A Multidisciplinary Approach to Evaluation and Treatment of Atopic Dermatitis

Boguniewicz, Mark; Nicol, Noreen Heer; Kelsay, Kim; Leung, Donald Y.M.

doi:10.1016/j.sder.2008.05.001

Cited by 68 publications

(45 citation statements)

References 49 publications

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“…But because no trials have been conducted and no control groups were included in the observational studies, there is no reliable data on which elements of alpine climate treatment are responsible for the observed effect. Multidisciplinary evaluation and treatment in a regular outpatient setting for several days also shows reduction of disease activity, corticosteroid use, and improved quality of life up to 2 years after the described treatment program (31,64). This suggests that apart from the climate, other elements may be important during alpine climate therapy, for example the multidisciplinary approach or the increased adherence to treatment.…”

Section: Risk Of Biasmentioning

confidence: 84%

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Alpine climate treatment of atopic dermatitis: a systematic review

Fieten

Weststrate

Zuuren

et al. 2014

Allergy

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Climate therapy has been used for decades in the treatment of atopic dermatitis (AD), but evidence of its effectiveness has not yet been assessed systematically. A systematic literature search in Medline, Embase, and the Cochrane library was performed to identify all original studies concerning alpine climate treatment. The risk of bias of individual studies was assessed following the Cochrane Handbook, and level of evidence was rated using GRADE guidelines. Fifteen observational studies were included concerning 40 148 patients. Four studies concerning 2670 patients presented follow-up data over a period of 1 year. Disease activity decreased in the majority of patients during treatment (96% of n = 39 006) and 12-month follow-up (64% of n = 2670). Topical corticosteroid use could often be reduced or stopped during treatment (82% of n = 1178) and during 12-month follow-up (72% of n = 3008). Quality assessment showed serious study limitations, therefore resulting in a very low level of evidence for the described outcomes. Randomized controlled trials designed with a follow-up period including welldefined patient populations, detailed description and measurement of applied interventions during climate therapy and using validated outcomes including costeffectiveness parameters, are required to improve the evidence for alpine climate therapy as an effective treatment for patients with AD.Atopic dermatitis (AD) is a chronic, inflammatory skin disease characterized by subsequent exacerbations and remissions (1). Its prevalence is increasing worldwide, and AD is currently among the most common skin diseases in children (2). Itching, disturbed sleep, and time-consuming medical treatment regimens lead to a reduced experienced quality of life in patients with AD (3, 4).AD is a complex disease with several genetic and environmental factors involved (5). A genetic predisposition leads to an atopic constitution and a disturbed immune response which results in chronic inflammation and an impaired skin barrier (6, 7). In several eczema birth cohorts, the association between AD and the subsequent development of asthma and allergic sensitization has been established (8, 9). Prevalence of allergic sensitization in children with AD varies between countries, ranging from 52% in Belgium to 83% in Australia (8). Around 30% of children diagnosed with AD will develop asthma later in life (10). Among adults with AD, there is also great variation in prevalence of allergic sensitization and asthma diagnosis (11).Exposure to irritants and allergens, changes in physical environment (pollution, humidity), infections, and psychosocial or emotional factors are possible triggers for exacerbations (12). AD treatment is based on control of inflammation/infection, skin hydration, and trigger avoidance (13,14). Treatment approaches include anti-inflammatory therapy with topical immunosuppressives (dermatocorticosteroids, calcineurin inhibitors) and antimicrobial treatment, according to current guidelines (13,14). In more severe cases, phototh...

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Section: Risk Of Biasmentioning

confidence: 84%

“…Limited healthcare resources and further advances in evidence-based medicine have put the existence of specialized high-altitude clinics under pressure. It is important to quantify the direct and long-term effects of climate treatment, as significant improvement in AD severity is also observed after clinical treatment in unspecified climate zones (31).…”

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confidence: 99%

Alpine climate treatment of atopic dermatitis: a systematic review

Fieten

Weststrate

Zuuren

et al. 2014

Allergy

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“…Skin hydration monitoring is a well-established and important technique in dermatology, for analyzing various diseases and determining the effectiveness of medical therapies [1][2][3][4]. Hydration measurement is also useful in cosmetology, for assessing the function of anti-aging and moisturization treatments [5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Epidermal Differential Impedance Sensor for Conformal Skin Hydration Monitoring

et al. 2012

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We present the design and use of an ultrathin, stretchable sensor system capable of conformal lamination onto the skin, for precision measurement and spatial mapping of levels of hydration. This device, which we refer to as a class of ‘epidermal electronics’ due to its ‘skin-like’ construction and mode of intimate integration with the body, contains miniaturized arrays of impedance-measurement electrodes arranged in a differential configuration to compensate for common-mode disturbances. Experimental results obtained with different frequencies and sensor geometries demonstrate excellent precision and accuracy, as benchmarked against conventional, commercial devices. The reversible, non-invasive soft contact of this device with the skin makes its operation appealing for applications ranging from skin care, to athletic monitoring to health/wellness assessment.

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“…Dry skin management includes basic proper daily skin care including appropriate bathing and use of cleansers and emollients [ 7,22 ] . If educational approaches are to be effective in managing dry skin in children, especially if of a chronic nature, then attention needs to be given to the parent's and child's knowledge and behaviour.…”

Section: Introductionmentioning

confidence: 99%