Online Support Tool Improves AD Self-Management

MONTREAL — An online behavioral intervention called Eczema Care Online, aimed at supporting self-management of atopic dermatitis (AD), resulted in a “small but sustained” improvement in eczema severity for up to 1 year, according to two randomized controlled trials presented at the International Society of Atopic Dermatitis (ISAD) 2022 annual meeting.

The intervention, directed either at parents of children with AD or young adults with AD, “is very low cost, evidence-based, easily accessible, and free from possible commercial bias,” said investigator Kim Thomas, MD, professor of applied dermatology research & co-director of the Centre of Evidence Based Dermatology, Faculty of Medicine & Health Sciences, University of Nottingham, UK.

The main focus of the intervention, along with general education, is “getting control” of the condition with flare-control creams and “keeping control” with regular emollient use.

Efficacy of the intervention, available free online, was compared with “usual eczema care” in 340 parents of children with AD up to age 12 and 337 young patients with AD aged 13 to 25. Participants were randomized to the intervention plus usual care or usual care alone. The primary outcome was the Patient-Oriented Eczema Measure (POEM) at 24 weeks, with a further measurement at 52 weeks.

In the parent group, about half were women and 83% were White, and the median age of their children was 4 years. About 50% of parents had a university degree, making them “possibly better-educated than we might want our target audience for this type of intervention,” Thomas commented. Most of the children had moderate AD.

In the young patient group, the mean age was 19 years, more than three quarters were female, 83% were White, and most had moderate AD.

At 24 weeks, both intervention groups had improved POEM scores compared with controls, with a mean difference of 1.5 points in the parent group (P = .002) and 1.7 points in the young patient group (P = .04). “A small difference, but statistically significant and sustained,” Thomas said, adding that this difference was sustained up to 52 weeks.

In terms of mechanism of action, a secondary outcome looked at the concept of enablement, “which again, seemed to be improved in the intervention group, which suggests it’s something to do with being able to understand and cope with their disease better,” she said. The tool, she added, is targeted to “people who wouldn’t normally get to a dermatologist and certainly wouldn’t get access to group interventions.”

An additional aim of the intervention was “to provide a single, consistent message received from every point of contact that people might engage with…[from] community doctors, pharmacists, dermatologists, and importantly, eczema charities all signposting [the intervention] and sharing a consistent message.”

While the intervention is free and available to patients anywhere, Thomas emphasized that it is tailored to the UK healthcare system. “If people would like to get in touch and help work with us to maybe adapt it slightly to make it more suitable for your own healthcare systems, that’s something we’d be very happy to look at with you.”

Asked for comment, Natalie Cunningham, MD, panel moderator, was lukewarm about the tool. “It can be a supplement, but you can never replace the one-on-one patient–healthcare provider interaction,” she told Medscape Medical News. “That could be provided by a nondermatologist and supplemented by an online component,” said Cunningham, from the Izaak Walton Killam Hospital for Children in Halifax, Nova Scotia, Canada.

“First-line treatment for eczema, no matter what kind of eczema, is topical steroids, and that is something that requires a lot of education — and something you want to do one-on-one in person because everyone comes to it with a different experience, baggage, or understanding,” she said. “We need to figure out what the barrier is so that you can do the right education.”

In addition, with systemic AD therapies currently approved for children, parents and young patients need to be able to advocate for specialist care to access these medications, she noted.

Thomas and Cunningham have reported no relevant financial relationships.

ISAD 2022. Abstract OL.16. Presented October 18, 2022.

Kate Johnson is a Montreal-based freelance medical journalist who has been writing for more than 30 years about all areas of medicine.

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