Action Plan Reduces AD Severity and Enhances QoL in Adults

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Atopic dermatitis (AD) symptoms, along with anxiety and depression, can negatively impact patients' quality of life.¹ Current treatments include topical, ultraviolet light, and systemic therapies, but many patients experience inadequate control and high disease burden.² Individualized action plans have improved management in children, but researchers behind a recent study stated similar plans for adults are lacking.^3-5 The American Academy of Dermatology recently published a patient action plan for children, but an equivalent validated plan for adults is still needed.⁶

Methods

This study assessed the impact of a newly designed patient action plan for adult AD on disease severity and patient outcomes. Conducted at the Inselspital University Hospital in Bern, Switzerland, the study used a pretest-posttest design with 20 adult patients from June to October 2022.

The action plan, created by a dermatologist and a nurse practitioner, was based on European AD guidelines and a pediatric plan from the American Academy of Dermatology. It included detailed instructions for skin care, anti-inflammatory therapy, itch control, and managing flare-ups.

Measurements

AD Severity: Assessed using the SCORing Atopic Dermatitis (SCORAD) index, with scores ranging from 0 (mild) to over 50 (severe).

Quality of Life: Evaluated using the Dermatology Life Quality Index (DLQI), with scores from 0 (no impact) to 30 (extreme impact).

Self-Care Needs: Measured by the Person-Centered Dermatology Self-Care Index (PeDeSI-G), with scores from 0 (high need) to 30 (low need).

Patient Benefit: Determined through the Patient Benefit Index (PBI), assessing the importance and benefit of treatment objectives.

Data was collected at the beginning and after 4 weeks of action plan implementation.

Results

Researchers stated the study, which involved 20 adult patients with AD, investigated the implementation of a patient action plan that led to “notable” improvements. Baseline assessments revealed a wide range of AD severity, with a median SCORAD score of 37.6 and “significantly” impacted quality of life, reflected in a median DLQI score of 11. After 4 weeks of using the action plan, researchers found that AD severity decreased significantly from 38.1 ± 20.8 to 22.0 ± 12.5 (p < 0.0001), with 60% of patients achieving scores indicative of mild AD and 95% showing overall improvement. Quality of life also improved markedly, with the study reporting DLQI scores dropping from 11.6 ± 7.2 to 6.3 ± 5.0 (p < 0.001), and 65% of patients reporting minimal or no impact on their daily lives post-intervention. Self-care capabilities, measured by PeDeSI-G, increased significantly from 18.2 ± 2.1 to 25.7 ± 3.8 (p < 0.0001), reducing the need for intensive education from 95% to 5%. Additionally, the PBI indicated to researchers that 95% of patients experienced minimal to substantial benefit from the action plan, with a mean PBI score of 2.73 (SD: 0.9), and 1 patient reported complete fulfillment of treatment needs.

Conclusion

This study is the first to evaluate the impact of individually tailored patient action plans on disease severity and patient-related outcomes in adults with AD. Researchers demonstrated that patient action plans can significantly improve AD severity, quality of life, and self-care, as measured by SCORAD, DLQI, and PeDeSI-G. Developed to enhance patient education and disease management, the action plan effectively engaged patients in managing their condition.

While the results align with findings from studies on pediatric patients and other skin diseases, the study stated direct comparisons are limited due to variations in study designs and measures. Although the study showed a 95% rate of minimal benefit from the action plan, researchers noted that the small sample size, single-center design, and lack of a control group limit the generalizability of the findings. They suggested future research should include larger, multicenter trials with long-term follow-up and translation of the action plan into multiple languages to further validate its effectiveness. Overall, they suggested that patient action plans are a valuable tool for enhancing self-management and improving AD outcomes in adults.

References

1. Simpson EL, Guttman-Yassky E, Margolis DJ, et al. Association of inadequately controlled disease and disease severity with patient-reported disease burden in adults with atopic dermatitis. JAMA Dermatol. 2018;154(8):903-912. doi:10.1001/jamadermatol.2018.1572
2. Zuberbier T, Orlow SJ, Paller AS, et al. Patient perspectives on the management of atopic dermatitis. J Allergy Clin Immunol. 2006;118(1):226-232. doi:10.1016/j.jaci.2006.02.031
3. Stringer T, Yin HS, Oza VS. A survey to assess use patterns and perceptions of efficacy of eczema action plans among pediatric dermatologists. Pediatr Dermatol. 2018;35(6):e432-e434. doi:10.1111/pde.13667
4. Shi VY, Nanda S, Lee K, et al. Improving patient education with an eczema action plan: a randomized controlled trial. JAMA Dermatol. 2013;149(4):481-483. doi:10.1001/jamadermatol.2013.2143
5. Thormann K, Lupe L, Radonjic-Hoesli S, et al. Implementation and evaluation of a patient action plan for patients with atopic dermatitis. JEADV Clin Pract. 2024; 1–8. https://doi.org/10.1002/jvc2.531
6. American Academy of Dermatology. January 22 Eczema Action Plan. 2021. https://assets.ctfassets.net/1ny4yoiyrqia/ZPT1WHhZHcxlpbDgq3hZX/3973a527e55d064306e40509d5004bb7/eczema-action-plan.pdf