Abstract
BackgroundParents and carers of children with eczema often underuse emollient therapy, essential to repairing and protecting the defective skin barrier in atopic eczema. Educational interventions delivered by specialist dermatology nurses in hospital settings have been shown to improve emollient use and reduce symptoms of atopic eczema, but benefits of community-based interventions are uncertain. Support and information about appropriate care may often be inadequate for patients and carers in the community.MethodsA multifaceted educational support programme was evaluated as a method of increasing emollient use and reducing atopic eczema in children. Support provided for parents and carers included an educational DVD, online daily diary and telephone helpline. The before and after study included 136 British children and their parents, providing baseline and 12 week follow-up data while receiving the programme. Measures included emollient use, POEM and PEST scores, and cost of care.ResultsAverage emollient use increased by 87.6 g (95% CI: 81.9 to 119.5 g, p = 0.001) from baseline with the change being immediate and persistent. The POEM score reduced on average by 5.38 (95% CI: 4.36 to 6.41, p = 0.001), a 47% reduction from baseline. Similarly the PEST score reduced on average by 0.61 (95% CI: 0.47 to 0.75, p = 0.001), a 48% reduction from baseline. Sleep disturbance was reduced by 1.27 nights per week (95% CI: 0.85 to 1.68, p = 0.001) and parental feeling of control improved by 1.32 points (95% CI: 1.16 to 1.48, p = 0.001). From the NHS perspective, the programme was cost neutral overall within the study period.ConclusionA community-based multifaceted educational support programme greatly increased emollient use, reducing symptoms of atopic eczema and general practitioner contacts, without increasing cost. Significant benefits may accrue to the families and carers of children with atopic eczema due to improved sleep patterns and greater feeling of control. PEST, a new simple measure of acute and remitting atopic eczema severity designed to help parents and children to monitor and manage eczema, merits further evaluation.
Highlights
Parents and carers of children with eczema often underuse emollient therapy, essential to repairing and protecting the defective skin barrier in atopic eczema
Atopic eczema in children is unpredictable in its course and may have a profound impact on the quality of life [1,2,3] of patients and their family, as well as being time-consuming for healthcare professionals to manage
To investigate the effectiveness of a multifaceted educational support programme to increase emollient use and reduce atopic eczema symptoms in children
Summary
Parents and carers of children with eczema often underuse emollient therapy, essential to repairing and protecting the defective skin barrier in atopic eczema. Educational interventions delivered by specialist dermatology nurses in hospital settings have been shown to improve emollient use and reduce symptoms of atopic eczema, but benefits of community-based interventions are uncertain. Atopic eczema (synonym atopic dermatitis) in children is unpredictable in its course and may have a profound impact on the quality of life [1,2,3] of patients and their family, as well as being time-consuming for healthcare professionals to manage. A six-week education programme for the management of moderate to severe atopic eczema was evaluated, with dermatological, nutritional and psychological facets; it was delivered as a two hour, once-weekly session by a multi-professional team. Improvement in the severity of atopic eczema (SCORAD) in children who received the education programme was significantly greater than in the control group. There were significant improvements in subjective assessments of severity, itching behaviour and emotional coping in the group receiving education compared to control
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