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Predictors of treatment success in children with difficult to treat atopic dermatitis using a personalized
K B Fieten1,2,3, R Schappin4, W T Zijlstra1
1Department of (Pediatric) Dermatology/Allergology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
Insights
Most children with difficult-to-treat atopic dermatitis (AD) achieve long-term success with a personalized integrative multidisciplinary treatment programme (PIM). Psychosocial factors, not clinical ones, predict treatment outcomes in pediatric AD patients.
Area of Science:
- Pediatric Dermatology
- Integrative Medicine
- Psychodermatology
Background:
- Difficult-to-treat atopic dermatitis (AD) in children often requires novel therapeutic approaches.
- A 6-week personalized integrative multidisciplinary treatment programme (PIM) was developed for pediatric AD patients unresponsive to standard guidelines.
Purpose of the Study:
- To identify clinical and psychosocial predictors of long-term treatment success following PIM.
- To evaluate the efficacy of PIM in children and adolescents with refractory AD.
Main Methods:
- PIM involved a personalized, integrative, and multidisciplinary approach for patients aged 8-18 years.
- Treatment success was defined as a 75% reduction in Eczema Area and Severity Index and/or Children's Dermatology Life Quality Index score ≤ 6, assessed 6 months post-PIM.
- Multivariate logistic regression analyzed clinical data from medical records and psychosocial data from questionnaires.
Main Results:
- Long-term treatment success was observed in 77% of 74 pediatric AD patients completing PIM.
- Maternal acceptance of the disease was a significant predictor of long-term success (OR 1.84).
- Factors associated with lower success rates included female gender, multiple somatic complaints, and maternal anxiety regarding topical corticosteroid use.
Conclusions:
- PIM demonstrates significant long-term efficacy for children and adolescents with difficult-to-treat AD.
- Psychosocial and family-related variables, rather than clinical factors, were identified as key predictors of treatment success.
- This highlights the importance of a holistic approach in managing refractory pediatric AD.
Background:
A 6-week personalized integrative multidisciplinary treatment programme (PIM) was developed for children with difficult to treat AD who appeared unresponsive to treatment according to current guidelines.
Objective:
The aim of the present study was to identify clinical and psychosocial characteristics that predict long-term treatment success after PIM.
Methods:
Treatment was considered successful when there was a 75% reduction on the Self-Administered Eczema Area and Severity Index and/or little impact of AD on daily life, measured with the Children's Dermatology Life Quality Index (score ≤ 6), 6 months after the end of PIM. PIM is a personalized, integrative, multidisciplinary treatment programme with clearly defined goals and strategies, addressing atopic, paediatric, mental health comorbidities and general well-being, for children and adolescents aged 8- to 18 years. Multivariate logistic regression models were constructed using a backward selection procedure. Questionnaires were used to assess psychosocial characteristics; clinical data was extracted from medical records.
Results:
In total, 79 children/adolescents with difficult to treat AD completed PIM and long-term treatment results were available for 74 children/adolescents. The majority (77%) of children/adolescents demonstrated long-term treatment success with PIM. Predictors of long-term treatment success (adjusted ORs) included maternal disease acceptance OR (95% CI) 1.84 (1.15-2.94). A group (23%) of mostly females OR (95% CI) 0.10 (0.02-0.54) with multiple somatic complaints OR (95% CI) 0.88(0.80-0.97), from families where the mother has anxiety for the use of topical corticosteroids OR (95% CI) 0.62(0.40-0.94), is less likely to obtain long-term treatment success.
Conclusion:
Most children and adolescents with difficult to treat AD, seemingly unresponsive to conventional treatment according to current guidelines, are able to improve with PIM. Psychosocial and family but not clinical variables, predicted long-term treatment success after participating in PIM.
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