Multidisciplinary interventions in the management of atopic dermatitis

Atopic dermatitis is the most common skin disease in children, affecting up to 1 in 5 children in the United States.  But it doesn’t do it justice to call it just a skin disease.  The itching and scratching leads to a breakdown of the skin, disruptions in sleep, conflicts with parents, and an inability to concentrate at school.  Studies have shown that children with atopic dermatitis have a higher risk of developing mental health disorders like attention-deficit hypersensitivity disorder, anxiety, depression, conduct disorder, and autism.

Because atopic dermatitis does not have a single cause and has such far-ranging effects, management can be a challenge.  As LeBovidge and colleagues describe, multidisciplinary interventions are being investigated as a way to help these children (J Allergy Clin Immunol 2016; 138(2): 325-334).  Evaluation by an allergist or dermatologist can help to determine triggers, and education by nurses can help improve adherence and technique of applying emollients.  Psychologists can help redirect unhelpful compulsive behaviors like scratching into more helpful activities, such as re-application of moisturizers.  And nutritionists can ensure that children, especially those that have food allergies that require restriction of certain foods, receive enough Vitamin D and other nutrients.

Several institutions have embraced this multidisciplinary approach, but randomized controlled trials are limited.  Some group-based models have shown an improvement in control but others found no difference in disease severity, quality of life, or medical therapy use.  New models of collaboration between specialists and primary care providers are being developed in order to improve the quality of care.  It is hoped that improving the quality of care will decrease the economic burden of the disease.

Atopic dermatitis may be a skin disease, but its effects are felt in more than just the skin.  In order to get the disease under better control, new ways of delivering care will have to be developed.  Professionals in various fields, including allergists, dermatologists, nurses, nutritionists, and psychologists, are aligning with parents to break the itch-scratch cycle that causes such misery to the millions to have atopic dermatitis.