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Atopic Dermatitis – From non-adherence to patient education
- 4min
- Jun. 2023
- Supported by
Atopic dermatitis (AD) is one of the most common chronic skin diseases which affects up to 20% of children and 2–8% of adults in most countries of the world.1 Emollient application is the most important step in AD management, however only 32% of children and 50% of adults adhere to their treatment which results in treatment failure and an impaired QOL.2,3 Multiple factors can influence this nonadherence and clinicians can improve patient outcomes by providing the right educational methods.4,5
AD is an intensely pruritic dermatosis that develops most commonly during early infancy and childhood and may follow a chronic, relapsing course into adulthood. The condition necessitates daily management with treatment plans that are oftentimes created specifically for individual patients. The severity of the condition will determine the approach. The cornerstone of AD treatment is based on daily application of an emollient to strengthen the skin barrier while improving symptoms such as itch, pain, and stinging sensations due to skin dryness, and restoring the skin microbiome. During flare-ups, a multitude of treatments exist, but topical therapies such as corticosteroids remain the first line treatment for this disease during crisis.4,6,7
Lack of adherence to a medication regimen could be the underlying source of treatment failure. Patients, especially those on long-term therapy, inevitably forget some applications, use too little or space out applications over time. Studies indicate that approximately 30% to 40% of all medications taken for chronic conditions are not taken as prescribed.4,8
Several factors can contribute to poor treatment adherence and therefore poor treatment outcome. One of the most important factors is the complexity of the treatment regimens, as the frequency of emollient application is very important, and the treatment may differ during periods of remission or flare-ups. Other factors linked to nonadherence are disease unawareness and lack of understanding, frustration with the effectiveness of the medication, inconvenience, forgetfulness, the financial burden of treatment and the time-consuming aspect. Improving treatment adherence for atopic dermatitis is a complex and multifaceted issue.4,9
Clinicians can improve patient outcomes by improving adherence to treatment regimens through educational methods. Therapeutic patient education (TPE) aims to help patients acquire or maintain the skills they need to manage their lives with a chronic disease. It is a truly integral and ongoing part of patient care. TPE can be carried out in different ways, some examples include:
AD is an intensely pruritic dermatosis that develops most commonly during early infancy and childhood and may follow a chronic, relapsing course into adulthood. The condition necessitates daily management with treatment plans that are oftentimes created specifically for individual patients. The severity of the condition will determine the approach. The cornerstone of AD treatment is based on daily application of an emollient to strengthen the skin barrier while improving symptoms such as itch, pain, and stinging sensations due to skin dryness, and restoring the skin microbiome. During flare-ups, a multitude of treatments exist, but topical therapies such as corticosteroids remain the first line treatment for this disease during crisis.4,6,7
Lack of adherence to a medication regimen could be the underlying source of treatment failure. Patients, especially those on long-term therapy, inevitably forget some applications, use too little or space out applications over time. Studies indicate that approximately 30% to 40% of all medications taken for chronic conditions are not taken as prescribed.4,8
Several factors can contribute to poor treatment adherence and therefore poor treatment outcome. One of the most important factors is the complexity of the treatment regimens, as the frequency of emollient application is very important, and the treatment may differ during periods of remission or flare-ups. Other factors linked to nonadherence are disease unawareness and lack of understanding, frustration with the effectiveness of the medication, inconvenience, forgetfulness, the financial burden of treatment and the time-consuming aspect. Improving treatment adherence for atopic dermatitis is a complex and multifaceted issue.4,9
Clinicians can improve patient outcomes by improving adherence to treatment regimens through educational methods. Therapeutic patient education (TPE) aims to help patients acquire or maintain the skills they need to manage their lives with a chronic disease. It is a truly integral and ongoing part of patient care. TPE can be carried out in different ways, some examples include:
- The written eczema action plan is a standardized set of written instructions for atopic dermatitis management, including everything from the daily skin care regimen to what to do for severe flares. Eczema action plan are helpful for 86% of parents and attributed as a factor in their child’s disease improvement by 68%. Not only does this tool simplify the treatment regimen for patients and their parents, but it also serves as a mean of educating them about the different medications and their importance.
- Workshops: It has been proven that demonstration of the application of emollient and provided educational materials have been successful in improving adherence for AD patients.4
- Children are often too young to realize the seriousness of their condition. Therefore, more intensive educational opportunities exist, such as atopic schools. These programs offer multi-disciplinary TPE aimed at both parents and pediatric patients. They offer child-friendly methods, such as the reward principle, graduation, or the application of emollient using more playful methods. It is becoming more common and positively correlates with better treatment results.5
REFERENCES
1Ann Nutr Metab 2015, 66 (Suppl. 1): 8-16. Review article: Atopic Dermatitis: Global Epidemiology and Risk Factors, DOI : 10.1159/000370220.
2Krejci-Manwaring J, Tusa MG, Carroll C, et al. Stealth monitoring of adherence to topical medication: adherence is very poor in children with atopic dermatitis. J Am Acad Dermatol. 2007;56(2):211-216. doi:10.1016/j.jaad.2006.05.073.
3Yentzer BA et al. Good adherence and early efficacy using desonide hydrogel for atopic dermatitis: results from a program addressing patient compliance. J Drugs Dermatol. 2010;9:324–9. PMID: 20514788.
4Patel N, Feldman SR. Adherence in Atopic Dermatitis. Adv Exp Med Biol. 2017;1027:139‑59.
5Fischer G. Compliance problems in paediatric atopic eczema. Australas J Dermatol. Mai 1996;37 Suppl 1:S10-13.
6Wirén K, Nohlgård C, Nyberg F, Holm L, Svensson M, Johannesson A, et al. Treatment with a barrier-strengthening moisturizing cream delays relapse of atopic dermatitis: a prospective and randomized controlled clinical trial. J Eur Acad Dermatol Venereol. nov 2009;23(11):1267‑72.
7Sophie Seite et al. Microbiome of affected and unaffected skin of patients with atopic dermatitis before and after emollient treatment. J Drugs Dermatol. 2014 Nov;13(11):1365-72.
8Dreno B, Amici JM, Demessant-Flavigny AL, Wright C, Taieb C, Desai SR, et al. The Impact of Acne, Atopic Dermatitis, Skin Toxicities and Scars on Quality of Life and the Importance of a Holistic Treatment Approach. Clin Cosmet Investig Dermatol. 2021;14:623‑32.
9Anna Soklova et al. Factors contributing to poor treatment outcomes in childhood atopic dermatitis. Australasian Journal of Dermatology, mar 2015. DOI: 10.1111/ajd.12331.
10Fallon E. Chipidza et al. Impact of the Doctor-Patient Relationship. Prim Care Companion CNS Discord. 2015; 17(5): 10.4088/PCC.15f01840.