Age related, structured educational programmes for the management of atopic dermatitis in children and adolescents: multicentre, randomised controlled trial

Staab, Doris; Diepgen, Thomas L.; Fartasch, Manigé; Kupfer, Jörg; Lob-Corzilius, Thomas; Ring, Johannes; Scheewe, S.; Scheidt, Reginald; Schmid-Ott, ­Gerhard; Schnopp, Christina; Szczepanski, R.; Werfel, Thomas; Wittenmeier, Marita; Wahn, Ulrich; Gieler, Uwe

doi:10.1136/bmj.332.7547.933

Cited by 386 publications

(470 citation statements)

References 23 publications

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“…27 Patients whose parents receive comprehensive education regarding AD and its care have better improvement in AD severity than patients whose parents do not receive this education. 33 Written action plans have been shown to improve adherence in children with asthma, and a similar model for patients with AD (see Fig 1 for an example), outlining specific indications for different products and medications, is likely to be helpful. 34,35 Maintenance Skin Care…”

Section: Treatment Principlesmentioning

confidence: 99%

Atopic Dermatitis: Skin-Directed Management

Tollefson¹,

Bruckner²,

Dermatology³

2014

Pediatrics

108

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Atopic dermatitis is a common inflammatory skin condition characterized by relapsing eczematous lesions in a typical distribution. It can be frustrating for pediatric patients, parents, and health care providers alike. The pediatrician will treat the majority of children with atopic dermatitis as many patients will not have access to a pediatric medical subspecialist, such as a pediatric dermatologist or pediatric allergist. This report provides up-to-date information regarding the disease and its impact, pathogenesis, treatment options, and potential complications. The goal of this report is to assist pediatricians with accurate and useful information that will improve the care of patients with atopic dermatitis. Pediatrics 2014;134:e1735-e1744Atopic dermatitis (AD), commonly referred to as eczema, is a chronic, relapsing, and often intensely pruritic inflammatory disorder of the skin. A recent epidemiologic study using national data suggested that the pediatric prevalence is at least 10% in most of the United States. 1 AD primarily affects children, and disease onset occurs before the ages of 1 and 5 years in 65% and 85% of affected children, respectively. 1 The number of office visits for children with AD is increasing. 2 Up to 80% of children with AD are diagnosed and managed by primary care providers, often pediatricians. 3 Although medical subspecialists, such as pediatric dermatologists and/or pediatric allergists, may be suited to provide more advanced care for children with AD, lack of a sufficient number of such physicians, particularly pediatric dermatologists, 4 likely means the burden of AD care will continue to fall to primary care providers. Although consensus guidelines and practice parameters regarding the management of AD in children have been published, 5-10 considerable variability persists in clinical practice, particularly regarding the roles that bathing, moisturizing, topical medications, and allergies play in management. Inconsistencies in opinion and treatment approach as well as the chronic and relapsing nature of AD can lead to frustration for the patient, family, and primary care providers when managing AD. STATEMENT OF THE PROBLEMNew data support the theory that AD results from primary abnormalities of the skin barrier, 11 suggesting that skin-directed management of AD is of paramount importance. This clinical report reviews AD and provides an up-to-date approach to skin-directed management that is based on pathogenesis. Effectively using this information to create treatment plans

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Section: Treatment Principlesmentioning

confidence: 99%

Atopic Dermatitis: Skin-Directed Management

Tollefson¹,

Bruckner²,

Dermatology³

2014

Pediatrics

108

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“…In previous studies, interventions including elements of cognitive behavioural therapy were shown to alter itch-related cognitions and/or the itch intensity in patients with chronic itch (24)(25)(26). Furthermore, education programmes for AD children and their parents including a session on itch/scratching caused an increase in functional itch-related cognitions and behaviours (27,28). Even though this study included more females than males and the median itch intensity was rather low in the sample, its findings still underline the relevance of especially cognitive restructuring as a treatment strategy for patients with chronic itch.…”

Section: Discussionmentioning

confidence: 66%

Coping as mediator of the relationship between stress and itch in patients with atopic dermatitis: a regression and mediation analysis

Schut

Weik

Tews

et al. 2014

Experimental Dermatology

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Even though it has been shown that stress and itch are associated in patients with atopic dermatitis (AD), it remains unclear whether this relationship occurs due to certain coping strategies being activated under stress. Therefore, this study investigates the role of coping as possible mediating factor between stress and itch in 31 patients with AD. Coping and itch were assessed by self-reported measures, while stress was measured both by a validated questionnaire and by a physiological stress marker, the postawakening cortisol. Using a regression and a mediation analysis, this study showed a relationship between perceived stress and itch (corrected R 2 = 0.21), which was fully mediated by negative itch-related cognitions. 62.3% of the variance of itch intensity could be explained by negative itchrelated cognitions. This finding helps to explain the positive effects of cognitive restructuring in the treatment of chronic itch.Key words: atopic dermatitis -coping -itch -postawakening cortisolstress Accepted for publication 28 October 2014Background Atopic dermatitis is a chronically relapsing skin disease characterized by pruritus, lichenification at certain body sites and other atopic diseases in the patient or his family (1). In most of the patients, itch occurs daily (2,3). Stress is proposed to have an impact on the itch intensity (4). Some studies have shown a link between stress and the AD severity (e.g. 5-8), but only one study has specifically shown a relationship between itch and stress in this patient group (9).Coping can be defined as adaptable thoughts and behaviours intended to manage subjective demanding experiences (10). Some authors found that depressive mood/social anxiety, negative itchrelated cognitions and catastrophization are associated with itch in patients with chronic itch (11,12), but whether the effect of stress on itch is mediated by this kind of coping remains unclear thus far. Question addressedThis study investigates whether the relationship between stress and itch in patients with AD is mediated by coping. Experimental designThe data were collected in the context of a greater research project on the effects of stress management in AD (13). Thirty one patients with AD came for two appointments. During the first appointment, patients gave their informed written consent and were instructed on how to collect saliva in the morning on two consecutive days. During the second appointment, perceived stress, coping and itch were assessed. This appointment took place on the second day of saliva collection. VariablesThe criterion variable, 'itch intensity', was determined using a visual analogue scale (0-10) in the context of assessing the severity of AD [SCORAD (14)].The predictor variable, 'perceived stress', was measured by the Recovery-Stress Questionnaire [REST-Q; short version (15)]. The stress items of the REST-Q were aggregated to 'overall strain'. Postawakening cortisol as a physiological marker of chronic stress (e.g. 16,17) was assessed as further predictor. Patients colle...

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“…Patient education on their use has a proven additional benefit with 88 regard to both disease severity and quality of life. 4 Sometimes, admitting a patient for a 89 few days for education and intensive topical therapy can be helpful, and also can as a prophylactic measure reduces the risk of disease flares. 5 In young children, 97 occlusive garments (wet wraps) are commonly used as a short-term therapy to reduce 98 more generalised eczematous inflammation and some centres also use them for long-99 term treatment of severe cases.…”

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confidence: 99%