Optimal management of atopic dermatitis (AD) requires patients to adhere to self-care behaviors. Technologies, such as cell phones, have been widely adopted in the USA and have potential to reinforce positive health behaviors. We conducted a pilot study with 25 adolescents and adults age 14 years and older [mean 30.5 yrs, SD 13.4] with AD. Daily text messages (TMs) that provided medication reminders and AD education were sent for six weeks to participants. Our goals were to (1) measure changes in pre- and posttest scores in treatment adherence, self-care behaviors, disease severity, and quality of life and (2) assess the usability and satisfaction of the TM system. Significant improvements in treatment adherence, self-care behaviors, skin severity, and quality of life (P ≤ .001, .002, <.001, and .014, resp.) were noted postintervention. User feedback on the TM system was positive with 88% and 92% of participants reporting that the reminder TMs and educational TMs were helpful, respectively. In conclusion, study participants were receptive to using TMs as a reminder aid and educational tool. The positive trends observed are promising and lay the ground work for further studies needed to elucidate the full potential of this simple and cost-effective intervention.

/pdf/text-messages-as-a-reminder-aid-and-educational-tool-in-118q2rpn2u.pdf

Text Messages as a Reminder Aid and Educational Tool in Adults and Adolescents with Atopic Dermatitis: A Pilot Study

Resume Introduction L’education therapeutique s’applique a de nombreuses maladies chroniques. Elle vise a ameliorer la prise en charge de ces maladies en developpant les competences des malades. La dermatite atopique est un champ de developpement de l’education therapeutique. L’objectif de ce travail etait de definir les competences propres a la gestion de la dermatite atopique pouvant faire l’objet d’une education therapeutique et de reunir ces competences sous forme d’un referentiel adapte a l’usage. Materiel et methode Trente soignants ont participe a la redaction de ce referentiel (dermatologues, medecin specialiste d’education therapeutique, psychologue, infirmieres). Tous avaient une experience en education therapeutique au cours de la dermatite atopique. Resultats Quatre tranches d’âge ont ete retenues (avant 5 ans, de 6 a 10 ans, pre adolescent/adultes, parents d’enfant de moins de 5 ans). Pour chaque tranche d’âge, les competences attendues des malades ou parents d’enfant et les methodes d’apprentissage adaptees ont ete choisies. Les competences ont ete classees en trois champs differents : (i) les connaissances (savoir) sur la maladie, les traitements, les facteurs declenchants, (ii) les savoir-faire : realisation des soins par les malades ou par les parents, (iii) les savoir etre : savoir expliquer la maladie et les soins aux proches, savoir quand et qui contacter. Enfin, un guide pour le diagnostic educatif en 10 questions a ete etabli. Discussion Nous rapportons les modalites d’elaboration et le contenu d’un referentiel de competences pour les malades atteints de dermatite atopique. Il ne s’agit pas d’exiger pour chaque malade l’ensemble des competences listees dans ce travail mais de mettre a disposition des soignants un referentiel complet permettant de choisir les competences a travailler au terme d’un diagnostic educatif. Ce referentiel s’adresse aux malades atteints de formes moderees a severes de dermatite atopique en situation d’echec therapeutique. Il est utilisable par toutes les personnes qui prennent en charge le malade : medecin, infirmiere ou psychologue selon les items explores. Il constitue un support a l’elaboration, a la diffusion et a l’evaluation d’un programme d’education therapeutique dans la dermatite atopique.

Dermatite atopique : un référentiel d'éducation du malade

Background Severe atopic dermatitis (AD) is a recurrent and debilitating disease often requiring systemic immunosuppressive treatment. The efficacy of cyclosporine A (CsA) is well proven but potential side effects are concerning. Several reports point at extracorporeal photopheresis (ECP) as an alternative treatment modality with few and mild side effects. However, no direct comparison between CsA and ECP in the treatment of AD has been performed so far. Objectives. To compare the efficacy of CsA (3 mg/kg/day) and ECP (administered two consecutive days twice a month) in a cohort of patients with severe AD. Methods A randomized cross-over study involving twenty patients with severe AD (SCORAD index 41-89) refractory to other treatments. The patients were allocated to a 4 month course of either of the two treatment modalities. Individual relapse periods (2-8 weeks) were interspersed before cross-over to the other treatment modality. Treatment efficacy was evaluated by SCORAD, PRURITUS (VAS-index 0-10), ”overall global assessment” and serological biomarkers; sIL-2Rα, sE-selectin, eosinophilocytes, basophilocytes and sIgE. Results 15 patients completed treatment. Both treatments lead to a marked and significant decrease in SCORAD and pruritus index. The average reduction of the SCORAD and pruritus index, respectively was a little higher for ECP treatment compared to CsA treatment, however the differences did not reach statistical significance. The ”overall global assessment” was significantly higher in patients who underwent ECP therapy as compared to CsA treatment. None of the biomarkers showed significant changes after either treatment when compared to the initial values. Conclusion ECP administered on two consecutive days twice a month to patients with severe AD has similar potency as CsA administered daily in a moderate dose. ECP is a treatment alternative in patients with severe AD that do not tolerate or are refractory to conventional immunosuppressants.

/pdf/cyclosporine-and-extracorporeal-photopheresis-are-equipotent-269f7khf0x.pdf

Cyclosporine and Extracorporeal Photopheresis are Equipotent in Treating Severe Atopic Dermatitis: A Randomized Cross-Over Study Comparing Two Efficient Treatment Modalities

Background Chronic hand eczema (CHE) is a major burden for patients. Maintenance treatment involves prevention measures limiting detrimental behaviour and aggravating factors. Objective To evaluate the effect of a standardised care program including therapeutic patient education (TPE) on hand care behaviours, clinical severity, quality of life, and work productivity. Methods A single-centre study was conducted prospectively. Together with the prescription of a topical steroid, patients participated in individual TPE sessions. Evaluations were performed initially and repeated three months after the therapeutic intervention. They included a structured analysis of hand care behaviours, the assessment of the mTLSS (modified Total Lesion Symptom Score), DLQI (Dermatology Life Quality Index), and WPAI (Work Productivity and Activity Impairment). Results Seventy-one patients were included (30 men, 42.3%). Three months after completion of the standardised care program, hand care behaviours such as hand washing and rinsing, hand drying, wearing protective gloves, using moisturizing creams, and following specific treatments and recommendations for CHE improved significantly in the 58 patients who completed the study and were associated with a significant improvement in the mTLSS, DLQI, and WPAI scores. Conclusions TPE helps patients change their hand care behaviours and adopt skin protection measures, and may improve CHE severity, quality of life, and work productivity.

Positive change in hand care habits using therapeutic patient education in chronic hand eczema

Atopic eczema is a chronic disease with a severe impact on quality of life, and compliance is important for the course of the disease. During the last decade educational programmes have been increasingly popular, but only few randomized controlled trials evaluating the effect of educational programmes and eczema schools exist. These studies, however, indicate a high participant satisfaction and a positive influence on compliance.

Compliance among patients with atopic eczema.

Introduction The assessment of the educational management of 40 moderate to severe atopic patients was performed in the atopic dermatitis school created in Nantes (France) from November 2000 to May 2001. Subjects and methods Patients with moderate to severe atopic dermatitis (SCORAD >20) were selected according to the criteria of Hanifin and Rajka and included in an open pilot study including a specific educational program. Atopic training included consultations, demonstrations, interviews with both dermatologist and nurses and workshops organized in three subgroups according to the age of the patients. SCORAD index, educational diagnosis and at least one educational objective were established during the first consultation. Evaluation criteria were defined in accordance with the educational objectives. Specific educational tools were used for each objective. Results Forty patients (mean age: 9 years) were followed during 6 months. At the beginning of the study the mean SCORAD was of 50.5. After a 6 months follow-up, the mean SCORAD was of 22 and improvement of the SCORAD was noted in 97 p. 100 of cases. Educational objectives were reached in 70.6 p. 100 of cases. One patient lost contact. Discussion The educational approach of atopic dermatitis includes global assessment of the disease after identification of risk factors, disrupted quality of life, skin-damaging behavior, family stress. Educational diagnosis focusing on local treatment is a major step; topical treatment is either misunderstood or conducted erroneously or non-existent. Therapeutic education plays a key role in the compliance and efficacy of treatment. Pain management, demonstration and explanation of skin care by health care professionals, information on the disease in age-specific workshops provided good results in more than 70 p. 100 of cases. Severe atopic dermatitis in children can lead to major domestic conflicts when the parents are in charge of the treatment. Giving responsibilities to the children, by teaching them how to treat themselves, relieves the parents from their involvement and finally reduces the conflicts. Conclusion The difficulties encountered in treating refractory atopic dermatitis may be secondary to the severity of the disease, to poor compliance or to the extent of the psychological impact. Therapeutic education of the patient, as performed in the atopic dermatitis school, represents a major breakthrough in the care of such patients.

[Assessment of an educational program in an "Atopic School": pilot study in 40 patients]

Management of severe atopic dermatitis

Introduction L’urticaire chronique (UC) a un fort retentissement sur la qualite de vie et le nomadisme medical. La meilleure connaissance des aspects physiopathologiques, des traitements, de leurs modes d’action et de leurs effets secondaires, mais aussi une prise en charge plus globale du vecu du patient est necessaire pour favoriser l’adherence au traitement avec un meilleur controle de l’UC et ameliorer la qualite de vie. Nous avons elabore un programme francais d’education therapeutique (ETP) dans l’UC. Materiel et methodes Onze medecins (dermatologues, allergologues et internistes) des groupes urticaire (GUS) et d’education therapeutique (GET) de la Societe francaise de dermatologie et leurs equipes d’education therapeutique : sept infirmieres et 2 psychologues cliniciennes ont elabore au cours de 2 journees de travail un programme d’ETP dans l’UC. Ce programme a ensuite ete relu et approuve par l’association des patients atteints d’UC (AFSAM-UCS). Resultats Nous avons mis en place une grille de diagnostic educatif qui permet de recueillir des donnees biomedicales, psychosociales, cognitives permettant l’elaboration du projet personnalise du patient. Un referentiel de competences comportant plusieurs objectifs de competences a acquerir sur la connaissance (7 items), le savoir-faire (10 items) et le savoir-etre (9 items) dans l’UC a ete redige. Quatre seances pour ce programme d’education therapeutique (ETP) ont ete elaborees. Elles portent sur la physiopathologie (1 module de 1h15), les traitements (1 module de 1h15) et les aspects psychologiques au cours de l’UC (2 modules de 2 h). Des outils ont ete crees pour chacun des modules ainsi qu’un plan d’action personnalise. Ces outils ont ete valides par l’association des patients atteints d’UC. Une evaluation de cet ETP sera realisee dans un second temps a l’aide de differents scores d’activite de l’UC (UAS7, AAS28), du controle de la maladie par les traitements (UCT) et de la qualite de vie (CU-Q2oL) avant et apres l’ETP (juste apres et a 1 et 6 mois). Un questionnaire de connaissances vrai/faux sera egalement utilise comme outil d’evaluation. Discussion Actuellement, de nombreux programmes d’ETP existent dans differentes maladies dermatologiques chroniques telles que la dermatite atopique, l’eczema chronique des mains ou le psoriasis. L’UC est une des maladies chroniques dermatologiques ayant le plus fort impact sur la qualite de vie. De facon surprenante, il n’existe a ce jour dans la litterature internationale et nationale aucun programme d’ETP dans l’UC publie. Conclusion Nous exposons ici, la mise en œuvre d’un programme national d’ETP dans l’UC. Ce programme ainsi elabore va etre valide dans nos centres hospitaliers respectifs chez les patients atteints d’UC pour ensuite etre diffuse pour toutes les equipes qui souhaitent le mettre en place dans leur structure de soins.

Élaboration d’un programme national d’éducation thérapeutique dans l’urticaire chronique

Resume L’eczema chronique des mains (ECM) est une dermatose inflammatoire, d’origine souvent multifactorielle, qui altere fortement la qualite de vie des patients tant sur le plan professionnel, que domestique et psychosocial. Un programme consensuel d’education therapeutique du patient (ETP) dans l’ECM a ete elabore par 19 soignants (dermatologues, medecins du travail, infirmieres, psychologue, conseillere medicale en environnement), au cours de 3 journees en suivant les recommandations de la HAS. Les documents valides comprennent le diagnostic educatif, le referentiel de competences, un guide de recueil des pratiques, le contenu des modules d’ETP. Le programme s’articule en 4 seances : une consultation individuelle de diagnostic educatif, deux seances collectives d’ETP et une consultation d’evaluation. Les ateliers collectifs se deroulent selon deux thematiques : la maladie, ses facteurs aggravants et ses traitements puis le vecu et ressenti. A chaque objectif educatif correspond un outil pedagogique specifique. L’ETP permet d’accompagner les patients dans l’adoption des mesures de protection cutanee indispensables au processus de guerison. Nous proposons un referentiel comprenant differents outils pedagogiques, destine aux equipes souhaitant developper l’ETP dans cette situation.

Éducation thérapeutique du patient dans l’eczéma chronique des mains

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[Assessment of an educational program in an "Atopic School": pilot study in 40 patients]

Management of severe atopic dermatitis

Élaboration d’un programme national d’éducation thérapeutique dans l’urticaire chronique

Éducation thérapeutique du patient dans l’eczéma chronique des mains