Guidelines for written eczema action plans need to be reviewed for effectiveness before more WAPs are created.
More research is needed to evaluate the effectiveness of written atopic eczema/dermatitis action plans (WAPs) before creating more WAPs, according to study findings published in Skin Health and Disease.
Researchers also say that patient and caregiver involvement is required when creating WAPs.
Atopic eczema/dermatitis is a common inflammatory condition that affects 15% to 30% of children and 2% to 10% of adults.
“Affected children suffer with significant impacts on quality of life, moreso than diabetes and asthma,” said the researchers regarding impact of the disease.
Atopic eczema/dermatitis can have a strong influence on patients, and its care can be challenging. It’s crucial for patients, parents, and caregivers to know how to take care of their skin, they emphasized when explaining they were trying to recognize and evaluate WAPs that are internationally accessible by these groups.
First, the study authors obtained 312 abstracts, supplemented by other searches, and they recognized 20 unique eczema WAPs from 9 countries; 18 were designed for children; tthey followed Preferred Reporting Items for Systematic reviews and Meta-analysis guidelines. They then searched pertinent databases like MEDLINE, Embase, and COCHRANE from inception throughl March 2022. Database search results were independently reviewed, and identified WAPs were reviewed for length, appearance, content, how they were created, and if they had been evaluated.
For most of the abstracts, it was not clear if any development work happened before their creation or their use in the intended clinical setting. Of the total, 19 had a stepwise approach, 17 considered when to look for help, 6 were visually pleasing, and 6 had a rationale between documented treatment in the WAP. Only 3 had been reviewed in clinical trials.
The researchers stated that this review emphasized the need for more assessment of existing WAPs rather than the production of new ones. Included in this may be translation or back-translation and translation of eczema WAPs into languages other than English.
Although WAPs that had pictures or icons primarily were for children, including images might be beneficial to all patients, especially adults with poor health literacy skills, the investigators underscored.
Most WAPs were aimed at children, and more work to create and review WAPs aimed at adults with eczema is needed.
“It remains difficult to make recommendations on which criteria should be included in WAPs,” the study authors concluded. "We provide links in the references, where available, to the WAPs so that clinicians can use this review to decide which best suits their setting and patient population, with the highest scoring three identified above."
Thandi CS, Constantinou S, Vincent R, Ridd MJ. Where and how have written action plans for atopic eczema/dermatitis been developed and evaluated? systematic review. Skin Health Dis. Published online March 22, 2023. doi:10.1002/ski2.213