Atopic dermatitis (AD) is a common chronic childhood disease that affects a significant number of infants worldwide. Its symptoms are debilitating and can impact the patient’s wellbeing and quality of life. There is no universal cure for AD, and control and prevention of the disease relies on well-planned disease management programs.
Key words: atopic dermatitis, eczema, inflammatory disease, allergic disease
Atopic Dermatitis Management
Atopic dermatitis (AD), or atopic eczema, is a chronic inflammatory condition of the skin. It is the most common allergic disease in infancy, and develops during the first six months of life in nearly half of infants affected (Kawamoto et al, 2012). The symptoms of AD are episodic with periodic flares and remissions, but in severe cases the condition is constant. There are also patterns of atopic dermatitis; in infants, AD tends to develop in the face and extensor surfaces of the limbs, sometimes presenting as circular patches on the skin (Kawamoto et al, 2012).
Atopic dermatitis affects 15-30% of children and 2-10% of adults of the world population (Krafchik, 2011). The prevalence of eczema in the United States has been estimated to be 10-12% in infants and children, and 0.9% in adults (Krafchik, 2011). Furthermore, clinical data for 1997-2004 showed a significant increase in clinical visits for atopic dermatitis, especially among African-Americans and Asians (Krafchik, 2011 and George, 2008). Infants whose mother or father had a history of AD were also at higher risk of developing the disease (Moore et al, 2004). Other populations at risk are immigrants from underdeveloped or transitional countries (Moore et al, 2004). However, regardless of race or ethnicity, urban populations are most likely to develop the disease (Fivenson, 2002).
AD is not a life-threatening illness; nevertheless the burden on the health care system can be substantial. Fivenson et al (2002) found that Medicaid covered 75% of AD patients seen in the emergency room. Medicaid also covered some outpatient visits and certain medications, but not all. The burden of care is higher on the individual; management of the disease often requires topical applications that are not covered by insurance, and there are indirect costs, such as the purchase of special household items and clothing, and days lost from work.
AD is a multifaceted condition that can be a therapeutic challenge, especially in primary care. A comprehensive management plant could offer real potential for improving the outcome of treatment, and perhaps the cost effectiveness of treatment. Educational programs could teach those who suffer from eczema how to control inflammation, prevent infection of the skin, and avoid triggering factors, such as allergens and irritants. Some medications do not work unless they are properly used, and supervision of patient compliance may be necessary.
Educational programs like these would be particularly effective in preventing the development of AD in infants of asymptomatic mothers, who may not be aware of potential risk factors that might affect the health and wellbeing their infant children. In addition to symptoms directly related to the disease itself, AD may have an adverse effect on a child’s emotional and social development and may predispose them to psychological problems (Absolon, 1997).
A systematic case management plan that focuses on education and prevention of the disease can reduce medical and associated costs. It has been estimated that nearly half the burden of illness associated with AD is due to loss of productivity. Days lost from work and nights of sleep lost were higher for parents of infant children with symptomatic AD, and their quality of life (QOL) was significantly lower (Fivenson, 2002).
Nurses are in an ideal position to coordinate a management plan, for the management of atopic dermatitis depends on the coordinated efforts of a multidisciplinary team that includes not only healthcare professionals like nurses, physicians, and psychologists, but also other members of the healthcare community; like social workers and educators.
There are also numerous nonmedical interventions that can help prevent the flaring of symptoms. No loving parent harms an infant with intent; nevertheless, for an infant, parents represent the highest risk for developing atopic dermatitis, for parents are control the infant’s diet. Marini et al (1996) isolated a number of dietary factors associated with allergic symptoms in infants: (1) no breastfeeding during the first week of life, (2) early weaning (<4 months), (3) eating beef (<6 months), (4) early exposure to cow’s milk (< 6 months), (5); and exposure to tobacco smoke. Therefore, parental knowledge and cooperation is critical for the management of atopic dermatitis.
Atopic dermatitis is a chronic and disabling disease associated with high BOI and low QOL of the individual. The incidence of AD is increasing worldwide and there is no reliable cure, although a strong correlation has been found between food allergies and the development of AD in infants. Thus, a restricted diet can reduce the risk of AD or modify its symptoms (Steinman, 1994). Therefore, to be effective, a good management plan for the disease should be interdisciplinary, multi-professional, and focus on prevention through educational programs.
References
Absolon C, Cottrell D, Eldridge S, & Glover M. (1997). Psychological disturbance in
atopic eczema: the extent of the problem in school aged children. Br j Dermatol,
137, 241-5.
George, S., Berth-Jones, J., Graham-Brown, R.A.C., (2008). A possible explanation for
the increased referral of atopic dermatitis from the Asian community in Leicester. British
Journal of Dermatology, 136
(4), 494-497.
Kawamoto N, Fukao T, Kaneko H, Hirayama K, Sakurai S, et al. (2012). Risk factors for
infantile atopic dermatitis and recurrent wheezing. J Investig Allergol Clin
Immunol, 22(2), 116-25.
Krafchik, B., (2011). Atopic Dermatitis. Medscape Reference Drugs, Diseases &
Procedures. Retrieved April 14, 2012 from
http://emedicine.medscape.com/article/1049085-overview#a0199
Marini A, Agosti M, Motta G, Mosca F (1996). Effects of a dietary and environmental
prevention programme on the incidence of allergic symptoms in high atopic risk
infants: three years' follow-up. Acta Paediatr Suppl, 414:1-21.
Moore, M. M., Rifas-Shiman, S. L., Rich-Edwards, J. W., Kleinman, K. P., Camargo, C.
A.,Gold, D. R., Weiss, S. T., Gillman, M. W., (2004). Perinatal Predictors of
Atopic
Dermatitis Occuring in the First Six Months of Life. Pediatrics Official
Journal Of The American Academy Of Pediatrics, 113 (3), 468-474.
Steinman HA, Potter PC. (1994). The precipitation of symptoms by common foods in
children with atopic dermatitis. Allergy Proc. 15(4), 203-10.
