Psychological and educational interventions for atopic eczema in children

Area of Science:

• Pediatric Dermatology
• Behavioral Medicine

Background:

• Psychological and educational interventions are adjuncts to conventional therapy for childhood atopic eczema.
• This is an update of a previous Cochrane review.

Purpose of the Study:

• To assess the effect of psychological and educational interventions for children with atopic eczema.

Main Methods:

• Updated searches of multiple databases (Cochrane, MEDLINE, EMBASE, PsycINFO, etc.) up to January 2013.
• Included randomized controlled trials (RCTs) of psychological or educational interventions for children and their caregivers managing atopic eczema.
• Data extraction and quality assessment by three independent authors; meta-analysis was not possible due to insufficient comparable data.

Main Results:

• 10 RCTs were included (5 new), with 2003 participants in educational interventions and 44 in a psychological study.
• The largest study (n=992) showed significant reductions in disease severity (SCORAD) and improvements in quality of life with nurse- and dermatologist-led educational interventions.
• While some studies showed statistically significant improvements in objective severity (SCORAD), confidence intervals often did not exceed the minimum clinically important difference.

Conclusions:

• New studies did not substantially alter previous conclusions; interventions often lack detailed design and theoretical basis.
• Limited evidence exists due to a relative lack of rigorously designed trials.
• Some evidence suggests educational interventions (multiprofessional, nurse-led) may improve disease severity and quality of life, but further development and comparative evaluation are needed.