Multidisciplinary Atopic Dermatitis Program Utilization Results in Disease Improvement

Lawrence Eichenfield, MD

An investigation into severe and difficult-to-control atopic dermatitis suggested that coordination between specialties simultaneously in a multidisciplinary setting, along with emphasis on compliance and patient education, resulted in significant disease improvement.

The findings were presented at the 2021 American College of Allergy, Asthma, and Immunology (ACAAI) Scientific Meeting in New Orleans.

Investigators led by Lawrence Eichenfield, MD, of the Rady Children’s Hospital and UC San Diego School of Medicine, noted that difficulties in managing severe atopic disease could be a result of disjointed dialogue between specialties, inconsistent treatment plans, a lack of educational material, and more.

As such, Eichenfield and colleagues implemented the Multidisciplinary Atopic Dermatitis Program (MADP) to bridge the gap in the care difficult-to-control pediatric atopic dermatitis patients experience when seen by single specialties.

The Methods

According to investigators, the MADP program included monthly clinical visits, educational modules, and an assessment of patients and provide reported outcomes.

A total of 26 patients with severe and difficult-to-control atopic dermatitis were enrolled in the study.

Each patient was evaluated by an allergist, dermatologist, and clinical pharmacist at each visit.

Patient and provider reported outcomes measures were recorded at baseline and follow-up visits.

Outcomes included data on the Eczema Area and Severity Index (EASI) scores, Body Surface Area (BSA) scores, and validated Investigator Global Assessment (vIGA) scores, pruritis scores, Patient Oriented Eczema Measure (POEM) scores, Children’s Dermatolofy Life Quality Index (DLQI) scores, and other patient reported outcomes.

Data was amassed through the utilization of the National Eczema Association website.

Patient satisfaction and provider assessment of patient knowledge are collected at the first visit and at 1 year.

Patients also met with a patient educator at the end of each visit to review curated educational slides to improve patient knowledge of the disease and treatment.

A paired t-test was utilized to calculate the mean difference in provider and patient reported outcomes between visits.

The Findings

Eichenfield and colleagues reported that out of 26 subjects, 85% achieved an EASI 50 within a year, while 77% achieved the same within 6 months.

Additionally, EASI scores increasingly declined over subsequent visits, with the mean decrease reported as 13.09 (p<0.001), 19.33 (p<0.001), 20.16 (p<0.001) for visits 2, 3, and 4, respectively.

Perhaps more promisingly, 58% of patients in the study had achieved an EASI-75 within a year, and 53.85% achieving EASI-17 within 6-months.

Eichenfield and investigators also reported that vIGA dropped by 1.08 by visit 2 (p<0.001) and 1.82 by visit 4 (p=0.002), with POEM and CDLQI scores decreasing significantly as well by visit 3.

Pruritus was the only parameter to not achieve clinical significance, with a mean difference of 2.94 by visit 3 (p<0.001).

Overall, patient and family satisfaction with the MADP was high, despite additional data collection being ongoing.

In their concluding statements, Eichenfield and colleagues stated that the MADP established a “cohesive and collaborative” clinic structure to treat patients with complex atopic dermatitis.

“Our clinic shows promise based on patient and provider reported outcome data collected,” the team wrote, “Data analysis has shown clinically significant disease improvement by the first follow-up visit for EASI, BSA, vIGA, POEM, and CDLQI. A more extended dataset will help elucidate longer term trends.”