SAN FRANCISCO – Children’s eczema and parents' confidence in managing it both improved when parents were given eczema action plans with stepwise instructions for treatment according to severity, a small study has shown.
The idea for the study came from asthma management, in which personalized action plans are routinely given to parents to help manage childhood asthma, according to lead author Jillian Rork, a third-year medical student at Harvard Medical School, Boston.
The eczema action plans (EAPs) developed by Ms. Rork and her colleagues at Children’s Hospital Boston and Seattle Children’s Hospital divided treatment into three "zones." The green zone comprises daily skin care, including use of moisturizers and cleansers, for when children have only mild redness or irritation. The yellow zone includes topical steroids for when parents begin to notice a flare, and the red zone is for severe redness, itching, and oozing, which could involve more potent topical steroids or other medications.
"The physician can actually fill in the blank as to which medication to use," Ms. Rork explained. That decision depends on the level of the child’s underlying disease. The approach is "very useful, not only for allergists but for primary care doctors, pediatricians, kind of the whole gamut. That was the goal, to have [the EAP be] very applicable," Ms. Rork said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
In the study, parents of 35 children ranging in age from 4 months to 17 years (mean 4 years), were given EAPs in a tertiary allergy program. Parents completed a survey regarding their child’s eczema at baseline and then again at 3-12 months’ follow-up.
At follow-up, the number of parents who rated their child’s eczema as severe dropped from 51% at baseline to 3%, a significant difference. The percentage of children with mild eczema increased from 3% initially to 57%, also a significant difference. Itching and scratching levels fell in 60% of children, and sleep improved in 65%. Overall, 80% of parents said their child’s eczema was less severe.
Meanwhile, 67% of parents said the EAP contributed to the improvements, and 86% said it clarified their child’s medication regimen. The number of parents saying they were comfortable managing their child’s eczema rose from 57% to 86%, a significant change.
Many parents said they gave copies of the EAP to day care providers or school nurses.
The approach "works really well for kids who have mild eczema - because they still need to have a green and yellow zone, and sometimes the red zone is the same - and [in] kids who have really severe skin who're going to have very different treatment methods in each zone," Ms. Rork said.
Although the utility of asthma action plans is widely supported in the literature, she noted, her study is the first to demonstrate utility for eczema.
Ms. Rork and her colleagues are considering an electronic version of the form that would allow clinicians to type instructions and print out the form for parents, in the same way that asthma action plans work in most offices. The researchers are also considering a similar approach to eczema for older patients. "We found it useful in kids. Maybe it can apply in adults, too," Ms. Rork said.
Ms. Rork said she has no disclosures.