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Ossanai Schoenardie B, Fortes Escobar G, Pauli Damke J, Cardozo Müller G, Rangel Bonamigo R. Corticophobia and adherence to topical corticosteroids in atopic dermatitis treatment in southern Brazil. An Bras Dermatol 2024; 99:439-442. [PMID: 38378364 DOI: 10.1016/j.abd.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/01/2023] [Accepted: 04/05/2023] [Indexed: 02/22/2024] Open
Affiliation(s)
| | | | - Jéssica Pauli Damke
- Dermatology Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Gabriel Cardozo Müller
- Programa de Pós-Graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Programa de Pós-Graduação em Ciências Médicas, Universidade do Vale do Taquari, Lajeado, RS, Brazil
| | - Renan Rangel Bonamigo
- Dermatology Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Dermatology Service, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
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Santer M, Ridd MJ, Harvey J, Lax S, Muller I, Roberts A, Thomas KS. Atopic eczema in primary care: evidence update and implications for practice. Br J Gen Pract 2024; 74:40-42. [PMID: 38154929 PMCID: PMC10755983 DOI: 10.3399/bjgp24x736101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023] Open
Affiliation(s)
- Miriam Santer
- Primary Care Research Centre, University of Southampton, Southampton
| | - Matthew J Ridd
- Centre for Academic Primary Care, University of Bristol, Bristol
| | - Jane Harvey
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham
| | - Stephanie Lax
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham
| | - Ingrid Muller
- Primary Care Research Centre, University of Southampton, Southampton
| | - Amanda Roberts
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham
| | - Kim S Thomas
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham
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Samuelov L, Shemer A, Greenberger S, Ziv I, Friedman D, Yacoby‐Zeevi O, Dodiuk‐Gad R, Ramot Y, Murad S, Sprecher E. SNG100, a novel topical treatment for moderate atopic dermatitis, in patients aged 6 years or older: A randomised, double-blind, active-controlled trial. SKIN HEALTH AND DISEASE 2023; 3:e293. [PMID: 38047249 PMCID: PMC10690700 DOI: 10.1002/ski2.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/01/2023] [Accepted: 09/11/2023] [Indexed: 12/05/2023]
Abstract
Background Atopic dermatitis (AD) is one of the most common inflammatory skin diseases. It is associated with significant itch and impaired quality of life. Systemic treatments are efficient but associated with side effects. Novel topical treatments with a favourable safety profile are needed. SNG100 is a novel composition of hydrocortisone 1% in a cream base comprising sulphated polysaccharide (SPS; extracted from in-house cultivated Porphyridium Cruentum unicellular algae), a well-known hydrating, moisturising and a skin barrier repairing agent. Objectives To assess the safety, usability and efficacy of SNG100 cream in patients aged ≥6 years with moderate AD. Methods In this proof of concept phase I, double-blind, randomised trial, participants received one of three treatments for 14 days: SNG100 twice daily (BID), hydrocortisone 1% BID or mometasone furoate once daily (QD). The primary endpoint was the safety and tolerability of SNG100 cream compared to hydrocortisone 1% and mometasone furoate. The secondary endpoint was the subject's usability of SNG100. Exploratory efficacy endpoints included percent change from baseline in SCOring AD (SCORAD), Eczema Area and Severity Index, Patient-Oriented Eczema Measure, Dermatology Life Quality Index, pruritus Numerical Rating Score (NRS), peak pruritus-NRS and Investigator's Global Assessment. Subjects were also followed up without any treatment for additional 14 days. Results Overall, 66 participants were screened, and 60 patients were randomised. SNG100 demonstrated a high safety profile, similar to marketed products hydrocortisone 1% and mometasone furoate 0.1%, with no unanticipated drug safety related events. SNG100 and mometasone furoate 0.1% cream achieved almost similar and statistically significant greater percentage reductions from baseline in SCORAD as compared to hydrocortisone 1% cream. SNG100 demonstrated significant improvement in NRS as compared to hydrocortisone 1% cream. Remarkably, SNG100 led to a lasting effect with only 29.4% of subjects returning to IGA3 during the follow-up period compared to 50% and 38.9% in the hydrocortisone 1% and in mometasone furoate treatment arms, respectively. Conclusions Topical SNG100 is an effective, safe, and well-tolerated innovative treatment for moderate AD. Trial registration number: NCT04615962 (Topical Cream SNG100 for Treatment in Moderate AD Subjects).
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Affiliation(s)
- Liat Samuelov
- Division of DermatologyTel Aviv Sourasky Medical CenterTel AvivIsrael
- Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Avner Shemer
- Faculty of MedicineTel Aviv UniversityTel AvivIsrael
- Department of DermatologySheba Medical CenterRamat‐GanIsrael
| | - Shoshana Greenberger
- Faculty of MedicineTel Aviv UniversityTel AvivIsrael
- Department of DermatologyPediatric Dermatology UnitSheba Medical CenterRamat GanIsrael
| | | | | | | | - Roni Dodiuk‐Gad
- Dermatology and Venereology DepartmentEmek Medical CenterAfulaIsrael
- Ruth and Bruce Rappaport Faculty of MedicineTechnion Institute of TechnologyHaifaIsrael
- Division of DermatologyDepartment of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Yuval Ramot
- Department of DermatologyHadassah‐Hebrew University Medical CenterJerusalemIsrael
- Faculty of MedicineHebrew University of JerusalemJerusalemIsrael
| | - Sari Murad
- Department of DermatologyHadassah‐Hebrew University Medical CenterJerusalemIsrael
- Dermatology UnitKaplan Medical CenterRehovotIsrael
| | - Eli Sprecher
- Division of DermatologyTel Aviv Sourasky Medical CenterTel AvivIsrael
- Faculty of MedicineTel Aviv UniversityTel AvivIsrael
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Bousquet J, Klimek L, Kuhl HC, Nguyen DT, Ramalingam RK, Canonica GW, Berger WE. A double-blind, placebo-controlled trial of the efficacy and safety of two doses of azelastine hydrochloride in perennial allergic rhinitis. FRONTIERS IN ALLERGY 2023; 4:1244012. [PMID: 37920410 PMCID: PMC10619846 DOI: 10.3389/falgy.2023.1244012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/11/2023] [Indexed: 11/04/2023] Open
Abstract
Background Azelastine hydrochloride (AZE) is a selective, non-sedating H1 antagonist with anti-inflammatory and mast cell stabilizing properties, which can be used as an alternative to intranasal corticosteroids. The objective of this study was to evaluate the efficacy of the new formulation of 0.15% AZE compared to that of the placebo at a dosage of two sprays per nostril twice daily for 4 weeks in patients with perennial allergic rhinitis (PAR). Materials and methods A total of 581 subjects were randomized in this double-blind (DB) placebo-controlled trial (NCT00712920) that compared 0.10% (1,096 μg daily) and 0.15% AZE (1,644 μg daily) to the placebo in PAR patients. The study consisted of a 7-day single-blind placebo lead-in period and a 28-day DB treatment period. The primary endpoint was the change from baseline in the 12-h reflective total nasal symptom score (rTNSS) for the entire 28-day study period of 0.15% AZE, two sprays per nostril BID compared to the placebo. The efficacy and safety of 0.15% AZE were compared to the placebo. Results Least square (LS) mean improvement from baseline in the morning (AM) and evening (PM) combined rTNSS was statistically significant for the 0.15% AZE group (p = 0.04) compared to the placebo group. LS mean improvement from baseline in the AM and PM combined rTNSS was 4.10 (4.26) units for 0.15% AZE and 3.81 (3.99) for 0.10% AZE. For individual symptoms, there was a statistically significant change in the LS mean (p = 0.04) improvement from baseline on the 12-h reflective assessment for the 0.15% AZE group for runny nose. Further numerical improvements were shown for itchy nose, nasal congestion, runny nose, and sneezing compared to the placebo. No deaths or serious adverse events related to the study medication were reported. Conclusion The present formulation of 0.15% AZE is safe and effective in relieving PAR symptoms. It effectively relieves nasal and non-nasal symptoms. Clinical Trial Registration ClinicalTrials.gov, identifier: NCT00712920.
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Affiliation(s)
- Jean Bousquet
- Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - Ludger Klimek
- Center for Rhinology and Allergology, Wiesbaden, Hessen, Germany
| | - Hans-Christian Kuhl
- Biometrics, Meda Pharma GmbH & Co KG (A Viatris Company), Bad-Homburg, Germany
| | - Duc Tung Nguyen
- Global Clinical Sciences, MEDA Pharma GmbH & Co KG (A Viatris Company), Bad Homburg, Germany
| | | | - G. W. Canonica
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Asthma & Allergy Unit, IRCCS Humanitas Research Hospital, Milan, Italy
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Brunner C, Schlüer AB, Znoj H, Schwieger-Briel A, Luchsinger I, Weibel L, Theiler M. Video-Based Education with Storytelling Reduces Parents' Fear of Topical Corticosteroid Use in Children with Atopic Dermatitis: A Randomized Controlled Trial (The EduDerm Study Part II). Adv Skin Wound Care 2023; 36:414-419. [PMID: 37471446 DOI: 10.1097/asw.0000000000000002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
OBJECTIVE To investigate the efficacy of educational videos using storytelling to reduce parents' fear of topical corticosteroid (TCS) use in children affected by atopic dermatitis (AD). METHODS Children aged 0 to 5 years who had AD were included. The primary outcome measures were parental fear of TCSs, as determined by Topical Corticosteroid Phobia score, and quality of life according to the Family Dermatology Life Quality Index. Disease severity, assessed by the Scoring Atopic Dermatitis tool, served as a secondary outcome measure. Assessments were performed at baseline (T1), 1 to 4 weeks later (T2), and at 3-month follow-up (T3). The intervention group was exposed to the videos between baseline and T2. RESULTS Forty patients were recruited: 21 in the intervention group and 19 in the control group. A statistically significant decrease in parental TCS fear was found in the intervention group at T2 after video education as compared with the control group (P < .0001); this was maintained at T3 (P = .001). The groups did not significantly differ in FDLQI or SCORAD scores at any point. CONCLUSIONS These findings suggest that video education based on the method of storytelling is effective in reducing TCS fear. Although the education did not impact disease severity or quality of life, effectively reducing TCS fear remains an important aspect for AD management.
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Affiliation(s)
- Corinne Brunner
- Corinne Brunner, MScN, RN, is Advanced Practice Nurse, Pediatric Skin Center, University Children's Hospital of Zurich, Switzerland, and PhD Student, Graduate School for Health Sciences, University of Bern. Anna-Barbara Schlüer, PhD, MScN, RN, is Scientific Researcher, Department of Health Sciences, ZHAW Zurich University of Applied Sciences, Winterthur. Hansjoerg Znoj, PhD, is Emeritus Professor, Department of Health Psychology and Behavioural Medicine, Institute of Psychology, University of Bern. Also at University Children's Hospital of Zurich, Pediatric Skin Center, Agnes Schwieger-Briel, MD, and Isabelle Luchsinger, MD, are Consultants for Pediatric Dermatology; Lisa Weibel, MD, is Head of the Department of Pediatric Dermatology; and Martin Theiler, MD, is Consultant for Pediatric Dermatology. Acknowledgments: The authors thank all of the patients and parents who participated in this study. They are grateful to Samuel Roselip and Doris Kunz for support in data collection and Marianne Müller for statistical support. Lisa Weibel, MD, received honoraria from Pfizer, Sanofi, Eli Lilly, and Novartis for consultancy services. Martin Theiler, MD, received honoraria from Pfizer and Eli Lilly for investigator services, and from Sanofi-Aventis and Pfizer for participation in advisory boards and consultancy. The EduDerm study was supported by the Nursing Science Foundation Switzerland (ID 2242-2019) and the Children's Research Center, University Children's Hospital Zurich, Switzerland. The authors have disclosed no other financial relationships related to this article. Submitted April 13, 2022; accepted in revised form October 20, 2022. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website ( www.ASWCjournal.com )
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Barakat M, Elnaem MH, Al-Rawashdeh A, Othman B, Ibrahim S, Abdelaziz DH, Alshweiki AO, Kharaba Z, Malaeb D, Syed NK, Nashwan AJ, Adam MF, Alzayer R, Albarbandi MS, Abu-Farha RK, Sallam M, Barakat Y, Mansour NO. Assessment of Knowledge, Perception, Experience and Phobia toward Corticosteroids Use among the General Public in the Era of COVID-19: A Multinational Study. Healthcare (Basel) 2023; 11:healthcare11020255. [PMID: 36673623 PMCID: PMC9859254 DOI: 10.3390/healthcare11020255] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/04/2023] [Accepted: 01/09/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Corticosteroids play a significant role in managing the vast majority of inflammatory and immunologic conditions. To date, population-based studies on knowledge and attitudes concerning corticosteroids are scarce. This study aims to comprehensively assess knowledge, perception, experience and phobia toward corticosteroid use among the general population in the era of COVID-19. METHODS A cross-sectional self-administrated questionnaire was used to collect the data from 6 countries. Knowledge and corticophobia scores, descriptive statistics and logistic regression were computed. RESULTS A total of 2354 participants were enrolled in this study; the majority were females (61.6%) with an average age of 30. Around 61.9% had been infected previously with COVID-19, and about one-third of the participants had experience with corticosteroid use. The mean knowledge score was relatively satisfactory (8.7 ± 4.5 out of 14), and Corticophobia ranked a high score in all countries. Age, female gender, and history of COVID-19 were positively correlated with developing corticophobia. CONCLUSION Our study highlights that the general knowledge about steroids was satisfactory. However, the phobia toward its use upon indication is high. Therefore, enhancing awareness and providing essential counseling regarding the rational use of corticosteroids may reduce corticophobia.
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Affiliation(s)
- Muna Barakat
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman 11931, Jordan
- MEU Research Unit, Middle East University, Amman 11831, Jordan
- Correspondence:
| | - Mohamed Hassan Elnaem
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, George Town 11800, Malaysia
| | | | - Bayan Othman
- Department of Pharmaceutical Sciences and Pharmaceutics, Faculty of Pharmacy, Applied Science Private University, Amman 11931, Jordan
| | - Sarah Ibrahim
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Amman 11942, Jordan
| | - Doaa H. Abdelaziz
- Pharmacy Practice and Clinical Pharmacy Department, Faculty of Pharmacy, Future University in Egypt, Cairo 11835, Egypt
- Department of Clinical Pharmacy, the National Hepatology and Tropical Medicine Research Institute, Cairo 11835, Egypt
| | - Anas O. Alshweiki
- Department of Pharmaceutical Sciences and Pharmaceutics, Faculty of Pharmacy, Applied Science Private University, Amman 11931, Jordan
| | - Zelal Kharaba
- Department of Clinical Pharmacy, College of Pharmacy, Al Ain University, Abu Dhabi 112612, United Arab Emirates
- AAU Health and Biomedical Research Center, Al Ain University, Abu Dhabi 112612, United Arab Emirates
- Faculty of Medical Sciences, Newcastle University, Newcastle Upon Type NE2 4HH, UK
| | - Diana Malaeb
- College of Pharmacy, Gulf Medical University, Ajman P.O. Box 4184, United Arab Emirates
- School of Pharmacy, Lebanese International University, Beirut 1083, Lebanon
| | - Nabeel Kashan Syed
- Pharmacy Practice Research Unit, Department of Pharmacy Practice, College of Pharmacy, Jazan University, Gizan 45142, Saudi Arabia
| | - Abdulqadir J. Nashwan
- Department of Nursing Education & Practice Development, Hazm Mebaireek General Hospital (HMGH), Hamad Medical Corporation (HMC), Doha 3050, Qatar
- Faculty of Nursing, University of Calgary in Qatar (UCQ), Doha 23133, Qatar
| | | | - Reem Alzayer
- Clinical pharmacy Practice, Department of pharmacy, Mohammed Al-Mana College for Medical Sciences, Dammam 34222, Saudi Arabia
| | - Mohammad Saleh Albarbandi
- Department of Neurosurgery, Ibn Al-Nafees Hospital, Damascus G8W4+MQW, Syria
- Department of Neurosurgery, Damascus Hospital, Damascus G72W+25C, Syria
| | - Rana K. Abu-Farha
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman 11931, Jordan
| | - Malik Sallam
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
- Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman 11942, Jordan
- Department of Translational Medicine, Faculty of Medicine, Lund University, 22184 Malmö, Sweden
| | - Yasmeen Barakat
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman 11931, Jordan
| | - Noha O. Mansour
- Clinical Pharmacy and Pharmacy Practice Department, Faculty of Pharmacy, Mansoura University, Mansoura 35516, Egypt
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Huang J, Choo YJ, Smith HE, Apfelbacher C. Quality of life in atopic dermatitis in Asian countries: a systematic review. Arch Dermatol Res 2022; 314:445-462. [PMID: 34086064 PMCID: PMC9162971 DOI: 10.1007/s00403-021-02246-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 05/22/2021] [Indexed: 11/28/2022]
Abstract
Atopic dermatitis (AD) is a common chronic inflammatory skin condition which impacts psychological wellbeing and social relationships. There have been studies of AD's impact on quality of life (QoL) in Western countries, but these findings cannot be directly extrapolated to Asian populations with genetic, environmental and cultural differences. Therefore, we aimed to systematically review the literature pertaining to QoL impairment in AD in East and Southeast Asia to characterize the impact of AD on patients and their families, and to identify the factors affecting the degree of QoL impairment. A search of English language papers was conducted on MEDLINE, EMBASE, PSYCInfo, Global Health and Web of Science. Observational studies measuring QoL using single or multi-item instruments in people with self-reported or physician diagnosed atopic dermatitis were included. 27 studies from 29 articles were included and synthesized. There is data documenting QoL impairment in AD sufferers and their families, across a wide range of Asian countries, healthcare settings and ages. Aspects of QoL impacted to a greater extent included symptoms of itch, feelings of embarrassment, and sleep disturbance. Severity of disease affects the degree of impairment of QoL, but there is no apparent link between QoL impairment and patient demographic factors, or other medical factors such as age at diagnosis or duration of illness. Our findings also highlighted the need for clinicians to actively explore the impact of patient's symptoms, especially in an Asian context where healthcare communications are traditionally doctor-centric.
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Affiliation(s)
- Jinghui Huang
- Department of Family Medicine and Primary Care, Nanyang Technological University, Lee Kong Chian School of Medicine, Singapore, Singapore
| | - Yue Jia Choo
- Department of Family Medicine and Primary Care, Nanyang Technological University, Lee Kong Chian School of Medicine, Singapore, Singapore
| | - Helen Elizabeth Smith
- Department of Family Medicine and Primary Care, Nanyang Technological University, Lee Kong Chian School of Medicine, Singapore, Singapore
| | - Christian Apfelbacher
- Department of Family Medicine and Primary Care, Nanyang Technological University, Lee Kong Chian School of Medicine, Singapore, Singapore.
- Institute of Social Medicine and Health Systems Research, Otto Von Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
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Hon KL, Chu S, Leung AKC, Wong A. Atopic Dermatitis: Conventional and Integrative Medicine. Curr Pediatr Rev 2022; 18:84-96. [PMID: 34279204 DOI: 10.2174/1573396317666210716152325] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/24/2021] [Accepted: 02/25/2021] [Indexed: 11/22/2022]
Abstract
Although Western medicine and ideas about atopic dermatitis (AD) have become popular in many Asian countries, local beliefs about the disease and its treatment often prevail. The multi- racial background of these countries as well as the influence of the diverse religions (such as Taoism and Ramadan) in these regions often lead to diverse belief systems about the causes of AD (such as the Chi concept, also known as the balance of yin and yang) and the types of treatment (e.g. herbal remedies, topical versus concoctions, and decoctions). In addition, many of the cultural practices are preserved among the Southeast Asian minorities residing in the United Kingdom and North America. Eastern treatments typically take a holistic approach to AD and emphasize the psychosomatic component of the disorder. This overview provides a summary of the difference between conventional, complementary, alternative, and integrative medicine in terms of epidemiology, aetiology, therapy, and prognosis in children with AD. There are a number of similarities in genetic and environmental factors in epidemiology and aetiology; however, differences exist in terms of the concept of management. Complementary and alternative medicine, traditional Chinese medicine, and integrative medicine usage are not only prevalent among the Asian population but are also becoming more popular and accepted in Western societies.
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Affiliation(s)
- Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Shenzhou, Hong Kong.,Department of Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Kowloon, Hong Kong
| | - Samantha Chu
- Faculty of Medicine, The Chinese University of Hong Kong, Shenzhou, Hong Kong
| | - Alexander K C Leung
- Department of Paediatrics, The University of Calgary, and The Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Alex Wong
- Department of Family Medicine, The University of Calgary, Calgary, Alberta, Canada
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Steroid Phobia: A Review of Prevalence, Risk Factors, and Interventions. Am J Clin Dermatol 2021; 22:837-851. [PMID: 34287768 DOI: 10.1007/s40257-021-00623-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Abstract
Topical corticosteroid phobia may lead to poor adherence, resulting in persistent disease and escalation to systemic agents. The aim of this paper was to review current literature to assess topical steroid phobia prevalence, populations most at risk, reasons behind steroid phobia, and interventions to reduce it. A systematic search of PubMed, Ovid (Journals@Ovid, MEDLINE), ScienceDirect, and Web of Science was performed. Studies ranged from May 2000 to February 2021. In total, 37 articles met the inclusion criteria. There was inter-study variation in the way steroid phobia is defined, from concern to irrational fear. The worldwide prevalence of topical steroid phobia ranges from 31 to 95.7% and does not differ with patient race/ethnicity or dermatological condition. Female patients and caregivers, and those who have experienced side effects of topical corticosteroids are most likely to express steroid phobia. Reasons for steroid phobia include lack of education, fear of side effects, polypharmacy, misinformation, negative experience with topical steroids, and frequently changing of clinics. Successful interventions to address steroid phobia include patient education in the form of educational videos followed by individualized oral education based on concerns, and demonstrations of application of topical steroids. Multiple interventions address topical corticosteroid phobia and improve adherence of topical corticosteroids in the management of dermatological conditions. Providers should screen patients for steroid phobia, especially in populations particularly at risk. Interventions using patient education should be individualized based on concerns expressed during screening. Further research should investigate if reducing steroid phobia can in fact improve long-term adherence.
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Hon KLE, Chan VPY, Leung AKC. Experimental Drugs with the Potential to Treat Atopic Eczema. J Exp Pharmacol 2021; 13:487-498. [PMID: 34012301 PMCID: PMC8126870 DOI: 10.2147/jep.s259299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/23/2021] [Indexed: 12/28/2022] Open
Abstract
Introduction Eczema or atopic dermatitis (AD) is a chronically relapsing dermatosis characterized by pruritus and a significant impact on the quality of life. Methods The authors undertook a structured search of peer-reviewed research articles from PubMed and Google Scholar. Recent and up-to-date studies relevant to the topic were included. Results This report overviews current treatment and experimental drug for AD. Topical agents including topical phosphodiesterase E4 (PDE4) inhibitors such as crisaborole are efficacious in the treatment of AD with few side effects. Monoclonal antibodies such as dupilumab given subcutaneously are efficacious for more severe disease. Systemic treatment can ameliorate symptoms in severe and recalcitrant AD. New systemic treatment includes several traditional herbal formulations that have undergone clinical trials using modern research methodology to determine their efficacy and safety. AD is associated with many complicating psychosocial issues. Often suboptimal efficacy is due to unrealistic expectations and poor compliance making treatment difficult in spite of effective treatment and efforts in drug discovery. Randomized trials have shown that novel topical and subcutaneous medications are safe and efficacious. Regarding herbs, a methodology for the investigation of herbal medications is often flawed and scientific evidence is lacking. Experimental drugs include various biologics, PDE4 and JAK inhibitors in topical, oral, subcutaneous or intravenous forms are in various phases of trials. Conclusion Many novel medications demonstrate efficacy for AD. Experimental drugs include various biologics, PDE4 and JAK inhibitors are in various phases of trials.
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Affiliation(s)
- Kam Lun Ellis Hon
- Department of Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Hong Kong, People's Republic of China
| | - Vivian P Y Chan
- Pharmacy Department, The Hong Kong Children's Hospital, Hong Kong, People's Republic of China
| | - Alexander K C Leung
- Department of Pediatrics, The University of Calgary, and the Alberta Children's Hospital, Calgary, Alberta, Canada
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Cheng NS, Chau JPC, Lo SHS, Choi KC, Hon KLE, Lam PH, Leung TF. Effects of a self-efficacy theory-based parental education program on eczema control and parental outcomes. Pediatr Allergy Immunol 2021; 32:535-543. [PMID: 33274772 DOI: 10.1111/pai.13421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/06/2020] [Accepted: 11/16/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Eczema is the most common childhood skin problem worldwide. Education that enhances parental self-efficacy in carrying out appropriate eczema management is crucial to controlling eczema symptoms of their children. However, the lack of such a structured education program hinders everyday lives of eczematous children and their families. This study evaluated the effects of a self-efficacy theory-based parental eczema education program in controlling eczema of Chinese children at three months after commencement of intervention. METHODS An assessor-blind, 2-arm, randomized controlled trial was conducted at an outpatient clinic of a regional hospital. One hundred and thirty-six Chinese children aged 3 months to 12 years with physician-diagnosed eczema, and their parents were recruited. The intervention was underpinned by the Social Cognitive Theory. Children's disease severity, parental self-efficacy, treatment adherence, and quality of life of family members were assessed by validated tools. Generalized estimating equation model was employed to compare differential change in each outcome across time between different groups. RESULTS Eczema severity of children and parental self-efficacy in the intervention group were found to show greater improvement at 3-month follow-up with regression coefficient (β) -16.98 (95% CI, -21.04 to -12.92; P < .001) and β 29.39 (95% CI, 22.64-36.14; P < .001), respectively. Nearly all parents (97%) receiving the intervention rated this program as useful and helpful. CONCLUSIONS This program is effective in enhancing parents' self-efficacy in managing their children's eczema and improving their adherence to eczema treatment and quality of life.
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Affiliation(s)
- Nam Sze Cheng
- Faculty of Medicine, The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Janita Pak Chun Chau
- Faculty of Medicine, The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Suzanne Hoi Shan Lo
- Faculty of Medicine, The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kai Chow Choi
- Faculty of Medicine, The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kam Lun Ellis Hon
- Faculty of Medicine, Department of Pediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Pok Hong Lam
- Faculty of Medicine, Department of Pediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ting Fan Leung
- Faculty of Medicine, Department of Pediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China.,Hong Kong Hub of Pediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
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12
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Practical Recommendations for the Topical Treatment of Atopic Dermatitis in South and East Asia. Dermatol Ther (Heidelb) 2020; 11:275-291. [PMID: 33313998 PMCID: PMC7859143 DOI: 10.1007/s13555-020-00467-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Indexed: 12/26/2022] Open
Abstract
Introduction There is some evidence to suggest that the prevalence of atopic dermatitis (AD) in Asia is rising. We have therefore developed an algorithm for the topical treatment of AD throughout South and East Asia for use by primary care physicians, pediatricians and dermatologists. Methods Nine AD experts from South and East Asia and one from Europe developed the algorithm based upon treatment guidelines, relevant literature and local treatment practices. The algorithm outlines current best practice for the use of emollients, topical corticosteroids (TCS) and topical calcineurin inhibitors (TCI), with the intention of simplifying the treatment regimen of mild-to-moderate AD in South and East Asia. Results Patients with AD should bathe and cleanse affected skin to remove crusts and scales daily. Emollients should also be applied daily as a maintenance treatment. When selecting appropriate topical anti-inflammatory treatment for AD flares, several factors should be taken into consideration, including the patient’s age, attitude to treatment options and site of AD lesions. Given the concerns regarding the risk of skin atrophy with use of TCS, a TCI should be used to treat AD lesions in sensitive skin areas: pimecrolimus is recommended for mild-to-moderate AD in these locations, while tacrolimus should be considered for moderate and severe cases. Either pimecrolimus or tacrolimus is recommended for flares in other, non-sensitive body locations. A proactive or intermittent maintenance treatment strategy involving regular emollient use and twice-weekly application of a TCI to previously affected areas is encouraged to reduce the risk of flares. Conclusions The algorithm proposed here is intended to simplify the topical treatment of mild-to-moderate AD in daily practice in South and East Asian countries.
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13
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Steroid phobia isn't reduced by improving patients' knowledge of topical corticosteroids. J Am Acad Dermatol 2020; 83:e403-e404. [PMID: 32171809 DOI: 10.1016/j.jaad.2020.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 11/23/2022]
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14
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Abstract
INTRODUCTION Topical corticosteroids (TCS) are commonly used in dermatology for their anti-inflammatory action. The recent development of the TOPICOP© (Topical Corticosteroid Phobia) scale to assess steroid phobia has made the quantification and comparison of steroid phobia easier. The objective of this study was to assess the degree of steroid phobia at our institute and identify sources from which patients obtain information regarding TCS. METHODS A cross-sectional survey was performed of dermatology patients regardless of steroid use. TOPICOP scale was used for the survey. Sources from which patients obtained information were identified and their level of trust in these sources assessed. RESULTS 186 surveys were analysed. The median domain TOPICOP subscores were 38.9% (interquartile range [IQR] 27.8%-50.0%, standard deviation [SD] 24.4%) for knowledge and beliefs, 44.4% (IQR 33.3%-66.7%, SD 24.4%) for fears and 55.6% (IQR 33.3%-66.7%, SD 27.2%) for behaviour. The median global TOPICOP score was 44.4% (IQR 33.3%-55.6%, SD 17.6%). Female gender was associated with higher behaviour, fear and global TOPICOP scores. There was no difference in the scores based on disease condition, steroid use, age or education. Dermatologists were the most common source of information on topical steroids and trust was highest in dermatologists. CONCLUSION The prevalence of steroid phobia in our dermatology outpatient setting was moderately high, with gender differences. Dermatologists were the most common source of information on TCS, and it was heartening to note that trust was also highest in dermatologists. Strategies to target steroid phobia should take into account these factors.
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Affiliation(s)
- Ellie Choi
- Division of Dermatology, Department of Medicine, National University Healthcare System, Singapore
| | - Nisha Suyien Chandran
- Division of Dermatology, Department of Medicine, National University Healthcare System, Singapore
| | - Chris Tan
- Division of Dermatology, Department of Medicine, National University Healthcare System, Singapore
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15
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Lansang P, Lam JM, Marcoux D, Prajapati VH, Spring S, Lara-Corrales I. Approach to the Assessment and Management of Pediatric Patients With Atopic Dermatitis: A Consensus Document. Section III: Treatment Options for Pediatric Atopic Dermatitis. J Cutan Med Surg 2019; 23:19S-31S. [PMID: 31692376 DOI: 10.1177/1203475419882647] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Because atopic dermatitis (AD) is a chronic, relapsing disease, treatment requires the use of both active therapy to control flares and preventative maintenance therapy to promote integrity of the skin barrier. In this third of four sections, important clinical considerations for the treatment of pediatric AD are reviewed. Emerging therapies in development for pediatric AD are introduced.
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Affiliation(s)
- Perla Lansang
- Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Division of Dermatology, Faculty of Medicine, University of Toronto, ON, Canada.,Division of Paediatric Medicine, Section of Dermatology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Joseph M Lam
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Danielle Marcoux
- Division of Dermatology, Department of Paediatrics, Sainte-Justine University Hospital Center, University of Montreal, QC, Canada
| | - Vimal H Prajapati
- Division of Dermatology, Department of Medicine, University of Calgary, AB, Canada.,Division of Community Pediatrics, Department of Pediatrics, University of Calgary, AB, Canada.,Division of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, AB, Canada.,Dermatology Research Institute, Calgary, AB, Canada
| | - Shanna Spring
- Division of Dermatology and Rheumatology, Children's Hospital of Eastern Ontario, Ottawa, Canada.,Department of Pediatrics, University of Ottawa, ON, Canada.,Division of Dermatology, Department of Medicine, University of Ottawa, ON, Canada
| | - Irene Lara-Corrales
- Division of Paediatric Medicine, Section of Dermatology, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, ON, Canada
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16
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Yin LJ, Wei TK, Choi E, Chandran NS. TOPICOP © scale for steroid phobia - difficulties and suggestions for application in clinical research. J DERMATOL TREAT 2019; 31:624-625. [PMID: 31418325 DOI: 10.1080/09546634.2019.1657221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Law Je Yin
- Yong Loo Lin School of Medicine, National University of Singapore
| | | | - Ellie Choi
- Division of Dermatology, Department of Medicine, National University Healthcare System
| | - Nisha Suyien Chandran
- Division of Dermatology, Department of Medicine, National University Healthcare System
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17
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Bos B, Antonescu I, Osinga H, Veenje S, de Jong K, de Vries TW. Corticosteroid phobia (corticophobia) in parents of young children with atopic dermatitis and their health care providers. Pediatr Dermatol 2019; 36:100-104. [PMID: 30338542 DOI: 10.1111/pde.13698] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Adherence to topical corticosteroids is low among atopic dermatitis patients and their parents. This can lead to treatment failure and decreased quality of life. OBJECTIVE To assess and compare the worries and beliefs concerning topical corticosteroids among parents of children with atopic dermatitis, involved health care professionals, and between different professionals. Also, we identify factors associated with corticosteroid phobia (corticophobia) in professionals. METHODS Parents and health care professionals were invited to complete a questionnaire about corticophobia (Topicop). Higher questionnaire scores, expressed as a percentage, indicate more severe corticophobia. Professionals were asked to answer the questions as though they were using topical corticosteroids on their own child. RESULTS The scores for 29 parents and 31 public health care nurses were equal: 44%. The score for 51 general practitioners was 39%. The score for 33 public health care physicians and of 47 pediatricians was 31%. The differences between parents and these professionals were statistically significantly different (P = 0.001). Type of profession and having a child with atopic dermatitis were significantly associated factors for the score. CONCLUSION Corticophobia is present among parents of children with atopic dermatitis and among health care professionals involved in caring for children with atopic dermatitis. Health care nurses express the same level of corticophobia as parents. The presence of corticophobia among health care professionals may affect parental perspectives and topical corticosteroids adherence negatively.
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Affiliation(s)
- Bernies Bos
- Department of Paediatrics, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Ioana Antonescu
- Department of Paediatrics, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Hilda Osinga
- Department of Paediatrics, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Sietske Veenje
- Department of Paediatrics, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Kim de Jong
- Department of Epidemiology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Tjalling W de Vries
- Department of Paediatrics, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
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18
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Hon KL, Leong KF, Leung TN, Leung AK. Dismissing the fallacies of childhood eczema management: case scenarios and an overview of best practices. Drugs Context 2018; 7:212547. [PMID: 30532792 PMCID: PMC6281040 DOI: 10.7573/dic.212547] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/03/2018] [Accepted: 09/04/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Eczema or atopic dermatitis (AD) is a common relapsing childhood dermatologic illness. Treatment of AD is primarily topical with emollients and corticosteroid/calcineurin inhibitor, which is efficacious for the majority of patients. However, AD is often complicated and difficult to manage in many Asian cities. Effective therapy is impeded by fallacies in the following aspects: (1) mistrust and unrealistic expectations about Western medicine, (2) skin care and allergy treatment, (3) ambiguity about optimal bathing and moisturizing, (4) hesitation and phobias about the usage of adequate topical corticosteroid and immunomodulatory therapies, (5) food and aeroallergen avoidance and dietary supplementation, and (6) complementary and alternative therapies. METHODS AND RESULTS Eleven anonymized case scenarios are described to illustrate issues associated with these fallacies. A literature review is performed and possible solutions to handle or dismiss these fallacies are discussed. CONCLUSIONS The first step in patient care is to accurately assess the patient and the family to evaluate possible concerns, anxiety, and phobias that could impede therapeutic efficacy. Education about the disease should be individualized. Conflicting recommendations on the usage of topical steroid have a detrimental effect on management outcomes, which must be avoided.
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Affiliation(s)
- Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong
| | - Kin Fon Leong
- Institut Pediatrik, Hospital Kuala Lumpur, Jalan Pahang, 50586 Kuala Lumpur, Malaysia
| | - Theresa Nh Leung
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong
| | - Alexander Kc Leung
- Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
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19
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Simpson EL, Paller AS, Boguniewicz M, Eichenfield LF, Feldman SR, Silverberg JI, Chamlin SL, Zane LT. Crisaborole Ointment Improves Quality of Life of Patients with Mild to Moderate Atopic Dermatitis and Their Families. Dermatol Ther (Heidelb) 2018; 8:605-619. [PMID: 30345457 PMCID: PMC6261115 DOI: 10.1007/s13555-018-0263-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Indexed: 12/02/2022] Open
Abstract
Introduction The impact of crisaborole ointment, a nonsteroidal phosphodiesterase 4 inhibitor for the treatment of mild to moderate atopic dermatitis (AD), on quality of life (QoL) was assessed in two identically designed phase 3 studies (AD-301: NCT02118766; AD-302: NCT02118792, both at http://www.clinicaltrials.gov). Methods In both studies, patients aged ≥ 2 years with mild to moderate AD per the Investigator’s Static Global Assessment were randomly assigned 2:1 to receive crisaborole or vehicle twice daily for 28 days. QoL was assessed using the Children’s Dermatology Life Quality Index (CDLQI) (2–15 years), the Dermatology Life Quality Index (DLQI) (≥ 16 years), and the Dermatitis Family Impact Questionnaire (DFI) (parents/caregivers/family of patients aged 2–17 years). Established QoL score severity bands provided clinical context. Results Greater mean improvement in QoL was observed in crisaborole-treated patients than in vehicle-treated patients at day 29 [mean change from baseline (∆BL), CDLQI: − 4.6 vs. − 3.0; P < 0.001; DLQI: − 5.2 vs. − 3.5; P = 0.015]. At baseline, more than half the patients had a “moderate effect” or higher of AD on QoL. At day 29, there was a trend toward more crisaborole- than vehicle-treated patients having “small effect” to “no effect”, The QoL of parents/caregivers/family improved more for crisaborole-treated than for vehicle-treated patients (∆BL, DFI: − 3.7 vs. − 2.7; P = 0.003). Conclusion Crisaborole treatment results in clinically meaningful improvement in QoL for patients and their parents/caregivers/families. Trial Registration AD-301: http://www.clinicaltrials.gov, NCT02118766; AD-302: http://www.clinicaltrials.gov, NCT02118792. Funding Anacor Pharmaceuticals, Inc., a wholly owned subsidiary of Pfizer Inc., New York, NY.
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Affiliation(s)
- Eric L Simpson
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA.
| | - Amy S Paller
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mark Boguniewicz
- Division of Allergy-Immunology, Department of Pediatrics, National Jewish Health, Denver, CO, USA.,Department of Pediatrics, University of Colorado School of Medicine, Denver, CO, USA
| | - Lawrence F Eichenfield
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital-San Diego, San Diego, CA, USA.,Department of Dermatology, University of California, San Diego, CA, USA.,Department of Pediatrics, University of California, San Diego, CA, USA
| | - Steven R Feldman
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jonathan I Silverberg
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sarah L Chamlin
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lee T Zane
- Anacor Pharmaceuticals, Inc., a wholly owned subsidiary of Pfizer Inc., New York, NY, USA
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20
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Hon KL, Bao YM, Chan KC, Chau KW, Chen RS, Cheok KTG, Chiu WK, Deng L, He CH, Ieong KM, Kung JSC, Lam P, Lam SYD, Lee QU, Lee SL, Leung TF, Leung TNH, Shi L, Siu KK, Tan WP, Wang MH, Wong TW, Wu BJ, Yip AYF, Zheng YJ, Ng DK. Determinants for asthma control, quality of life and use of complementary and alternative medicine in asthmatic pediatric patients in four cities. World J Pediatr 2018; 14:482-491. [PMID: 30047047 DOI: 10.1007/s12519-018-0167-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 05/28/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Asthma is a significant chronic health problem worldwide. Management aims at disease control by reducing functional impairment and exacerbations and improving quality of life (QoL). We report a multi-center study to survey asthma control and QoL in four cities in the Pearl River Delta. METHODS The conjoint survey involved ten Hong Kong pediatric hospitals/units, two Shenzhen hospitals, two Macau hospitals, and two Guangzhou hospitals on asthma control (using Asthma Control Test) and QoL (Pediatric Allergic Disease Quality of Life Questionnaire, PADQLQ). Acceptability of a treatment is graded as very good/good/fair/poor. RESULTS Good asthma control was only reported in 80% subjects in Hong Kong, but higher in sister cities (85-94%, P < 0.001). Allergic rhinitis, "incense burning", and "smoker in family" were prevalent among the four cities. Logistic regression showed better control of asthma was associated with better PADQLQ (B = - 0.029, P < 0.001), better acceptability of bronchodilator (B = - 1.488, P = 0.025), negatively with "smoker in family" (B = - 0.83, P = 0.015) and various PADQLQ domains. Conversely, worse PADQLQ was associated with allergic rhinitis severity (B = 4.77, P < 0.001), poor control of asthma (B = 7.56, P < 0.001), increased frequency of traditional Chinese medicine use (B = 1.7, P < 0.05), increased frequency of bronchodilator usage (B = 1.05, P < 0.05), "smoker in family" (B = 4.05, P < 0.05), and incense burning at home (B = 3.9, P < 0.05). CONCLUSIONS There are some clinical and cultural differences among the four southern Chinese cities within the Guangdong province. This study identifies potentially modifiable environmental and treatment factors associated with poor asthma control and QoL for health-care interventions. Having a smoker in the family is independently associated with poor asthma control and QoL.
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Affiliation(s)
- Kam Lun Hon
- Department of Pediatrics, The Chinese University of Hong Kong 6/F Prince of Wales Hospital, Room 84042, Shatin, N.T, Hong Kong SAR, China.
| | - Yan Min Bao
- Department of Respiratory Diseases, Shenzhen Children's Hospital, Shenzhen, 518026, China
| | - Kate C Chan
- Department of Pediatrics, The Chinese University of Hong Kong 6/F Prince of Wales Hospital, Room 84042, Shatin, N.T, Hong Kong SAR, China
| | - Kin Wai Chau
- Hong Kong Society of Pediatric Respirology and Allergy, Hong Kong SAR, China.,Pediatric Respiratory and Sleep Disorders Center, Room 1315D, Argyle Centre Phase 1, 688 Nathan Road, Mongkok, Kowloon, Hong Kong SAR, China
| | - Rong-Shan Chen
- Department of Respiration, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, China
| | | | - Wa Keung Chiu
- Department of Pediatrics and Adolescent Medicine, United Christian Hospital, 130, Hip Wo Street, Kwun Tong, Hong Kong SAR, China
| | - Li Deng
- Department of Respiration, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, China
| | - Chun-Hui He
- Department of Respiration, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, China
| | - Kin Mui Ieong
- Department of Pediatrics, Central Hospital Conde S. Januario, Macau, China
| | - Jeng Sum C Kung
- Department of Pediatrics, The Chinese University of Hong Kong 6/F Prince of Wales Hospital, Room 84042, Shatin, N.T, Hong Kong SAR, China
| | - Ping Lam
- Department of Pediatrics and Adolescent Medicine, Caritas Medical Center, 111, Wing Hong Street, Sham Shui Po, Hong Kong SAR, China
| | - Shu Yan David Lam
- Department of Pediatrics and Adolescent Medicine, Tuen Mun Hospital, 23 Tsing Chung Koon Road,Tuen Mun, New Territories, Hong Kong SAR, China
| | - Qun Ui Lee
- Department of Pediatrics and Adolescent Medicine, Princess Margaret Hospital, 2-10 Princess Margaret Hospital Road, Lai Chi Kok, Kowloon, Hong Kong SAR, China
| | - So Lun Lee
- Department of Pediatrics and Adolescent Medicine, Queen Mary Hospital, 102, Pokfulam Road, Hong Kong SAR, China.,Department of Pediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ting Fan Leung
- Department of Pediatrics, The Chinese University of Hong Kong 6/F Prince of Wales Hospital, Room 84042, Shatin, N.T, Hong Kong SAR, China
| | - Theresa N H Leung
- Department of Pediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong SAR, China.,Department of Pediatrics and Adolescent Medicine, Pamela Youde Nethersole Eastern Hospital, 3, Lok Man Road, Chaiwan, Hong Kong SAR, China.,Department of Pediatrics, The University of Hong Kong-Shenzhen Hospital, 1, Haiyuan 1st Road, Futian, Shenzhen, China
| | - Lei Shi
- Department of Pediatrics and Adolescent Medicine, Pamela Youde Nethersole Eastern Hospital, 3, Lok Man Road, Chaiwan, Hong Kong SAR, China
| | - Ka Ka Siu
- Department of Pediatrics, The University of Hong Kong-Shenzhen Hospital, 1, Haiyuan 1st Road, Futian, Shenzhen, China
| | - Wei-Ping Tan
- Department of Pediatrics and Adolescent Medicine, Kwong Wah Hospital, 25 Waterloo Road, KLN Hong Kong SAR, China
| | - Maggie Haitian Wang
- Department of Pediatrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China.,JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Tak Wai Wong
- Department of Pediatrics and Adolescent Medicine, Alice Ho Miu Ling Nethersole Hospital, 11, Chuen On Road, Tai Po, Hong Kong SAR, China
| | - Bao-Jing Wu
- Department of Pediatrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Ada Y F Yip
- Department of Pediatrics and Adolescent Medicine, Kwong Wah Hospital, 25 Waterloo Road, KLN Hong Kong SAR, China
| | - Yue-Jie Zheng
- Department of Respiratory Diseases, Shenzhen Children's Hospital, Shenzhen, 518026, China
| | - Daniel K Ng
- Department of Pediatrics and Adolescent Medicine, Kwong Wah Hospital, 25 Waterloo Road, KLN Hong Kong SAR, China
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Song SY, Jung SY, Kim E. Steroid phobia among general users of topical steroids: a cross-sectional nationwide survey. J DERMATOL TREAT 2018; 30:245-250. [PMID: 30081700 DOI: 10.1080/09546634.2018.1508817] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The aim of this study was to assess steroid phobia among general users of topical corticosteroids and to analyze factors associated with steroid phobia. METHODS A cross-sectional nationwide survey was conducted using an online panel with participants stratified by age, sex, and region. Those aged 18-65 years with experience of topical steroid use within the past 1 year were included. RESULTS Of the 3000 respondents included, 929 (31%) had steroid phobia. Among those with steroid phobia, 322 (35%) reported that their fear developed after obtaining information from the media. Weight gain, asthma, skin thinning, growth stunting, and skin aging were the side effects cited as the main reasons behind development of steroid phobia. Female respondents and those with experience of the side effects of topical steroids were more likely to have steroid phobia, while those who obtained information on topical steroid use from a healthcare professional were less likely to have steroid phobia. CONCLUSIONS Steroid phobia among general users of topical steroids appears to be relatively high despite most of them being non-chronic topical steroid users. Healthcare professionals should not refrain from counseling patients, but instead actively address the issues leading to fears in patients.
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Affiliation(s)
- Seung Yeon Song
- a Evidence based and Clinical Research Laboratory, Department of Health, Social and Clinical Pharmacy , Chung-Ang University College of Pharmacy , Seoul , Republic of Korea
| | - Sun-Young Jung
- b College of Pharmacy , Chung-Ang University , Seoul , Republic of Korea
| | - EunYoung Kim
- a Evidence based and Clinical Research Laboratory, Department of Health, Social and Clinical Pharmacy , Chung-Ang University College of Pharmacy , Seoul , Republic of Korea.,b College of Pharmacy , Chung-Ang University , Seoul , Republic of Korea.,c Division of Licensing of Medicines and Regulatory Science , The Graduate School Pharmaceutical Management, Chung-Ang University , Seoul , Republic of Korea
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22
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Li Y, Han T, Li W, Li Y, Guo X, Zheng L. Awareness of and phobias about topical corticosteroids in parents of infants with eczema in Hangzhou, China. Pediatr Dermatol 2018; 35:463-467. [PMID: 29786146 DOI: 10.1111/pde.13527] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES Knowledge of and phobias about topical corticosteroids in parents of infants with eczema affect efficacy of eczema treatment. METHODS We surveyed 300 parents of children with eczema using a questionnaire to investigate knowledge of and phobias about topical corticosteroids. RESULTS Overall, 85.7% (n = 257) of children had used topical corticosteroids, with 12.8% (n = 33) of children having steroids applied for only 1-3 days per episode; 79.4% (n = 204) of patients discontinued topical steroid therapy immediately after improvement. Twenty-five percent (n = 75) of parents refused a prescription of steroid ointment, and 32.3% (n = 97) did not use the steroid ointment on their children despite having received a prescription. During steroid treatment, 95.7% (246) of parents were very concerned about the side effects of topical steroids. One hundred eight parents (42%) did not use a topical steroid ointment for recurrence of eczema because of concerns about using topical corticosteroids. CONCLUSION Most parents of infants with eczema had excessive concerns about topical corticosteroids, leading to inadequate treatment of atopic dermatitis. In clinical practice, physicians should reinforce parents' understanding of steroid treatment for eczema and guide rational use of topical steroids for infantile eczema.
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Affiliation(s)
- Yunling Li
- Department of Dermatology, Children's Hospital, School of Medicine, University of Zhejiang, Hangzhou, China
| | - Ting Han
- Department of Children's Health Care, Children's Hospital, School of Medicine, University of Zhejiang, Hangzhou, China
| | - Wei Li
- Department of Dermatology, Children's Hospital, School of Medicine, University of Zhejiang, Hangzhou, China
| | - Yin Li
- Department of Dermatology, Children's Hospital, School of Medicine, University of Zhejiang, Hangzhou, China
| | - Xiaoxuan Guo
- Department of Dermatology, Children's Hospital, School of Medicine, University of Zhejiang, Hangzhou, China
| | - Lei Zheng
- Department of Dermatology, Children's Hospital, School of Medicine, University of Zhejiang, Hangzhou, China
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23
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Takeuchi S, Oba J, Esaki H, Furue M. Non-corticosteroid adherence and itch severity influence perception of itch in atopic dermatitis. J Dermatol 2017; 45:158-164. [PMID: 29168215 DOI: 10.1111/1346-8138.14124] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 10/09/2017] [Indexed: 12/31/2022]
Abstract
Topical corticosteroid phobia is an important problem in the treatment of atopic dermatitis as it can affect the ability to control disease severity and itch by reducing treatment adherence. Topical corticosteroid phobia often ends up even non-corticosteroid adherence. As such, non-corticosteroid adherence, disease severity and itch are likely to be associated with each other, but their relationship has yet to be thoroughly investigated. Thus, the purpose of this study is to investigate it in atopic dermatitis. Using data from 1190 participants in an Internet survey, we identified 255 non-corticosteroid users and 225 with moderate to severe itch who were defined as non-corticosteroid adherents. Corticosteroid users with the same itch categories (n = 878) served as controls. We also examined how itch severity affects the perception of itch in atopic dermatitis. Unexpectedly, non-corticosteroid adherents were less sensitive to the conditions to elicit itch such as perspiring, commuting homeward, drinking alcohol and wearing woolen clothes compared with the control. We also found that patients with severer itch were more sensitive to itch during/after bathing, when lying in bed, commuting homeward, studying/working, drinking alcohol, undressing, getting up in the morning, after a meal, ingesting piquant foods and when they were unoccupied, angry, busy, nervous, sad or enjoying themselves. In conclusion, we found that non-corticosteroid adherence and itch severity influence perception of itch in atopic dermatitis and discuss possible mechanisms underlying these results. The information obtained in this study may be useful for communication with and education of atopic dermatitis patients and their treatment in outpatient clinics.
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Affiliation(s)
- Satoshi Takeuchi
- Department of Dermatology, Federation of National Public Service Personnel Mutual Aid Associations, Hamanomachi Hospital, Fukuoka, Japan.,Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Junna Oba
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hitokazu Esaki
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masutaka Furue
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Chong JH, Koh MJA. Non-topical management of recalcitrant paediatric atopic dermatitis. Arch Dis Child 2017; 102:681-686. [PMID: 28209661 DOI: 10.1136/archdischild-2016-312106] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 01/22/2017] [Accepted: 01/24/2017] [Indexed: 01/14/2023]
Abstract
Atopic dermatitis (AD) is a common chronic, pruritic skin disease in children. As the incidence of AD increases, especially in high-income countries, paediatricians may see an increasing number of recalcitrant AD cases in their practice. Although these cases are principally managed by paediatric dermatologists, it is important for paediatricians to be aware of the use and side effects of non-topical treatment like phototherapy and systemic agents as well as the evidence for alternative treatment, which caregivers may ask about. This review presents paediatric evidence for the practical use of phototherapy and certain oral immunosuppressants for paediatric AD including doses, duration of use and monitoring of adverse effects. The use of alternative therapy including traditional medicine, probiotics and the role of nutrition are also discussed. Narrow band ultraviolet B phototherapy is effective in recalcitrant paediatric AD. When phototherapy is ineffective or contraindicated, systemic drugs may be administered cautiously with close surveillance of side effects. The use of azathioprine, ciclosporin, methotrexate and mycophenolate mofetil is generally safe in the short term under close monitoring and can be effective alongside compliance to topical treatment. Alternative complementary treatment is not known to be effective. Holistic management including therapeutic patient education is important. Good quality paediatric studies for non-topical AD treatment are needed for definitive guidelines.
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Affiliation(s)
- Jin Ho Chong
- Dermatology service, KK Women's and Children's Hospital, Singapore.,Department of General Paediatrics, KK Women's and Children's Hospital, Singapore
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25
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Drucker AM, Wang AR, Li WQ, Sevetson E, Block JK, Qureshi AA. The Burden of Atopic Dermatitis: Summary of a Report for the National Eczema Association. J Invest Dermatol 2017; 137:26-30. [DOI: 10.1016/j.jid.2016.07.012] [Citation(s) in RCA: 238] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 06/23/2016] [Accepted: 07/12/2016] [Indexed: 10/21/2022]
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26
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Lun Hon E, Liu M, Zee B. Airway disease and environmental aeroallergens in eczematics approaching adulthood. ACTA ACUST UNITED AC 2017. [DOI: 10.4103/prcm.prcm_18_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Santer M, Muller I, Yardley L, Lewis-Jones S, Ersser S, Little P. Parents' and carers' views about emollients for childhood eczema: qualitative interview study. BMJ Open 2016; 6:e011887. [PMID: 27543590 PMCID: PMC5013451 DOI: 10.1136/bmjopen-2016-011887] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Leave-on emollients form the mainstay of eczema treatment, but adherence is poor. We aimed to explore parents'/carers' views on effectiveness and acceptability of leave-on emollients for childhood eczema through secondary analysis of data from 2 qualitative data sets. SETTING Study 1 recruited through mail-out from 6 general practices in southern England. Study 2 recruited from a feasibility trial of an intervention to support eczema self-care in 31 practices in the same area. PARTICIPANTS Study 1 included 28 interviews with carers of children aged ≤5 years with eczema. Study 2 included 26 interviews with carers of children aged ≤5 years with eczema. METHODS Interviews followed semistructured guides: study 1 explored carers' understandings around eczema treatments in order to develop a web-based self-care support intervention; study 2 explored carers' understandings of eczema and eczema treatments after using the intervention. Interviews were carried out face to face or by telephone, audio-recorded and transcribed. Secondary analysis of data from both studies focused on views and experiences of emollient use. Data were analysed using an inductive thematic approach facilitated by NVivo V.10 software. RESULTS In study 1, most participants felt emollients improved eczema but held mixed views about long-term use to prevent flare-ups. In study 2, where carers had used the web-based intervention, all participants held positive views about long-term emollient use. In both studies, participants expressed a range of preferences about emollient 'thickness'; some felt that 'thick' emollients (ointments) were most effective, while others found these difficult to use. Carers described a process of 'trial and error', trying emollients suggested by professionals, friends and family, or bought over-the-counter. Carers expressed a need for understanding differences between products and their effective use. CONCLUSIONS Providing a rationale for long-term emollient use and choice of emollients could help improve adherence and help families gain more rapid control of eczema.
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Affiliation(s)
- M Santer
- Primary Care & Population Sciences, Aldermoor Health Centre, University of Southampton, Southampton, UK
| | - I Muller
- Primary Care & Population Sciences, Aldermoor Health Centre, University of Southampton, Southampton, UK
| | - L Yardley
- Primary Care & Population Sciences, Aldermoor Health Centre, University of Southampton, Southampton, UK
| | - S Lewis-Jones
- Ninewells Hospital & University of Dundee, Dundee, UK
| | | | - P Little
- Primary Care & Population Sciences, Aldermoor Health Centre, University of Southampton, Southampton, UK
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