A Family-Engaged Educational Program for Atopic Dermatitis: A Seven-Year,Multicenter Experience in Daegu-Gyeongbuk,South Korea

Background

It is important to educate families of pediatric patients with atopic dermatitis (AD) so that they have a correct understanding of AD.

Objective

The purpose of this study is to introduce, evaluate, and improve our family-engaged educational program.

Methods

Children suffering from AD and their families have participated in a half-day educational program called "AD school" with catchy slogans such as "Enjoy with AD Families!" every year since 2005. Educational lectures were conducted for parents. For children with AD, various entertaining programs were provided. A feedback survey about AD school was administered for the purpose of evaluation.

Results

A total of 827 people (376 patients and 451 family members) participated in this program over 7 years. On-site surveys showed a positive response (i.e., "excellent" or "good") for the prick test (95.1%), emollient education (78.4%), educational lecture (97.0%), drawing contest and games (90.2%), and recreation (magic show; 99.0%) respectively. Telephone surveys one year later also elicited a positive response.

Conclusion

We herein introduce the experience of a half-day, family-engaged educational program for AD. Family-engaged education programs for AD such as this AD school encourage and validate family participation in the treatment of their children''s AD.     

Patient education programs for childhood atopic dermatitis: who is interested?

Background: Atopic dermatitis (AD) is a skin disease which causes psychological distress to patients and their families. Patient education programs for childhood AD have positive effects on the severity of the skin disease as well as on psychological variables. So far it has not been determined whether particular patient characteristics lead to being interested in patient education programs. The aim of this cross‐sectional study was to identify exploratory predictors of being interested in patient education programs in parents of children with atopic dermatitis. Patients and methods: A severity index (SCORAD) as well as questionnaire data were collected from 73 parents of children with AD to measure satisfaction with medical care, quality of life, coping strategies, and the subjective benefit of former treatments as possible predictors. Results: A regression analysis revealed that besides dissatisfaction with medical care, low social support and high active problem‐solving behavior were significant predictors of interest in patient education programs (R²= 0.244). Conclusions: Our study gives a preliminary indication that participation in a patient education program for childhood AD should be offered to parents without sufficient social support, but who would like to gather more information on coping with AD. This could also enhance satisfaction with the medical care provided.     

An Educational Program That Contributes to Improved Patient and Parental Understanding of Atopic Dermatitis

Background

Providing an educational program as part of a health care program for the management of atopic dermatitis (AD) patients has rapidly become popular. AD educational programs can be of benefit in measured outcomes for both dermatology specialists and patients.

Objective

To determine the effects of programmed education delivered by dermatology specialists on the management and knowledge of AD, we assessed the effectiveness of patient/parental education at improving AD knowledge, and determined the usefulness of the education.

Methods

The program consisted of five, 20-minutes sessions which were prepared, discussed, reviewed, and delivered by professors of dermatology. At the end of the program, AD knowledge was assessed using a standardized questionnaire. A total of 148 people were included. Fifty-eight patients/parents received the programmed education and the remaining 90 did not receive the programmed education.

Results

The mean questionnaire scores from both groups were compared. Mean knowledge scores were significantly higher for those who received the education (p=0.00). We analyzed the knowledge score according to factors such as gender, education level, marital status, and occupation. The data indicated that education level influences the subjects'' knowledge level of AD, but gender, occupation, and marital status do not.

Conclusion

An educational program can be an effective tool to improve patient quality of life and treatment compliance by providing psychological support to the patients and their parents.     

Patient education programs for childhood atopic dermatitis: who is interested?

Background: Atopic dermatitis (AD) is a skin disease which causes psychological distress to patients and their families. Patient education programs for childhood AD have positive effects on the severity of the skin disease as well as on psychological variables. So far it has not been determined whether particular patient characteristics lead to being interested in patient education programs. The aim of this cross-sectional study was to identify exploratory predictors of being interested in patient education programs in parents of children with atopic dermatitis. Patients and methods: A severity index (SCORAD) as well as questionnaire data were collected from 73 parents of children with AD to measure satisfaction with medical care, quality of life, coping strategies, and the subjective benefit of former treatments as possible predictors. Results: A regression analysis revealed that besides dissatisfaction with medical care, low social support and high active problem-solving behavior were significant predictors of interest in patient education programs (R(2) = 0.244). Conclusions: Our study gives a preliminary indication that participation in a patient education program for childhood AD should be offered to parents without sufficient social support, but who would like to gather more information on coping with AD. This could also enhance satisfaction with the medical care provided.     

Escuela de dermatitis atópica: importancia de la formación de cuidadores

IntroductionThe aim of this study was to determine the perception of knowledge about atopic dermatitis (AD) in caregivers of children with this disease, and the impact of therapeutic patient education (TPE) on improving this knowledge.MethodologyA non-validated questionnaire was used on parents of children suffering from AD that attended to Atopic School (AS) of Pontevedra. It consisted of 9 questions about: repercussion of AD in different life spheres, time taken up with topical treatments, and knowledge about AD before and after TPE.ResultsA total of 61 questionnaires were collected from 5 sessions in the AS. The large majority (83.6%) of the respondents perceived that AD had a moderate or severe influence on their children's quality of life. Just 6.6% of respondents mentioned that they had a lot of information before attending the AS, and in all cases the respondents thought the information given in the AS increased their knowledge.ConclusionOur data support that TPE increases the knowledge about AD. Since AD has a negative impact on the quality of life of children, TPE sessions are of utmost importance.     

Chief resident selection in US dermatology residency programs

Chief residents are typically selected as leaders from the senior-most residents in a residency program. The definition of the role likely varies widely between various residency programs. We aimed to gain a better understanding of responsibilities of chief residents in dermatology programs and to identify selection methods. After institutional review board review, we created a Qualtrics survey distributed through a listserv of program directors (PDs) from US dermatology residency programs. Of 51 survey responses, 100% had chief residents, and 35.3% had all senior residents designated as chief residents. The majority of programs used several selection processes, but most frequently PD selection (n = 20). Programs (76%) reported other leadership opportunities for seniors. The most important attribute in selecting a chief resident was helpfulness, and PDs rated their perceived resident satisfaction with the selection process as an 8.24 out of 10, with 10 being most satisfied. Additional benefits for chief residents were reported at 86.9% (n=40) of programs. Most programs select chief residents based on merit. There is perceived satisfaction of residents regarding this process, and most programs report additional benefits for their chief residents.     

Assessing dermatology resident confidence in caring for patients with skin of color

Many dermatology residency programs lack sufficient didactics and experiences with patients with skin of color (SOC). This may impact resident confidence with this patient population, which may affect patient satisfaction and perceptions of care. Dermatology residents nationwide were surveyed to determine their confidence in care of patients with SOC and white skin across several dimensions, including detailing morphology, making diagnostic and therapeutic decisions, tailoring treatment recommendations, and detecting suspicious lesions. A total of 125 dermatology residents representing 46 programs (of 119, 39%) responded. Resident confidence was significantly lower across all categories measured regarding caring for patients with SOC compared with patients with white skin (P <.001). After multivariate analysis adjusting for demographic and residency program characteristics, confidence in caring for patients with SOC remained significantly lower. Residents in programs with SOC education (i.e., SOC didactics, SOC clinical rotation) reported significantly higher confidence in one or more aspects of SOC care compared with residents in programs without such curricula. A deficiency in SOC education may contribute to the lower resident confidence observed. Integrating only one type of SOC education into residents’ curricula, although helpful, may not sufficiently enhance confidence across all dimensions of care. A multifaceted approach is needed.     

Increased Expression of Interleukin-12 in Lesional Skin of Atopic Dermatitis Patients with Psoriasiform Features on Histopathology: An Immunohistochemical Study

BackgroundBased on clinical and genetic differences, atopic dermatitis (AD) and psoriasis have been classified in two different diseases, but recently, some authors regarded them as in one spectrum. The histological similarities including epidermal hyperplasia between chronic stages of AD and psoriasis supports the presence of two diseases in one spectrum.ObjectiveWe investigated clinical and immunohistopathological characteristics of adult Korean patients with AD showing psoriasiform chronic dermatitis on histopathology.MethodsIn total, 59 Korean patients with chronic AD were enrolled. Clinical, laboratory, and histopathological features were compared between AD patients with psoriasiform features and those with non-psoriasiform chronic dermatitis features on histology. In addition, immunohistopathological characteristics were analyzed using antibodies for key regulatory and effector cytokines in psoriasis.ResultsFifteen patients (25.4%) showed a more “psoriasiform” histological appearance. The lesions in patients with psoriasiform features often showed clearer boundaries and noticeable scaling. The interleukin (IL)-23 expression in the psoriasiform chronic dermatitis group was not different from that in the psoriasis group, but the IL-17 expression was less than that in the psoriasis group. In the case of IL-12, multiple dermal inflammatory cells with dendrites were stained in the psoriasiform chronic dermatitis group compared with the 2 other non-psoriasiform subgroups.ConclusionThe results suggest that IL-12 secreted from dermal inflammatory cells might be one of the important factors associated with the formation of psoriasiform features in chronic AD. However, further studies are required to better define the specific role of IL-12.     

Evaluation of the American Academy of Dermatology's National Skin Cancer Early Detection and Screening Program

Background: Increasing incidence and mortality rates from cutaneous melanoma are a major public health concern. As part of a national effort to enhance early detection of melanoma/skin cancer, the American Academy of Dermatology (AAD) has sponsored an annual education and early detection program that couples provision of skin cancer information to the general public with almost 750,000 free skin cancer examinations (1985–1994).Objective: To begin to evaluate the impact of this effort, we determined the final pathology diagnosis of persons attending the 1992–1994 programs who had a suspected melanoma at the time of examination.Methods: We directly contacted all such persons by telephone or mail and received pathology reports from those who had a subsequent biopsy.Results: We contacted 96% of the 4458 persons with such lesions among the 282,555 screenings in the 1992–1994 programs. We obtained a final diagnosis for 72%, and the positive predictive value for melanoma was 17%. Three hundred seventy-one melanomas were found in 364 persons. More than 98% had localized disease. More than 90% of the confirmed melanomas with known histology were in situ or “thin” lesions (≤ 1.50 mm thick). The median thickness of all melanomas was 0.30 mm. The 8.3% of AAD cases with advanced melanoma (metastatic disease, regional disease, or lesions ≥ 1.51 mm) is a lower proportion than that reported by the 1990 Surveillance, Epidemiology and End Result Registry. The rate of thickest lesions (≥ 4 mm) and late-stage melanomas among all participants was 2.83 per 100,000 population. Of persons with a confirmed melanoma, 39% indicated (before their examination) that without the free program, they would not have considered having a physician examine their skin.Conclusion: The 1992–1994 free AAD programs disseminated broad skin cancer educational messages, enabled thousands to obtain a free expert skin cancer examination, and found mostly thin, localized stage 1 melanomas (usually associated with a high projected 5-year survival rate). Because biases impose possible limitations, future studies with long-term follow-up and formal control groups should determine the impact of early detection programs on melanoma mortality.     

Calidad de vida relacionada con la salud,satisfacción y cumplimiento de los pacientes con dermatitis atópica moderada-grave que siguen un tratamiento farmacológico de mantenimiento. Estudio CONDA-SAT

Introduction and objectivesTo evaluate health-related quality of life (HRQOL), patient satisfaction, and adherence to treatment in patients with moderate or severe atopic dermatitis on maintenance therapy.Material and methodsWe performed a national, multicenter, cross-sectional, epidemiological study in adults and children with moderate or severe atopic dermatitis of at least 16 months’ duration who were receiving maintenance therapy. We used the Dermatology Life Quality Index (DLQI), the children's version of this scale (cDLQI), and the Morisky medication adherence scale. Visual analog scales were used to measure treatment satisfaction. We used the Mann-Whitney U test to compare HRQOL between patients with moderate and severe disease and the Wilcoxon test to compare the frequency and duration of flares before and after the start of maintenance therapy.ResultsWe studied 141 children and 141 adults; the prevalence of moderate AD in these groups was 85.8% and 79.4%, respectively. The impact of AD on HRQOL was mild to moderate. Maintenance therapy led to a significant decrease in the frequency and duration of flares (P < .001). While treatment satisfaction was high in both groups, adherence was poor (18.4%-42.6% in children and 14.9%-27.0% in adults).ConclusionsPatients with moderate and severe AD receiving maintenance therapy experience a reduction in the number and duration of flares and an improvement in HRQOL. While treatment satisfaction is high, adherence rates could be improved.     

Development and co-construction of a therapeutic patient education program for albinism

BackgroundLong-term and ongoing support in accordance with the changing needs of patients and their families is one of the main components of patient care, including therapeutic patient education (TPE).ObjectiveTo co-construct a TPE program for albinism with all those involved in the management of albinism patients.MethodsEight steps have been defined for the co-construction process: 1) identify all the relevant experts and invite them to participate in the construction of a TPE program to improve care for and support of patients with albinism, 2) review and analyse all publications regarding TPE for albinism, 3) conduct semi-structured interviews with the patients’ parents, 4) conduct brainstorming meetings with the participating experts for an exchange of experience and expertise, 5) elaborate the program's concrete content with the experts, 6) draw up a TPE skills checklist, 7) create TPE educational tools to facilitate learning, 8) review and summarize each step of the co-construction protocol.ResultsCo-construction of a TPE program for children, adolescents, and young adults with albinism, and their parents.ConclusionStrengths and advantages of the co-construction process include: i) highlighting of the experiential knowledge mentioned in the repository, ii) multiplicity of points of view and perspectives, iii) rapid improvement in TPE training both for the association and the patients, iv) awareness of the shift caregivers’ position with regards to TPE and recognition of the polysemy of their discourse. The TPE program for albinism has been authorized since 2018.     

Cataract,Glaucoma, and Dry Eye Disease in Adults with Atopic Dermatitis: A Nationwide Cross-Sectional Study from the Republic of Korea

BackgroundAtopic dermatitis (AD) is an inflammatory skin disorder characterized by relapsing eczema with intractable itching. Ocular diseases in patients with AD, including cataract, retinal detachment, blepharitis, glaucoma, keratoconjunctivitis, and keratoconus, have frequently been reported worldwide. However, only a few studies using a large-sample, population-based study design have been reported so far.ObjectiveWe investigated the association between cataract, glaucoma, and dry eye disease and AD in an adult population in the Republic of Korea.MethodsA total of 14,900 adults who participated in the Korean National Health and Nutrition Examination Survey, a nationwide, population-based, cross-sectional survey, between 2010 and 2012 were included in the study. Multiple logistic regression analyses identified the possible association between cataract, glaucoma, and dry eye disease and AD relative to matched controls.ResultsAfter we adjusted for confounding factors in patients with AD, cataract and glaucoma were significantly associated with AD. Moreover, patients with AD had a higher prevalence of ophthalmic surgery compared to those without AD.ConclusionDermatologists should therefore be aware of possible ocular disorders in patients with AD and should recommend regular ophthalmic screening for early detection.     

Evaluating skin of color education in dermatology residency programs: data from a national survey

A dearth of skin of color (SOC) education exists among dermatology residency programs despite the increasingly diverse United States population; a 2008 study reported that 52% of dermatology residency programs had didactic sessions or lectures focusing on diseases in SOC. In the last decade, no new studies have examined the state of residency SOC education. In this study, dermatology residents across the United States were surveyed anonymously about SOC education at their residency program, satisfaction with SOC education, opinions on improving SOC education, and perspective on cultural competence. Of the 125 respondents, 63.2% reported their program provides SOC-related didactics; 44.0% had a rotation where residents primarily saw patients with SOC, although only 11.2% had a dedicated SOC rotation. While more than 60% of residents reported being satisfied or very satisfied with their SOC education, residents’ satisfaction with their knowledge of diseases primarily seen in SOC was lowest (56.8%) of all categories. Thematic analysis revealed four major themes for improvement of SOC education, including curricular reform, clinical exposure, emphasizing determinants of health, and opportunities to learn from faculty with diverse interests and expertise about SOC. These findings highlight unique opportunities for dermatologists to enhance SOC education and care for patients of all backgrounds.     

Perceptions and Practices Regarding Atopic Dermatitis: A Survey

Parents (N = 392) completed a survey at the Minnesota State Fair in August and September 2015 addressing knowledge regarding the pathogenesis of atopic dermatitis (AD), basic skin care practices, and the perceived role of infection and food allergies in AD. Of participating parents, 82% identified food allergy or sensitivity in AD pathogenesis, whereas only 42% identified bacterial infection as an important factor in AD severity. Participants most often received education on skin health from their pediatrician (49%), followed by Internet‐based sources (23%), rather than a dermatologist or pediatric dermatologist. Parents of children with AD overestimate the role of food allergies in this condition and are not as aware of the role of bacterial infection. Future educational directions from our specialty should focus on resources for pediatricians and families that emphasize these factors.     

Current Status of Atopic Dermatitis-Related Information Available on the Internet in South Korea

BackgroundPatients with atopic dermatitis (AD) often resort to the internet for disease-related information. We believe that dermatologists be informed about the current accessibility of information to patients and the potential for misleading patients into making poor treatment decisions.ObjectiveThe study was carried out in order to determine the nature of AD-related information available on the internet in Korea, and to identify any changes since our last survey in 2005. The quality of information offered and the involvement of medical doctors in certain websites were also investigated.MethodsTaking into account the current search engine market share in Korea, we gathered all search results obtained from the three major search engines using the keyword ''atopy'', and investigated the nature of the information retrieved.ResultsThe search results showed less commercial sites than our previous study in 2005. There is a dramatic increase in the number of public bodies offering information about AD. In addition, the quality of information available online has improved since our last survey.ConclusionThe phenomenon of ''commercial overcrowding'' seems to have stabilized. As AD becomes a more social phenomenon, patients are better informed than ever before. However, the information available on the internet still requires to be accompanied by consultation by dermatologists. We believe that self-regulation using a format such as the Health on the Net Foundation''s code of conduct (HONcode) may improve the quality of online information accessible to patients with AD in Korea.     

2019 Consensus Korean Diagnostic Guidelines to Define Severity Classification and Treatment Refractoriness for Atopic Dermatitis: Objective and Subjective Assessment of Severity

BackgroundSystemic immunomodulatory treatment is actively recommended in the treatment for moderate to severe atopic dermatitis (AD) patients. However, consensus criteria for the classification of AD severity or treatment refractoriness have not been established yet.ObjectiveTo establish consensus criteria on the definition of severity classification and treatment refractoriness of AD to provide a basis for proper treatment strategy.MethodsThe Korean Atopic Dermatitis Association (KADA) comprised a task force team to establish a definition of moderate to severe AD. A draft of definition of moderate to severe AD was made on the basis of evidence. The recommendation was confirmed by KADA members through a web-based survey.ResultsKADA approved that AD with 16≤eczema area and severity index (EASI)<23 should be basically defined as moderate AD whereas AD with EASI score ≥23 should be considered as severe AD. They agreed that it would be reasonable to raise the severity level if patient''s daytime or nighttime pruritus numerical rating scale is equal to or higher than 7 (≥7) or dermatology life quality index score exceeds 10. AD patients who do not reach EASI 50 after appropriate treatment for three months should be considered as a non-responder. Patients with recurrence (EASI ≥16) within three months after cessation of treatment should be considered as a recurrent AD.ConclusionKADA built a consensus of definition of moderate and severe AD and treatment-refractoriness. These guidelines are expected to help physicians determine proper treatment options in need.     

The family impact of atopic dermatitis in children: the role of the parent caregiver

Although some preliminary work exists examining the impact of atopic dermatitis (AD) in children on their families, there is no empirical work examining specific parent caregiver factors that could contribute to the family impact of this condition. We conducted a cross-sectional, exploratory analysis of how parent caregivers are affected by their child's AD, and how certain parent caregiver characteristics and perceptions affect the family impact of this condition. Parent caregivers of children with AD (n = 49) were administered a survey to collect detailed data on socioeconomic status, health perceptions, and caregiving issues. Family impact of the child's AD was measured using a modified AD Family Impact Scale. Multiple regression analyses revealed that three major factors associated with the parent caregiver were correlated with large increases in the family impact scores: 1) perception that the child's condition is severe (13%, p < 0.01), 2) high use of nonmedical services for child's condition (21%, p < 0.01), and 3) financial concern about the child's condition (18%, p < 0.01). These preliminary data indicate distinct characteristics of the parent caregiver that are associated with higher family impact of AD in children. These parent caregiver factors may be important in identifying suitable audiences and areas for education for optimal management of children's AD.     

Dental Caries in Adults with Atopic Dermatitis: A Nationwide Cross-Sectional Study in Korea

BackgroundDental caries is the most prevalent chronic infectious oral disease of multifactorial etiology. Increased risk of dental caries development in patients with asthma and allergic rhinitis has been frequently reported. In contrast, only a few studies on dental caries in patients with atopic dermatitis (AD) have been reported.ObjectiveWe investigated the association between AD and dental caries development in an adult population in the Republic of Korea.MethodsA total of 21,606 adults who participated in the Korean National Health and Nutrition Examination Survey, a nationwide, population-based, cross-sectional survey between 2010 and 2015, were included in the study. Multiple logistic regression analyses with confounder adjustment suggested odds ratios (ORs) to identify the possible association between AD and decayed, missing, filled teeth (DMFT) experience compared to non-AD participants. Multiple Poisson regression analyses estimated the mean ratio of the DMFT index according to the presence of AD.ResultsAfter adjusting for various confounding factors, the prevalence of DMFT was significantly associated with AD (OR, 1.58; 95% confidence interval (CI), 1.08~2.29; p=0.017). In addition, the mean value of the DMFT index was significantly different between the AD and non-AD groups (mean ratio, 1.07; 95% CI, 1.00~1.14; p=0.046).ConclusionAD was significantly associated with the development of dental caries. Dermatologists should be aware of the dental manifestations of AD patients and recommend regular dental check-ups for the early detection of caries.     

Experiences with the first eczema school in the United States

Patient education programs are beneficial in the treatment of chronic diseases. In Germany, France, and other countries worldwide, educating children, adolescents, and adults plus the parents of children with atopic dermatitis (AD) leads to better coping with the skin disease, as well as to a reduction in the severity of the skin symptoms and signs. The results in Europe led to the idea to also establish an eczema school in the United States. In the style of the German eczema school, an eczema school was founded in 2014 at Temple University, Philadelphia, PA. Since then, a team consisting of a dermatologist, psychologist, nutritionist, and nurse practitioner has offered an eczema school to interested patients with AD and their families three times a year. This patient education program consists of three weekly 2-hour sessions, which address proper skin care, the itch-scratch cycle, healthy nutrition, and the role of stress in AD. The current review summarizes the first experiences with the education program in the United States.