Peter A. Lio

TOPICAL ANTIBACTERIAL AGENTS

Decreased systemic toxicity, ease of application, and increased concentrations at the target site are some of the important advantages topical antibacterial agents offer. This article reviews the literature on selected indications for these agents and provides in-depth examination of specific agents for the prophylaxis and treatment of skin and wound infections.

Online video improves clinical outcomes in adults with atopic dermatitis: A randomized controlled trial

BACKGROUND Atopic dermatitis (AD) is a chronic inflammatory skin disorder characterized by intense pruritus that causes significant disease and psychosocial burden in patients. Patient education has the potential to improve clinical outcomes and patient knowledge of this condition. OBJECTIVES We sought to assess the effectiveness of online video education at improving AD knowledge and disease severity compared with a written pamphlet, and to determine the usefulness and appeal of the two educational delivery vehicles. METHODS In a randomized controlled trial, 80 participants were randomized to receive either online video-based patient education or written pamphlet education about AD and its management. We assessed AD disease severity using the patient-oriented eczema measure (POEM) scale. AD knowledge was assessed with standardized questionnaires at baseline and after the 12-week intervention. RESULTS All participants had similar baseline knowledge and AD severity at the beginning of the study. On study completion, improvements in AD knowledge assessed by questionnaire were significantly greater in the video group than the pamphlet group (3.05 vs 1.85, P = .011). Online video-based education resulted in greater improvement in clinical outcome, as measured by POEM, compared with pamphlet-based education (POEM score reduction of 3.30 vs 1.03, P = .0043). Finally, although the usefulness of both interventions was rated equally (P = .77), the online video was significantly more appealing than the pamphlet (P = .0086). LIMITATIONS This study is limited to AD in adults. CONCLUSION Online video for patient education is an effective and appealing tool for improving clinical outcomes in adult patients with AD.

Comparison of Vancouver and International League of Associations for rheumatology classification criteria for juvenile psoriatic arthritis

OBJECTIVE The International League of Associations for Rheumatology (ILAR) criteria constitute the current international diagnostic standard for juvenile psoriatic arthritis (PsA), replacing the less-restrictive Vancouver criteria. The impact of this change on the population diagnosed with juvenile PsA is unknown. METHODS We reviewed the records of patients seen in a pediatric rheumatology clinic with International Classification of Diseases, Ninth Revision diagnosis codes for psoriasis, PsA, or spondylarthritis. Characteristics of children who met the Vancouver and ILAR criteria were compared. RESULTS Of 139 children meeting the Vancouver criteria for juvenile PsA, ILAR criteria excluded 80 (58%). Grounds for exclusion were insufficiently definitive rash (44%), a competing diagnosis of enthesitis-related arthritis (23%), family history of psoriasis limited to second-degree relatives (16%), fulfillment of criteria for >1 subtype of juvenile idiopathic arthritis (JIA) (5%), and HLA-B27 in a male with arthritis onset after age 6 (2%). Remaining patients were not homogeneous but could be divided into younger and older subpopulations differing in clinical features as described previously among patients identified under the Vancouver standard. Of excluded patients, 76% were reclassified as having other forms of JIA yet were phenotypically comparable with those retained. CONCLUSION Despite apparently modest changes from previous criteria, ILAR definitions strikingly restrict the diagnosis of PsA in childhood. Similarity between excluded and included patients suggests that these restrictions may not reflect substantive clinical differences. To the extent that excluded patients become reclassified within JIA, current criteria risk compromising other ILAR categories while reducing the number of patients available for the study of juvenile PsA.

Effectiveness of acupressure on pruritus and lichenification associated with atopic dermatitis: a pilot trial.

Background Pruritus is a debilitating aspect of atopic dermatitis (AD). Acupuncture has been reported to diminish pruritus, but self-administered acupressure has not been previously evaluated. Objectives To evaluate the effectiveness of acupressure on the severity of eczema in a pilot trial. Methods Adult patients with AD were randomised to an intervention group (acupressure with standard of care) or a control group (standard of care alone). Subjects in the intervention group performed acupressure using a 1.2 mm acupellet at the LI11 point, applying pressure for 3 min three times per week for 4 weeks. The severity of itching and AD at baseline and at 4 weeks were measured on a visual analogue scale (VAS), the Investigators Global Assessment (IGA) and the Eczema Area and Severity Index (EASI). Results Fifteen subjects were enrolled, 12 of whom completed the study between November 2009 and May 2011. There was no significant change between baseline and follow-up survey scores within the control group. In the investigation group there was a decrease in the VAS score (p=0.05) and EASI lichenification (p=0.03), although without significant change in the overall EASI score. Comparison of the scores between groups showed a greater decrease in VAS in the experimental group than in the control group (p=0.04), and a decrease in the IGA (p=0.03) and EASI lichenification score (p=0.03). The overall EASI scores were unchanged. Conclusion Subjects using acupressure at LI11 for 4 weeks had improvement in pruritus and lichenification. Acupressure may prove to be an easily administered alternative treatment, but larger-scale studies are needed to confirm these preliminary findings.

Therapeutic Patient Education in Atopic Dermatitis: Worldwide Experiences

Therapeutic patient education (TPE) has proven effective in increasing treatment adherence and improving quality of life (QoL) for patients with numerous chronic diseases, especially atopic dermatitis (AD). This study was undertaken to identify worldwide TPE experiences in AD treatment. Experts from 23 hospitals, located in 11 countries, responded to a questionnaire on 10 major items. Patients in TPE programs were mainly children and adolescents with moderate to severe AD or markedly affected QoL. Individual and collective approaches were used. Depending on the center, the number of sessions varied from one to six (corresponding to 2 to 12 hours of education), and 20 to 200 patients were followed each year. Each centers education team comprised multidisciplinary professionals (e.g., doctors, nurses, psychologists). Evaluations were based on clinical assessment, QoL, a satisfaction index, or some combination of the three. When funding was obtained, it came from regional health authorities (France), insurance companies (Germany), donations (United States), or pharmaceutical firms (Japan, Italy). The role of patient associations was always highlighted, but their involvement in the TPE process varied from one country to another. Despite the nonexhaustive approach, our findings demonstrate the increasing interest in TPE for managing individuals with AD. In spite of the cultural and financial differences between countries, there is a consensus among experts to integrate education into the treatment of eczema.

Therapeutic patient education in children with atopic dermatitis: position paper on objectives and recommendations

Poor adherence is frequent in patients with atopic dermatitis (AD), leading to therapeutic failure. Therapeutic patient education (TPE) helps patients with chronic disease to acquire or maintain the skills they need to manage their chronic disease. After a review of the literature, a group of multispecialty physicians, nurses, psychologists, and patients worked together during two international workshops to develop common recommendations for TPE in AD. These recommendations were structured as answers to nine frequently asked questions about TPE in AD: What is TPE and what are its underlying principles? Why use TPE in the management of AD? Who should benefit from TPE in AD? How can TPE be organized for AD? What is the assessment process for TPE in AD? What is the evidence of the benefit of TPE in AD? Who are the people involved in TPE? How should TPE be funded in dermatology? What are the limits of the TPE process?

Comparison of Dermatology and Allergy Guidelines for Atopic Dermatitis Management

IMPORTANCE Atopic dermatitis (AD) is a common skin condition treated by dermatologists, allergists, pediatricians, and primary care physicians. Several treatment guidelines and therapeutic parameters exist for the management of this disease. Health care professionals may be unaware of guidelines created by specialty organizations other than their own. OBJECTIVE To review, compare, and contrast the most recent AD management guidelines. EVIDENCE REVIEW The guidelines for AD management published by the American Academy of Dermatology 2014 work group were compared with those created by the 2012 Joint Task Force on Practice Parameters representing the American Academy of Allergy, Asthma & Immunology; the American College of Allergy, Asthma & Immunology; and the Joint Council of Allergy, Asthma & Immunology. International guidelines created by the 2012 European Task Force on Atopic Dermatitis and the 2013 Asia-Pacific Consensus Group for Atopic Dermatitis were also considered. FINDINGS Several differences among the guidelines suggest that there may be disparity in the perceptions of AD between US dermatologists and allergists and health care professionals in other areas of the world. There are notable differences among the guidelines regarding the recommendations for the use of diluted bleach baths, vitamin D, and environmental modifications. CONCLUSIONS AND RELEVANCE Comparison of different guidelines may ultimately augment knowledge of treatment strategies and enhance realization of biases in the understanding and management of AD.

Clinical Management of Atopic Dermatitis: Practical Highlights and Updates from the Atopic Dermatitis Practice Parameter 2012

Atopic dermatitis is a challenging condition for clinicians and patients. Recent advances were documented in the Atopic Dermatitis Practice Parameter 2012, and we want to provide clinicians with key points from the Atopic Dermatitis Practice Parameter 2012. In this article, we highlight the evidence-based therapy of atopic dermatitis as well as provide practical tips for clinicians and families. An updated review of immunopathology provides a firm basis for patient education and therapy. We also review clinical diagnosis and ways to improve quality of life for patients with atopic dermatitis.

Improving patient education with an eczema action plan: A randomized controlled trial

A majorchallengetoatopicdermatitis(AD)management lies in its complex treatment,whichmustbe tailoredforbothacuteexacerbationsandlong-term maintenance. The addition of a written eczema action plan (EAP) to the routine verbal instruction (VI) may enhance patients’ understanding of AD and facilitate treatment adherence. This randomized controlled study was designed to evaluate the effect of a written EAP on patient and caregiverunderstandingofAD,distresslevelregardingtreatment regimen,andpreferencefortheadditionofanEAPcompared with those receiving traditional in-office VI.

Topical Antibacterial Agents

Decreased systemic toxicity, ease of application, and increased concentrations at the target site are some of the important advantages topical antibacterial agents offer. This article reviews the literature on selected indications for these agents and provides in-depth examination of specific agents for the prophylaxis and treatment of skin and wound infections.