Background
Atopic dermatitis (eczema), can have a significant impact on well‐being and quality of life for affected people and their families. Standard treatment is avoidance of triggers or irritants and regular application of emollients and topical steroids or calcineurin inhibitors. Thorough physical and psychological assessment is central to good‐quality treatment. Overcoming barriers to provision of holistic treatment in dermatological practice is dependent on evaluation of the efficacy and economics of both psychological and educational interventions in this participant group. This review is based on a previous Cochrane review published in 2014, and now includes adults as well as children.
Objectives
To assess the clinical outcomes of educational and psychological interventions in children and adults with atopic dermatitis (eczema) and to summarise the availability and principal findings of relevant economic evaluations.
Search methods
We searched the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, APA PsycINFO and two trials registers up to March 2023. We checked the reference lists of included studies and related systematic reviews for further references to relevant randomised controlled trials (RCTs) and contacted experts in the field to identify additional studies. We searched NHS Economic Evaluation Database, MEDLINE and Embase for economic evaluations on 8 June 2022.
Selection criteria
Randomised, cluster‐randomised and cross‐over RCTs that assess educational and psychological interventions for treating eczema in children and adults.
Data collection and analysis
We used standard Cochrane methods, with GRADE to assess the certainty of the evidence for each outcome. Primary outcomes were reduction in disease severity, as measured by clinical signs, patient‐reported symptoms and improvement in health‐related quality‐of‐life (HRQoL) measures. Secondary outcomes were improvement in long‐term control of symptoms, improvement in psychological well‐being, improvement in standard treatment concordance and adverse events. We assessed short‐ (up to 16 weeks after treatment) and long‐term time points (more than 16 weeks).
Main results
We included 37 trials (6170 participants). Most trials were conducted in high‐income countries (34/37), in outpatient settings (25/37). We judged three trials to be low risk of bias across all domains. Fifteen trials had a high risk of bias in at least one domain, mostly due to bias in measurement of the outcome. Trials assessed interventions compared to standard care.
Individual educational interventions may reduce short‐term clinical signs (measured by SCORing Atopic Dermatitis (SCORAD); mean difference (MD) −5.70, 95% confidence interval (CI) −9.39 to −2.01; 1 trial, 30 participants; low‐certainty evidence) but patient‐reported symptoms, HRQoL, long‐term eczema control and psy...