Self-management in daily life with psoriasis: an integrative review of patient needs for structured education

Non-pharmacological interventions for patients with psoriasis: a scoping review

OBJECTIVES

Healthcare ultimately aims to eradicate diseases and restore normality to people's lives. However, until this is achieved for every person, there is a need to support and assist patients with psoriasis using non-pharmacological interventions. These 'adjuvant' approaches have received little attention, whereas dermatologists and researchers strive for better pharmacological therapy. Here, we aimed to perform a scoping review to identify and catalogue non-pharmacological interventions for patients with psoriasis.

DESIGN

A scoping review.

SETTING

All healthcare settings.

SEARCH STRATEGY

EMBASE, PubMed, CINAHL, PsycINFO and Scopus databases were searched from their inception to June 2022. Irrespective of the study type, the studies included non-pharmacological interventions for patients with psoriasis. This theme was extracted from the included articles. Two reviewers independently screened and analysed the data.

RESULTS

From 1322 initial records, 71 studies were identified and analysed. Non-pharmacological interventions for patients with psoriasis include two levels: organisational and individual. The organisational non-pharmacological interventions included the nationwide healthcare model (PsPSP, ProvenCare, German PsoHealth and Psoriasis Network, IMPROVE model and PsoWell clinic), innovative teledermatology models (mHealth app, electronic Targeted Intervention for Psoriasis study and therapist-guided internet-based cognitive and behavioural treatments) and multidisciplinary interventions. The individual non-pharmacological interventions included educational interventions (therapeutic patient education, psychoeducational intervention and self-management education), psychosocial interventions (cognitive and behavioural treatments, self-help and peer-to-peer support programmes) and others (happify and motivational interviewing-based training).

CONCLUSIONS

Based on previous literature, a nationwide healthcare model protocol was constructed for patients with psoriasis. This provided the direction for developing a new psoriasis healthcare model and a basis for summarising the non-pharmacological interventions for patients with psoriasis, which helps them adjust to changes in the skin disease.

Iontophoresis in dermal delivery: A review of applications in dermato-cosmetic and aesthetic sciences

OBJECTIVE

Iontophoresis is defined as the use of electric current to drive molecules across cell membranes through an electrolyte solution. In therapeutic context, it is used to facilitate the administration of bioactive substances, either systemically or locally. The technique presents various advantages and that is why it has been successfully used by a plethora of medical sciences. The constantly developing field of dermato-cosmetic science has also taken advantage of the possibilities offered by iontophoresis, aiming to enhance the delivery of the applied active ingredients and, thus, induce the desired cosmetic effects.

METHODS

The available literature was examined for evidence-based reports of safe and successful iontophoresis of pharmaceutical and cosmetic substances, in order to explore different iontophoretic applications in the field of dermato-cosmetic and dermato-aesthetic sciences.

CONCLUSION

Iontophoresis can be safely and successfully used in the treatment of ageing, photoageing, hyperpigmentation, oxidative stress, hair loss, hair removal, acne, acne sequelae and cellulite, providing many possibilities for enhanced treatment results.

Acceptance of illness and need for education to support dermatology self-care in psoriasis patients: a cross-sectional study

Introduction

Acceptance of illness greatly affects the quality of life of psoriatic patients. Assessment of patients’ need for education and support is very important for patients’ counselling and follow-up.

Aim

To evaluate acceptance of illness and need for education to support dermatology self-care in Arabic patients with psoriasis.

Material and methods

A cross-sectional study using a survey was conducted. The survey collected patients’ demographics, disease characteristics, Acceptance of Illness Scale (AIS) and Person-Centered Dermatology Self-Care Index (PeDeSI). Outcome measures were presented in total and in relation to age, gender, disease duration, disease severity, quality of life and level of education. The correlation between AIS and PeDeSI was examined using Spearman’s rank correlation test.

Results

In total, 209 psoriatic patients from 12 Arabic countries participated in the survey with mean ± SD age of 35.8 ±10.0 years. The median (IQR) AIS score was 28 (19–35). The median (IQR) of the PeDeSI score was 15 (11–22). Both AIS and PeDeSI did not differ in relation to age, gender, disease duration, and level of education. However, patients with a higher impairment in quality of life reported lower levels of illness acceptance (p = 0.001) and a higher need for education and support (p = 0.004). AIS and PeDeSI were moderately correlated (rho = 0.33, p < 0.001).

Conclusions

Arabic psoriatic patients showed moderate acceptance of illness and required some education to support dermatology self-care. Greater clinical attention with focus on patient education and counselling should be given to Arabic patients with psoriasis especially those with more impaired quality of life.

Safety and efficacy of topical, fixed-dose combination calcipotriene (0.005%) and betamethasone (0.064% as dipropionate) gel in adolescent patients with scalp and body psoriasis: a phase II trial

Background

Psoriasis is a disease that commonly manifests in adolescence. Up to half of adults with psoriasis develop it before the age of 20. Topical formulations containing corticosteroids and/or vitamin D3 analogs are recommended for treatment.

Objective

This phase II study aimed to evaluate the safety, including any potential effect on the hypothalamic–pituitary–adrenal axis and calcium metabolism, and efficacy of fixed‐dose combination calcipotriene (0.005%) and betamethasone (0.064% as dipropionate) (Cal/BD) gel in adolescents with psoriasis.

Methods

Patients aged 12 to <17 years, with at least mild psoriasis on the body and scalp, received topical Cal/BD gel once daily for ≤8 weeks. Safety response criteria included adverse drug reactions [ADRs; any adverse event (AE) possibly or probably related to treatment as determined by the investigator; a primary response criterion] and AEs (a secondary response criterion). Only treatment‐emergent AEs (events that occurred after the first application of Cal/BD gel or events which started before this and increased in intensity after the first application of Cal/BD gel) are presented here. Efficacy response criteria included controlled disease, by physician's global assessment of disease severity (PGA), following Cal/BD gel treatment.

Results

A total of 107 patients (median age 14 years; range 12–16) were enrolled and treated. Eight ADRs were observed in 7 (7%) patients and 38 (36%) patients experienced ≥1 AE. The most common AEs were headache [6 (6%) patients], nasopharyngitis [6 (6%) patients] and blood parathyroid hormone increased [4 (4%) patients]. One severe AE was reported (attempted suicide) but was considered unrelated to treatment. At the end of treatment, 58% of patients had controlled disease on the body and 69% on the scalp according to PGA.

Conclusion

In this uncontrolled phase II study, Cal/BD gel was well tolerated and effective for treating scalp and body psoriasis in adolescents.

Experience of Being Young With Psoriasis: Self-Management Support Needs

Psoriasis is a long-term condition with a possibly cumulative life course impairment. Young people struggle to minimize its effects on appearance and functioning. To date, the self-management needs of adolescents suffering from psoriasis have been underinvestigated. Using focus groups and individual interviews, we present an interpretive description of young people's experiences of living with psoriasis, the challenges they face, and the support they need to relieve suffering and come to terms with their condition. This process is characterized by loneliness, the self-imposition of limitations, and the lack of personalized knowledge and communication skills to manage the impact of disease and society's reactions. Our study provides insight into needs of early interventions tailored to address condition, role, and emotional management, involving parent education, peer support, storytelling, and roles for professionals. We argue that further research should involve young people, their parents, and professionals in the development and evaluation of interventions.

Educational interventions to improve quality of life in people with chronic inflammatory skin diseases: systematic reviews of clinical effectiveness and cost-effectiveness

BACKGROUND

Inflammatory skin diseases include a broad range of disorders. For some people, these conditions lead to psychological comorbidities and reduced quality of life (QoL). Patient education is recommended in the management of these conditions and may improve QoL.

OBJECTIVES

To assess the clinical effectiveness and cost-effectiveness of educational interventions to improve health-related quality of life (HRQoL) in people with chronic inflammatory skin diseases.

DATA SOURCES

Twelve electronic bibliographic databases, including The Cochrane Library, MEDLINE and EMBASE, were searched to July 2014. Bibliographies of retrieved papers were searched and an Advisory Group contacted.

REVIEW METHODS

Systematic reviews were conducted following standard methodologies. Clinical effectiveness studies were included if they were undertaken in people with a chronic inflammatory skin condition. Educational interventions that aimed to, or could, improve HRQoL were eligible. Studies were required to measure HRQoL, and other outcomes such as disease severity were also included. Randomised controlled trials (RCTs) or controlled clinical trials were eligible. For the review of cost-effectiveness, studies were eligible if they were full economic evaluations, cost-consequence or cost analyses.

RESULTS

Seven RCTs were included in the review of clinical effectiveness. Two RCTs focused on children with eczema and their carers. Five RCTs were in adults. Of these, two were of people with psoriasis, one was of people with acne and two were of people with a range of conditions. There were few similarities in the interventions (e.g. the delivery mode, the topics covered, the duration of the education), which precluded any quantitative synthesis. Follow-up ranged from 4 weeks to 12 months, samples sizes were generally small and, overall, the study quality was poor. There appeared to be positive effects on HRQoL in participants with psoriasis in one trial, but no difference between groups in another trial in which participants had less severe psoriasis. Carers of children in one RCT of eczema showed improvement in HRQoL; however, in a RCT evaluating a website intervention there were no demonstrable effects on HRQoL. Neither the RCT in those adults with acne nor the RCT in those adults with mixed skin conditions demonstrated an effect on HRQoL. One RCT reported subgroups with atopic dermatitis or psoriasis and education was effective for psoriasis only. Other outcomes also showed mixed results. It is unclear how clinically meaningful any of the observed improvements are. Three studies of cost-effectiveness were included. The interventions, comparators and populations varied across the studies and, overall, the studies provided limited information on cost-effectiveness. The studies did provide detailed information on resources and costs that could be useful to inform a future cost-effectiveness evaluation in this area.

LIMITATIONS

The application of the inclusion criterion around whether the interventions were aimed at improving HRQoL or the inference that they could improve HRQoL was difficult as information was rarely reported.

CONCLUSIONS

There is uncertainty regarding whether educational interventions addressing issues that could improve HRQoL in people with chronic skin conditions are effective. Tentative conclusions about the best approach to delivering these kinds of interventions are that face-to-face, group, sessions may be beneficial; however, text messages may also be effective. Delivery over a period of time and by a multidisciplinary team may also be associated with positive outcomes. There is uncertainty over whether or not educational interventions are cost-effective.

STUDY REGISTRATION

This study is registered as PROSPERO CRD42014007426.

FUNDING

The National Institute for Health Research Health Technology Assessment programme.

Incentives for self-management after coronary artery bypass graft surgery

BACKGROUND

Chronic illnesses such as coronary heart disease are among the most prevalent and costly of all global health problems. Coronary heart disease is a leading cause of death worldwide, including Iran. One aspect of living with chronic illness is self-management which can reduce the impact of illness on daily life and maintain the quality of life. A qualitative understanding of how patients perceive the necessity of self-management is important for self-management support. The current study aims to determine patients' perception of the need for self-management following coronary artery bypass graft (CABG) surgery.

MATERIALS AND METHODS

We used a content analysis approach to conduct this qualitative study. Data were collected by interviews with 25 patients who underwent CABG surgery at least 1 year prior to the study. Purposeful, followed by theoretical sampling was used until data saturation. Data were analyzed by descriptive qualitative content analysis according to the Graneheim and Lundman approach.

RESULTS

Participants had different perceptions regarding the need for self-management. Three themes, "reflective thinking," "information revision," and "beliefs influences," comprised the basis of forming patients' perceptions to the need for self-management.

CONCLUSIONS

Patients' perceptions vary regarding the need for self-management. The difference in perception should be the basis for training programs to guide CABG patients for successful self-management.