Self-care for Atopic Dermatitis Potentially Feasible as Treatment Intervention

With mixed findings from previous studies focused on atopic dermatitis and the use of cognitive behavioral therapy (CBT) as a treatment modality, investigators modified an existing online CBT intervention to account for the lack of clinical psychologists in the dermatological space.

Preliminary findings from an investigation of cognitive behavioral therapy (CBT) among patients who have atopic dermatitis (AD) that compared a revised self-care intervention with its original online CBT intervention show comparable outcomes after 3 months.

Findings were published in JAMA Dermatology, and they also indicate that psychological self-care for AD is feasible if such an intervention meets the following criteria: There is dermatological input during the development phase, especially regarding safety, and clinical interviews and on-demand technical support are included for participants.

Seventy-two patients were included in this analysis (n = 51, online CBT cohort; n = 21, psychological self-care cohort), with a population comprising primarily female patients. Those in the self-care group were slightly older than the online CBT group, with a mean (SD) age of 42.5 (16.0) vs 37.0 (11.0) years, and the most common eczema severity at the start of the study was severe and moderate in each group: 43% and 41%, respectively, for those receiving online CBT and 38% each for those taking part in the self-care initiative. Also, the highest level of education for a majority of each patient group was university or higher (65% or the online CBT group and 61% of the self-care group.

This study was conducted from March 15 to August 20, 2021, and for it, the self-care intervention was adapted to be a shorter length, both in words (16,726 vs 111,142) and weeks of treatment (8 vs 12). The primary outcome was Patient Oriented Eczema Measure (POEM) score (range, 0-28), in which a higher score indicates greater eczema severity.

“Online CBT often uses written therapist guidance. However, to our knowledge, many clinical psychologists are not knowledgeable about AD, and psychologists are rare in dermatological care,” the study authors wrote. “Therefore, an intervention requiring no therapist support may be more accessible and easier to implement.”

Results show that postintervention POEM scores were lower in the self-care group compared with the online CBT group, 0.61 (95% CI, 0.11-1.12) vs 0.93 (95% CI, 0.32-1.24), and this trend remained evident at the 3-month follow up, although the gap had closed: 0.84 (95% CI, 0.38-1.37) vs 0.89 (95% CI, 0.50-1.28).

By the time of the 3-month follow-up, a higher response rate was seen from the self-care group than the online CBT group, 69% vs 65%, although mean treatment satisfaction score was lower, at 22.7 (4.2) vs 25.0 (4.4). Still, the authors noted this still meant treatment satisfaction was acceptable.

They also noted different optimization for each treatment intervention: Desktop interface was optimized for the online CBT group and mobile interface for the self-care group.

Overall, no one reported symptom increase or any adverse events, at least 1 exposure exercise was reported by 85% of the self-care group, and 5 of 8 homework assignments were returned by 65% of the self-care group.

The lack of a control group was the primary limitation to generalizability of these study findings, and because of this, the authors noted their results should be interpreted as preliminary. However, they did still emphasize, “Findings suggest that a self-care intervention is feasible and potentially comparable to a comprehensive, therapist-guided version, provided that the intervention is well designed and includes clinical interviews and on-demand technical support.”

Reference

Kern D, Ljótsson B, Lönndahl L, et al. Optimized user experience, efficiency, and resource use in online self-management of atopic dermatitis. JAMA Dermatol. 2022;158(11):1325-1327. doi:10.1001/jamadermatol.2022.3434

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