Self-Management is Effective in Atopic Dermatitis – Results of the German Atopic Dermatitis Intervention Study (GADIS)

Abstract

Atopic dermatitis (AD) is a well known but difficult to treat common, chronically relapsing, inflammatory skin disease with a high economic burden, high impact on the quality of life and an increasing prevalence within the last decades. Patient education programs are part of patient empowerment to solve problems with chronic diseases but there efficacy has not yet been proven for AD. The aim of our study was to evaluate the efficacy of an educational program for the self management of AD in children. Age related standardized atopic dermatitis group intervention programs have been developed by a National Study Group for the following three age groups: parents of AD children aged 0 to 7 years, parents and children aged between 8–12 years and adolescents aged 13–18 years. The standardized treatment program consisted of 6 weekly group sessions of 2 hours each. Inclusion criteria were the diagnose of atopic dermatitis in a child or adolescent with the severity of eczema according to the SCORAD scale of at least 20 points. In a randomised prospective controlled trial we investigated the efficacy of these atopic dermatitis intervention programs in the three different age groups. The groups were randomised and compared with a waiting control group (0–7 years: n=518; 8–12 years: n=208; 13–18 years: n=148) and followed up for 1 year. Besides severity of eczema according of the SCORAD scale, standardized questionnaires regarding subjective severity, quality of life and itching behaviour were used. The changes of the investigated parameters at the beginning of the study (T0) and 12 months after the end of the education program (T3) were analysed by using analyses of covariance. The drop out rate after 12 months follow-up was relatively low in all three age groups (0–7 years: 17.9%; 8–12 years: 11.1%; 13–18 years: 18.9%). Significant better effects were observed in the intervention group compared to the control group with regard to severity of eczema in the SCORAD, subjective severity, itching cognition and quality of life in all three age groups. Our results demonstrate that this educational group intervention program is effective in the long term disease management of atopic dermatitis in children aged between 0 and 18 years. Our educational program should be considered a part of the routine care of children and adolescents with AD.