Dermatitis Family Impact Questionnaire Research Articles

Impact of atopic dermatitis on quality of life in children and their families: A tertiary care hospital-based study from Northern India

Objectives: Atopic dermatitis (AD) is a chronic inflammatory skin disease that is more frequent among children. Childhood is a critical time for physical and psychosocial development and AD develops more commonly in children in the first five years of life. The objective of the study was to determine the impact of AD on the quality of life (QoL) of Indian children and their families and correlate it with AD severity and the perception of severity as estimated by the family. Material and Methods: In the present study, 30 children clinically diagnosed with AD and 30 age- and sex-matched healthy controls presenting to our hospital were evaluated. Data on QOL were obtained through a questionnaire; Infants Dermatitis Quality of Life Index (IDQOL), Children’s Dermatology Life Quality Index (CDLQI), and Dermatology Life Quality Index (DQLI) were used for patients,and the Dermatitis Family Impact (DFI) questionnaire for the family of the patients. The severity of the disease was determined using the Scoring for AD (SCORAD) index. Results: In our study, there were 16 male patients and 14 female patients. History of atopy was significantly higher in children with AD (p <0.001); 13 patients had mild, 17 had moderate, and none of the patients had severe disease. The severity of the disease was found to correlate negatively with the age of the child. IDQOL positively correlated with the age of children with AD (r = 0.865, P < 0.001). CDLQI negatively correlated with the age of children with AD (r = −0.616, P = 0.033). Impairment in IDQOL and CDLQI showed a significant positive correlation with DFI (r = 0.846, P < 0.001; r = 0.910, P < 0.001). Conclusion: AD is associated with lowered QOL of the patient,which increases with the severity of the disease. Itch and sleep disturbance were the most severely affected symptoms of AD. The disease significantly impacted the QOL of the family. The main issue with parents caring for AD children is continuous expenditure on treatment, emotional distress, and physical exhaustion. Therefore, efforts are needed to help parents by medical care personnel so that the outcomes in both the child and the significantly burdened parent caregiver can be improved.

Clinically meaningful change threshold in health‐related quality of life among patients aged 6 months to 5 years with atopic dermatitis and their caregiver(s)/family

AbstractBackgroundAtopic dermatitis (AD) significantly impacts health‐related quality of life (HRQoL) in children and their caregiver(s)/family. Measures to assess HRQoL include the Children's Dermatology Life Quality Index (CDLQI), Infants' Dermatitis Quality of Life Index (IDQoL) and Dermatitis Family Impact (DFI) questionnaire. Currently, there are no established clinically meaningful within‐person change thresholds for these measures in young children (6 months to 5 years) and their caregiver(s)/family.ObjectivesTo determine the clinically meaningful within‐person change thresholds for CDLQI (4–5 years), IDQoL (<4 years) and DFI scores in children aged 6 months to 5 years with moderate‐to‐severe AD and their caregiver(s)/family.MethodsData from the 16‐week, randomised, double‐blind, placebo‐controlled, phase 3 LIBERTY AD PRESCHOOL part B study in children aged 6 months to 5 years were used. The anchor‐based method was used to assess meaningful change thresholds for the three instruments, using the Caregiver Global Impression of Disease (CGID; range: ‘no symptoms’ to ‘very severe’) as the primary anchor, and Caregiver Global Impression of Change (CGIC; range: ‘much better’ to ‘much worse’) as a supportive anchor.ResultsThe mean CDLQI change scores were −6.3 and −9.5 based on CGID 1‐point improvement and CGIC improvement of ‘a little better’, respectively. The mean IDQoL change scores were −5.6 and −3.4 based on the CGID and CGIC anchors. The mean DFI change scores were −7.0 and −6.7 based on the CGID and CGIC anchors.ConclusionsBased on primary anchor findings, improvements of ≥6 points on the CDLQI total score for children aged 4–5 years and on the IDQoL total score for children aged <4 years were recommended as the clinically meaningful within‐person change thresholds in children with moderate‐to‐severe AD. A 7‐point improvement on the DFI total score may be considered as the meaningful threshold for the caregiver(s)/family of children aged 6 months to 5 years with moderate‐to‐severe AD.

PA26 Paediatric atopic dermatitis: correlation between Eczema Area Severity Index, quality of life and visual analogue scale severity scores reported by children and their parents, and in different age groups

Abstract Atopic dermatitis (AD) often has a significant impact on the quality of life (QoL) of those affected and their families. Validated QoL and visual analogue scales (VAS) are widely used in dermatology to measure the impact of this common disease. As part of a larger prospective study, we subanalysed data to look at the correlation between Eczema Area and Severity Index (EASI) score, three different QoL scores and parental/child VAS scores for overall severity, itch and sleep disturbance. Data were analysed from 68 paediatric patients with AD (42 males, 26 females), aged 4–16 years (mean 10 years, 0 months). Patient age groups were subdivided into 4–8 years (n = 17), 8–12 years (n = 25) and 12–16 years (n = 26). Scores for EASI, Children’s Dermatology Life Quality Index (CDLQI), Patient Oriented Eczema Measure (POEM) and Dermatitis Family Impact questionnaire (DFI) were measured, and VAS scores (0–10) were assessed for overall severity, itch and sleep loss. The mean EASI score for the cohort was 18.3, and comparable for all age groups: 4–8 years (17.6), 8–12 years (18.1) and 12–16 years (19.0). The CDLQI correlated with DFI (r = 0.72), POEM (r = 0.66) and overall VAS severity scores (r = 0.61). Further analysis by age group showed CDLQI correlated with POEM and DFI most strongly in younger age groups (4–8 years: POEM r = 0.86; DFI r = 0.77; 8–12 years: POEM r = 0.72; DFI r = 0.81) compared with older children aged (12–16 years: POEM r = 0.41; DFI r = 0.53). The CDLQI and VAS overall severity scores correlated consistently across age groups (4–8 years, r = 0.59; 8–12 years, r = 0.67; 12–16 years, r = 0.66). By comparing EASI with CDLQI scores, moderate correlation was found between the age groups (4–8 years, r = 0.39; 8–12 years, r = 0.53; 12–16 years, r = 0.46). Comparing EASI with the three VAS severity scores, we found poor correlation between EASI score and overall severity score (r = 0.24). This was most marked in the 4–8 years group (n = 17, r = 0.04) vs. the 8–12 years group (n = 25, r = 0.27) and 12–16 years group (n = 22, r = 0.33). Similarly, there was poor correlation between EASI and sleep loss score (r = 0.21) and itch score (r = 0.35) across all age groups. In our study, all of the existing validated QoL scores above correlated well with each other and across different age groups. The CDLQI and VAS severity scores also correlated consistently at all ages. There was poor correlation between EASI and VAS severity scores. This was more apparent in younger age groups, implying a high degree of caregiver distress due to eczema in younger children. This may indicate that as children mature their own perception of eczema may diverge from the perceived parental disease severity/impact on the family.

Impact of the Family and Household Environment on Pediatric Atopic Dermatitis in Japan.

Pediatric atopic dermatitis (AD) can negatively impact the family quality of life (QoL). We report data from the real-world Epidemiology of Children with Atopic Dermatitis Reporting on their Experience (EPI-CARE) study in Japanese pediatric patients, focusing on disease impact on family QoL. Children and adolescents aged 6 months to <18 years completed an online survey between September 2018-December 2019. The impact of disease severity on family QoL and its effect on parents' time were assessed using the dermatitis family impact (DFI) questionnaire. The impact of a family history of allergic conditions, current residency, second-hand smoke exposure, and household pets on AD prevalence and severity was also assessed. Family QoL decreased as AD severity increased, particularly in families with children aged <6 years; but had the greatest impact on sleep and tiredness in families with children aged <12 years. Parents spent at least 4.6 h/week caring for children <6 years, including those with mild symptoms. Most children (>80%) had a family history of allergic conditions; AD prevalence was increased in those exposed to second-hand smoke or household pets. This study demonstrated that pediatric AD in Japanese individuals has negative impacts on family QoL and that family and household environments can influence pediatric AD prevalence.

Dupilumab improves clinical symptoms in children with Netherton syndrome by suppressing Th2-mediated inflammation.

Netherton syndrome is a rare, life-threatening autosomal recessive genetic disorder with no effective treatment yet. Skin barrier dysfunction caused by SPINK5 gene mutations is a hallmark of the disease. Antigen penetration through the defective skin and nonspecific inflammation provide a pro-T helper 2 (Th2) immune microenvironment in the disease. Therefore, Th2 cytokines are considered to be candidate therapeutic targets. To evaluate the clinical responses of patients with Netherton syndrome to dupilumab, an IL-4Rα antagonist, and identify changes in the Th1/2/17 pathway activity, skin barrier defect protein LEKTI expression after treatment. Four children with severe Netherton syndrome (aged 2 y to 4 y and 6m) who were treated with dupilumab from January to June 2022 were evaluated at baseline, and at 4, 8, 12, 16, and 20 weeks after the start of dupilumab administration. Treatment response was assessed using the Eczema Area and Severity Index (EASI), the Numerical Rating Scale (NRS), the Dermatology Life Quality Index (CDLQI), and the Dermatitis Family Impact-questionnaire (DFI). Blood eosinophil counts, serum IgE levels and inflammatory cytokines were measured. The immunotyping of Th1/2/17 cells was performed by flow cytometry and cytokine expressions in T cell subsets were analyzed by single-cell RNA sequencing. In addition, expression of the LEKTI in skin lesions was evaluated by immunohistochemical analysis. All four patients experienced clinical improvement, with significantly reduced EASI scores (by 75.0-83.9%) and NRS (by 87.5-90.0%) from baseline to 20 weeks of treatment. Improved quality of life scores were also seen for all patients, as measured by CDLQI and DFI. Serum IgE levels also fell by 75.6-86.9%. The serum Th2 cytokines IL-4, IL-5 and IL-13 were found at low level, with no significant changes during the treatment. However, Th2 cytokines expressed by T cells, especially IL-4, decreased at single-cell level after treatment (P = 0.029). The baseline percentage of Th2 cells (among total CD3+CD4+ T cells) was significantly higher in patients than that in healthy controls (HC) (P < 0.0001); this percentage fell from 8.25% ± 0.75% to 4.02% ± 0.62% after 20 weeks dupilumab treatment. There was no noticeable change in LEKTI protein expression in skin lesions pre- and post-treatment. Two patients reported mild ocular adverse effects, but there were no severe adverse events. Dupilumab may be an effective and safe treatment option in a subset of pediatric patients with Netherton syndrome, especially in improving itch and the quality of life. These effects were achieved in part by suppression of the Th2-mediated inflammation.

Atopic Dermatitis in Latin America: A Roadmap to Address Data Collection, Knowledge Gaps, and Challenges.

Atopic dermatitis (AD) is a systemic, multifactorial disease that causes significant morbidity and health care burden in Latin America (LA). Data on AD are scarce in LA. Lack of disease registries and non-standardized study methodologies, coupled with region-specific genetic, immunological, and environmental factors, hamper data collection. A panel of LA experts in AD was given a series of relevant questions to address before a conference. Each narrative was discussed and edited through numerous rounds of deliberation until achieving consensus. Identified knowledge gaps in AD research were updated prevalence, adult-disease epidemiology, local phenotypes and endotypes, severe-disease prevalence, specialist distribution, and AD public health policy. Underlying reasons for these gaps include limited funding for AD research, from epidemiology and public policy to clinical and translational studies. Regional heterogeneity requires that complex interactions between race, ethnicity, and environmental factors be further studied. Informed awareness, education, and decision making should be encouraged.

The Family Impact of Atopic Dermatitis in the Pediatric Population: Results from an International Cross-sectional Study

To evaluate the impact of atopic dermatitis on families of pediatric patients. This cross-sectional, web-based survey of children/adolescents (6months to <18years old) with atopic dermatitis and their parents and caregivers was conducted in 18 countries encompassing North America, Latin America, Europe, Middle East/Eurasia, and East Asia. Children and adolescents with atopic dermatitis and their parents and caregivers were identified by the International Study of Asthma and Allergies in Childhood criteria and ever being told by a physician that they had "eczema". Atopic dermatitis severity was assessed using the Patient-Oriented Eczema Measure and the Patient Global Assessment. Atopic dermatitis impact on families' lives was evaluated using the Dermatitis Family Impact questionnaire and stand-alone questions on hours of atopic dermatitis-related care (past week) and missed work days (past 4weeks) owing to their child's atopic dermatitis. A total of 7465 pairs of pediatric participants with atopic dermatitis and their parents or caregivers were surveyed. Across age groups, the Dermatitis Family Impact questionnaire total score for all regions ranged from 7.1 to 8.6, 13.2 to 14.9, and 17.0 to 17.2 for Patient-Oriented Eczema Measure mild, moderate, and severe atopic dermatitis, respectively. Subscale scores showed that greater atopic dermatitis severity had a greater impact on all family life domains, including sleep and tiredness. No specific patterns or trends were observed across age groups. Time spent on childcare and missed work days increased with atopic dermatitis severity. Across pediatric age groups and geographic regions, greater atopic dermatitis severity was associated with a greater negative impact on physical, emotional, social, and economic components of family life.

The impact of atopic dermatitis on the quality of life

AbstractAtopic dermatitis (AD) has a significant impact on people's quality of life. Studies have further evaluated the impact of AD on patients' family members. Various tools have been used to quantify quality of life including Dermatology Life Quality Index (DLQI), Infants Dermatology Quality of Life Index (IDQOL), Children's Dermatology Life Quality Index (CDLQI), Dermatitis Family Impact Questionnaire (DFI), and many others. Several studies have found AD to have significant impairment on sleep, cognitive function, and workplace productivity. It may come to no surprise the higher rates of depression seen in patients with AD compared with those without AD. It is important that clinicians consider the utilization of quality‐of‐life measures when evaluating patients with AD.

Impact of childhood atopic dermatitis on family: correlation with disease severity

Background Atopic dermatitis (AD) is a common skin disease that not only severely burdens patients but also their families and society. AD is a chronic inflammatory disease that is usually detected in childhood.Objectives We aim to evaluate the quality of life of parents of children with AD and to crosscheck it with the intensity of the disease.Patients and methods This is a cross-sectional study, where the data of parents of 100 children with AD were collected from the outpatient clinic of the Dermatology, Venereology, and Andrology Department, Assiut University Hospitals, from May 2017 to May 2019. Parents answered the validated Arabic version of the Dermatitis Family Impact (DFI) questionnaire. The disease severity was assessed using the SCORAD index.Results Families of children with severe dermatitis had quite high DFI scores (16.37±3.727) compared with the families of those with dermatitis of moderate intensity (12.10±3.356) and dermatitis of low intensity (8.50±0.707) (P<0.001). It was observed that the impact of dermatitis on families had a positive significant correlation with the degree of intensity of AD (P<0.001, r=0.658). The highest-scoring DFI domains were sleep time, followed by a feeling of tiredness, emotional stability, general life, household work, and expenditure.Conclusion AD directly affects the quality of life of patients’ parents, and the adverse effects on the quality of life are significantly correlated with the disease severity.

Impact of skin conditions of infants on their mothers’ quality of life

Many parents worry about their infants' skin conditions, which can greatly impact their quality of life (QOL). This is applicable even to skin problems that are not severe enough to require medical intervention. This study aimed to explore the impact of infants' skin problems on their mothers' QOL depending on the type of the problems. Mothers' QOL was measured using the Dermatitis Family Impact questionnaire (DFI), and a DFI score of 2 or higher was defined as impacting mothers' QOL. A total of 143 mothers believed their infants had skin problems and completed the DFI. Twenty-eight mothers (19.6%) of infants with eczema had an impacted QOL. Diaper dermatitis and facial skin problems significantly affected mothers' QOL (p = 0.042 and 0.031, respectively). In conclusion, diaper dermatitis and facial skin problems in infants can affect mothers’ QOL. Pediatric and perinatal health professionals should consider such impacts and provide support and reassurance to parents.

Impact of atopic dermatitis on the quality of life of children and their families.

Background Atopic dermatitis (AD) is the most common chronic inflammatory skin disease, with a significant effect on the quality of life (QoL). This study aims to evaluate the impact of AD on the QoL of children and their parents and to identify predictors affecting their QoL. Methods The cross-sectional study was conducted in Montenegro. It included 200 children with AD aged 5-16 years and their parents. The severity of disease was measured by the Three Item Severity (TIS) score, while QoL was assessed with the Children's Dermatology Life Quality Index (CDLQI) and the Dermatitis Family Impact (DFI) questionnaire. Results The mean CDLQI score of the children affected by AD was 17.11 and the mean DFI score of their parents 19.86. There was a significant correlation between AD severity score assessed by a doctor (TIS) and both CDLQI and DFI scores (r=0.53 and r=0.27, respectively). A moderate positive correlation was observed between the QoL of children with AD and QoL of their parents (r=0.53). According to multiple linear regression, more impaired QoL of affected children was associated with more severe AD, younger parent's age and their lower educational level. Poorer QoL of parents was associated with female sex, younger age of children, more severe AD, lower educational level of parents and absence of a family history of atopic disease. Conclusions The present study confirmed that AD has a large negative impact on QoL of both patients with AD and their families. More impaired QoL was associated with more severe AD.

Dupilumab for children and adolescents with atopic dermatitis: An Asian perspective

Atopic dermatitis (AD) is a common, chronic, recurrent inflammatory skin disease. Poorly controlled AD can lead to reduced quality of life (QoL) and psychosocial impairment. Dupilumab is the first approved monoclonal antibody targeting type 2 inflammation, for adolescent and adult patients with moderate-to-severe AD. We performed a retrospective analysis of the efficacy and safety of dupilumab in a cohort of Asian children and adolescents with moderate-to-severe AD. Clinical response was documented with investigator global assessment (IGA) and eczema area and severity index (EASI) scores. Improvement in QoL was assessed using child dermatology life quality index (CDLQI) or Teenager's quality of life (T-QoL), and caregivers' QoL was assessed using dermatitis family impact (DFI) questionnaire. Twelve patients were recruited, aged between 6 to 18 years of age (mean 13.3 years), with mean duration of AD of 9.8 years. At baseline, the mean IGA score was four and the mean EASI was 48.2. The mean T-QoL and DFI scores at baseline were 18.7 and 19.6, respectively. After 12 to 16 weeks of treatment, the mean IGA score decreased to 2.2. The mean EASI decreased to 19.3 with mean reduction of 28.9. The mean T-QoL decreased to 7.5 with mean reduction of 11.2, and the mean DFI decreased to 8.6 with mean reduction of 11. Adverse events included mild conjunctivitis in two patients and paradoxical head and neck erythema in one patient. Our study supports dupilumab as an effective and safe treatment option for Asian children and adolescents with moderate-to-severe AD.

A review of quality of life of patients suffering from ichthyosis.

SummaryIntroductionIchthyoses include a heterogeneous group of skin diseases often characterized by persistent scaling and hyperkeratosis with variable erythema, pruritus, and sweating impairment. The aim of our review was to assess the quality of life in patients with ichthyosis.MethodsIn July 2018 we performed a systematic search in the electronic database PubMed (MEDLINE). The MESH term “quality of life” was combined, through the Boolean operator AND with the key word “ichthyosis”. We considered eligible for the systematic review studies written in English.ResultsThe literature search yielded 63 publications, but 7 studies were included in the review. Studies were published in 2003-2014 and involved a minimum of 10 and a maximum of 235 patients. Authors used 5 types of tools: Dermatology Life Quality Index (DLQI), Dermatitis Family Impact Questionnaire (DFI), Nottingham Health Profile (NHP) questionnaire, Short Form Questionnaire 36 and 12 (SF-36, SF-12). Many patients reported worse scores than general population. Patients referred physical problems related to pain (which negatively influenced the mobility).ConclusionsIchthyosis considerably impaired the QoL, especially for paediatric patients. Further studies and efforts should be done to manage and treat the pain.

Inhibition of thymic stromal lymphopoietin production to improve pruritus and quality of life in infants and children with atopic dermatitis

BackgroundAtopic dermatitis (AD) is an inflammatory pruritic chronic dermatosis involving the alarmin thymic stromal lymphopoietin (TSLP), which is directly implicated in AD pruritus.AimsTo evaluate the efficacy of Tambourissa trichophylla leaf extract (TTLE) titrated in polyphenols and 18β‐glycyrrhetinic acid (GA) in vitro and in vivo for AD pruritus.Patients/MethodsInitially, in vitro assessment of TSLP production in keratinocytes was undertaken. In normal human keratinocytes in vitro, TSLP was induced by polyinosinic:polycytidylic acid (Poly:IC), tumor necrosis factor (TNF)‐α, and interleukin (IL)‐4 and then quantified by ELISA in supernatants. Some cells were pretreated with TTLE and/or GA. Thereafter, an in vivo clinical study was performed including 48 infants and children with mild to severe AD flare‐ups, some of which were treated with topical corticosteroids. A topical spray containing TTLE and GA was applied. After 21 days of topical spray application, pruritus, sleeplessness, the SCORing Atopic Dermatitis (SCORAD) index, the Infant's Dermatitis Quality of Life index (IDQOL), and the Dermatitis Family Impact Questionnaire (DFIQ) were assessed.ResultsThymic stromal lymphopoietin secretion was inhibited significantly in an AD environment by TTLE and GA by up to 57.2% and 73.3%, respectively. The use of the topical spray induced a significant reduction in pruritus and sleeplessness scores, as well as the SCORAD, IDQOL, and DFIQ indexes in the total group. Similar results were observed in patient subgroups with or without topical corticosteroid treatment.ConclusionsA topical spray containing TTLE and GA, which inhibit TSLP secretion, efficiently decreases AD pruritus and improves the quality of life of AD patients.

Illness perceptions and quality of life in families with child with atopic dermatitis

ObjectiveTo assess the Quality of Life (QoL) of children with Atopic Dermatitis (AD) and their families and the impact of the mothers’ illness perceptions on the family QoL. Materials and methodsSeventy-five children with AD (54 infants and 21 children) and their mothers participated in the study. The following questionnaires were administrated: 1. Brief Illness Perception Questionnaire (Brief IPQ); 2. Infant's Dermatitis Quality of Life Index (IDQOL); 3. Children's Dermatology Life Quality Index (CDLQI); 4. Dermatitis Family Impact Questionnaire (DFIQ) and 5. The Severity Scoring of Atopic Dermatitis (SCORAD). ResultsAtopic dermatitis had a moderate impact on the QoL of the infants (6.67±5.30), children (7.86±7.19) and their families (9.42±7.03). The DFIQ was associated with certain dimensions of the Brief IPQ, specifically, with Illness Identity (greater symptom burden) (r=0.615, p=0.000), beliefs about the Consequences of the illness (r=0.542, p=0.000), the Concerns (r=0.421, p=0.000) and the Emotional Representations (r=0.510, p=0.000). Correlation was demonstrated between IDQOL and DFIQ (r=0.662, p=0.000) and between CDLQI and DFIQ (r=0.832, p=0.000), and a weaker correlation between SCORAD and DFIQ (r=0.255, p=0.035). The chronicity of the AD showed negative association with DFIQ (p<0.001). ConclusionsThe QoL of families with a child with AD is associated with the mother's illness perceptions about AD, the children's QoL and with both the severity and the chronicity of the disease. Therefore, clinicians should pay attention not only to the clinical characteristics of the children, but also to the parents’ beliefs and emotions, to improve the family QoL.

Factors associated with improvement of quality of life among parents of children with atopic dermatitis: 1-year prospective cohort study.

Previous studies exploring the impact of atopic dermatitis (AD) in children focused on factors associated with parental quality of life at one point in time. To examine factors associated with change of quality of life among parents of children affected with AD. The study cohort comprised 98 parent-children pairs treated for AD at the Clinic of Dermatovenereology; however, 18 parents (18.4%) were lost to follow-up after 1year. Children were assessed with SCORing Atopic Dermatitis Index (SCORAD) and Children Dermatology Life Quality Index (CDLQI) or the Infants' Dermatitis Quality of Life Index (IDQOL), depending on their age. Parents filled in socio-demographic questionnaire and Dermatitis Family Impact Questionnaire (DFI). After 1year, both children and parents were reassessed using the same AD-related battery of questionnaires. After follow-up, a significant improvement in the average total DFI score was observed, especially for domains of fatigue/exhaustion, emotional distress and impact of helping in child treatment. Lower baseline SCORAD, greater improvement of SCORAD over follow-up, better CDLQI/IDQOL at baseline, greater improvement in CDLQI/IDQOL over follow-up, not having asthma and having older child with AD were associated with better parental quality of life after 1year of follow-up. Parental higher education level, shorter AD duration, better baseline SCORAD and greater improvement in CDLQI/IDQOL over follow-up were associated with greater improvement in parental life quality over 1year of follow-up. Contributors to parental quality of life after 1year included clinical features of AD and child's comorbidity (asthma), but also the perception of child's quality of life and its improvement.

The quality of life of caregivers of children with atopic dermatitis in a South African setting

Background. Atopic dermatitis (AD) is known to adversely affect patients’ quality of life (QOL). However, less is known about the extent to which caregivers are affected, particularly in developing countries. Objectives. To investigate factors affecting QOL in caregivers of children with AD in the South African (SA) setting and to document the associated effect of disease severity. Methods. This was a prospective study of 142 AD patients and their caregivers attending Grey’s Hospital in KwaZulu-Natal, SA, between May and September 2016. Disease severity was assessed according to the Objective Scoring of Atopic Dermatitis (Objective SCORAD) index. The Dermatitis Family Impact (DFI) questionnaire was used to assess QOL. Results. The study population included 119 (84%) black, 20 (14%) Indian and 3 (2%) coloured patients. Among the group, 44% of cases ( n =62) were classified as mild, 53% ( n =76) as moderate and 3% ( n =4) as severe. The DFI score was significantly associated with the Objective SCORAD index ( p <0.0001). QOL factors significantly affected were emotional distress of the caregiver ( p <0.0001), tiredness of the caregiver ( p <0.0001) and family leisure activities ( p <0.0001). Involvement in treatment ( p =0.016), food preparation and feeding ( p =0.003), the family’s sleep ( p =0.001) and the caregiver’s relationships ( p =0.025) were moderately affected. Conclusion. The QOL of caregivers of children with AD in this setting was adversely affected and declined with increasing disease severity. An evaluation of the psychosocial health of caregivers and appropriate referral where necessary are important for holistic management of both the patient and the caregiver and to improve disease outcome.

Crisaborole Ointment Improves Quality of Life of Patients with Mild to Moderate Atopic Dermatitis and Their Families

IntroductionThe impact of crisaborole ointment, a nonsteroidal phosphodiesterase 4 inhibitor for the treatment of mild to moderate atopic dermatitis (AD), on quality of life (QoL) was assessed in two identically designed phase 3 studies (AD-301: NCT02118766; AD-302: NCT02118792, both at http://www.clinicaltrials.gov).MethodsIn both studies, patients aged ≥ 2 years with mild to moderate AD per the Investigator’s Static Global Assessment were randomly assigned 2:1 to receive crisaborole or vehicle twice daily for 28 days. QoL was assessed using the Children’s Dermatology Life Quality Index (CDLQI) (2–15 years), the Dermatology Life Quality Index (DLQI) (≥ 16 years), and the Dermatitis Family Impact Questionnaire (DFI) (parents/caregivers/family of patients aged 2–17 years). Established QoL score severity bands provided clinical context.ResultsGreater mean improvement in QoL was observed in crisaborole-treated patients than in vehicle-treated patients at day 29 [mean change from baseline (∆BL), CDLQI: − 4.6 vs. − 3.0; P < 0.001; DLQI: − 5.2 vs. − 3.5; P = 0.015]. At baseline, more than half the patients had a “moderate effect” or higher of AD on QoL. At day 29, there was a trend toward more crisaborole- than vehicle-treated patients having “small effect” to “no effect”, The QoL of parents/caregivers/family improved more for crisaborole-treated than for vehicle-treated patients (∆BL, DFI: − 3.7 vs. − 2.7; P = 0.003).ConclusionCrisaborole treatment results in clinically meaningful improvement in QoL for patients and their parents/caregivers/families.Trial RegistrationAD-301: http://www.clinicaltrials.gov, NCT02118766; AD-302: http://www.clinicaltrials.gov, NCT02118792.FundingAnacor Pharmaceuticals, Inc., a wholly owned subsidiary of Pfizer Inc., New York, NY.

Adding emollient bath additives to standard eczema management for children with eczema: the BATHE RCT.

Childhood eczema is very common. Treatment often includes emollient bath additives, despite there being little evidence of their effectiveness. To determine the clinical effectiveness and cost-effectiveness of emollient bath additives in the management of childhood eczema. Pragmatic, randomised, open-label, multicentre superiority trial with two parallel groups. Ninety-six general practices in Wales, the west of England and southern England. Invitation by personal letter or opportunistically. Children aged between 12 months and 12 years fulfilling the UK Diagnostic Criteria for Atopic Eczema. Children with inactive or very mild eczema (a score of ≤ 5 on the Nottingham Eczema Severity Scale) were excluded, as were children who bathed less than once per week or whose parents/carers were not prepared to accept randomisation. The intervention group were prescribed bath additives by their usual clinical team and were asked to use them regularly for 12 months. The control group were asked to use no bath additives for 12 months. Both groups continued standard eczema management, including regular leave-on emollients and topical corticosteroids (TCSs) when required. The primary outcome was eczema control measured by Patient Oriented Eczema Measure [POEM, 0 (clear) to 28 (severe)] weekly for 16 weeks. The secondary outcomes were eczema severity over 1 year (4-weekly POEM), number of eczema exacerbations, disease-specific quality of life (QoL) (Dermatitis Family Impact Questionnaire), generic QoL (Child Health Utility-9 Dimensions) and type and quantity of topical steroid/calcineurin inhibitors prescribed. Children were randomised (1 : 1) using online software to either bath additives plus standard eczema care or standard eczema care alone, stratified by recruiting centre, and there was open-label blinding. From December 2014 to May 2016, 482 children were randomised: 51% were female, 84% were white and the mean age was 5 years (n = 264 in the intervention group, n = 218 in the control group). Reported adherence to randomised treatment allocation was > 92% in both groups, with 76.7% of participants completing at least 12 (80%) of the first 16 weekly questionnaires for the primary outcome. Baseline POEM score was 9.5 [standard deviation (SD) 5.7] in the bath additives group and 10.1 (SD 5.8) in the no bath additives group. Average POEM score over the first 16 weeks was 7.5 (SD 6.0) in the bath additives group and 8.4 (SD 6.0) in the no bath additives group, with no statistically significant difference between the groups. After controlling for baseline severity and confounders (ethnicity, TCS use, soap substitute use) and allowing for clustering of participants within centres and responses within participants over time, POEM scores in the no bath additive group were 0.41 points higher than in the bath additive group (95% confidence interval -0.27 to 1.10), which is well below the published minimal clinically important difference of 3 points. There was no difference between groups in secondary outcomes or in adverse effects such as redness, stinging or slipping. Simple randomisation resulted in an imbalance in baseline group size, although baseline characteristics were well balanced between groups. This trial found no evidence of clinical benefit of including emollient bath additives in the standard management of childhood eczema. Further research is required on optimal regimens of leave-on emollients and the use of emollients as soap substitutes. Current Controlled Trials ISRCTN84102309. This project was funded by the NIHR Health Technology Assessment Programme and will be published in full in Health Technology Assessment; Vol. 22, No. 57. See the NIHR Journals Library website for further project information.

ATOPIC DERMATITIS AND THE QUALITY OF LIFE IN CHILDREN, ADOLESCENTS AND THEIR FAMILIES

Background: Atopic dermatitis (AD) is a pruritic disease that usually starts in early infancy with an international prevalence rate of 15– 30% in children and 2-10% in adults. Measuring the impact of AD on the quality of life is very useful as it allows patients to express their feelings and appreciate their physicians' concerns. It improves doctor-patient communication and helps in disease management. Objectives: A cross sectional observational study that was conducted aimed to determine the effect of atopic dermatitis on the quality of life among children and adolescents attending dermatology outpatient clinics at Kasr Al Ainy hospital and Pediatric specialized hospital, during the period from November 2015 to June 2016. Methods: A sample of 400 children, adolescents and their families were included in the study. They were asked to fill the QOL questionnaires (Children Dermatology Life Quality Index (CDLQI), Dermatology Life Quality Index (DLQI) and Dermatitis Family Impact questionnaire (DFI). Results: Results of the study showed that 48% of AD patients aged (6-16) has very large effect on QOL, 47.3% have extremely large effect and 4.8% have moderate effect while 52% of AD patients aged (16-18) has extremely large effect on QOL and 47% have very large effect. Families of AD patients have very large effect on QOL where 44% have extremely large effect. Conclusion: This study concluded that AD has a negative impact on the QOL of children, adolescent and their families irrespective to socio-demographic and socioeconomic factors.