Two Online Behavioral Interventions Led to Sustained Improvements in Atopic Dermatitis Severity

Miriam Santer, MD

New research suggests that 2 online behavioral interventions offered to atopic dermatitis patients, in addition to their normal care, were found to have provided sustained benefits.

The effects on quality of life for patients facing atopic eczema, also known as atopic dermatitis, are noted in the study as substantial and often requiring a variety of interventions. The investigators cite that self-management is important but that there is a dearth of information on online interventions developed for eczema patients.

The study was designed to provide a larger amount of data on 2 specific online interventions, and the study was led by Miriam Santer, MD, from the Primary Care Research Centre at the University of Southampton.

“We evaluated two online…behavioural interventions to support self-management of eczema: one aimed at the parents or carers of children with eczema, and the other aimed at young people with eczema,” Santer and colleagues wrote. “As parents and carers of children and young people with eczema are likely to have different support needs, we developed two separate interventions to be evaluated in two independent randomised controlled trials.”

Background and Research

The study was a multicenter, individually-randomized set of 2 trials, with both online interventions designed and delivered through LifeGuide software. They recruited 340 parents or guardians for one arm and 337 children with eczema for the other, dividing both up as the ‘usual care’ or ‘intervention’ arms.

Both online interventions were developed separately but in parallel, with 1 made for parents or guardians of children with atopic dermatitis, and the other designed for younger eczema patients themselves. The researchers noted that their interventions were developed to be conducted entirely online and made to be self-guided, so that those involved could use the intervention tools as much as needed.

The investigators’ primary goal for their interventions was said to be reduction of eczema severity as well as developing core behaviors to address eczema management. This included the following:

• Regular emollients use
• Appropriate topical corticosteroids use
• Scratch minimization
• Management of emotions

The interventions themselves were designed by a team made up of clinicians (including general practitioners, dermatology nurse consultants, dermatologists), behavioural psychologists, representatives of patients, and researchers. They were then further tailored to patients by user feedback collected to make sure they functioned and were practical, as well as useful.

Study Findings

The study results indicated that by week 24, follow-up rates for study participants were listed as 91.5%, or 311 out of 340, for parents or guardians. The rate for younger patients with eczema was 90.2%, or 304 out of 337).

The researchers, after controlling for baseline eczema severity and other variables, compared the intervention groups to the usual care groups over 24 weeks, finding that eczema severity improved in the intervention groups. They noted that the mean difference in Patient-Oriented Eczema Measure (POEM) score was −1.5 for parents or guardians (95% confidence interval, −2.5 to −0.6; P=0.002) and −1.9 for children (−3.0 to −0.8; P<0.001).

The investigators also noted that the improvements observed in patients after the interventions were also sustained up to 52 weeks for both of the trials. The team’s subgroup analyses for each trial demonstrated that those in the intervention arm had similar eczema outcomes, regardless of sex, age, severity of condition, baseline treatment use, prior belief in usefullness of intervention, or even previous use of other atopic dermatitis websites.

“Few fully powered trials have been carried out of self-management or educational interventions for eczema, and those that have been published used different outcome measures, making direct comparisons challenging,” they wrote. “However, much more costly educational interventions have only shown modest improvements in eczema, and we believe the effect size in our trials compares favourably with more intensive interventions.”

The study, “Eczema Care Online behavioural interventions to support self-care for children and young people: two independent, pragmatic, randomised controlled trials,” was published online in The BMJ.