Atopic Dermatitis Care Research Articles

Management strategies and corticophobia among healthcare professionals involved in the care for atopic dermatitis: a Dutch survey.

Many healthcare professionals (HCPs) deliver care for patients with atopic dermatitis (AD). Although pivotal, management strategies and the relation with corticophobia among HCPs have not been investigated. This study aimed to investigate management strategies for AD and its relation with corticophobia among HCPs. Dutch general practitioners (GPs), youth healthcare physicians (YHPs), pediatricians, dermatologists, pharmacists, and pharmacy assistants participated in a survey on management strategies and corticophobia. The Topical Corticosteroid Phobia questionnaire for professionals (TOPICOP-P) was used to measure attitudes toward topical corticosteroids (TCS). Higher scores reflect a more negative attitude. A total of 407 HCPs (124 GPs, 33 YHPs, 51 pediatricians, 56 dermatologists, 58 pharmacists, and 85 pharmacy assistants) participated. Compared to dermatologists other HCPs were more reluctant with TCS as illustrated by the portion (50%) of GPs that reported to prescribe TCS of only mild potency for infants with severe AD, compared to dermatologists (9%). Dermatologists had lowest TOPICOP-P scores (median: 19, IQR:12-28). GPs and pharmacy assistants had highest scores (GPs median: 36, IQR:31-44, pharmacy assistants: median: 36, IQR:31-42). More corticophobia was significantly associated with prescription of a lower TC potency class (B -0.04, 95%CI: -0.07-0.01, P=0.01), and a trend was found between more corticophobia and longer perceived durability of one TCS tube. This study shows the differences in management of AD and reluctance towards TCS in HCPs. Furthermore, corticophobia among HCPs and its effect on management of AD was confirmed. To reduce corticophobia and improve care for AD, more education is needed.

Sleep Efficiency and Neurocognitive Decline in Atopic Dermatitis: A Systematic Review.

Atopic dermatitis is often accompanied by a lack of sleep efficiency, which may impact neurocognitive functions. This review assesses the association between sleep quality in atopic dermatitis patients and neurocognitive decline. Databases searched included PubMed, Scopus, and Web of Science from inception to 8 January 2024, adhering to PRISMA guidelines. Cross-sectional and longitudinal studies were included. Records were screened and assessed for eligibility, with 13 studies included in the final analysis. From an initial pool of 4,529 records, 13 studies involving 272,868 participants met the inclusion criteria. The review identified a consistent pattern of sleep disruption in individuals with atopic dermatitis, which was associated with various short-term neurocognitive challenges such as impaired focus, decreased sleep efficiency, and lower IQ. Limited evidence was found for potential long-term cognitive decline associated with chronic atopic dermatitis. Lower sleep quality in atopic dermatitis is associated with neurocognitive deficits. While immediate effects are evident, further research is needed to understand potential long-term consequences. Integrating sleep management into atopic dermatitis care is imperative.

Reducing disparities in the care of atopic dermatitis.

Atopic Dermatitis (AD) is associated with a number of published disparities, including those related to self-identified racial/ethnic populations. Black/African American populations in the United States experience greater AD prevalence, severity, and persistence compared to other demographic groups, such as those who self-identify as White. There is consistent evidence that healthcare, environmental, and socioeconomic factors affect the prevalence, severity, and/or persistence of AD. Additionally, because of institutional and systemic racism, these same risk factors are more prevalent in racial and ethnic minority populations. Herein, we review the underlying causes of racial/ethnic disparities in AD and potential strategies to improve AD diagnosis and disease control.

54468 Racial and socioeconomic inequities in atopic dermatitis care: A study of price and pharmacy deserts for recommended skincare products

54468 Racial and socioeconomic inequities in atopic dermatitis care: A study of price and pharmacy deserts for recommended skincare products

33748 Real-world insights into quality improvement in atopic dermatitis care

Overview: We conducted a quality improvement (QI) program to identify and develop strategies to address challenges and opportunities for improvement in the case of patients with moderate-to-severe atopic dermatitis (AD). Methods: To identify gaps and inform team-based improvements in AD care, surveys on clinical practice trends and challenges were administered to 8 clinical teams (5 dermatology and 3 allergy-immunology practices). Teams then participated in audit-feedback sessions, led by AD expert faculty, to review their data and set action plans. Results: Surveys were collected from 86 health care providers (HCPs) (29% physicians, 19% physician assistants, 15% nurse practitioners, 37% nurses). On a 5-point Likert scale, most HCPs (62%) reported always assessing pruritus, although fewer HCPs always assessed sleep quality (26%) and mental health (19%). Most HCPs reported using oral steroids to treat flares (59%) and to bridge to maintenance therapy (43%). Among pediatric patients, top barriers to biologic therapy were patient/caregiver safety concerns (75%); needle phobia (55%); and cost (27%). Key challenges discussed in the audit-feedback sessions included assessment of disease severity and control; use of biologic therapies and systemic steroids; and shared decision-making. Teams designed action plans to integrate into workflows, including using tools to improve disease assessment; developing standardized documentation practices; creating patient education tools; utilizing steroid-sparing strategies; and improving communication with primary care providers. Conclusions: HCPs encounter several challenges in managing patients with AD. Expert-led audit-feedback sessions can help teams design strategies to address these challenges. Findings from this program can inform future education and QI activities.

Sociodemographic characteristics and emergency department visits and inpatient hospitalizations for atopic dermatitis in Ontario: a cross-sectional study

BackgroundSome jurisdictions experience sociodemographic disparities in atopic dermatitis care, including emergency department visits, but data from Canada are limited. Our objectives were to estimate the prevalence of atopic dermatitis in Ontario and to identify sociodemographic factors associated with emergency department visits and hospitalizations for this condition.MethodsWe conducted a cross-sectional analysis of patients in the Electronic Medical Record Primary Care database linked with administrative health data for Ontario, Canada. We estimated period prevalence and health service utilization for atopic dermatitis from 2005 to 2015. We used multivariable log-binomial regression to calculate adjusted risk ratios (RRs) and 95% confidence intervals (CIs) for associations between local dermatologist density and the proportion of emergency department visits and hospitalizations for atopic dermatitis.ResultsAmong 249 984 patients, we identified 7812 with atopic dermatitis (period prevalence 2005–2015: 3.1%). Almost all physician visits for atopic dermatitis were to primary care physicians (> 99%). For every additional dermatologist per 100 000 population, the proportions of emergency department visits and hospitalizations for atopic dermatitis increased by 29% (RR 1.29, 95% CI 1.05–1.57). This relationship occurred in and around Toronto but was not consistent across the province.InterpretationIn Ontario, higher dermatologist density was not associated with lower emergency department utilization and hospitalization for atopic dermatitis; the association varied in different locales with similar dermatologist densities. Strategies to improve access to care for atopic dermatitis should be tailored to local contexts.

Needs and preferences of patients regarding atopic dermatitis care in the era of new therapeutic options: a qualitative study

To optimally tailor atopic dermatitis (AD) care to patients’ needs, especially considering the many emerging therapeutic options, insight into patients’ needs and preferences regarding AD care is needed. To explore patients’ needs and preferences regarding AD care, a qualitative study consisting of three focus groups with a total of 20 adult AD patients was conducted. All sessions were transcribed verbatim and inductively analyzed using several phases of coding to create an overview of patients’ needs and preferences. AD patients emphasized the need for a patient-tailored approach in all identified aspects of AD care. With regard to consultations, patients stressed the need for a personal approach and increased recognition of the disease impact, which should mainly be determined by patients. With regard to the organization of AD care, the need for psychosocial and medical supportive care as well as quick access to health-care providers during disease flares was emphasized. Within the decision-making process, patients indicated that the provided information, the role of the patient and physician, whether or not treatment goals should be set, and decisive factors for indication and feasibility of novel therapies should be patient dependent. AD care should be patient tailored with increased attention for the psychosocial burden, as well as better access to health care during disease flares. To provide patient-tailored care, the personal situation, needs, and preferences of the patient should be taken into account in the therapeutic decision-making process, with respect for the autonomy of the patient.

Is There a Missing Link in the Care of Atopic Dermatitis? A Mind-Body Technique May Help Stop the Habitual Scratch

Is There a Missing Link in the Care of Atopic Dermatitis? A Mind-Body Technique May Help Stop the Habitual Scratch

Features of nursing care for atopic eatures of nursing care for atopic dermatitis in young children

The article presents the results of research and synthesis of information on nursing assistance in prevention, diagnosis and treatment of atopic dermatitis in children.

Topical Application of 7,3',4'-Trihydroxyisoflavone Alleviates Atopic Dermatitis-Like Symptoms in NC/Nga Mice.

Atopic dermatitis is a skin disease characterized by chronic inflammatory lesions, and new therapies are needed to address its rising prevalence. Soy isoflavone has been highlighted as a potential new cosmeceutical material that may have applications in atopic dermatitis care. We have developed a technique to attach an additional -OH group to the ortho position of -OH in the phenol ring using a special enzyme. By adding the -OH group to daidzein, 7,3',4'-trihydroxyisoflavone can be generated for possible use as a cosmeceutical and functional food material. In this study, we sought to examine the anti-atopic effects of 7,3',4'-trihydroxyisoflavone, an analog of daidzein. Topical application of 7,3',4'-trihydroxyisoflavone reduced Dermatophagoides farina extract-induced atopic dermatitis symptoms in NC/Nga mice. Histological analysis demonstrated that 7,3',4'-trihydroxyisoflavone suppressed D. farina extract-induced infiltration of eosinophils and mast cells into skin lesions. We also found that 7,3',4'-trihydroxyisoflavone significantly reduces the D. farina extract-induced increases in serum IgE and macrophage-derived chemokine (CCL22) levels. We observed that 7,3',4'-trihydroxyisoflavone suppresses atopic markers including macrophage-derived chemokine (CCL22) and thymus and activation-regulated chemokine (CCL17) in HaCaT cells. 7,3',4'-Trihydroxyisoflavone also reduced TNF-α/IFN-γ-induced phosphorylation of ERK1/2 and JNK1/2. These results highlight several desirable properties of 7,3',4'-trihydroxyisoflavone, which support its use as a cosmeceutical ingredient for the treatment of atopic dermatitis.

Atopic Dermatitis: Management in the School Setting.

Atopic dermatitis, a form of eczema, has a physical, psychological, and social impact on students at school. The purpose of this article is to provide current information surrounding the symptoms and treatment of this disorder. School nurses can be a partner in atopic dermatitis care and improve health outcomes for these students.

Improving Outcomes Through Therapeutic Patient Education.

Therapeutic patient education is a nascent movement in the care of atopic dermatitis, offering patients-and, for children, their caregivers-knowledge, skills, support, and coping strategies for managing what for many is a relapsing/ remitting chronic disease that severely compromises quality of life. Interventions range from a written treatment plan provided in the office to a 6-week education program. Studies indicate that this approach yields benefits for patients and their caregivers. Most of these studies involved children and their parents or other caregivers, but reduced signs and symptoms of disease and improved quality of life also has been documented in adults. Semin Cutan Med Surg 36(supp4):S106-S107.

Patient-Centered, Direct-Access Online Management of Atopic Dermatitis

Because of dermatologist shortages, teledermatology has been used in rural and underserved communities. Typically, the primary care provider sends patient information and images to the dermatologist, who then relays back information. This system is time-consuming, and dermatologic follow-up is problematic. Investigators performed a randomized, controlled equivalency study comparing a direct-access, asynchronous online model with in-person office visits for follow-up care of atopic dermatitis (AD). One hundred fifty-six patients …

Therapeutic Benefits in Atopic Dermatitis Care from the Patients' Perspective: Results of the German National Health Care Study ‘Atopic Health'

Background/Aims: Numerous therapies are recommended to treat atopic dermatitis. The German national health care study ‘Atopic Health' generated nationwide data on the care situation from the patients' perspective. Methods: Data for 1,678 adult patients were collected within a retrospective cohort study throughout the year 2010. Six scores to capture satisfaction with care, quality of life (Dermatology Life Quality Index, EQ-5D-VAS), therapeutic success and benefits (Patient Benefit Index) were analyzed using descriptive methods and analysis of variance. Results: 82.1% of patients were highly satisfied with their treatment. Topical corticosteroids and climate therapies were associated with the best success ratings. Quality of life was moderately impaired (mean Dermatology Life Quality Index 8.5 ± 6.5). 88.4% of the patients indicated a relevant therapeutic benefit (Patient Benefit Index ≥1) with significantly better scores for topical immunomodulating therapies and climate therapies. Conclusion: The most frequently applied therapies presented pleasant success and benefit ratings, even if quality of life could be improved for more than one third of patients.

New topical drug development in atopic dermatitis: a place for hope

Conflicts of interest C.P. has served as a consultant to Astellas, Novartis and Pierre Fabre and has performed clinical studies for Astellas, Galderma, Novartis and Pierre Fabre. Atopic dermatitis is a chronic disease affecting children and adults with an increasing prevalence in industrialized countries. There are several barriers to topical drug development in atopic dermatitis which may explain the limited number of topical treatment options available today, mainly topical corticosteroids and topical calcineurin inhibitors. Firstly, clinical development programs for new drugs have to run in parallel in children and adults. Secondly, topical drug penetration and permeation issues as well as tolerability of formulations must be considered carefully. Finally, selection of endpoints and evaluation of long‐term treatment strategies are factors which add to the complexity. In this issue of the British Journal of Dermatology, Bissonnette et al. report on the efficacy of a new topical agent, WBI‐1001 in adults with mild to severe atopic dermatitis affecting 3–20% of the body surface area.1 The compound appears to be a stilbene derivative, having both antimicrobial and anti‐inflammatory properties in vitro.2 The authors provide substantial preliminary evidence that the topical agent is effective in atopic dermatitis with some degree of dose–effect relationship, although a wider range of concentrations should have been tested. When looking at the Investigator’s Global Assessment (IGA), a categorical scale frequently considered as a gold standard for atopic dermatitis evaluation, between 50% and 63% of patients experienced treatment success after 6 weeks of twice‐daily treatment. The definition of treatment success in the WBI‐1001 study was less stringent compared with that from the tacrolimus studies, and disease severity was different, making historical efficacy comparisons irrelevant. The level of disease improvement observed with WBI‐1001, if confirmed in subsequent studies, is certainly clinically meaningful. Intriguingly, the 95% confidence intervals for the IGA treatment success rates reported in the article do not include the point estimate, which raises questions. The main limitation of the study is represented by the primary endpoint selection, the mean reduction from baseline in the IGA, a categorical score the researchers inappropriately transformed into a continuous score and expressed as percentage reduction from baseline. Despite these limitations the study results raise new hope for patients and practitioners involved in atopic dermatitis care. Randomized controlled studies against active comparators are needed to understand the relative efficacy of WBI‐1001 vs. topical corticosteroids and calcineurin inhibitors. Pharmacokinetic studies in patients with atopic dermatitis with large body area surface involvement are also required to evaluate the potential for systemic absorption. The local side‐effects described as papular eruption and contact dermatitis in the study need better characterization. Ultimately, meaningful evaluation of treatment effect in atopic dermatitis pivotal trials requires the selection of validated endpoints.3 In this respect, the ongoing international HOME (Harmonizing Outcome Measurements in Eczema) initiative which has already identified core outcome domains relevant to patients, physicians and regulatory representatives should help to facilitate new drug development in atopic dermatitis.4

The Comparison between Objective and Subjective Severity Scores of Atopic Dermatitis

RationaleMethods of measuring extent and severity of atopic dermatitis (AD) are based on assessment of signs and symptoms. Many scoring systems were validated, but they might not represent subjective severity of patients. The purpose of this study is to compare the subjective with the objective severity of scoring systems.MethodsFifty children (26 males, 24 females, aged between 3 months and 12 years) with AD were recruited by the pediatric allergy center at Soonchunhyang university hospital from June 1, 2007 to July 31, 2007. We checked their SCORAD (SCORing Atopic Dermatitis) score, EASI (Eczema Area and Severity Index) score, SASSAD (Six Area, Six Sign Atopic Dermatitis) score, Parental visual analog scale (PaVAS, 0-10 point), and Investigator's VAS (INVAS,0-10 point). We analyzed and compared each score with scales.ResultsSCORAD score had a strong correlation with EASI and SASSAD score (r = 0.84 vs 0.92). EASI score showed significant correlation with SASSAD score (r = 0.86). PaVAS was found to be less correlated with SCORAD, EASI and SASSAD scores (r = 0.37, 0.23, 0.33), whereas INVAS showed greater correlations with SCORAD, EASI and SASSAD score (r = 0.6, 0.52, 0.52). It demonstrated that established severity scoring systems has a greater correlation with severity by investigator's view-point but less correlation with subjective severity by patients'.ConclusionsEstablished scoring system or indices are generally reflect the objective severity by investigators. Therefore physicians should consider the patients' subjective severity when they take care of atopic dermatitis. RationaleMethods of measuring extent and severity of atopic dermatitis (AD) are based on assessment of signs and symptoms. Many scoring systems were validated, but they might not represent subjective severity of patients. The purpose of this study is to compare the subjective with the objective severity of scoring systems. Methods of measuring extent and severity of atopic dermatitis (AD) are based on assessment of signs and symptoms. Many scoring systems were validated, but they might not represent subjective severity of patients. The purpose of this study is to compare the subjective with the objective severity of scoring systems. MethodsFifty children (26 males, 24 females, aged between 3 months and 12 years) with AD were recruited by the pediatric allergy center at Soonchunhyang university hospital from June 1, 2007 to July 31, 2007. We checked their SCORAD (SCORing Atopic Dermatitis) score, EASI (Eczema Area and Severity Index) score, SASSAD (Six Area, Six Sign Atopic Dermatitis) score, Parental visual analog scale (PaVAS, 0-10 point), and Investigator's VAS (INVAS,0-10 point). We analyzed and compared each score with scales. Fifty children (26 males, 24 females, aged between 3 months and 12 years) with AD were recruited by the pediatric allergy center at Soonchunhyang university hospital from June 1, 2007 to July 31, 2007. We checked their SCORAD (SCORing Atopic Dermatitis) score, EASI (Eczema Area and Severity Index) score, SASSAD (Six Area, Six Sign Atopic Dermatitis) score, Parental visual analog scale (PaVAS, 0-10 point), and Investigator's VAS (INVAS,0-10 point). We analyzed and compared each score with scales. ResultsSCORAD score had a strong correlation with EASI and SASSAD score (r = 0.84 vs 0.92). EASI score showed significant correlation with SASSAD score (r = 0.86). PaVAS was found to be less correlated with SCORAD, EASI and SASSAD scores (r = 0.37, 0.23, 0.33), whereas INVAS showed greater correlations with SCORAD, EASI and SASSAD score (r = 0.6, 0.52, 0.52). It demonstrated that established severity scoring systems has a greater correlation with severity by investigator's view-point but less correlation with subjective severity by patients'. SCORAD score had a strong correlation with EASI and SASSAD score (r = 0.84 vs 0.92). EASI score showed significant correlation with SASSAD score (r = 0.86). PaVAS was found to be less correlated with SCORAD, EASI and SASSAD scores (r = 0.37, 0.23, 0.33), whereas INVAS showed greater correlations with SCORAD, EASI and SASSAD score (r = 0.6, 0.52, 0.52). It demonstrated that established severity scoring systems has a greater correlation with severity by investigator's view-point but less correlation with subjective severity by patients'. ConclusionsEstablished scoring system or indices are generally reflect the objective severity by investigators. Therefore physicians should consider the patients' subjective severity when they take care of atopic dermatitis. Established scoring system or indices are generally reflect the objective severity by investigators. Therefore physicians should consider the patients' subjective severity when they take care of atopic dermatitis.

Estudio observacional para evaluar la repercusión de una intervención educativa-informativa en el estado emocional (ansiedad) de los pacientes con dermatitis atópica (CUIDA-DEL)

Introduction One of the first therapeutic measures in atopic dermatitis should be the educational and informative approach about prophylactic aspects and evolution of the disease. This type of proceedings has been shown to be beneficial for the anxious type of emotional status in patients with atopic dermatitis. We evaluated the impact of an educational/informative intervention in the emotional status (anxiety) of patients with atopic dermatitis in Spain. Material and methods Investigators were randomized into two study groups: the control group (CG) that followed current clinical practice and the intervention group (IG) that handed patients, in each visit, a booklet of information about different prophylactic aspects and care of atopic dermatitis. The duration of the study was 6months with quarterly visits. All included patients had a diagnosis of atopic dermatitis. Anxiety was evaluated with the STAI anxiety questionnaire and clinical data regarding dermatological aspects (IGA, pruritus scale, location of the lesions) were also recorded. Results A total of 1,247 patients were recruited thanks to the collaboration of 158 investigators. Patients were distributed as follows: 683 (54.7 %) in the CG and 564 (45.2 %) in the IG. Both group were homogeneous with respect to basal characteristics, and were constituted by 54 % of women with a mean age of 19 years. Eighty-six percent of atopic dermatitis lesions were preferentially located in extremities. Patients of both study groups showed improvement in their emotional status (trait and state anxiety) throughout the study with significant decreases in the STAI scores compared to basal ones. Regarding improvement in the questionnaire scores, no significant differences were observed between groups except in children aged 9 to 15 years, in the pediatric version of the STAI trait where the percentage of score decrease at 6months adjusted to the basal score was 5.5 (19.0) for the CG and 10.6 (18.9) for the IG, (p < 0.05). A higher percentage of patients finished the study in the IG compared to the CG (83.1 % vs. 76.1% p < 0.005). Discussion and conclusions Although patients in the IG showed greater compliance with the follow-up of the study, the informative intervention about prophylactic aspects of atopic dermatitis designed in this study does not appear to have had an impact in improving the emotional status of adult patients.

Observational Study to Evaluate the Impact of an Educational/Informative Intervention in the Emotional Status (Anxiety) of Patients With Atopic Dermatitis (Cuida-DeL)

Introduction One of the first therapeutic measures in atopic dermatitis should be the educational and informative approach about prophylactic aspects and evolution of the disease. This type of proceedings has been shown to be beneficial for the anxious type of emotional status in patients with atopic dermatitis. We evaluated the impact of an educational/informative intervention in the emotional status (anxiety) of patients with atopic dermatitis in Spain. Material and methods Investigators were randomized into two study groups: the control group (CG) that followed current clinical practice and the intervention group (IG) that handed patients, in each visit, a booklet of information about different prophylactic aspects and care of atopic dermatitis. The duration of the study was 6 months with quarterly visits. All included patients had a diagnosis of atopic dermatitis. Anxiety was evaluated with the STAI anxiety questionnaire and clinical data regarding dermatological aspects (IGA, pruritus scale, location of the lesions) were also recorded. Results A total of 1,247 patients were recruited thanks to the collaboration of 158 investigators. Patients were distributed as follows: 683 (54.7%) in the CG and 564 (45.2%) in the IG. Both group were homogeneous with respect to basal characteristics, and were constituted by 54% of women with a mean age of 19 years. Eighty-six percent of atopic dermatitis lesions were preferentially located in extremities. Patients of both study groups showed improvement in their emotional status (trait and state anxiety) throughout the study with significant decreases in the STAI scores compared to basal ones. Regarding improvement in the questionnaire scores, no significant differences were observed between groups except in children aged 9 to 15 years, in the pediatric version of the STAI trait where the percentage of score decrease at 6 months adjusted to the basal score was 5.5 (19.0) for the CG and 10.6 (18.9) for the IG, (p < 0.05). A higher percentage of patients finished the study in the IG compared to the CG (83.1% vs. 76.1% p < 0.005). Discussion and conclusions Although patients in the IG showed greater compliance with the follow-up of the study, the informative intervention about prophylactic aspects of atopic dermatitis designed in this study does not appear to have had an impact in improving the emotional status of adult patients.

Training of Patients with Atopic Dermatitis and Psoriasis vulgaris in an Ambulant Neighborhood Rehabilitation Program: Presentation of a Pilot Project

Background: The structures currently available for the care of patients with chronic inflammatory dermatoses are inadequate to meet the needs and specific problems of patients suffering from these diseases. This work describes an interdisciplinary pilot project carried out for ambulant neighborhood rehabilitation and training of atopic dermatitis and psoriasis vulgaris patients as an alternative to conventional care arrangements. Patients and Methods: From 1997 to 2000, adult patients suffering from atopic dermatitis (n = 36) and psoriasis vulgaris (n = 27) and parents of children with atopic dermatitis (n = 42) took part in an ambulant neighborhood rehabilitation and training program. Questionnaires and scoring systems (SCORAD and PASI) were used to determine the quality of the procedures and the results; the overall rehabilitation program and the training were evaluated separately. Results: The quality of process used in the overall rehabilitation program and in the training course were rated as very good by the patients in all 3 groups, with both SCORAD and PASI showing significant downward trends. Although the training course brought distinct improvement in the patients’ knowledge and understanding of their disease and in their ability to cope with it, it did little to induce behavioral changes. Conclusions: Current experience with training and the ambulant neighborhood rehabilitation program indicates that both can have a valuable place in the care of atopic dermatitis and psoriasis vulgaris patients. It seems reasonable to upgrade the status of these models in the future. This would be helped by the introduction of comparable concepts and the implementation of scientific studies nationwide.

Atopic dermatitis in children: Who cares? Who pays?

Atopic dermatitis is an important cause of morbidity in children of all ages. Despite its high prevalence, there has been no examination of ways in which care for atopic dermatitis is delivered. This study reviewed the costs for care of childhood atopic dermatitis in an urban setting and estimated the national cost for treatment of the disease. We used data from one children's hospital to study the use of the emergency room for atopic dermatitis and used national data sets to estimate the cost of care in the United States. A large proportion of visits occur in the emergency department, during daytime office hours, and mostly by patients who have public insurance. The total national cost for treatment of childhood atopic dermatitis is $364 million annually, which is a conservative estimate. Given its high prevalence, associated morbidity, and cost, resources must be better allocated to improve the organization of care for patients with atopic dermatitis.