Extended implementation of educational programs for atopic dermatitis in childhood

Abstract

Children with atopic dermatitis (AD) suffer from chronic relapsing inflammatory skin lesions accompanied by insatiable itching, dryness, excoriated skin, or even (super-)infections. This burden impairs the quality of life of affected children and their families. Due particularly to the recurrent course of the disease, patients often lose confidence in treatment and fear side effects of steroids. Family education programs for AD have been established in the last decades to provide appropriate education and psychosocial support. However, the need for long-lasting strategies in treatment and prevention has even increased. Recent findings not only underline the importance of an intact skin barrier in regard to acute therapy but also suggest that an impairment of skin barrier integrity promotes the development of subsequent atopic diseases in the course of the atopic march. Moreover, in addition to the psychosocial burden due to stigmatized appearance or sleep disturbance, new observations document an increased presence of psychosomatic comorbidities in patients with AD. We reviewed recent educational interventions regarding the theoretical background and here will discuss the heterogeneous approaches of existing programs in childhood. Despite high variations of educational strategies, an overriding aim should be the broader integration of supporting programs in the treatment of children with AD to empower the affected child and its caregiver's to obtain the best possible care, quality of life, and to promote (secondary) prevention.

Editorial comments on this issue of the Journal

“…The educational program—which aimed to empower the patient in a primary care setting—proved to be beneficial for drug prescription and the early recognition of exacerbated symptoms of asthma, amongst other things. This article confirms earlier reports in PAI which assessed the effectiveness of education in asthma and other related diseases such as atopic dermatitis and food allergy …”

“…This article confirms earlier reports in PAI which assessed the effectiveness of education in asthma 5 and other related diseases such as atopic dermatitis and food allergy. 6,7 Obesity as a risk factor and how it influences allergic diseases such as asthma has been shown earlier in PAI, 8,9 in particular how it affects hospital re-admission and length of stay. 10 Liu et al 11 have in this issue investigated a possible link between incidence and severity of allergic rhinitis and obesity, a closely related problem.…”

Atopic dermatitis characteristics and medication-use patterns in school-age children with AD and asthma symptoms

“…TCS potency was not correlated with AD severity or QoL, whereas the number of different therapies and the total number of prescriptions were correlated, thus these last two parameters might serve as a measure for AD severity and AD‐related QoL. In addition, it seems that children with multiple atopic disorders experience AD as more impairing, thus interventions specifically targeted at this group might empower these children and improve QoL …”

“…In addition, it seems that children with multiple atopic disorders experience AD as more impairing, thus interventions specifically targeted at this group might empower these children and improve QoL. 25 What's already known about this topic?…”

Treatment of allergic children – Where is the progress (for the practicing allergist)?

“…Besides therapeutics and preventive measures, much attention is gathered around family educational programs for AD. Ahrens et al (27). reviewed existing educational strategies and concluded that there is enough evidence to integrate appropriate programs routinely into the treatment of AD children that will ultimately empower the affected child and its caregivers to obtain best possible care, prevention, and quality of life.…”