1
|
Amerio P, Ferrucci SM, Galluzzo M, Napolitano M, Narcisi A, Levi A, Di Fino S, Palladino C, Patruno C, Rossi M. A Multidisciplinary Approach Is Beneficial in Atopic Dermatitis. Dermatol Ther (Heidelb) 2024; 14:1443-1455. [PMID: 38811470 PMCID: PMC11169114 DOI: 10.1007/s13555-024-01185-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 05/10/2024] [Indexed: 05/31/2024] Open
Abstract
Atopic dermatitis (AD) is a highly heterogeneous chronic inflammatory skin disorder that is frequently associated with a plethora of comorbidities. AD is, therefore, considered a systemic disease impacted by a considerable burden and leading to poor quality of life, especially in patients with moderate-to-severe disease. Since atopic and non-atopic comorbidities can further worsen the disease course, accurate establishment of the patient's individual intrinsic risk profile and needs is crucial and may help in guiding the selection of the best treatment option. Better quality of care for patients with AD can be delivered through a multidisciplinary team led by a dermatologist, for comprehensive patient management. The implementation of a multidisciplinary approach for AD could enhance the delivery of optimised and safe treatments, improve the standard of care and patient outcomes in the short and long term, and prevent or delay the lifelong impact of uncontrolled AD. Understanding the unmet needs, assessing correctly the patient risk profile and enhancing the shared patient-physician decision-making process can lead to disease control and quality-of-life improvement, especially in the context of the introduction of newer treatment for AD. This narrative review is a call for more data to establish standardised patient profiles and multidisciplinary strategies in AD management. In view on the fast-evolving treatments for AD, this review aims at highlighting the importance of a multidisciplinary approach to a comprehensive assessment and holistic care in patients with moderate-to-severe AD.
Collapse
Affiliation(s)
- Paolo Amerio
- Dermatology Unit, Department of Medicine and Aging Science, University of Chieti Pescara, 66100, Chieti, Italy
| | - Silvia Mariel Ferrucci
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Galluzzo
- Dermatology Unit, Fondazione Policlinico "Tor Vergata", Rome, Italy
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Maddalena Napolitano
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy.
| | | | | | | | | | - Cataldo Patruno
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Mariateresa Rossi
- Department of Clinical and Experimental Sciences, Dermatology Unit, University of Brescia, Brescia, Italy
| |
Collapse
|
2
|
Wilken B, Zaman M, Asai Y. Patient education in atopic dermatitis: a scoping review. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2023; 19:89. [PMID: 37833754 PMCID: PMC10576377 DOI: 10.1186/s13223-023-00844-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) is a chronic inflammatory skin disease that affects children and adults. Poor treatment adherence in AD requires interventions to promote self-management; patient education in chronic diseases is key to self-management. Many international AD management guidelines published to date include a recommendation for educating patients as part of their treatment but there are no formal recommendations on how to deliver this knowledge. MAIN: We performed a scoping review to map the existing literature on patient education practices in AD and to highlight the clinical need for improved patient education in AD. The literature search was performed with the online databases MEDLINE, Embase, Grey Matters, ClinicalTrails.gov and the International Clinical Trials Registry Platform (ICTRP). The search strategy yielded 388 articles. Of the 388 articles screened, 16 studies met the eligibility criteria, and the quantitative data was summarized by narrative synthesis. The majority of studies were randomized controlled trials conducted in Europe, Asia and North America. Since 2002, there have been limited studies evaluating patient education in the treatment of AD. Frequent education methods used included group-based educational programs, educational pamphlets, individual consultations and online resources. Education was most commonly directed at caregivers and their children. Only one study compared the efficacy of different education methods. In all included studies, the heterogenous nature of outcome measures and study design limited the consistency of results. Despite the heterogeneity of studies, patient education was shown to improve quality of life (QoL), disease severity and psychological outcomes in AD patients. CONCLUSION This scoping review highlights that patient education is effective in a variety of domains relevant to AD treatment. Further comparative studies and randomized trials with longer-term follow-up are needed to provide validated and consistent patient education recommendations for AD; these may depend on age and population.
Collapse
Affiliation(s)
- Bethany Wilken
- Translational Institute of Medicine, Department of Medicine, Queen's University, Kingston, ON, Canada.
| | - M Zaman
- School of Medicine, Queen's University, Kingston, ON, Canada
| | - Y Asai
- Division of Dermatology, Department of Medicine, Queen's University, Kingston, ON, Canada
| |
Collapse
|
3
|
Xiang L, Zhou X, He R, Gao Y, Li M, Zeng S, Cao H, Wang X, Xu Y, Zhao G, Xu Q, Liu Z, Guo J, Yan X, Tang B, Sun Q, Wu IXY. Medication Status and Related Factors in Essential Tremor Patients: A Cross-Sectional Study in China. Neuroepidemiology 2023; 57:260-270. [PMID: 37586340 DOI: 10.1159/000533171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/20/2023] [Indexed: 08/18/2023] Open
Abstract
INTRODUCTION Essential tremor (ET) is one of the most common movement disorders. Oral drugs play a crucial role in treating ET, with various available options such as propranolol, primidone, and topiramate. However, the medication status and related factors among Chinese ET patients are unknown yet. METHODS This study used the baseline data from the National Survey of Essential Tremor Plus in China cohort. ET patients with information related to medication intake were included. Medication patients were defined as patients who were taking medication at the time of the survey. We further defined recommended medication users according to Chinese guideline recommendations and clinical knowledge. We used mean and standard deviation (SD), median and interquartile range (IQR), or frequencies and percentages when appropriate for descriptive analysis. We used multivariate logistic regression analyses to explore factors related to medication intake in all ET patients and in recommended medication users. RESULTS Of 1,153 included ET participants, 207 (18.0%) took medication. Arotinolol (115, 55.6%) and propranolol (63, 30.4%) were the top 2 used medicines. Patients with middle school education (odds ratio 0.57, 95% confidence interval 0.39-0.83), college or higher level education (0.46, 0.28-0.76), and late-onset ET (LO-ET) (0.38, 0.23-0.63) were less likely to take medication. Patients with intention tremor (1.90, 1.38-2.62), every 10-unit increase in age (1.10, 1.00-1.21), Tremor Research Group Essential Tremor Rating Assessment Scale (TETRAS) Part 1 (1.63, 1.37-1.93), and TETRAS Part 2 (1.81, 1.48-2.22) were more likely to take medication. Among 332 recommended medication users, only 104 (31.3%) took medicine. The associations of LO-ET (0.36, 0.17-0.75), intention tremor (2.27, 1.35-3.81), TETRAS Part 1 (1.52, 1.09-2.13), and TETRAS Part 2 (1.59, 1.15-2.20) with medication were similar to all ET patients. CONCLUSION The proportion of medication intake is low among both all ET patients and recommended medication users. The top 2 commonly used medications among all ET patients are arotinolol and propranolol. Influencing factors of medication intake are different between all ET patients and recommended medication users. Clinicians are suggested to provide counseling and education on ET medication to promote medication intake.
Collapse
Affiliation(s)
- Linghui Xiang
- Department of Epidemiology and Health Statistic, Xiangya School of Public Health, Central South University, Changsha, China,
| | - Xun Zhou
- Department of Neurology, Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Runcheng He
- Department of Neurology, Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Yinyan Gao
- Department of Epidemiology and Health Statistic, Xiangya School of Public Health, Central South University, Changsha, China
| | - Mingqiang Li
- Department of Neurology, The First Affiliated Hospital of University of South China, Hengyang, China
| | - Sheng Zeng
- Department of Geriatric Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Hongmei Cao
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xuejing Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanming Xu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Guohua Zhao
- Department of Neurology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
| | - Qian Xu
- Department of Neurology, Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China
| | - Zhenhua Liu
- Department of Neurology, Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China
| | - Jifeng Guo
- Department of Neurology, Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China
| | - Xinxiang Yan
- Department of Neurology, Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China
| | - Beisha Tang
- Department of Neurology, Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China
| | - Qiying Sun
- Department of Neurology, Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China
| | - Irene X Y Wu
- Department of Epidemiology and Health Statistic, Xiangya School of Public Health, Central South University, Changsha, China
| |
Collapse
|
4
|
Zagami M, Klepper E, Wienecke E, Andrzejewski M, Sikder A, Ahmed A, Robinson H. A review of psychocutaneous disorders from a psychotherapeutic perspective—Toolkit for the dermatologist. SKIN HEALTH AND DISEASE 2023. [PMID: 37538328 PMCID: PMC10395638 DOI: 10.1002/ski2.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Introduction The study of psychocutaneous disorders requires a multidisciplinary approach. It is of paramount importance that dermatologists understand the psychiatric premise for these disorders. Mental health professionals can also benefit from a better understanding of the dermatologic manifestations of psychiatric disorders they may encounter in their practice. Aim The aim of this study is to elevate the level of understanding regarding psychotherapeutic treatment of psychocutaneous disorders. Methods We performed a literature review using the major databases. Four researchers reviewed English, full text, peer-reviewed articles that were published after 2000 using our specific search terms and inclusion/exclusion criteria. Results The majority of psychocutaneous disorders seem to be clustered among three DSM-5 disorders: depressive disorders, anxiety disorders, and obsessive-compulsive related disorders. Conclusions Better recognition of the underlying psychiatric comorbidities may lead to improved patient outcomes.
Collapse
Affiliation(s)
- Mary Zagami
- Robinson & Max Dermatology PA Lutherville‐ Timonium Maryland USA
| | - Edward Klepper
- Robinson & Max Dermatology PA Lutherville‐ Timonium Maryland USA
| | - Eric Wienecke
- Robinson & Max Dermatology PA Lutherville‐ Timonium Maryland USA
| | | | - Ahmed Sikder
- Robinson & Max Dermatology PA Lutherville‐ Timonium Maryland USA
| | - Ali Ahmed
- Robinson & Max Dermatology PA Lutherville‐ Timonium Maryland USA
| | - Howard Robinson
- Robinson & Max Dermatology PA Lutherville‐ Timonium Maryland USA
| |
Collapse
|
5
|
Standen L, Garip G. The influence of self-management, anxiety and depression on chronic eczema-related quality of life. SKIN HEALTH AND DISEASE 2022; 2:e106. [PMID: 36479268 PMCID: PMC9720206 DOI: 10.1002/ski2.106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/15/2022] [Accepted: 02/24/2022] [Indexed: 06/17/2023]
Abstract
Chronic eczema, a persistent inflammatory skin condition, affects 1 in 12 adults in the United Kingdom and negatively influences quality of life. Self-management can potentially influence chronic conditions, such as eczema, reducing symptoms and positively influencing quality of life; however, there is a lack of public education for eczema. Anxiety and depression negatively influence quality of life, and frequently present alongside eczema. Psychological interventions for anxiety and depression have shown to be effective for eczema-related quality of life. This study aimed at examining the relationship between self-management, anxiety, and depression, on quality of life in individuals with chronic eczema. The main hypothesis proposed that anxiety and depression reduce the influence of eczema self-management on quality of life, potentially as individuals might be less likely to support their eczema treatment when experiencing symptoms of anxiety and depression. A cross-sectional design and opportunistic sampling were used to analyse the data from 77 participants who responded to four self-report scales to assess self-management understanding, anxiety, depression and quality of life in participants with chronic eczema. Data were analysed by a hierarchical multiple linear regression to assess the variance contributed by each variable added to the model. Results from this sample shows a trend whereby self-management of eczema contributes less variance to quality of life alongside comorbid anxiety and depression; this suggests that self-management has reduced influence on eczema-related quality of life when anxiety and depression are present. Furthermore, low self-management, high anxiety, and high depression significantly negatively influence quality of life. The three variables combined accounted for 41.1% of variance in quality of life scores, suggesting anxiety, depression and self-management influence quality of life in the sample. Self-management, anxiety, and depression significantly influence eczema-related quality of life, and participants who reported comorbid anxiety and depression were more likely to report lower levels of self-management in this sample.
Collapse
Affiliation(s)
- Laura Standen
- College of Health, Psychology & Social CareUniversity of DerbyDerbyUK
| | - Gulcan Garip
- College of Health, Psychology & Social CareUniversity of DerbyDerbyUK
| |
Collapse
|
6
|
Fan X, Li H, Lai L, Zhou X, Ye X, Xiao H. Impact of internet plus health education on urinary stoma caregivers in coping with care burden and stress in the era of COVID-19. Front Psychol 2022; 13:982634. [PMID: 36532976 PMCID: PMC9748695 DOI: 10.3389/fpsyg.2022.982634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/15/2022] [Indexed: 09/21/2023] Open
Abstract
OBJECTIVE To explore the impact of "Internet Plus Health Education" on coping with care burden and pressure in urinary stoma caregivers in the era of COVID-19. MATERIALS AND METHODS Eighty caregivers of patients with urinary ostomy were equally randomized to experimental and control groups. Caregivers in the experimental group received digital nursing education intervention, which involved nursing intervention of Internet Plus Health Education (IPHE), and those in the control group received conventional care instructions. Six months later, care burden and emotional pressure were assessed in all caregivers using the Zarit Caregiver Burden Interview (ZBI) and the Simplified Coping Style Questionnaire (SCSQ). RESULTS Before the intervention, the ZBI and SCSQ scores were comparable between both groups (p > 0.05). After the intervention, the ZBI scores in the experimental group were significantly higher than in the control group and vice versa for SCSQ scores (p < 0.01). Furthermore, after the intervention, the family care satisfaction scale (FCSS) of the experimental group was significantly higher than the control group. CONCLUSION Providing "Internet Plus Health Education" to urinary stoma caregivers can reduce their care burden and enhance their pressure-coping ability in the COVID-19 era.
Collapse
Affiliation(s)
- XuFei Fan
- Department of Hernia and Abdominal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - HaiYan Li
- Department of Urology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - LiYa Lai
- Department of Hernia and Abdominal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - XiaoFeng Zhou
- Department of Urology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - XiangXiang Ye
- Department of Urology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - HaiNiao Xiao
- Department of Urology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| |
Collapse
|
7
|
Sahin U, Reeve K, Tochtermann G, Kilanowski K, Navarini A, Imhof L, Held U, Hofbauer GFL. HautTief Multidisciplinary Educational Program for Patients with Psoriasis or Atopic Dermatitis: A Randomized Controlled Study. Dermatology 2022; 238:1050-1059. [PMID: 35533665 PMCID: PMC9677846 DOI: 10.1159/000524225] [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: 10/17/2021] [Accepted: 03/05/2022] [Indexed: 11/29/2022] Open
Abstract
Background Improving health-related quality of life (HRQoL), disease severity, and treatment adherence through patient education is an increasingly important, yet relatively new area in dermatology. This randomized controlled trial aims to contribute to this growing area of research by exploring the effects of a 9-week educational program for patients with chronic skin diseases. Objective The aim of the study was to evaluate the effect of a multidisciplinary educational program on HRQoL and disease severity in patients with psoriasis or atopic dermatitis (AD). Methods Sixty-four patients with diagnosed psoriasis or AD were recruited from University Hospital Zurich and randomized (1:1) to the intervention or control group. To assess HRQoL, the following self-reported questionnaires were used: Dermatology Life Quality Index (DLQI), Skindex-29, EuroQol-5D (EQ-5D), RAND 36-Item Short Form Survey (SF-36), and Beck Depression Inventory (BDI) to measure depression symptoms. Psoriasis Area and Severity Index (PASI) and the Eczema Area and Severity Index (EASI) were used to capture disease extent. These scores were assessed at four study visits, which were performed at baseline and 3, 6, and 9 months after the start of the program. Results At month 6, an improvement of at least 25% in BDI was recorded in 15 (68.2%) of 22 patients in the intervention group and 6 (27.3%) of 22 patients in the control group (difference 40.9%, p = 0.016). 53.3% (16 of 30) of patients achieved an improvement in one subdomain of the SF-36 score (role limitations due to emotional problems) at 6-month follow-up, compared with 23.1% (6 of 26) of those not attending the educational program (difference 30.2%; p = 0.042). No significant differences in DLQI, Skindex-29, EQ-5D, PASI, and EASI between both groups at the three time points were found. Conclusion An educational program may improve HRQoL and depression status of patients with psoriasis or AD.
Collapse
Affiliation(s)
- Ugur Sahin
- Department of Dermatology, University Hospital Zurich (USZ), University of Zurich (UZH), Zurich, Switzerland
| | - Kelly Reeve
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich (UZH), Zurich, Switzerland
| | - Giulia Tochtermann
- Department of Dermatology, University Hospital Zurich (USZ), University of Zurich (UZH), Zurich, Switzerland
| | - Kamilla Kilanowski
- Department of Dermatology, University Hospital Zurich (USZ), University of Zurich (UZH), Zurich, Switzerland
| | - Alexander Navarini
- Department of Dermatology, University Hospital Zurich (USZ), University of Zurich (UZH), Zurich, Switzerland
| | - Laurence Imhof
- Department of Dermatology, University Hospital Zurich (USZ), University of Zurich (UZH), Zurich, Switzerland
| | - Ulrike Held
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich (UZH), Zurich, Switzerland
| | - Günther F L Hofbauer
- Department of Dermatology, University Hospital Zurich (USZ), University of Zurich (UZH), Zurich, Switzerland
| |
Collapse
|
8
|
Thompson DL. Comment on 'Position statement on the role of nurses in therapeutic patient education in atopic dermatitis'. J Eur Acad Dermatol Venereol 2021; 36:e341-e342. [PMID: 34753199 DOI: 10.1111/jdv.17799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- D L Thompson
- School of Nursing and Midwifery, Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia.,Women's and Children's Health Network, North Adelaide, SA, Australia
| |
Collapse
|
9
|
Carrascosa JM, de la Cueva P, de Lucas R, Fonseca E, Martín A, Vicente A, Fortes MP, Gómez S, Rebollo FJ. Patient Journey in Atopic Dermatitis: The Real-World Scenario. Dermatol Ther (Heidelb) 2021; 11:1693-1705. [PMID: 34426957 PMCID: PMC8484426 DOI: 10.1007/s13555-021-00592-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/11/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction The diagnosis and management of atopic dermatitis (AD) is extensively addressed in detailed clinical guidelines. However, the high heterogeneity regarding presentation and progression and the increasingly broad therapeutic landscape suggest a complex real-world scenario, leading to multiple trajectories of AD patients. Methods Using a Delphi methodology for assessing the degree of consensus, we explored the views of a panel of dermatologists regarding the patients’ trajectory through the diagnosis (block 1), treatment (block 2), and long-term management (block 3) of AD. Based on a systematic search of the literature, a scientific committee prepared a questionnaire of relevant items that were rated on a 10-point scale (from “totally agree” to “totally disagree”) by a panel of dermatologists attending patients with AD in the hospital setting. Consensus was established based on predefined rules. Results The final questionnaire included 58 items and was answered by 17 dermatologists. Overall, consensus was reached on 22 items (37.9%), each of which was a consensus for agreement. The consensus rates in blocks 1, 2, and 3 were 22.7%, 19.0%, and 86%, respectively. Conclusions Our analysis revealed a remarkable lack of consensus on various aspects of the routine diagnosis and treatment of AD. These findings suggest the presence of unmet needs or limited implementation of guidelines for the management of AD and encourage further research to explore the causes of this low consensus on the management of AD in the real-world setting. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-021-00592-y.
Collapse
Affiliation(s)
| | | | | | - Eduardo Fonseca
- Complejo Hospitalario Universitario de La Coruña, La Coruña, Spain
| | - Ana Martín
- Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | | | - Maria Pilar Fortes
- Pfizer SLU, Avenida Europa 20B, Parque Empresarial La Moraleja, 28108, Madrid, Spain
| | - Susana Gómez
- Pfizer SLU, Avenida Europa 20B, Parque Empresarial La Moraleja, 28108, Madrid, Spain
| | | |
Collapse
|
10
|
Guerrero D, Calmette R. Therapeutic patient education: the Avène-Les-Bains experience. J Eur Acad Dermatol Venereol 2021; 34 Suppl 5:53-57. [PMID: 32870561 DOI: 10.1111/jdv.16449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 03/31/2020] [Indexed: 11/28/2022]
Abstract
Originally developed to improve the management of serious chronic diseases such as diabetes mellitus, obesity, cardiovascular diseases, asthma and as aftercare following oncological treatments, therapeutic patient education (TPE) has been extended to other situations, including chronic dermatoses such as atopic dermatitis, eczema and psoriasis. In this article, we provide a brief overview of the development, implementation and evaluation of TPE at the Avène-Les-Bains Hydrotherapy Center, France.
Collapse
Affiliation(s)
- D Guerrero
- Station Thermale Avène, Avène les Bains, France
| | - R Calmette
- Station Thermale Avène, Avène les Bains, France
| |
Collapse
|
11
|
Eichenfield LF, Kusari A, Han AM, Barbarot S, Deleuran M, Lio P, Marcoux D, Nosbaum A, Stalder JF. Therapeutic education in atopic dermatitis: A position paper from the International Eczema Council. JAAD Int 2021; 3:8-13. [PMID: 34409365 PMCID: PMC8361897 DOI: 10.1016/j.jdin.2021.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2021] [Indexed: 01/31/2023] Open
Abstract
Background Atopic dermatitis (AD) is a chronic, inflammatory skin disease that affects as many as 12.5% of children aged 0-17 years and 3% of the adult population. In the United States, 31.6 million children and adults are estimated to be living with AD. Objective Therapeutic patient education (TPE) has proven its value in the management of chronic diseases for which adherence to therapy is suboptimal. This article explores experts' opinions and treatment practices to determine if TPE is a recommended and effective method for treating AD. Methods Forty-two (51%) of 82 Councilors and Associates of the International Eczema Council (IEC), an international group with expertise in AD, responded to an electronic survey on TPE and AD. Results Most respondents (97.5%) agreed that TPE should play an important role in the management of AD. Many respondents (82.9%) believed that all patients with AD, regardless of disease severity, could benefit from TPE. Limitations The International Eczema Council survey lacks specific information on AD severity. Conclusions Publications have shown the positive effect of TPE on the course of the disease, the prevention of complications, and the autonomy and quality of patient life. Survey respondents agreed that TPE can improve the quality of patient care and patient satisfaction with care.
Collapse
Affiliation(s)
- Lawrence F Eichenfield
- Department of Dermatology, University of California, San Diego, California.,Department of Pediatrics, University of California, San Diego, California.,Rady Children's Hospital, San Diego, California
| | - Ayan Kusari
- Department of Dermatology, University of California, San Diego, California
| | - Allison M Han
- Department of Dermatology, University of California, San Diego, California
| | | | - Mette Deleuran
- Department of Dermato-Venereology, Aarhus University Hospital, Aarhus C, Denmark
| | - Peter Lio
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Danielle Marcoux
- Department of Pediatrics Division of Dermatology, University of Montreal and CHU Sainte-Justine, Montreal, Canada
| | - Audrey Nosbaum
- Department of Allergy and Clinical Immunology, University Hospital Lyon Sud, Hospices Civiles de Lyon, Lyon, France
| | | |
Collapse
|
12
|
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
|
13
|
van Os-Medendorp H, Deprez E, Maes N, Ryan S, Jackson K, Winders T, De Raeve L, De Cuyper C, Ersser S. The role of the nurse in the care and management of patients with atopic dermatitis. BMC Nurs 2020; 19:102. [PMID: 33292229 PMCID: PMC7640616 DOI: 10.1186/s12912-020-00494-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 10/20/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The purpose of this paper is to provide an overview of key aspects of specialised dermatology nursing practice in the management of patients with moderate to severe atopic dermatitis. The role of dermatology nurse specialists in supporting patients and promoting disease understanding, education and treatment adherence continues to evolve. As features of specialised nursing care can also inform other nursing staff in a wide range of care settings, an overview of key components is examined. Observations presented are from a pan-European perspective and represent the collected view of a group of dermatology nurse specialists, dermatologists and patient advocates following two round-table discussions. MAIN BODY Atopic dermatitis is a common, chronic, inflammatory disease characterised by erythematous/scaling skin lesions, with often intense pruritus. Disease course is cyclic with periodic disease flares of varying intensity, presenting management challenges to patients and families. Dermatology nurse specialists play a key role in providing education and substantial patient support to improve treatment outcomes and quality of life to patients and their family, delivered within a multidisciplinary team framework. Nurse-led education and 'eczema schools' are of benefit in reducing disease severity and improving quality of life by enhancing self-management, adherence and patient engagement. eHealth tools, such as patient portals or online training platforms, can provide online learning, individualised education, and help to improve engagement. These and other initiatives, such as written action plans, are all essential to improve or maintain treatment adherence, self-management and quality of life. CONCLUSIONS Dermatology nurse specialists play a central role in the assessment and management of moderate to severe atopic dermatitis patients and families. This places them in an ideal position to build strong and often long-term relationships with patients and parents. Such engagement promotes trust, assists in setting realistic expectations of treatment and outcomes, and enhances self-management and engagement in their own care. Providing emotional support, as well as formal and systematic education (including individualised practical advice) all contribute to improved treatment adherence and can enhance the quality of life of patients and their families throughout the course of this long-term condition.
Collapse
Affiliation(s)
| | - Elfie Deprez
- Department of Dermatology, University Hospital Ghent, Ghent, Belgium
| | - Nele Maes
- Department of Dermatology, University Hospital Ghent, Ghent, Belgium
| | - Sheila Ryan
- Department of Dermatology, University Hospital Limerick, Limerick, Ireland
| | - Karina Jackson
- St John's Institute of Dermatology, Guy's and St Thomas' Foundation NHS Trust, London, UK
| | - Tonya Winders
- Allergy & Asthma Network / Global Allergy & Airways Patient Platform (GAAPP), Vienna, VA, USA
| | - Linda De Raeve
- Department of Dermatology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Christa De Cuyper
- Department of Dermatology, AZ Sint Jan, Brugge-Oostende, AV, Belgium.,EADV-Nurse Association Working group Coordinator, Lugano, Switzerland
| | - Steven Ersser
- Department of Nursing Science, Bournemouth University, Poole, UK
| |
Collapse
|
14
|
Gisondi P, Girolomoni G. Undertreatment in adult patients with moderate‐to‐severe atopic dermatitis and other chronic inflammatory skin diseases. J Eur Acad Dermatol Venereol 2020; 34:2168-2169. [DOI: 10.1111/jdv.16876] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 08/11/2020] [Indexed: 12/31/2022]
Affiliation(s)
- P. Gisondi
- Section of Dermatology and Venereology Department of Medicine University of Verona Verona Italy
| | - G. Girolomoni
- Section of Dermatology and Venereology Department of Medicine University of Verona Verona Italy
| |
Collapse
|
15
|
Abstract
Atopic dermatitis is a common inflammatory skin disorder characterised by recurrent eczematous lesions and intense itch. The disorder affects people of all ages and ethnicities, has a substantial psychosocial impact on patients and relatives, and is the leading cause of the global burden from skin disease. Atopic dermatitis is associated with increased risk of multiple comorbidities, including food allergy, asthma, allergic rhinitis, and mental health disorders. The pathophysiology is complex and involves a strong genetic predisposition, epidermal dysfunction, and T-cell driven inflammation. Although type-2 mechanisms are dominant, there is increasing evidence that the disorder involves multiple immune pathways. Currently, there is no cure, but increasing numbers of innovative and targeted therapies hold promise for achieving disease control, including in patients with recalcitrant disease. We summarise and discuss advances in our understanding of the disease and their implications for prevention, management, and future research.
Collapse
Affiliation(s)
- Sinéad M Langan
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK; St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK; Health Data Research UK, London, UK.
| | - Alan D Irvine
- Department of Clinical Medicine, Trinity College Dublin, Dublin, Ireland; Dermatology, Children's Health Ireland, Crumlin, Ireland; National Children's Research Centre, Dublin, Ireland
| | - Stephan Weidinger
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Kiel, Germany
| |
Collapse
|
16
|
Liu YS, Lu NH, Shieh PC, Sun CK. Combination of a Self-Regulation Module and Mobile Application to Enhance Treatment Outcome for Patients with Acne. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E276. [PMID: 32512875 PMCID: PMC7353865 DOI: 10.3390/medicina56060276] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 06/02/2020] [Accepted: 06/02/2020] [Indexed: 01/30/2023]
Abstract
Background and Objectives: Acne, an inflammatory disorder of the pilosebaceous unit associated with both physiological and psychological morbidities, should be considered a chronic disease. The application of self-regulation theory and therapeutic patient education has been widely utilized in different health-related areas to help patient with a chronic disease to attain better behavioral modification. The present study aims at investigating the treatment efficacy of combining a self-regulation-based patient education module with mobile application in acne patients. Materials and Methods: This was one-grouped pretest-posttest design at a single tertiary referral center with the enrollment of 30 subjects diagnosed with acne vulgaris. Relevant information was collected before (week 0) and after (week 4) treatment in the present study, including the Acne Self-Regulation Inventory (ASRI), Cardiff Acne Disability Index (CADI), and Dermatology Life Quality Index (DLQI) that involved a questionnaire-based subjective evaluation of the patient's ability in self-regulation and quality of life as well as clinical Acne Grading Scores (AGS) that objectively assessed changes in disease severity. To reinforce availability and feasibility, an individualized platform was accessible through mobile devices for real-time problem solving between hospital visits. Results: Thirty subjects completed the designed experiment. An analysis of the differences between scores of pretest and posttest of ASRI demonstrated substantial elevations (p < 0.001). The questionnaire survey of CADI and DLQI dropped significantly after the application of a self-regulation-based patient education module with a mobile application, revealing substantial reductions in both parameters (p < 0.001). The sign test demonstrated a remarkably significant difference in AGS (Z = -7.38, p < 0.001), indicating notable improvement in the clinical severity of acne after treatment. Conclusions: After incorporating modern mobile application, a self-regulation-based therapeutic patient education module could significantly improve treatment outcomes among acne patients.
Collapse
Affiliation(s)
- Yi-Shan Liu
- Department of Pharmacy, Tajen University, Pingtung 907391, Taiwan;
- School of Chinese Medicine for Post-Baccalaureate, College of Medicine, I-Shou University & Department of Dermatology, E-Da Hospital, Kaohsiung 824410, Taiwan
| | - Nan-Han Lu
- School of Medicine, College of Medicine, I-Shou University & Department of Radiology, E-Da Hospital, Kaohsiung 824410, Taiwan;
| | - Po-Chuen Shieh
- Department of Pharmacy, Tajen University, Pingtung 907391, Taiwan;
| | - Cheuk-Kwan Sun
- School of Medicine, College of Medicine, I-Shou University & Department of Emergency Medicine, E-Da Hospital, Kaohsiung 824410, Taiwan;
| |
Collapse
|
17
|
Li Y, Zheng H, Li Y, Li W, Guo X, Lv Z. Parental knowledge of moisturizers and their application to infants with eczema in Hangzhou, China. Medicine (Baltimore) 2020; 99:e20329. [PMID: 32481406 DOI: 10.1097/md.0000000000020329] [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: 11/25/2022] Open
Abstract
Parental knowledge regarding the role of moisturizers in restoring the skin barrier, as well as regular and long-term use of moisturizers, is critical in the treatment of infantile eczema and the prevention of relapse.The parents of children with eczema were enrolled in this study. Their knowledge of the role, use, and effect of moisturizers on their children, as well as their concerns regarding moisturizers were surveyed.A total of 350 parents were enrolled in this study. Two hundred fifty-two parents (72%) knew that eczema requires moisturizers to restore the skin barrier. Among these 252 parents, 175 parents (50.0%) knew that moisturizers can restore the skin barrier. Only 27 parents (27/175, 15.4%) of them knew that moisturizers can improve eczema. Overall, 69.4% used moisturizers; of these, 75.3% used only moisturizers on the face, 87.2% on dry areas of face and other body parts, and only 6.6% on the entire body. Furthermore, 13.2% used topical moisturizers in the long-term; 62.6% used moisturizers 1 to 2 times per day, while 5.4% used moisturizers once every few days. A total of 80.7% discontinued moisturizers immediately after improvement in dryness, and 75.3% reported skin dryness despite moisturizer usage. Among parents of children who used moisturizers, 16.5% were worried about the side effects of moisturizers.Despite a fair level of knowledge about moisturizers, parents of children with eczema are using them inadequately. Pediatrician should be more patient to educate parents the information on the importance of moisturizers for the improvement of eczema and prevention of recurrence.
Collapse
Affiliation(s)
- Yunling Li
- Department of Dermatology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health
| | - Huiwen Zheng
- Department of Dermatology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health
| | - Yin Li
- Department of Dermatology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health
| | - Wei Li
- Department of Dermatology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health
| | - Xiaoxuan Guo
- Department of Dermatology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health
| | - Zhongfa Lv
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
18
|
Abstract
Atopic dermatitis (AD) in older adults (elderly AD) has recently emerged as a newly defined subgroup of AD. When selecting treatment options, clinical characteristics of elderly AD and age-specific factors of older patients must be considered. As in other age groups, regular application of moisturizers in combination with topical corticosteroids and calcineurin inhibitors, adjunctive administration of oral antihistamines/anti-allergic drugs, and avoidance of exacerbating factors comprise basic treatments for elderly AD. For moderate-to-severe cases and/or in those with a decreased ability to use topical treatments, powerful anti-inflammatory treatments may become necessary as additional treatment options. While low-dose oral corticosteroids may be useful for cases of elderly AD, careful attention should be paid to adverse effects. Oral cyclosporine (ciclosporin) is less commonly used due to the increased risk of malignancy and organ toxicity in older patients with AD. Narrow-band ultraviolet B phototherapy may also be useful for older patients, although the necessity of frequent hospital visits for irradiation therapy may become a burden of disease for such patients. As a biologic, dupilumab therapy markedly improves skin lesions and itch in older patients with AD, with a rapid response and non-serious adverse effects. Nevertheless, injection pain, expensive medical care, and regular follow-up every 2 weeks are disadvantages of dupilumab therapy. Therefore, clinicians must prioritize individualized treatment options that will reduce the burden of disease for cases of elderly AD.
Collapse
|
19
|
Quality of Life and Disease Impact of Atopic Dermatitis and Psoriasis on Children and Their Families. CHILDREN-BASEL 2019; 6:children6120133. [PMID: 31810362 PMCID: PMC6955769 DOI: 10.3390/children6120133] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/08/2019] [Accepted: 11/25/2019] [Indexed: 12/11/2022]
Abstract
Atopic dermatitis (AD) and psoriasis are common chronic skin diseases affecting children. These disorders negatively impact the quality of life (QoL) of patients in health-related aspects such as physical, psychosocial, and mental functioning. This health impact is more accurately represented when accounting for the numerous comorbidities associated with each disorder, and the impact the disorders have on patients’ families. A number of QoL tools have been developed and can be routinely implemented in the evaluation of QoL in pediatric patients and their caregivers. Ways to improve QoL include a multidisciplinary approach to care, education, and psychological support.
Collapse
|
20
|
Evaluation of a Novel Educational Tool in Adolescents With Inflammatory Bowel Disease: The NEAT Study. J Pediatr Gastroenterol Nutr 2019; 69:564-569. [PMID: 31261247 PMCID: PMC8024984 DOI: 10.1097/mpg.0000000000002431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Among adolescents with inflammatory bowel disease (IBD), nonadherence rates are 50 to 88% across medications. Improving education in adults with IBD has been shown to improve coping and adherence to treatment in adults with IBD. Therapeutic patient education (TPE) has been used in patients with chronic diseases to train patients in skills to support treatment adaptation and condition management. This study tested the feasibility and preliminary efficacy of a novel TPE intervention in adolescents with IBD. METHODS In this pilot, mixed-methods study, we evaluated the feasibility and preliminary efficacy of TPE with the IBD Pocket Guide on medication adherence, IBD knowledge, and transition readiness in adolescents ages 11 to 18 years. Medication adherence was monitored using a MedMinder Pill Dispensing system. Participants who were <90% adherent during a 4-week pre-intervention monitoring period were randomized to either a usual care group or an educational intervention (EI) group. Participants were followed for an additional 4 weeks after intervention. RESULTS Trends were found in the EI group indicating improved medication adherence and IBD knowledge compared with the usual care group, though differences between groups did not reach statistical significance. Qualitative data showed that participants perceived that they had improved knowledge after the educational intervention. CONCLUSIONS Therapeutic patient education may be beneficial for improving patient medication adherence and IBD knowledge. Future directions include testing the effects of the intervention with a larger sample.
Collapse
|
21
|
Tauber M, Lourari S, Bérard E, Questel E, Redoules D, Giordano-Labadie F, Simon M, Carle P. Positive change in hand care habits using therapeutic patient education in chronic hand eczema. Contact Dermatitis 2019; 82:10-17. [PMID: 31461531 DOI: 10.1111/cod.13390] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 08/23/2019] [Accepted: 08/27/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chronic hand eczema (CHE) is a major burden for patients. Maintenance treatment involves prevention measures limiting detrimental behaviour and aggravating factors. OBJECTIVE To evaluate the effect of a standardised care program including therapeutic patient education (TPE) on hand care behaviours, clinical severity, quality of life, and work productivity. METHODS A single-centre study was conducted prospectively. Together with the prescription of a topical steroid, patients participated in individual TPE sessions. Evaluations were performed initially and repeated three months after the therapeutic intervention. They included a structured analysis of hand care behaviours, the assessment of the mTLSS (modified Total Lesion Symptom Score), DLQI (Dermatology Life Quality Index), and WPAI (Work Productivity and Activity Impairment). RESULTS Seventy-one patients were included (30 men, 42.3%). Three months after completion of the standardised care program, hand care behaviours such as hand washing and rinsing, hand drying, wearing protective gloves, using moisturizing creams, and following specific treatments and recommendations for CHE improved significantly in the 58 patients who completed the study and were associated with a significant improvement in the mTLSS, DLQI, and WPAI scores. CONCLUSIONS TPE helps patients change their hand care behaviours and adopt skin protection measures, and may improve CHE severity, quality of life, and work productivity.
Collapse
Affiliation(s)
- Marie Tauber
- Dermatology and Allergology Department, Larrey Hospital, Toulouse University, Toulouse, France.,UDEAR, U1056 INSERM, Paul Sabatier Toulouse University, Toulouse, France
| | - Siham Lourari
- Dermatology and Allergology Department, Larrey Hospital, Toulouse University, Toulouse, France
| | - Emilie Bérard
- Department of Epidemiology, Health Economics and Public Health, UMR1027 INSERM- Toulouse University, Toulouse University Hospital (CHU), Toulouse, France
| | | | | | | | - Michel Simon
- UDEAR, U1056 INSERM, Paul Sabatier Toulouse University, Toulouse, France
| | - Paul Carle
- Dermatology and Allergology Department, Larrey Hospital, Toulouse University, Toulouse, France.,UDEAR, U1056 INSERM, Paul Sabatier Toulouse University, Toulouse, France
| | | |
Collapse
|
22
|
Simon D, Wollenberg A, Renz H, Simon HU. Atopic Dermatitis: Collegium Internationale Allergologicum (CIA) Update 2019. Int Arch Allergy Immunol 2019; 178:207-218. [DOI: 10.1159/000497383] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 01/30/2019] [Indexed: 11/19/2022] Open
|
23
|
Takaoka R, Coelho E. Patient Education in Atopic Dermatitis: Why It Is Needed and How to Improve It. CURRENT DERMATOLOGY REPORTS 2018. [DOI: 10.1007/s13671-018-0241-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
|
24
|
Liang Y, Tian J, Shen CP, Xu F, Wang H, Li P, Guo YP, Wei FL, Ma L. Therapeutic patient education in children with moderate to severe atopic dermatitis: A multicenter randomized controlled trial in China. Pediatr Dermatol 2018; 35:70-75. [PMID: 29243849 DOI: 10.1111/pde.13362] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Therapeutic patient education is a continuous, systematic, patient-centered learning process to help patients and their families acquire and maintain the skills they need to manage their lives with a chronic disease. It has been proven effective in increasing treatment adherence and improving quality of life for patients with atopic dermatitis (AD) in Western countries. We introduce the first multicenter, randomized controlled clinical trial of therapeutic patient education in Chinese children with AD. OBJECTIVES To evaluate the effects of therapeutic patient education on the severity of AD, quality of life, and understanding and successful use of emollients in Chinese children with eczema. METHODS We recruited 580 children, ages 2-14 years, with moderate to severe AD from six hospitals in China. Participants were randomized (1:1) to an intervention (n = 293) or control (n = 249) group. In addition to the severity of AD, data on quality of life and a questionnaire on family and patient knowledge of emollients were evaluated at the 6-month follow-up. RESULTS On study completion, we found that the intervention group showed a significantly greater reduction in mean SCORing Atopic Dermatitis (P < .001) and Infant's Dermatology Life Quality Index (P = .030) scores than the control group. In addition, knowledge about the use of emollients improved significantly in the intervention group. There was no significant difference between groups in Children's Dermatology Life Quality Index scores. CONCLUSIONS The first randomized controlled trial of a therapeutic patient education program in China had positive long-term effects on decreasing eczema severity and improvement of quality of life in children 2-4 years of age with AD, as well as in promoting greater understanding of the use of emollients.
Collapse
Affiliation(s)
- Yuan Liang
- Department of Dermatology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Jing Tian
- Department of Dermatology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Chun Ping Shen
- Department of Dermatology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Feng Xu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Hua Wang
- Department of Dermatology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Ping Li
- Department of Dermatology, Shenzhen Children's Hospital, Shenzhen, China
| | - Yan Ping Guo
- Department of Dermatology, Harbin Children's Hospital, Harbin, China
| | - Feng Lei Wei
- Department of Dermatology, Dalian Children's Hospital of Dalian Medical University, Dalian, China
| | - Lin Ma
- Department of Dermatology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| |
Collapse
|
25
|
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.
Collapse
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
| | | |
Collapse
|
26
|
LeBovidge JS, Elverson W, Timmons KG, Hawryluk EB, Rea C, Lee M, Schneider LC. Multidisciplinary interventions in the management of atopic dermatitis. J Allergy Clin Immunol 2017; 138:325-34. [PMID: 27497275 DOI: 10.1016/j.jaci.2016.04.003] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 04/13/2016] [Accepted: 04/14/2016] [Indexed: 12/30/2022]
Abstract
Atopic dermatitis (AD) is the most common pediatric skin disease. AD has a significant effect on patient and family quality of life caused by intense pruritus, sleep disruption, dietary and nutritional concerns, and psychological stress associated with the disease and its management. Multidisciplinary approaches to AD care have been developed in appreciation of the complex interplay among biological, psychological, behavioral, and dietary factors that affect disease control and the wide range of knowledge, skills, and support that patients and families require to effectively manage and cope with this condition. Common components of multidisciplinary treatment approaches include medical evaluation and management by an AD specialist, education and nursing care, psychological and behavioral support, and nutritional assessment and guidance. Models of care include both clinical programs and structured educational groups provided as adjuncts to standard clinical care. Available evidence suggests beneficial effects of multidisciplinary interventions in improving disease severity and quality of life, particularly for patients with moderate-to-severe disease. Additional research is needed to identify the best candidates for the various multidisciplinary approaches and evaluate the cost-effectiveness of these programs.
Collapse
Affiliation(s)
- Jennifer S LeBovidge
- Allergy Program, Division of Immunology, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
| | - Wendy Elverson
- Center for Nutrition, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Mass
| | - Karol G Timmons
- Allergy Program, Division of Immunology, Boston Children's Hospital, Boston, Mass
| | - Elena B Hawryluk
- Harvard Medical School, Boston, Mass; Dermatology Program, Division of Immunology, Boston Children's Hospital, Boston, Mass; Department of Dermatology, Massachusetts General Hospital, Boston, Mass
| | - Corinna Rea
- Harvard Medical School, Boston, Mass; Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Mass
| | - Margaret Lee
- Dermatology Program, Division of Immunology, Boston Children's Hospital, Boston, Mass; Department of Dermatology, Boston University School of Medicine, Boston, Mass
| | - Lynda C Schneider
- Allergy Program, Division of Immunology, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| |
Collapse
|
27
|
Psychological and Educational Interventions for Atopic Dermatitis in Adults: A Systematic Review and Meta-Analysis. BEHAVIOUR CHANGE 2017. [DOI: 10.1017/bec.2017.4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Psychological and educational interventions are valuable adjuncts in the management of adult atopic dermatitis. We performed a systematic review and meta-analysis of randomised controlled trials (RCTs) of the efficacy of these interventions. Twelve articles published between 1986 and 2013 were identified through electronic searches. The methodological quality was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions, version 5.1.1 (Higgins & Green, 2015). A random-effects model was used to estimate the standardised mean difference (SMD). No significant difference was found in eczema severity determined in three RCTs (124 participants; SMD, -0.29; 95% CI [-0.64, 0.07]) and dropout rate in five RCTs (198 participants; relative risk, 0.66; 95% CI [0.20, 2.17]). Education via online video was significantly superior to handouts in ameliorating eczema severity in one RCT (80 participants). We conclude that, rather than a combination of these interventions with conventional therapy being of no value, the data did not have sufficient power to provide evidence-based conclusions.
Collapse
|
28
|
Tanei R, Hasegawa Y. Atopic dermatitis in older adults: A viewpoint from geriatric dermatology. Geriatr Gerontol Int 2016; 16 Suppl 1:75-86. [DOI: 10.1111/ggi.12771] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Ryoji Tanei
- Department of Dermatology; Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology; Itabashi Tokyo Japan
| | - Yasuko Hasegawa
- Department of Geriatric Pathology; Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology; Itabashi Tokyo Japan
| |
Collapse
|
29
|
Le Rhun A, Wastiaux HA, Moret L, Misery L, Danou N, Aujoulat I, Lagger G, Barbarot S. Fears regarding the use of topical corticosteroids in atopic dermatitis: looking at the coping strategies and the role of health care providers. A qualitative study. ACTA ACUST UNITED AC 2015. [DOI: 10.1051/tpe/2015011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
30
|
Spielman SC, LeBovidge JS, Timmons KG, Schneider LC. A Review of Multidisciplinary Interventions in Atopic Dermatitis. J Clin Med 2015; 4:1156-70. [PMID: 26239470 PMCID: PMC4470222 DOI: 10.3390/jcm4051156] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 05/07/2015] [Indexed: 01/28/2023] Open
Abstract
Multidisciplinary interventions have been developed for patients with atopic dermatitis (AD) and their families, with the aim of improving outcomes such as disease control, adherence, and quality of life. We reviewed the content of different multidisciplinary approaches to intervention for AD and evidence for their impact on key outcome measures. We also provided data from our multidisciplinary outpatient program for pediatric AD. Studies included in the review suggest benefits of multidisciplinary interventions as models of treatment or adjuncts to standard medical care, with a positive impact on outcomes including disease severity and itching/scratching. There were limitations to existing studies, including heterogeneous methods used to assess quality of life outcomes across studies and lack of controlled studies assessing the outcome of clinical care programs. Further research will be useful in assessing the impact of multidisciplinary interventions on important outcomes such as treatment adherence and sleep, identifying the elements of multidisciplinary interventions that are most critical for improved outcomes, and identifying the best candidates for multidisciplinary intervention approaches.
Collapse
Affiliation(s)
- Sara C Spielman
- Division of Immunology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA.
| | - Jennifer S LeBovidge
- Division of Immunology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA.
- Harvard Medical School, Boston, MA 02115, USA.
| | - Karol G Timmons
- Division of Immunology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA.
| | - Lynda C Schneider
- Division of Immunology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA.
- Harvard Medical School, Boston, MA 02115, USA.
| |
Collapse
|
31
|
Tanei R. Clinical Characteristics, Treatments, and Prognosis of Atopic Eczema in the Elderly. J Clin Med 2015; 4:979-97. [PMID: 26239460 PMCID: PMC4470211 DOI: 10.3390/jcm4050979] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 04/19/2015] [Accepted: 05/07/2015] [Indexed: 12/28/2022] Open
Abstract
Atopic eczema (AE) in the elderly is gradually increasing and has been added to the classification of AE in recent years. This investigation retrospectively analyzed 60 patients with elderly AE. Among the clinical characteristics, a male predominance, existence of several patterns of onset and clinical course, and associations with immunoglobulin (Ig)E-allergic-status and asthmatic complication were observed. The highest positive-rate and positive-score for serum-specific IgE against Dermatophagoides farinae were 83.8% and 2.65 in patients with IgE-allergic AE, and a lower incidence of lichenified eczema in the elbow and knee folds were observed. In terms of treatments and outcomes, clinical improvement and clinical remission were observed in 80.8% and 36.5% of cases, respectively, using standard treatments and combined therapy with oral corticosteroid in severe cases. As for complications and final prognosis, most elderly AE patients reached the end of life with AE, but patients with IgE-allergic AE showed significantly lower incidences of complications of malignancy and death from malignancy. These results indicate that AE in the elderly represents a new subgroup of AE with specific features.
Collapse
Affiliation(s)
- Ryoji Tanei
- Departments of Dermatology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, 35-2 Sakaecho, Itabashi, Tokyo 173-0015, Japan.
| |
Collapse
|
32
|
Senra MS, Wollenberg A. Psychodermatological aspects of atopic dermatitis. Br J Dermatol 2015; 170 Suppl 1:38-43. [PMID: 24930567 DOI: 10.1111/bjd.13084] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2014] [Indexed: 11/30/2022]
Abstract
Psychodermatology is an evolving area of science that focuses on the interaction between the mind, skin and body. It is known that various neuroendocrine mediators - including adrenocorticotropin, β-endorphin, catecholamines and cortisol - are produced in response to stress. The resulting increase in endogenous glucocorticoids can disrupt the skin's barrier function, leaving it vulnerable to inflammatory disorders like atopic dermatitis (AD). In turn, AD is associated with high levels of stigmatization, social withdrawal, anxiety and depression among patients and their carers. It is well known that the stress caused by AD can make the symptoms of the disease worse. Therefore, the goal of psychodermatological treatment is not only to improve the condition of the skin, but also to teach patients/carers how to cope with the disease. This requires a multifaceted approach, and time and patience, to ascertain the needs of individual patients. A multidisciplinary team that includes a dermatologist, psychiatrist and psychologist will be necessary to deliver high-quality, tailored care to patients.
Collapse
Affiliation(s)
- M S Senra
- Department of Dermatology, Ipanema Hospital, Rio de Janeiro, Brazil
| | | |
Collapse
|
33
|
Proactive Therapy and Emollient Therapy in Atopic Dermatitis. CURRENT TREATMENT OPTIONS IN ALLERGY 2014. [DOI: 10.1007/s40521-014-0036-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|