[Direct versus video-aided parent education in atopic eczema in childhood as a supplement to specialty physician treatment. A controlled pilot study]. Web-based consultations for parents of children with atopic dermatitis: results of a randomized controlled trial. Evaluation of a parental training program for the management of childhood atopic dermatitis. Age related, structured educational programmes for the management of atopic dermatitis in children and adolescents: multicentre, randomised controlled trial. Randomized controlled trial of a single dermatology nurse consultation in primary care on the quality of life of children with atopic eczema. A controlled trial of traditional Chinese medicinal plants in widespread non-exudative atopic eczema. Treatment of infants with atopic eczema with pimecrolimus cream 1% improves parents' quality of life: a multicenter, randomized trial. Randomised controlled trial of advice on an egg exclusion diet in young children with atopic eczema and sensitivity to eggs. Probiotics in the treatment of atopic eczema/dermatitis syndrome in infants: a double-blind placebo-controlled trial.
Psychological problems in children and parents related to children's atopic eczema (AE) may impede the success of treatment. We studied the question, if behavior-based parental education in groups (DPE) or standardized video-education (VPE) could enhance dermatological treatment effects and reduce skin-damaging behaviors in children and stress in their mothers.
                47 mothers attending the university outpatient-clinic for dermatology and their AE-children (mean age 4 years) participated in the study. 18 mothers underwent the DPE (10 sessions), 15 mothers worked with VPE at home. Dermatological standard treatment (CG; N = 14) served as control for a 16-weeks-evaluation-period.
                AE-symptoms improved overall, but the effectiveness of the treatments differed significantly, improval with parent education and was best with VPE. Psychological problems of mothers were equally reduced with DPE and VPE.
                It is suggested that VPE is a cost effective and less time consuming method for supporting dermatological therapy of AE in children. To analyse how web-based consultations for parents of children with atopic dermatitis affect self-management behaviour, health outcome, health resource use and family costs.
                Ninety-eight children with atopic dermatitis were randomly assigned to intervention and control groups. The intervention group received remote dermatology consultations through a secure web-based communication system. The control group was encouraged to seek treatment through traditional means such as general practitioner visits and hospital care. Both groups received an extensive individual educational session prior to the intervention.
                Thirty-eight percent of the intervention group used web-based consultations 158 times ranging from 1 to 38 consultations per patient. We found no change in self-management behaviour, health outcome or costs. The intervention group tended to have fewer visits to practitioners offering complementary therapies than the control group, and we found a positive correlation between emergency visits at baseline and messages sent. Both groups, however, reduced the mean number of skin care treatments performed per week and had fewer total health care visits after the intervention.
                We found no effect of supplementing traditional treatment for childhood dermatitis with web-based consultations. This study showed that web consultations is feasible, but more research is needed to determine its effect on self-management skills, health outcome and resource use. Atopic dermatitis (AD) in childhood is a common disease with prevalence rates as high as 20%. Its early onset in infancy and its chronic relapsing course puts a special burden on families. Supporting parents in dealing with the management of AD presents a challenge for physicians. The objective of this study was to determine the effect of a structured parental training program on managing AD in children. Two-hundred and four families participated in a prospective, randomized controlled trial. Children (5 months to 12 years in age) had suffered from moderate-to-severe AD for at least 4 months. They were randomly assigned to either the intervention group or a waiting, control group who could participate in the training program 1 year later. The intervention was an inter-disciplinary, structured educational program which covered medical, nutritional, and psychological issues in six group sessions of 2 h each. The families were assessed at the beginning of the study and 1 year later. Main outcome measures were: severity of eczema (SCORAD); treatment habits; treatment costs; quality of life; and coping strategies. Significant effects were shown regarding treatment behavior, such as regular use of emollients, use of antiseptics and topical steroids in the event of exacerbation, and a reduction in the use of unconventional therapies. Satisfaction with medical treatment was improved, and rumination as an ineffective coping strategy was reduced. Finally, significant reduction of treatment costs was achieved. We conclude that structured training programs for parents of children with AD is a helpful adjunct to dermatological treatment. To determine the effects of age related, structured educational programmes on the management of moderate to severe atopic dermatitis in childhood and adolescence.
                Multicentre, randomised controlled trial.
                Seven hospitals in Germany.
                Parents of children with atopic dermatitis aged 3 months to 7 years (n = 274) and 8-12 years (n = 102), adolescents with atopic dermatitis aged 13-18 years (n = 70), and controls (n = 244, n = 83, and n = 50, respectively).
                Group sessions of standardised intervention programmes for atopic dermatitis once weekly for six weeks or no education (control group).
                Severity of eczema (scoring of atopic dermatitis scale), subjective severity (standardised questionnaires), and quality of life for parents of affected children aged less than 13 years, over 12 months.
                Significant improvements in severity of eczema and subjective severity were seen in all intervention groups compared with control groups (total score for severity: age 3 months to 7 years - 17.5, 95% confidence intervals - 19.6 to - 15.3 v - 12.2, - 14.3 to - 10.1; age 8-12 years - 16.0, - 20.0 to - 12.0 v - 7.8, - 11.4; - 4.3; and age 13-18 years - 19.7, - 23.7 to - 15.7 v - 5.2, - 10.5 to 0.1). Parents of affected children aged less than 7 years experienced significantly better improvement in all five quality of life subscales, whereas parents of affected children aged 8-12 years experienced significantly better improvement in three of five quality of life subscales.
                Age related educational programmes for the control of atopic dermatitis in children and adolescents are effective in the long term management of the disease. Atopic eczema is mostly managed in primary care but there is often insufficient time for patient education; a nurse practitioner could help with this.
                To evaluate the effects of a single consultation with a primary care nurse on the quality of life (QOL) of children with atopic eczema aged 0.5-16 years and the impact of the disease on their families.
                Children with eczema were invited to join the trial. Volunteers were randomized to a control group or an intervention group who attended the nurse for a single 30-min session. Family impact was determined using the Family Dermatitis Index (FDI), and QOL was assessed using the Infant Dermatitis Quality of Life questionnaire (IDQOL) or, in children aged 4-16 years, the Children's Dermatology Life Quality Index (CDLQI). Baseline scores for family impact and QOL were compared with those at 4 weeks and 12 weeks post-intervention.
                Two hundred and thirty-five children were recruited over 12 months; 115 were aged 0.5-4 years and 120 were aged 4-16 years. Follow-up data were missing for 38 children (84% completion rate, n = 197). All measures of QOL or family impact at baseline were skewed. The median scores were IDQOL, 5, and CDLQI, 6. About 20% of children had zero scores for the FDI (no impact on family life); median FDI scores were 2 or 3. At baseline the FDI correlated with the IDQOL or CDLQI. In addition, the FDI and IDQOL were related to parental assessment of disease severity. Non-responders had, on average, worse QOL at baseline than those who provided complete data. In the children with complete data, the mean differences in CD < Q1 and 1DQO< scores between intervention and control children were small at 4 and 12 weeks (P > 0.05). The improvement in FDI at 4 weeks was slightly better in intervention than control children (P < 0.06).
                The impact on QOL of a single intervention by a dermatology nurse was marginal for family impact at 4 weeks and was not apparent for other measures, either in the short or longer term. The planned sample size was derived from data in hospital patients but in our population disease activity was milder and the effects on QOL were less. On this account the present study was of low statistical power for some measures. Further studies in larger populations using additional outcome measures are required before advocating the wider introduction of nurse specialists. Severe and widespread atopic eczema often fails to respond adequately to currently available therapies. Following the observation of substantial benefit in patients receiving oral treatment with daily decoctions of traditional Chinese medicinal plants, we undertook a placebo-controlled double-blind trial of a specific prescription formulated for widespread non-exudative atopic eczema. Forty-seven children were given active treatment and placebo in random order, each for 8 weeks, with an intervening 4-week wash-out period. Thirty-seven children tolerated the treatment and completed the study. Response to active treatment was superior to response to placebo, and was clinically valuable. There was no evidence of haematological, renal or hepatic toxicity. These findings anticipate a wider therapeutic potential for traditional Chinese medicinal plants in this disease, and other skin diseases. Atopic eczema begins primarily in infancy or early childhood, and sleep loss due to night-time pruritus can have a considerable impact on patients' and parents' quality of life (QoL). In this study, infants (n = 196) with mild to severe atopic eczema were randomized 2:1, double-blind, to receive either pimecrolimus cream 1% (Elidel, Novartis Pharma, Nürnberg, Germany) or the corresponding vehicle bid for 4 wk, followed by a 12 wk, open-label phase and a 4 wk, treatment-free, follow-up period. The parents' QoL was measured at baseline and at the end of the double-blind phase, using the questionnaire 'QoL in Parents of Children with Atopic Dermatitis' (PQoL-AD), thus data presented here refer to the initial 4-wk treatment phase only. After 4 wk of double-blind treatment, an increase in the mean percentage change from baseline in eczema area and severity index of 71.5% was observed with pimecrolimus, compared with 19.4% with vehicle. The increase in efficacy was paralleled by the following mean percentage changes from baseline in the five domains of the questionnaire in pimecrolimus and vehicle, respectively: psychosomatic well-being: 14.6% vs. 6.2%; effects on social life: 6.7% vs. 2.3%; confidence in medical treatment: 10.0% vs. 3.7%; emotional coping: 16.1% vs. 6.5%; acceptance of disease: 19.6% vs. 7.0%. Analysis (ancova) of the dependent variable difference from baseline and the covariate baseline value revealed values of p < 0.05 for all five domains, despite the very short duration of the study. It is concluded that improvements in atopic eczema in infants achieved by treatment with pimecrolimus have a significant beneficial effect on the QoL of parents. The role of exclusion diets in the management of atopic eczema in young children is uncertain. This randomised controlled trial evaluates the effect of excluding egg from the diet in young children with atopic eczema and sensitivity to eggs. Fifty-five such children were randomised either to a 4-week regimen, in which mothers were given general advice on care of eczema and additional specific advice from a dietician about an egg exclusion diet (diet group), or to a control group in which general advice only was given. Both groups continued conventional topical treatment. Disease activity was assessed by estimates of the surface area affected by eczema and by an arbitrary severity score. Possible egg sensitivity was identified by RAST before randomisation and after the trial by double-blind placebo-controlled egg challenge.
                The mean reduction in surface area affected by eczema was significantly greater (p = 0.02) in the group receiving dietary advice (from 19.6% to 10.9% area affected) than in the control group (from 21.9% to 18.9%). A significant improvement also occurred in severity score (p = 0.04): from 33.9 to 24.0 units for the diet group compared with a decrease from 36.7 to 33.5 in the control group. The study suggests that advice on the dietary exclusion of eggs is useful as part of the overall management of young children with atopic eczema and sensitivity to eggs. Probiotic bacteria are suggested to reduce symptoms of the atopic eczema/dermatitis syndrome (AEDS) in food-allergic infants. We aimed to investigate whether probiotic bacteria have any beneficial effect on AEDS.
                Follow-up of severity of AEDS by the Severity Scoring of Atopic Dermatitis (SCORAD) index in 230 infants with suspected cow's milk allergy (CMA) receiving, in a randomized double-blinded manner, concomitant with elimination diet and skin treatment, Lactobacillus GG (LGG), a mixture of four probiotic strains, or placebo for 4 weeks. Four weeks after the treatment, CMA was diagnosed with a double-blind placebo-controlled (DBPC) milk challenge in 120 infants.
                In the whole group, mean SCORAD (at baseline 32.5) decreased by 65%, but with no differences between treatment groups immediately or 4 weeks after the treatment. No treatment differences were observed in infants with CMA either. In IgE-sensitized infants, however, the LGG group showed a greater reduction in SCORAD than did the placebo group, -26.1 vs-19.8 (P=0.036), from baseline to 4 weeks after the treatment. Exclusion of infants who had received antibiotics during the study reinforced the findings in the IgE-sensitized subgroup.
                Treatment with LGG may alleviate AEDS symptoms in IgE-sensitized infants but not in non-IgE-sensitized infants.
A lack of rigorously designed trials (excluding one recent German study) provides only limited evidence of the effectiveness of educational and psychological interventions in helping to manage the condition of children with atopic eczema. Evidence from included studies and also adult studies indicates that different service delivery models (multi-professional eczema school and nurse-led clinics) require further and comparative evaluation to examine their cost-effectiveness and suitability for different health systems.