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Open Access Highly Accessed Research article

Improved emollient use reduces atopic eczema symptoms and is cost neutral in infants: before-and-after evaluation of a multifaceted educational support programme

James M Mason1, Julie Carr2, Carolyn Buckley3, Steve Hewitt3, Phillip Berry3, Josh Taylor4 and Michael J Cork567*

Author Affiliations

1 School of Medicine, Pharmacy & Health, Durham University, Durham, UK

2 Sheffield Children’s NHS Foundation Trust, Sheffield, UK

3 Reckitt Benckiser Healthcare UK, Slough, UK

4 Partizan International, London, UK

5 Academic Unit of Dermatology Research, School of Medicine & Biomedical Sciences, University of Sheffield, Sheffield, UK

6 Department of Dermatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK

7 Department of Infection and Immunity, The University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK

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BMC Dermatology 2013, 13:7  doi:10.1186/1471-5945-13-7

Published: 16 May 2013

Abstract

Background

Parents and carers of children with eczema often underuse emollient therapy, essential to repairing and protecting the defective skin barrier in atopic eczema. Educational interventions delivered by specialist dermatology nurses in hospital settings have been shown to improve emollient use and reduce symptoms of atopic eczema, but benefits of community-based interventions are uncertain. Support and information about appropriate care may often be inadequate for patients and carers in the community.

Methods

A multifaceted educational support programme was evaluated as a method of increasing emollient use and reducing atopic eczema in children. Support provided for parents and carers included an educational DVD, online daily diary and telephone helpline. The before and after study included 136 British children and their parents, providing baseline and 12 week follow-up data while receiving the programme. Measures included emollient use, POEM and PEST scores, and cost of care.

Results

Average emollient use increased by 87.6 g (95% CI: 81.9 to 119.5 g, p = 0.001) from baseline with the change being immediate and persistent. The POEM score reduced on average by 5.38 (95% CI: 4.36 to 6.41, p = 0.001), a 47% reduction from baseline. Similarly the PEST score reduced on average by 0.61 (95% CI: 0.47 to 0.75, p = 0.001), a 48% reduction from baseline. Sleep disturbance was reduced by 1.27 nights per week (95% CI: 0.85 to 1.68, p = 0.001) and parental feeling of control improved by 1.32 points (95% CI: 1.16 to 1.48, p = 0.001). From the NHS perspective, the programme was cost neutral overall within the study period.

Conclusion

A community-based multifaceted educational support programme greatly increased emollient use, reducing symptoms of atopic eczema and general practitioner contacts, without increasing cost. Significant benefits may accrue to the families and carers of children with atopic eczema due to improved sleep patterns and greater feeling of control. PEST, a new simple measure of acute and remitting atopic eczema severity designed to help parents and children to monitor and manage eczema, merits further evaluation.

Keywords:
Atopic eczema; Children; Emollient therapy; Compliance; Symptoms; Measurement; Community study; Health economics; Patient support; Educational support