Improvement of pruritus and quality of life of children with atopic dermatitis and their families after joining support groups

Weber, Magda Blessmann; Neto, Paulo de Tarso da Luz Fontes; Prati, Clarissa; Soirefman, M; Mazzotti, Nicolle Gollo; Barzenski, Bruna; Cestari, T F

doi:10.1111/j.1468-3083.2008.02697.x

Cited by 78 publications

(35 citation statements)

References 47 publications

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“…The most interesting result from the only trial 359 to have looked at the role of support groups in eczema is that quality of life and effect of itching on mood of the children with eczema significantly improved whereas impact of eczema on the whole family did not. The children participated in their own separate group session with only their peers and the support group co-ordinators.…”

Section: Overall Implications For Research and Practicementioning

confidence: 85%

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Scoping systematic review of treatments for eczema

Nankervis

Kim

Delamere

et al. 2016

Programme Grants Appl Res

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BackgroundEczema is a very common chronic inflammatory skin condition.ObjectivesTo update the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) systematic review of treatments for atopic eczema, published in 2000, and to inform health-care professionals, commissioners and patients about key treatment developments and research gaps.Data sourcesElectronic databases including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Skin Group Specialised Register, Latin American and Caribbean Health Sciences Literature (LILACS), Allied and Complementary Medicine Database (AMED) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched from the end of 2000 to 31 August 2013. Retrieved articles were used to identify further randomised controlled trials (RCTs).Review methodsStudies were filtered according to inclusion criteria and agreed by consensus in cases of uncertainty. Abstracts were excluded and non-English-language papers were screened by international colleagues and data were extracted. Only RCTs of treatments for eczema were included, as other forms of evidence are associated with higher risks of bias. Inclusion criteria for studies included availability of data relevant to the therapeutic management of eczema; mention of randomisation; comparison of two or more treatments; and prospective data collection. Participants of all ages were included. Eczema diagnosis was determined by a clinician or according to published diagnostic criteria. The risk of bias was assessed using the Cochrane Collaboration risk-of-bias tool. We used a standardised approach to summarising the data and the assessment of risk of bias and we made a clear distinction between what the studies found and our own interpretation of study findings.ResultsOf 7198 references screened, 287 new trials were identified spanning 92 treatments. Trial reporting was generally poor (randomisation method: 2% high, 36% low, 62% unclear risk of bias; allocation concealment: 3% high, 15% low, 82% unclear risk of bias; blinding of the intervention: 15% high, 28% low, 57% unclear risk of bias). Only 22 (8%) trials were considered to be at low risk of bias for all three criteria. There was reasonable evidence of benefit for the topical medications tacrolimus, pimecrolimus and various corticosteroids (with tacrolimus superior to pimecrolimus and corticosteroids) for both treatment and flare prevention; oral ciclosporin; oral azathioprine; narrow band ultraviolet B (UVB) light; Atopiclair™ and education. There was reasonable evidence to suggest no clinically useful benefit for twice-daily compared with once-daily topical corticosteroids; corticosteroids containing antibiotics for non-infected eczema; probiotics; evening primrose and borage oil; ion-exchange water softeners; protease inhibitor SRD441 (Serentis Ltd); furfuryl palmitate in emollient; cipamfylline cream; andMycobacterium vaccaevaccine. Additional research evidence is needed for emollients, bath additives, antibacterials, specialist clothing and complementary and alternative therapies. There was no RCT evidence for topical corticosteroid dilution, impregnated bandages, soap avoidance, bathing frequency or allergy testing.LimitationsThe large scope of the review coupled with the heterogeneity of outcomes precluded formal meta-analyses. Our conclusions are still limited by a profusion of small, poorly reported studies.ConclusionsAlthough the evidence base of RCTs has increased considerably since the last NIHR HTA systematic review, the field is still severely hampered by poor design and reporting problems including failure to register trials and declare primary outcomes, small sample size, short follow-up duration and poor reporting of risk of bias. Key areas for further research identified by the review include the optimum use of emollients, bathing frequency, wash products, allergy testing and antiseptic treatments. Perhaps the greatest benefit identified is the use of twice weekly anti-inflammatory treatment to maintain disease remission. More studies need to be conducted in a primary care setting where most people with eczema are seen in the UK. Future studies need to use the same core set of outcomes that capture patient symptoms, clinical signs, quality of life and the chronic nature of the disease.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Section: Overall Implications For Research and Practicementioning

confidence: 85%

“…This small, poorly reported trial 359 compared participants attending fortnightly 90-minute support group sessions (over a 6-month period) with a control group. The trial randomised 36 families with a child aged between 2 and 16 years with moderate to severe eczema.…”

Section: Studiesmentioning

confidence: 99%

Scoping systematic review of treatments for eczema

Nankervis

Kim

Delamere

et al. 2016

Programme Grants Appl Res

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“…Five studies demonstrated a statistically significant improvement in QoL as a result of patient education in patients with chronic skin diseases (p = < 0.004-0.04) (25,27,28,30,34). The remaining five studies found no significant improvement in QoL (26,29,(31)(32)(33).…”

Section: Quality Of Lifementioning

confidence: 94%

“…Patient education focused on children in six studies (27,(29)(30)(31)(32)34), on adults in three (25,28,33), and on both children and adults in one (26). All studies employed a parallel group design.…”

Section: Literature Searchmentioning

confidence: 99%

“…Searching the references used in a systematic review on atopic dermatitis by Errser et al (24) yielded one additional publication (25). Ultimately, our search yielded ten articles that satisfied the inclusion criteria (25)(26)(27)(28)(29)(30)(31)(32)(33)(34). The quality of the methodologies employed in the included studies was assessed using the CONSORT statement, as illustrated in Table L Study description…”

Section: Literature Searchmentioning

confidence: 99%

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Patient Education in Chronic Skin Diseases: A Systematic Review

Bes¹,

Legierse²,

Prinsen³

et al. 2011

Acta Derm Venerol

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The negative impact of skin disease on quality of life (QoL) has been described in many studies. Patient education as an adjunct to treatment, with the aim of improving QoL and reducing disease severity, is a relatively new technique in dermatology. The objective of this article is to analyse and summarise evidence concerning the effects of patient education on QoL and disease severity in patients with chronic skin diseases. All source material was identified through searches in MEDLINE and Embase. The CONSORT statement was used to assess the quality of reported randomised controlled studies. Ten of 254 studies met the inclusion criteria. In five of them, statistically significant improvements in QoL were reported. The severity of skin disease significantly improved in three studies. In conclusion, patient education appears to be effective in improving QoL and in reducing the perceived severity of skin disease.

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Psychological and educational interventions for atopic eczema in children

Ersser

Cowdell

Latter

et al. 2014

Cochrane Database of Systematic Reviews

125

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This update has incorporated five new RCTs using educational interventions as an adjunct to conventional treatment for children with atopic eczema. We did not identify any further studies using psychological interventions. The inclusion of new studies has not substantially altered the conclusions from the original review. The educational studies in both the original review and this update lack detail about intervention design and do not use a complex interventions framework. Few use an explicit theoretical base, and the components of each intervention are not sufficiently well described to allow replication. A relative lack of rigorously designed trials provides limited evidence of the effectiveness of educational and psychological interventions in helping to manage the condition of atopic eczema in children. However, there is some evidence from included paediatric studies using different educational intervention delivery models (multiprofessional eczema interventions and nurse-led clinics) that these may lead to improvements in disease severity and quality of life. Educational and psychological interventions require further development using a complex interventions framework. Comparative evaluation is needed to examine their impact on eczema severity, quality of life, psychological distress, and cost-effectiveness. There is also a need for comparison of educational interventions with stand-alone psychosocial self-help.

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Improvement of pruritus and quality of life of children with atopic dermatitis and their families after joining support groups

Abstract: The improvement on pruritus and QoL showed that atopic dermatitis patients had benefits with the attendance to support groups. We consider that these non-pharmacological approaches can be a very effective accessory tools in the management of recalcitrant forms of the disease.

Cited by 78 publications

References 47 publications

Scoping systematic review of treatments for eczema

Scoping systematic review of treatments for eczema

Patient Education in Chronic Skin Diseases: A Systematic Review

Psychological and educational interventions for atopic eczema in children

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