Srivastava A, Ceccacci R, Lin C, MacDonald M, Wen A, Steen J, Levine M, Pyne L, Schneider L, Chu DK. Cancer risk with topical calcineurin inhibitors, pimecrolimus and tacrolimus, for atopic dermatitis: a systematic review and meta-analysis. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:13-25. [PMID: 36370744 DOI: 10.1016/s2352-4642(22)00283-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Atopic dermatitis is a prevalent condition in children and can be effectively managed with medications such as topical calcineurin inhibitors (pimecrolimus or tacrolimus). A key unresolved safety concern is whether use of topical calcineurin inhibitors is associated with cancer. We systematically reviewed the risk of cancer in patients with atopic dermatitis exposed to topical calcineurin inhibitors. METHODS As part of the 2022 American Academy of Allergy, Asthma and Immunology and American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters atopic dermatitis guidelines, we searched MEDLINE, Embase, the Latin American and Caribbean Health Sciences Literature database, the Índice Bibliográfico Espanhol de Ciências da Saúde database, the Global Resource of Eczema Trials database, WHO's International Clinical Trials Registry Platform, the US Food and Drug Administration database, the European Medicines Agency database, company registers, and relevant citations from inception to June 6, 2022. We included randomised controlled trials and comparative and non-comparative non-randomised studies in any language addressing cancer risk in patients with atopic dermatitis using topical calcineurin inhibitors. We excluded split-body studies and studies with less than 3 weeks of follow-up. Paired reviewers independently screened records, extracted data, and assessed risk of bias in duplicate. We used Bayesian models to estimate the probability for cancer due to topical calcineurin inhibitor exposure and the GRADE approach to determine the certainty of the evidence. Patients, advocacy groups, and care providers set a priori thresholds of important effects. This study is registered with Open Science Framework, https://osf.io/v4bfc. FINDINGS We identified and analysed 110 unique studies (52 randomised controlled trials and 69 non-randomised studies [11 were non-randomised study extensions of randomised controlled trials]) including 3·4 million patients followed up for a mean of 11 months (range 0·7-120). The absolute risk of any cancer with topical calcineurin inhibitor exposure was not different from controls (absolute risk 4·70 per 1000 with topical calcineurin inhibitors vs 4·56 per 1000 without; odds ratio 1·03 [95% credible interval 0·94-1·11]; moderate certainty). For all age groups and using data from observational studies and randomised controlled trials, the use of pimecrolimus (OR 1·05 [95% credible interval 0·94-1·15]) or tacrolimus (0·99 [0·89-1·09]) is likely to have had little to no association with cancer compared with no topical calcineurin inhibitor exposure. For pimecrolimus versus tacrolimus, the finding was similar (0·95 [95% credible interval 0·83-1·07]). Findings were similar in infants, children, and adults, and robust to trial sequential, subgroup, and sensitivity analyses. INTERPRETATION Among individuals with atopic dermatitis, moderate-certainty evidence shows that topical calcineurin inhibitors do not increase the risk of cancer. These findings support the safe use of topical calcineurin inhibitors in the optimal treatment of patients with atopic dermatitis. FUNDING American Academy of Allergy, Asthma and Immunology and American College of Allergy, Asthma and Immunology via the Joint Task Force on Practice Parameters.
Collapse
Affiliation(s)
| | - Alexandro Chu
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Melanie Wong
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | | | - Renata Ceccacci
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Clement Lin
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | | | - Aaron Wen
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Jeremy Steen
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Mitchell Levine
- Department of Medicine, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Lonnie Pyne
- Department of Medicine, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton, ON, Canada
| | | | - Derek K Chu
- Department of Medicine, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
| |
Collapse
|
14
|
Gomes TF, Kieselova K, Guiote V, Henrique M, Santiago F. A low level of health literacy is a predictor of corticophobia in atopic dermatitis. An Bras Dermatol 2022; 97:704-709. [PMID: 36057460 PMCID: PMC9582876 DOI: 10.1016/j.abd.2021.11.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 10/30/2021] [Accepted: 11/08/2021] [Indexed: 11/01/2022] Open
|
15
|
Singleton H, Hodder A, Boyers D, Doney L, Almilaji O, Heaslip V, Thompson AR, Boyle RJ, Axon E, Van Onselen J, O'Meara S, Roberts A, Ersser SJ. Psychological and educational interventions for managing eczema. Hippokratia 2021. [DOI: 10.1002/14651858.cd014932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Heidi Singleton
- Department of Nursing Science; Bournemouth University; Bournemouth UK
| | - Andrew Hodder
- Department of Dermatology; Royal Cornwall Hospitals NHS Trust; Truro UK
- Department of Dermatology; University Hospitals Dorset; Christchurch UK
| | - Dwayne Boyers
- Health Economics Research Unit; University of Aberdeen; Aberdeen UK
| | - Liz Doney
- Cochrane Skin, Centre of Evidence Based Dermatology; University of Nottingham; Nottingham UK
| | - Orouba Almilaji
- Department of Medical Science and Public Health; Bournemouth University; Bournemouth UK
| | - Vanessa Heaslip
- Department of Nursing Science; Bournemouth University; Bournemouth UK
| | - Andrew R Thompson
- South Wales Clinical Psychology Training Programme; Cardiff and Vale University Health Board & Cardiff University; Cardiff UK
| | - Robert J Boyle
- Cochrane Skin, Centre of Evidence Based Dermatology; University of Nottingham; Nottingham UK
- National Heart & Lung Institute, Section of Inflammation and Repair; Imperial College London; London UK
| | - Emma Axon
- Cochrane Skin, Centre of Evidence Based Dermatology; University of Nottingham; Nottingham UK
| | | | | | - Amanda Roberts
- Nottingham Support Group for Carers of Children with Eczema; Nottingham UK
| | - Steven J Ersser
- Department of Nursing Science; Bournemouth University; Bournemouth UK
| |
Collapse
|
16
|
Refractory Pediatric Psoriasis and Atopic Dermatitis: The Importance of Therapeutical Adherence and Biological Management. Biomedicines 2021; 9:biomedicines9080958. [PMID: 34440162 PMCID: PMC8391197 DOI: 10.3390/biomedicines9080958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/27/2021] [Accepted: 07/30/2021] [Indexed: 11/25/2022] Open
Abstract
The rates of refractory pediatric psoriasis and atopic dermatitis (AD) have steadily risen over the last few decades, demanding newer and more effective therapies. This review aims to explore the reasons for resistant disease, as well as its management; this includes the indications for, efficacy of, and safety of current therapies for refractory pediatric dermatologic disease. A PubMed search for key phrases was performed. Poor medication adherence is the most common cause of resistant disease and may be managed with techniques such as simplified treatment regimens, more follow-ups and educational workshops, as well as framing and tailoring. Once problems with adherence are ruled out, escalating treatment to stronger biologic therapy may be indicated. Development of anti-drug antibodies (ADAs) can cause patients’ disease to be refractory in the presence of potent biologics, which may be addressed with regular medication use or concomitant methotrexate. If patients with AD fail to respond to biologic therapy, a biopsy to rule out mycosis fungoides, or patch testing to rule out allergic contact dermatitis, may be indicated. A limitation of this study is the absence of more techniques for the management of poor medication adherence. Managing medication adherence, escalating treatment when appropriate, and addressing possible anti-drug antibodies will help assure control and relief for patients with resistant disease.
Collapse
|
17
|
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.
Collapse
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
| |
Collapse
|
18
|
Teasdale E, Sivyer K, Muller I, Ghio D, Roberts A, Lawton S, Santer M. Children's Views and Experiences of Treatment Adherence and Parent/Child Co-Management in Eczema: A Qualitative Study. CHILDREN-BASEL 2021; 8:children8020158. [PMID: 33672514 PMCID: PMC7923777 DOI: 10.3390/children8020158] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/16/2021] [Accepted: 02/16/2021] [Indexed: 11/16/2022]
Abstract
Eczema affects one in five children and can have a substantial impact on quality of life. This qualitative study aimed to explore children's views and experiences of eczema and what may affect treatment adherence from their perspective. We conducted semi-structured, face-to-face interviews with children with eczema aged 6-12 years from March to July 2018. Interviews were transcribed verbatim and analysed using inductive thematic analysis. We found that children do not typically view eczema as a long-term condition, and topical treatments (predominately emollients) were seen to provide effective symptom relief. Uncertainty around co-managing at home was expressed as children typically felt that parental reminders and assistance with applying different types of topical treatments were still needed. For some children, eczema can be difficult to manage at school due to a lack of convenient access and appropriate spaces to apply creams and psychosocial consequences such as attracting unwanted attention from peers and feeling self-conscious. Treatment adherence could be supported by reinforcing that eczema is a long-term episodic condition, providing clear information about regular emollient use, practical advice such as setting reminders to support co-management at home, and working with schools to facilitate topical treatment use when necessary.
Collapse
Affiliation(s)
- Emma Teasdale
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK; (I.M.); or (D.G.); (M.S.)
- Correspondence: ; Tel.: +44-2380-591753
| | - Katy Sivyer
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton SO17 1BJ, UK; or
- Department of Psychology, University of Portsmouth, Portsmouth PO1 2UP, UK
| | - Ingrid Muller
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK; (I.M.); or (D.G.); (M.S.)
| | - Daniela Ghio
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK; (I.M.); or (D.G.); (M.S.)
- School of Health and Society, Allerton Building, University of Salford, Manchester M6 6PU, UK
| | - Amanda Roberts
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham NG7 2RD, UK;
| | - Sandra Lawton
- Department of Dermatology, Rotherham NHS Foundation Trust, Rotherham, S60 2UD, UK;
| | - Miriam Santer
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK; (I.M.); or (D.G.); (M.S.)
| |
Collapse
|
19
|
Koster ES, Philbert D, Zheng X, Moradi N, de Vries TW, Bouvy ML. Reducing corticosteroid phobia in pharmacy staff and parents of children with atopic dermatitis. Int J Clin Pharm 2021; 43:1237-1244. [PMID: 33582952 PMCID: PMC8460576 DOI: 10.1007/s11096-021-01241-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 01/18/2021] [Indexed: 11/30/2022]
Abstract
Background Besides physicians, pharmacy staff has an important role to inform patients on appropriate medication use. However, they might also experience corticophobia themselves, affecting patient counseling and subsequently patient’s disease management. Objective Implementation of an intervention for pharmacy staff to improve knowledge and stimulate positive perceptions towards TCS use, in order to reduce corticophobia in pharmacy staff and parents of young AD patients. Setting Nine community pharmacies in the Netherlands. Method We developed an intervention consisting of education of pharmacy staff followed by counseling of parents. The intervention was implemented in pharmacies and intervention effectiveness was studied using a pre-post design with an intervention period of 3 months. At baseline and follow-up (3 months), pharmacy staff and parents completed a questionnaire. Main outcome measure Corticophobia, both beliefs and worries, measured with the TOPICOP questionnaire. Higher scores indicate a more negative attitude. Result Baseline and follow-up data were available for 19 pharmacy staff members and 48 parents who attended a counseling session in the pharmacy. In both groups there was as decrease in negative beliefs and worries towards TCS (p < 0.05). Mean total TOPICOP scores decreased from 42 to 35% and from 33 to 25% for parents and pharmacy staff respectively. Conclusion Our results show the prevalence of corticophobia among parents. Education of pharmacy staff and targeted patient counseling seems to be effective in reducing corticophobia.
Collapse
Affiliation(s)
- Ellen S Koster
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, PO Box 80082, 3508 TB, Utrecht, The Netherlands.
| | - Daphne Philbert
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, PO Box 80082, 3508 TB, Utrecht, The Netherlands
| | - Xiang Zheng
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, PO Box 80082, 3508 TB, Utrecht, The Netherlands
| | - Nila Moradi
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, PO Box 80082, 3508 TB, Utrecht, The Netherlands
| | - Tjalling W de Vries
- Department of Pediatrics, Medical Centre Leeuwarden (MCL), Henri Dunantweg 2, 8934 AD, Leeuwarden, The Netherlands
| | - Marcel L Bouvy
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, PO Box 80082, 3508 TB, Utrecht, The Netherlands
| |
Collapse
|
20
|
Capozza K. Never the twain shall meet? Bridging the divide between patient perspectives and health professionals and systems. Br J Dermatol 2020; 184:587-588. [PMID: 33048345 DOI: 10.1111/bjd.19545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 11/28/2022]
Affiliation(s)
- K Capozza
- Global Parents for Eczema Research, Los Angeles, CA, USA
| |
Collapse
|