Management Of Atopic Dermatitis In Children Research Articles

A Mobile Health App for Facilitating Disease Management in Children With Atopic Dermatitis: Feasibility and Impact Study.

Inadequate control of atopic dermatitis (AD) increases the frequency of exacerbations and reduces the quality of life. Mobile health apps provide information and communication technology and may increase treatment adherence and facilitate disease management at home. The mobile health app, Atopic App, designed for patients and their caregivers, and the associated web-based patient education program, Atopic School, provide an opportunity for improving patients' and caregivers' engagement and adherence to the management of AD. This noninterventional, observational study aimed to explore the feasibility and potential impact on the management of AD in children by caregivers using the Atopic App mobile health app. The patient-oriented eczema measure (POEM) and numerical rating scale for the grading of pruritus were used as severity scores (scale range: 0-28). The artificial intelligence model of the app was used to assess the severity of AD based on the eczema area and severity index approach. The deidentified data enabled the analysis of the severity of AD, treatment plan history, potential triggers of flare-ups, usage of available features of the app, and the impact of patient education. During a 12-month period, of the 1223 users who installed the app, 910 (74.4%) registered users were caregivers of children with AD. The web-based Atopic School course was accessed by 266 (29.2%) caregivers of children with AD, 134 (50.4%) of whom completed the course. Usage of the app was significantly more frequent among those who completed the Atopic School program than among those who did not access or did not complete the course (P<.001). Users who completed a second POEM 21 to 27 days apart exhibited a significant improvement of AD severity based on the POEM score (P<.001), with an average improvement of 3.86 (SD 6.85) points. The artificial intelligence severity score and itching score were highly correlated with the POEM score (r=0.35 and r=0.52, respectively). The Atopic App provides valuable real-world data on the epidemiology, severity dynamics, treatment patterns, and exacerbation-trigger correlations in patients with AD. The significant reduction in the POEM score among users of the Atopic App indicates a potential impact of this tool on health care engagement by caregivers of children with AD.

A Case Study on the Ayurvedic Management of Childhood Atopic Dermatitis

Atopic Dermatitis (AD) is a chronic inflammatory skin condition with impaired cell-mediated immune function and compromised skin barrier. It is characterized by erythema, oedema, vesicles, oozing in the acute stage, and thickening and hyperpigmentation (lichenification) in the chronic stage. The incidence of skin diseases is increasing day by day. Other medical systems provide temporary relief but not a complete cure. Ayurveda can contribute remarkably in the management of skin problems. Atopic dermatitis comes under Twak vikaras which can be correlated with Charmadala described in Kashyapa samhitha. This is the case report of a nine-year-old girl with dry, itchy and scaly skin associated with blackish excoriated lesions and oozing. She visited the outpatient department of Government Ayurveda Hospital. Ayurveda medications were administered along with dietary advice for a period of three weeks, followed by inpatient treatment with internal medications along with Snehapana (intake of ghee) followed by Vamana (emesis) and external procedures like Dhara (pouring of medicated liquids) with Kushtahara (alleviates itching) and Kandughna (anti-pruritic) Dravyas along with dietary advice for a period of one month. Encouraging results were observed in the form of a reduction in itching, dryness, and excoriation. The efficacy of the treatment was assessed using SCORAD (scoring atopic dermatitis scale), where the pre-value is 54.7 and the post-value is 17. On POEM (patient-oriented eczema measure) scale evaluation the condition changed from severe eczema to clear or almost clear. Dietary restrictions and internal medication must be continued to prevent the recurrence of the condition.

Harmful Effect of Indoor Formaldehyde on Atopic Dermatitis in Children: A Longitudinal Study.

PurposeEvidence supporting a link between indoor formaldehyde exposure and atopic dermatitis (AD) in humans is limited. The purpose of this longitudinal study was to investigate whether AD symptoms in children could be affected by indoor formaldehyde levels in ordinary households.MethodsFifty-five children with moderate-to-severe AD aged under 18 years were enrolled as a panel. They were followed up from February 2019 through February 2020. Indoor formaldehyde levels of patients' houses and their AD symptoms were repeatedly measured on a daily basis. The generalized linear mixed model was utilized for statistical analysis. Subdivision analysis was performed by stratifying patients by sex, body mass index, presence of parental allergy, and indoor environments including mold/dampness, temperature, and relative humidity (RH).ResultsA total of 4,789 person-days of AD symptom data were collected. The average concentration of formaldehyde was 13.6 ± 16.4 ppb, with the highest value found in spring (18.1 ± 20.6 ppb). Higher levels of formaldehyde were observed when there was parental smoking, increased indoor temperature over 25.5°C, or RH over 60% (P < 0.0001). When the effect size was compared between each season after controlling for ambient particulate matter, temperature, and RH, an increase in 10 ppb of formaldehyde increased AD symptoms by 79.2% (95% confidence interval [CI], 19.6–168.4) in spring and by 39.9% (95% CI, 14.3–71.2) in summer. AD symptoms in children aged 6−18 years appeared to increase significantly, whereas there was no significant increase in children under 6 years. When indoor temperature was over 25.5°C, an increase in formaldehyde by 10 ppb increased AD symptoms by 17.8% (95% CI, 3.9–33.6).ConclusionsIndoor formaldehyde can exacerbate AD symptom in children with moderate-to-severe AD, particularly in spring and summer, even at allowable levels. Thus, minimizing exposure to indoor formaldehyde may be needed for the proper management of AD in children.

Management of Atopic Dermatitis in Children Younger Than Two Years of Age by Community Pediatricians: A Survey and Chart Review

To characterize primary care providers' (PCPs) practice patterns for atopic dermatitis (AD) in children <2years old and determine the need for AD guidelines for PCPs focused on this age group. This is a mixed-methods study consisting of a survey and a retrospective medical record review of PCP practices in the Chicago metropolitan area. The survey was analyzed using both quantitative and qualitative methods. In the survey (n=52 respondents), PCPs reported management of AD is different in children <2years compared with older children (88%). They were more likely to refer to a specialist (65%) and less likely to use high-potency topical corticosteroids (64%). In the chart review, PCP visits for children 2-5years old (n=50 914) vs those <2years old (n=71 913) for AD, older children had medium- and high-potency topical corticosteroids prescribed more frequently than younger children (0.66% vs 0.37%, P<.01 and .15% vs 0.05%, P<.01, respectively). In the subset of children <2years of age who also were evaluated by a specialist (n=109), medium- and high-potency topical corticosteroids were prescribed disproportionately at visits to providers in dermatology (57%) vs allergy (30%) vs pediatrics (15%) (P<.01). PCPs suggested that guidelines for this age group should include recommendations for preferred corticosteroids (39%), allergy management (35%), referral criteria (22%), and assessment of disease severity (11%). PCP management of AD in children <2years is different from older children, with possible underuse of medium/high-potency topical corticosteroids. Clear guidelines for this age group are needed.

Wool Clothing for the Management of Childhood Atopic Dermatitis (DESSINE2)

Wool Clothing for the Management of Childhood Atopic Dermatitis (DESSINE2)

Family management of childhood atopic dermatitis

To identify the variables that affect family management of childhood atopic dermatitis and establish a prediction model based on Bandura's self-efficacy theory. Atopic dermatitis is a chronic recurrent skin disease and common health problem in childhood. It is necessary to use an approach that includes parental factors when considering the effective management of childhood atopic dermatitis. A cross-sectional study design. A convenience sample, comprising 168 Korean mothers caring for a child with atopic dermatitis under the age of 13, was recruited from the paediatric outpatient departments of two general hospitals in Seoul, South Korea. Data were collected using structured self-reported questionnaires including severity, antecedents, effort, self-efficacy and family management of childhood atopic dermatitis from 1 November 2015-28 February 2016. Descriptive statistics about the participants and variables were examined and data were analysed using structural equationmodelling. The hypothetical model had an adequate fit to the data, indicating that severity, antecedents, effort and self-efficacy influenced family management of childhood atopic dermatitis. These results suggest that strategies to support children with atopic dermatitis and their family should consider the influence of such variables.

Role of Microbial Modulation in Management of Atopic Dermatitis in Children.

The pathophysiology of atopic dermatitis (AD) is multifactorial and is a complex interrelationship between skin barrier, genetic predisposition, immunologic development, skin microbiome, environmental, nutritional, pharmacological, and psychological factors. Several microbial modulations of the intestinal microbiome with pre- and/or probiotics have been used in AD management, with different clinical out-come (both positive, as well as null findings). This review provides an overview of the clinical evidence from trials in children from 2008 to 2017, aiming to evaluate the effect of dietary interventions with pre- and/or pro-biotics for the treatment of AD. By searching the PUBMED/MEDLINE, EMBADE, and COCHRANE databases 14 clinical studies were selected and included within this review. Data extraction was independently conducted by two authors. The primary outcome was an improvement in the clinical score of AD severity. Changes of serum immunological markers and/or gastrointestinal symptoms were explored if available. In these studies some dietary interventions with pre- and/or pro-biotics were beneficial compared to control diets in the management of AD in children, next to treatment with emollients, and/or local corticosteroids. However, heterogeneity between studies was high, making it clear that focused clinical randomized controlled trials are needed to understand the potential role and underlying mechanism of dietary interventions in children with AD.

Ayurvedic management of childhood atopic dermatitis - A case report

Atopic dermatitis (AD) is a common, chronic skin disorder that can significantly impact the quality of life of affected individuals as well as their families. Not only patients are affected by the social stigma of a visible skin condition, but the intense itching characteristic of the disease often leads to significant sleep disturbances. If the itch can be controlled, the rash can be more readily treated. As per Ayurvedic classics, Atopic dermatitis can be incorporated under the category of twak vikara (skin disease). In this article, a case of 7 year old boy with dry, itchy and scaly skin with excoriative lesions who was treated with parisheka (affusion sudation) and internal medicaments. The parisheka (affusion sudation) was prepared out of Karanja (Pongamia pinnata Pierre.) and Nimba patra (Azadirachta indica A. Juss.) which are kushtahara (alleviates skin lesions) and kandughna (anti-pruritic). Encouraging results were observed in the form of reduction in itching and dryness of skin.

Topical Therapy in Atopic Dermatitis in Children.

Atopic dermatitis (AD) is a common, chronic childhood skin disorder caused by complex genetic, immunological, and environmental interactions. It significantly impairs quality of life for both child and family. Treatment is complex and must be tailored to the individual taking into account personal, social, and emotional factors, as well as disease severity. This review covers the management of AD in children with topical treatments, focusing on: education and empowerment of patients and caregivers, avoidance of trigger factors, repair and maintenance of the skin barrier by correct use of emollients, control of inflammation with topical corticosteroids and calcineurin inhibitors, minimizing infection, and the use of bandages and body suits.

Improved management of childhood atopic dermatitis after individually tailored nurse consultations: A pilot study.

For optimal therapy of atopic dermatitis (AD) in children, parent education for treatment strategies that consider the episodic course and multiple triggers is essential. Regular consultations with doctors often cannot appropriately provide this. Therefore, supplemental patient education tools have been established. We evaluate single nurse consultations, assessing their global benefit, parents' self-confidence, and children's symptoms and sleep disturbance. Parents of children with AD were invited for an individually tailored nurse consultation by the doctor initially consulted in cases where difficulties in implementing care recommendations were detected and established therapeutic patient education (TPE) group programmes were impracticable. Parents' estimation of their own self-confidence, current disease severity and its treatment was assessed by a questionnaire at the consultation and by telephone 14days later. Parents of 1628 children (mean age 1.7yr) attended consultations in 22 centres (317-6 patients; median 38). At follow-up parents indicated a significantly increased self-confidence to handle the recommendations and >90% rated the consultation highly supportive. The frequency of severe symptoms was significantly lower (20% of initial cases), as of moderate symptoms (50%). Median scores for sleep disruption and pruritus decreased by >50%. Individually tailored single nurse consultations for AD are associated with a significant benefit for the families after 14days. We recommend these in addition to the usual medical care in cases where participation in TPE programmes is impossible or a short-time follow-up is required. To substantiate their effect, studies with a long-term follow-up and a control group are warranted.

Skin-Directed Management of Childhood Atopic Dermatitis

Atopic dermatitis (AD), also known as eczema, occurs in 10% of children in the U.S. It is a chronic, relapsing, pruritic inflammatory skin disorder

Atopic Dermatitis: Insights on Pathogenesis, Evaluation and Management

Background: Atopic Dermatitis (AD) is a highly pruritic chronic inflammatory skin disease that commonly presents during early childhood. Several studies indicate that the disease is very common in western world with lifetime prevalence in children of 10% to 20%. Data sources: We make recommendations regarding the evaluation and management of AD in children based on systematic literature searches using the best-available evidence from PubMed, Medline, Google Scholar, NICE, the American Academy of Dermatology and the World Allergy Organization. Results: AD has an immunologic basis. Both innate and adaptive immune responses are impaired in AD patients. Intense pruritus is a hallmark of the disease which leads to extensive scratching and further breakdown of the skin barrier. Treatment of AD may be topical or systemic. Topical corticosteroids and calcineurin inhibitors are used as topical anti-inflammatory agents. Patients should be carefully instructed in the use of topical glucocorticoids to avoid side effects. Conclusions: Treatment of atopic eczema should be based on a “stepped-care plan” where treatments are stepped up or down depending on the assessment of the state of the child’s skin by the physician. Physicians who treat children with mild to moderate AD should tell children and their caregivers that AD is a lifelong illness.

Frontiers of rapid itch relief: a review of methylprednisolone aceponate

In a paediatric population, the successful management of childhood atopic dermatitis (AD) should include the careful evaluation and selection of available therapies, based not only on demonstrated safety and tolerability in small children and infants, but also on their evidence-based, anti-pruritic benefits. Moreover, the speed of anti-pruritic effect should be considered a significant parameter in treatment selection. The fourth-generation topical corticosteroid (TC) methylprednisolone aceponate (MPA) is a potent anti-inflammatory agent with a demonstrated fast and effective itch relief profile in children and infants (as young as 2 months) with AD. Compared with traditional TCs, MPA has a significantly improved therapeutic index; that is, increased potency without a proportionate increase in side effects. In addition to its established efficacy, the once-daily application and broad range of available formulations make MPA an optimal choice for acute and maintenance therapy in paediatric patients with AD-related pruritus.

Atopic Dermatitis in Italian Children: Evaluation of Its Economic Impact

Introduction The aim of our study was to evaluate the economic impact of atopic dermatitis (AD) on the family of young children affected by the disease in Italy. Methods Thirty-three families of young children affected by AD were asked to fill in a questionnaire about financial costs associated with providing health care during the past year for their child affected by AD. For each child AD severity was evaluated by using the SCORAD index. Results By analyzing the questionnaire, an annual average cost of 1254€ (about U.S. $1540) for each family was determined. Main expenses concern the use of moisturizing therapies, particular detergent, and private specialist consultations. Annual family average cost was lower for children with mild AD compared with those with moderate to severe AD. Discussion AD has a deep impact on the family budget, with an increasing cost in proportion to the increasing severity of the disease. These data support previous reports suggesting that the management of AD in children is complex and costly, altering the quality of life of children and their families.

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

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.

The Consensus Conference on Pediatric Atopic Dermatitis

Source: Eichenfield LF, Hanifin JM, Luger TA, et al. Consensus Conference on Pediatric Atopic Dermatitis. J Am Acad Dermatol 2003;49:1088–1095.A recent consensus conference convened by the American Academy of Dermatology addressed the epidemiology, pathogenesis, and treatment of atopic dermatitis (AD) in children. The disease is now recognized as a syndrome consisting of pruritus, typical morphology and age-specific patterns, and a chronic or relapsing history, associated with early age of onset, atopy, xerosis, and a combination of accompanying, less specific clinical findings such as keratosis pilaris, white dermographism, and lichenification. AD results from a number of immunologic, neurochemical, and genetic factors, although which factors predominate remains uncertain. Controversies remain regarding the role of food allergens, the mode and timing of exposures, and the role of food avoidance in the pathogenesis of AD.With regard to therapy of AD there were several areas of consensus:Conflicting or lack of data regarding the utility, safety, and efficacy of other therapies in the pediatric population, including antihistamines, topical and systemic antibiotics, avoidance of environmental allergens, phototherapy, tar/coal tar solutions, systemic immunomodulators, and alternative or complementary therapies, all of which warrant further, rigorous investigation.Despite uncertainties, consensus exists in a number of areas, particularly with regard to the management of AD in children. Although steroid phobia has prompted some to shift away from topical steroids, these agents remain the first choice of many experienced clinicians because they are effective and safe when used under medical supervision. Newer topical immunomodulators are an exciting new therapeutic alternative with the promise of fewer side effects, but should be used with some caution because of our relative lack of experience with these drugs, and the potential for delayed adverse effects that might not manifest for many years to come.1 (See AAP Grand Rounds, June 2003;9:65–66. Also see Arvola, et al2 in the March issue of AAP Grand Rounds, 2004;11:30).

Psychosomatic Aspect and Stress Management of Childhood Atopic Dermatitis

Psychosomatic Aspect and Stress Management of Childhood Atopic Dermatitis

Acute and maintenance treatment of atopic dermatitis in children – two comparative studies with fluticasone propionate (0.05%) cream

BACKGOUND: Two multicentre, randomised, parallel group, double‐blind, comparative studies in children (2–14 yr) evaluated fluticasone propionate (FP) 0.05% cream for both acute and maintenance treatment of moderate to severe atopic dermatitis (AD).METHODS: One study compared FP with hydrocortisone (HC) 1% cream (FP 70, HC 67) and the other with hydrocortisone butyrate (HCB) 0.1% cream (FP 67, HCB 62). Treatments were applied twice daily, for 2–4 weeks until the AD was stabilised, and thereafter intermittently (‘as required’) for up to 12 weeks.RESULTS: The primary outcome measure, Total AD Score, recorded at the end of the acute and maintenance phases, was significantly lower (indicating improvements in disease severity) following treatment with FP compared with either HC or HCB (acute phase difference vs. HC, −2.39, 95%CI −3.47, −1.31; p<0.001 and vs. HCB, −1.25, 95%CI −2.46, −0.05; p=0.042) and (maintenance phase difference vs. HC, −1.88, 95%CI −3.20, −0.56; p=0.006 and vs. HCB, −1.39, 95%CI −2.72, −0.05; p=0.042). In both studies treatments were equally well tolerated with no visible signs of skin atrophy.CONCLUSION: In both the acute and longer term management of AD in children, FP demonstrated a high level of efficacy and maintenance of disease control with a tolerability similar to HC 1%, a lower potency corticosteroid.

Evaluation of SDZ-ASM 981 [ELIDEL™ (pimecrolimus)] in a trial simulating clinical practice in managing childhood atopic dermatitis

A multicentre clinical trial (Study B313), involving clinicians from countries across Europe, was designed to evaluate the possible role of SDZ-ASM 981 as one part of a long-term strategy in the management of childhood atopic dermatitis (AD). The principal feature of the study was a therapeutic regimen in which SDZ-ASM 981 (or control base) was applied, in addition to routine emollients, to very early signs of inflammation. Topical corticosteroids were available in both arms for active flares of disease. 474 patients were recruited to the active arm and 237 patients to the control arm. The age-distribution, disease severity at baseline and other major parameters were identical in the two groups. The primary end point of the study was the number of flares after 6 months of treatment. Secondary endpoints included the number of flares at 12 months, also flares assessed against disease severity at 6 and 12 months, the amount of topical corticosteroid used and the effect on Eczema Area and Severity Index (EASI). Safety parameters assessed included adverse events throughout the study, a physical examination and laboratory tests at baseline, 6 and 12 months, and skin recall antigen tests at the end of the study. Of the patients who were enrolled, 24% had discontinued the study in the active arm at 6 months compared with 48% in the control arm. By 12 months these figures were 32% and 52%, respectively. The main reason for discontinuance was lack of efficacy (12% SDZ-ASM 981; 30% control). There were fewer flares at 6 and 12 months in the active arm than the control arm and the discontinuation rate correlated with the number of flares in the AD. The positive effect of SDZ-ASM 981 was seen in mild, moderate and severe AD. Patients in the SDZ-ASM 981 arm used substantially less corticosteroid than those in the control arm. There was a rapid and sustained improvement in EASI in the active arm, approximately twice as great as that seen in the control patients. There was no significant difference in adverse events between the two groups and rates were similar for both bacterial and viral infections. There was no difference seen in the rate of local side-effects at the site of application of the creams. Skin recall antigen responses were comparable between the two populations at the end of the study. This study has demonstrated a positive effect of SDZ-ASM 981 in controlling flares of AD in children, in all degrees of severity. The patients treated with SDZ-ASM 981 used less topical corticosteroid and there was no increase in local or systemic side-effects.

Structured parent education in the management of childhood atopic dermatitis: The Berlin model

Childhood atopic dermatitis (AD) is a common disease with the prevalence rates increasing. Its chronic course with frequent relapses puts a special burden on both children and their parents. To maximise positive long-term outcome in the management of AD it is important to support parents in dealing with the chronic condition of their child in addition to treating symptoms. In the present article, we describe in detail the goals, structure, and content of the Berlin education program for parents of children with AD. The program aims to contribute towards a comprehensive, family-oriented management of childhood AD. Its objective is to improve parent’s self-management skills with regard to their child’s disease and to positively impact the course of the disease as well as the family’s quality of life. Medical, nutritional and psychological issues are covered in six group sessions which are conducted by a multiprofessional team of paediatricians, psychologists and dieticians. Preliminary data show that the program has a desirable effect on aspects of quality of life and coping.