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Published on: September 27, 2019
"Scratching" beneath the surface: an integrative psychosocial approach to pediatric pruritus and pain
Traci R Stein1, Nomita Sonty, John M Saroyan
1Division of Pain Medicine, Department of Anesthesiology, Columbia University Medical Center. ts2007@columbia.edu
Insights
This study shows an integrative approach using psychological, complementary, and medical therapies effectively reduced severe itching and improved skin condition in a child with atopic dermatitis.
Area of Science:
- Dermatology
- Pediatrics
- Integrative Medicine
Background:
- Pruritus (itching) significantly impacts children with atopic dermatitis, affecting mood, sleep, and daily functioning.
- Severe atopic dermatitis with refractory itch and pain poses a treatment challenge, impacting a child's quality of life.
Observation:
- A 7-year-old African American female with severe atopic dermatitis experienced intractable itching and pain despite conventional treatments.
- The patient exhibited bleeding from scratching, anxiety, and declining scholastic performance.
Findings:
- A multimodal program incorporating family cognitive behavioral therapy, imagery, aromatherapy, drawing, and biofeedback was implemented.
- Within one month, significant reductions in itch, scratching, pain, and anxiety were observed.
- By the fourth month, skin lesions decreased, bleeding episodes reduced, and near-complete skin clearance was achieved.
Implications:
- A short-term, integrative program combining psychological, complementary and alternative medicine (CAM), and medical therapies offers a novel and effective treatment for severe pediatric atopic dermatitis.
- This approach addresses the multifaceted nature of atopic dermatitis, improving both physical symptoms and psychological well-being.
Abstract:
Pruritus is prevalent in children with atopic dermatitis and associated with effects on mood, quality of life, sleep, scholastic performance, social and family functioning. In this study a 7-year-old African American female with severe atopic dermatitis, itching and pain refractory to multiple systemic and topical medications was referred for treatment. At baseline, the patient scratched to the point of bleeding, despite maximal doses of anti-histamines, antidepressant and topical therapies. The patient became progressively shy, anxious, and her scholastic performance suffered. A literature review prompted the implementation of a multi-modal program of family cognitive behavioral therapy, imagery, aromatherapy, drawing, and biofeedback. The results were that decreased itch, scratching, pain, and anxiety were seen within the first month. Fewer lesions and episodes of bleeding were observed with almost complete skin clearance by the fourth month. The article concludes that a short-term, integrative program including psychological, complementary and alternative medicine (CAM), and medical therapies may represent a novel, efficacious approach for children suffering from severe atopic dermatitis.
