Adherence in Atopic Dermatitis.

Atopic dermatitis is a chronic dermatologic condition requiring extended treatment times with topical application of medications. While atopic dermatitis treatments can be highly effective when used as directed, oftentimes patients do not respond as expected, raising concern for nonadherence versus nonresponse. This chapter aims to describe what is currently known about adherence in atopic dermatitis and to discuss strategies to improve adherence in order to improve treatment outcomes. Whether intentional or unintentional, nonadherence to treatment can limit patient outcomes of this disease for a variety of reasons. These include frustration with medication efficacy, inconvenience, and fear of side effects. Other factors include forgetfulness, financial burden of treatment, lack of trust in the physician, dislike of prescribed medication, or lack of understanding of disease or treatment. Several interventions have been studied with the aim of improving adherence in atopic dermatitis-such as educational workshops for patients and caregivers, earlier follow-up visits, and text messages reminders-however, these are often limited by sample size and power. Further research is needed to study both specific patterns of nonadherence in atopic dermatitis, as well as methods to improve them.

What's new in atopic eczema? An analysis of systematic reviews published in 2017. Part 1: treatment and prevention.

This review forms part of a series of annual updates that summarize the evidence base for atopic eczema (AE). It provides a summary of key findings from 25 systematic reviews that were published or indexed during 2017, and focuses on the treatment and prevention of AE. There is high-quality evidence to demonstrate that dupilumab is better than placebo for the treatment of AE, is not associated with a higher incidence of adverse effects and does not increase the risk of infection compared with placebo; however, comparison studies with other systemic treatments are necessary. Topical tofacitinib is a promising treatment for mild-moderate AE, but currently lacks sufficient evidence from well-designed randomized controlled trials (RCTs) comparing with other active treatments. Topical doxepin may be effective for pruritus in AE, but available studies have short follow-up periods and longer-term outcomes are needed. Bleach baths were no more effective than water baths alone at reducing AE severity. Topical antibiotics cannot be recommended for infected AE, owing to insufficient evidence of benefit. There is little comparison of different emollients in RCTs, but overall evidence indicates that they reduce AE severity, are steroid-sparing and lead to better outcomes in combination with topical corticosteroids (TCS) than TCS alone. No clear benefit was demonstrated for vitamin D/C/E supplementation in pregnancy for eczema prevention.

Patient education programs for childhood atopic dermatitis: who is interested?

BACKGROUND: Atopic dermatitis (AD) is a skin disease which causes psychological distress to patients and their families. Patient education programs for childhood AD have positive effects on the severity of the skin disease as well as on psychological variables. So far it has not been determined whether particular patient characteristics lead to being interested in patient education programs. The aim of this cross-sectional study was to identify exploratory predictors of being interested in patient education programs in parents of children with atopic dermatitis. PATIENTS AND METHODS: A severity index (SCORAD) as well as questionnaire data were collected from 73 parents of children with AD to measure satisfaction with medical care, quality of life, coping strategies, and the subjective benefit of former treatments as possible predictors. RESULTS: A regression analysis revealed that besides dissatisfaction with medical care, low social support and high active problem-solving behavior were significant predictors of interest in patient education programs (R(2) = 0.244). CONCLUSIONS: Our study gives a preliminary indication that participation in a patient education program for childhood AD should be offered to parents without sufficient social support, but who would like to gather more information on coping with AD. This could also enhance satisfaction with the medical care provided.

Atopic dermatitis.

Atopic dermatitis (AD) is a common dermatologic disease that can occur at different ages with different clinical manifestations. The etiologic factors and the pathogenetic pathways of AD have been thoroughly investigated but as often happens, something more has to be yet elucidated before the statement, that we possess the overall comprehension of the disease, could be considered the truth. Treatment of AD is often challenging, because of the chronic course of the disease and the fact that even the best of therapies is affected by adverse events, intolerances, or the possible occurrence of contraindications resulting from a sudden change in the overall health status of the patient (e.g., the onset of some comorbidities). Hence, the need to know "how, when, with what, and why" to treat AD patients with the many therapeutic modalities is now in the hands of the dermatologists.

[Co-occurrence of psychiatric and dermatologic disorders. Case studies]. / Wspólwystepowanie zaburzen psychicznych i dermatologicznych. Opisy przypadków.

Cytokine regulation disturbances have a significant role in the pathogenesis of psychiatric disorders, schizophrenia and depression, as well as in dermatologic disorders. Probably it is one of the reasons of the co-occurrence of these two kinds of disorders. Two cases of psychiatric and dermatologic disorders occurring together are presented in this paper. In the first case study depression was associated with atopic dermatitis, in the second case the delusion disorder was described with secondary dermatologic sequellae. In both cases, after psychopharmacotherapy, the improvement of the psychic state was correlated with the relief or regression of skin symptoms.

Involving the patient: impact of inflammatory skin disease and patient-focused care.

Atopic dermatitis (AD) and psoriasis are common chronic inflammatory diseases that are associated with significant psychosocial morbidity and a decrease in health-related quality of life (QOL). To better understand the effects of these two diseases on quality of life, as reported in the literature, a review of all English-language articles from 1970 to 2003 was performed using PubMed. Results from these studies and surveys illustrate the profound negative impact exerted by these conditions and the importance of early and appropriate treatment. These concerns can be incorporated into patient management strategies that focus on a new model for healthcare delivery, "patient-centered care," in which QOL plays an integral role. The impact of AD and psoriasis on physical, social, psychological, and financial aspects of life should not be trivialized and must be considered with the same importance as other chronic conditions. Because psoriasis and AD are chronic conditions that require patient and/or caregiver involvement for optimal management, the concept of patient-centered care with its emphasis on effective two-way communication is particularly important and useful for the clinician.

Atopic eczema: nurse-led care--1. Making the most of the consultation.

Nurses are now increasingly involved in diagnosing, prescribing and initiating treatments for clients with eczema. In the first of a two-part article, a nurse consultant in dermatology focuses on the clinical criteria for deciding whether the client has eczema and advises on how both nurse and client can make optimum use of the consultation. Ways of assessing clients' eczema and its impact on their daily life are discussed. Part 2 of the article, to be published in the next issue of Journal of Family Health Care, will examine treatments for eczema.

Parents' experience of childhood atopic eczema in the public health sector of Gauteng.

BACKGROUND: The World Allergy Organization found that 20% - 30%of the world's population suffers from an allergic disease. Most allergic patients are seen by non-allergy-trained healthcare workers. The public primary healthcare (PHC) management of childhood atopic eczema (CAE) in the central Gauteng district was the focus of the overall study. The focus of this article is the parents' experience of CAE and the management thereof. The research question was: What is the experience of parents living with a child with atopic eczema (AE)? OBJECTIVES: The overall purpose was to develop validated PHC management guidelines for CAE. One of the objectives was to explore and describe the experiences of parents regarding the AE of their children and the management thereof. METHOD: An embedded single case study design using a qualitative, explorative, descriptive and contextual strategy was employed. Data was collected through semi-structured individual interviews from a purposively selected sample and field notes. Ten parents were interviewed, after which data saturation occurred. Data were analysed according to Tesch's steps of descriptive data analysis. Lincoln and Guba's model was used to ensure trustworthiness. RESULTS: Three main themes were identified. This article focuses on theme one: The physical, emotional and social impact of CAE. Theme two identified the management challenges and theme three indicated recommendations regarding the management of CAE. CONCLUSION: The facilitation of management of CAE focuses on developing PHC guidelines and addressing management challenges in order to achieve better controlled CAE.

Case study: enhancing compliance in an adolescent with atopic dermatitis.

Compliance in the adolescent with atopic dermatitis can be a challenge to the dermatology nurse. Compliance can be enhanced through education and followup with the patient, his/her family, school, and other health care professionals.

Gender differences in health-related and family quality of life in young children with atopic dermatitis.

BACKGROUND: Atopic dermatitis (AD) has an established impact on health-related quality of life (HRQoL) and family QoL. OBJECTIVES: This study was designed to investigate gender differences in health-related and family QoL in children with AD. METHODS: Cohorts of 25 girls and 25 boys with AD aged <4years were selected from 102 children with AD. Children in the girls' and boys' groups were individually matched across groups for age and severity of AD according to their scores on the SCORAD Index (SCORing of Atopic Dermatitis). The children's parents filled in the Infants' Dermatitis Quality of Life (IDQoL) Index and the Dermatitis Family Impact (DFI) questionnaires. RESULTS: The impact of AD on QoL (P<0.05) and family QoL (P<0.05) was more severe in girls. The severity of AD as assessed by the parents was equal in both groups. More parents of girls reported that AD impacted on the "child's mood" (P<0.05) and "enjoying family activity" (P<0.05). "Child's mood" and "sleep disturbance" were highly scored by parents of girls (P=0.01 and P<0.05, respectively). Severity of AD as assessed by parents and IDQoL Index scores correlated with SCORAD scores in both groups. Scores on the DFI correlated with patient age in boys. The child's age correlated with the emotional distress of parents in both groups and had an impact on "relationships in the family" in girls only. Several DFI items and overall family QoL correlated with patient age in boys. CONCLUSIONS: The impact of AD on QoL and family QoL was more severe for girls. Relationships between parents progressively worsen with patient age in girls. Reported gender differences should be further investigated and may influence educational programs and advice given to parents of children with AD.

"Scratching" beneath the surface: an integrative psychosocial approach to pediatric pruritus and pain.

Pruritus is prevalent in children with atopic dermatitis and associated with effects on mood, quality of life, sleep, scholastic performance, social and family functioning. In this study a 7-year-old African American female with severe atopic dermatitis, itching and pain refractory to multiple systemic and topical medications was referred for treatment. At baseline, the patient scratched to the point of bleeding, despite maximal doses of anti-histamines, antidepressant and topical therapies. The patient became progressively shy, anxious, and her scholastic performance suffered. A literature review prompted the implementation of a multi-modal program of family cognitive behavioral therapy, imagery, aromatherapy, drawing, and biofeedback. The results were that decreased itch, scratching, pain, and anxiety were seen within the first month. Fewer lesions and episodes of bleeding were observed with almost complete skin clearance by the fourth month. The article concludes that a short-term, integrative program including psychological, complementary and alternative medicine (CAM), and medical therapies may represent a novel, efficacious approach for children suffering from severe atopic dermatitis.

[Atopic dermatitis. Psychosomatic and psychotherapeutic treatment]. / Neurodermitis. Psychosomatische und psychotherapeutische Behandlung.

Patients with chronic relapsing atopic dermatitis often suffer from stress-related exacerbations, exhaustion, depression, anxiety and helplessness. They then may feel they cannot influence the course of their disease, and often develop problems in social interaction. These case reports focus on the different possibilities in addition to classical dermatologic therapy--empathic psychosomatic-orientated conversations, strategies of behavioral medicine and the effect of long-term psychodynamic psychotherapy.

How beneficial is cognitive behaviour therapy in the treatment of atopic dermatitis? A single-case study.

A single-case design was used to examine the benefits of cognitive behaviour therapy (CBT) in the treatment of two patients with atopic dermatitis (AD). Improvements were indicated for both cases in global outcome measures, with reductions in anxiety, depression and stigmatization beliefs and improvements in quality of life. Self-rated AD severity remained relatively stable across treatment time. For both cases, treatment gains were particularly evident in terms of reducing avoidance behaviours. The findings were discussed in relation to the need for CBT as an adjunct treatment for patients with AD and its potential role in improving psychological functioning.

[Psychosomatic criteria in the treatment of atopic neurodermatitis]. / Psychosomatische Kriterien bei der Behandlung der Neurodermitis atopica.

We report on psychosomatic aspects regarding out-patient and hospital treatment of atopic dermatitis, including information concerning the disease, motivation for psychotherapeutic forms of treatment (relaxation, diagnostic and therapeutic conversation), as well as psychosomatic indicators for the discharge from hospital.

Management of atopic eczema in the community.

Eczema tends to be over-shadowed by asthma. Professionals often regard it as a simple skin problem which will go away. But eczema can persist for many years, and be a considerable source of distress and difficulty for both the affected child and its parents. Ann Bridgman describes ways to lessen its impact, including the wet-wrap technique.