Pediatric Allergy and Immunology

ORIGINAL ARTICLE

Skin

Predictors of benefit from an atopic dermatitis education programme  Fartasch3, Uwe Gieler4, Jo € rg Kupfer5, Kristine Breuer1, Uwe Matterne2, Thomas L. Diepgen2, Manige 6 7 8 2 Thomas Lob-Corzilius , Johannes Ring , Sibylle Scheewe , Reginald Scheidt , Gerhard Schmid-Ott9, € diger Szczepanski6, Marita Wittenmeier11, Ulrich Wahn10 Christina Schnopp7, Doris Staab10, Ru 12 & Thomas Werfel 1

Department of Allergology and Occupational Dermatology, Dermatologikum Hamburg, Hamburg, Germany; 2Department of Clinical Social Medicine, Center of Health Systems Research, Occupational and Environmental Dermatology, University of Heidelberg, Heidelberg, Germany; 3 Department for Clinical and Experimental Occupational Dermatology, Institute for Prevention and Occupational Medicine of the German Social Accident Insurance Institute of the Ruhr-University Bochum (IPA), Bochum, Germany; 4Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University, Giessen, Germany; 5Institute of Medical Psychology, Justus Liebig University, Giessen, Germany; 6 €ck, Osnabru €ck, Germany; 7Department of Dermatology and Allergy Biederstein, TU Munich, Munich, Germany; Childrens Hospital Osnabru 8 Rehabilitation Clinic for Children and Adolescents, Sylt, Germany; 9Department of Psychosomatic Medicine, Institute for Innovative €hne, Germany; 10Department of Rehabilitation, Hospital Management and Distress Medicine (IREHA), Berolina Clinic, Lielje Group, Lo , Humboldt University, Berlin, Germany; 11FAAK Ko €ln, Childrens Hospital Cologne, Cologne, Pediatric Pulmonology and Immunology, Charite Germany; 12Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany

To cite this article: Breuer K, Matterne U, Diepgen TL, Fartasch M, Gieler U, Kupfer J, Lob-Corzilius T, Ring J, Scheewe S, Scheidt R, Schmid-Ott G, Schnopp C, Staab D, Szczepanski R, Wittenmeier M, Wahn U, Werfel T. Predictors of benefit from an atopic dermatitis education programme. Pediatr Allergy Immunol 2014: 25: 489–495.

Keywords atopic dermatitis; children; coping; eczema; education; health-related quality of life (HRQoL); long-term outcome; education programme Correspondence Kristine Breuer, Dermatologikum Hamburg, Stephansplatz 5, 20354 Hamburg, Germany Tel.: +49 40 351075 0 Fax: +49 40 351075 314 E-mail: [email protected] Accepted for publication 3 May 2014 DOI:10.1111/pai.12249

Abstract Background: Multidisciplinary, age-related, structured, group educational programmes for children with atopic dermatitis (AD) and their parents have shown positive long-term outcomes with respect to quality of life and coping behaviour of the participants. We aimed to identify predictors of favourable long-term outcome of an education measure for parents of children with AD aged 3 months to 7 years in the framework of The German Atopic Dermatitis Intervention Study (GADIS). Methods: In an exploratory approach, the data of 274 child–parent pairs were analysed with respect to the influence of various somatic and psychological variables as possible predictors of treatment success. Changes in parents’ QoL, SCORAD (Scoring Atopic Dermatitis), topical corticosteroid use and parents’ knowledge about AD between baseline and 12-months’ follow-up were chosen as measures of long-term treatment success (outcome). Results: Psychological rather than somatic parameters were identified as predictors of treatment success. Parents who had negative treatment experiences in the past and possessed only poor coping abilities with regard to scratch control benefitted the most from the training programme. The outcome of the education measure was independent of parents’ schooling, vocational level and income. Conclusions: Parents of children with AD who lack adequate coping abilities should be particularly encouraged to take part in such an education programme.

Atopic dermatitis (AD) is an inflammatory skin disease with a high prevalence which arises from an interaction between environmental and genetic factors (1–5). Itching is a primary symptom of AD (6) resulting in sleeplessness and an impairment of quality of life; moreover, the skin disorder poses a large psychosocial and often also financial burden on the patients and their families (7–9). Lack of information about

and confidence in standard medical treatment may lead to the use of unconventional therapies, frequent changes of physicians and increased utilization of the medical system (7, 10). With the aim to empower children with AD and their parents to more successfully self-manage the skin condition in the longterm, multidisciplinary, age-related, structured group education programmes for the management of AD were set up in Germany

Pediatric Allergy and Immunology 25 (2014) 489–495 ª 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

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Predictors of benefit from an atopic dermatitis education programme

in 1996. Within the framework of a large multicentre, randomized controlled trial, the efficacy of these education programmes was demonstrated in children and adolescents. A favourable outcome with respect to disease severity, itch, children‘s and parents’ QoL at 12 months’ follow-up was shown when the intervention groups were compared with the control groups (11). Other analyses revealed significant correlations between itch and parameters of QoL and coping behaviour (12). Furthermore, the coping behaviour of children aged 8–12 years and their parents was significantly improved in the intervention group as compared to the control group (13). To allow a closer matching of patients to specific education programmes, it is crucial to identify characteristics of patients who do or do not benefit (14). To the best of our knowledge, possible predictors of treatment success of educational measures in parents of children with AD have not yet been investigated. Consequently, the present analyses looked at the role of various variables in the prediction of the long-term effects of the GADIS (German Atopic Dermatitis Intervention Study) education programme for parents of children aged 3 months to 7 years.

Breuer et al.

dryness, redness, blisters/nodules, weeping/crusting, scratch lesions and deep creases on a 4-point scale ranging from ‘no’ to ‘very strong’. A total score was computed by adding the six items. We created a new variable to measure the proximity between the physician assessed ‘objective’ SCORAD (SCORAD without the parameters ‘itch’ and ‘sleeplessness’) and parents assessed severity by subtracting the latter from the former. Prior to subtraction, both variables were z-standardized to create variables with same scaling properties. Disease severity index An index was calculated using the parameters onset of AD (

Predictors of benefit from an atopic dermatitis education programme.

Multidisciplinary, age-related, structured, group educational programmes for children with atopic dermatitis (AD) and their parents have shown positiv...
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