Role Of Patient Education In The Treatment Of Atopic Dermatitis

BackgroundAtopic dermatitis (AD) is a chronically relapsing, inflammatory skindisease, and its incidence presents an increasing trend. Itching is the mainclinical feature of AD, also a necessary condition for diagnosis, it can lead toa vicious cycle of itching-scratching-inflammatory response, resulting in arecurrent, protracted course, seriously affecting the quality of life of thechildren and the entire family. Topical glucocorticoid are still the first-linetherapy of AD, but long-term, large-scale use of steroids may lead to local orsystemic adverse reactions, and steroid phobia often exist in patients andtheir parents, resulting in poor compliance with topical use. Drug withdrawaltoo fast and insufficient anti-inflammatory treatment can give rise torecurrent episodes. Although there is no topical steroid-induced side effectssuch as skin atrophy in calcineurin inhibitors, but questions about thesecurity and system absorption in long-term use is not clear. To reduce therecurrence of the disease and the side effects of the drug, to improve thequality of life requires the joint efforts of the doctors and patients.Recent Studies has shown that patient education for AD children and parents can effectively alleviate its onset, and greatly improve the quality oflife. Therefore, the China Association of Dermatologists (CDA)-PierreFabre atopic dermatitis foundation established six atopic dermatitiseducation centers in six countries, to carry out researches about patienteducation and its impact on treatment of AD. We, as one of the centers,carried out specialized, standardized education seminars for atopicdermatitis children and parents in Chongqing as well as the southwest region,Intending to explore the role of patient education in the treatment of atopicdermatitis.ObjectTo evaluate the validity of patient education on management andtreatment of AD, and the impact on quality of life and emollients cognitive.MethodA single-center randomly controlled clinical trial was conducted. Atotal of48patients diagnosed with AD and their parents were randomized toeither the educational or non-educational group (control group). In additionto the conventional therapy of AD, The educational group undertook3hoursof education intervention, while the control group didn’t. After6months offollow-ups, we evaluate disease severity (SCORAD), dermatology qualityof life index (IDQLI, CDQLI) and emollient cognitive state at the baseline,the3rd month and the6thmonth. Results1．Impact of patient education on the severity of AD：Significantimprovements in SCORAD were seen in educational group compared withcontrol group at the3rdmonth and the6thmonth（the3rdmonth：educationalgroup Average difference-27.454，95%CI:-32.757to-22.151v controlgroup-18.193，-23.368to-13.019, P=0.016；the6thmonth：-34.614,-39.654to-29.573v-19.529,-24.448to-14.611, P=0.000）In which, improvements in SCORAD of2to6years AD patient ineducational group were significant than control group at the3rdmonth andthe6thmonth（the3rdmonth：educational group Average difference-26.028，95%CI:-32.818to-19.360v control group-16.199,-22.410to-9.881，P=0.035；the6thmonth：-35.654，-41.267to-29.839v-17.495，-22.902to-12.264，P=0.000）.But there was no statistically significant in group age7-14years（the3rdmonth：educational group Average difference-29.654，-43.311to-23.486v control group-23.703，-30.322to-9.614，P=0.085；the6thmonth：-32.076，-42.599to-18.291v-25.320，-40.527to-13.919，P=0.721）.2．Impact of patient education on the dermatology life quality of AD：In the3rdand the6thmonth follows-up, either education group or controlgroup showed improvements in DLQI, but only in the6thmonth,significant difference of improvement in IDLQI, CDLQI were seen.(IDLQI:the6thmonth：educational group Average difference-7.96，95%CI:-9.69to-6.24v control group-5.10，-0.67to-3.49，P=0.019；CDLQI: the6thmonth： educational group Average difference-8.66，95%CI:-10.46to-6.89v-4.38,-6.31to-2.45， P=0.005). of the six subscales reflecting the childrendermatology life quality, the three subscales leisure and entertainment (P=0.009), sleep (P=0.020) and treatment (P=0.007) improved significantly inthe education group in the6thmonth.3．Impact of patient education on emollient cognitive: In the end of thestudy, there was no statistically significant in emollient cognitiveimprovement between educational group and control group (educationalgroup Average difference:-6.80，95%CI:-7.80to-4.50v control group-3.33，95%CI:-5.56to-2.34，P=0.06). In the three subscales of emollientcognitive, only cognitive about Ingredient of emollient improved moresignificantly in educational group than in control group in the6thmonth(P=0.046）。Conclusions1. Patient education can significantly improve severity of AD in2to6years, but in this study, the impact on7to14years group was not significant.2. Patient education can improve the long-term quality of life ofpatients and their families.3．Patient education has certain effect on emollient cognitive, but asemollients are non-prescription drugs and very expensive, its use andpopularization still need a long way to go4．The improvement in disease severity and dermatology life quality, reveals the effectiveness of patient education in the treatment andmanagement of AD. However, the form and content of education should beMeet the needs of different age groups5．The results confirmed that, on the basis of traditional treatment,patient education can be an adjuvant therapy in the long-term managementof AD.