Can Psychological and Educational Interventions Reduce Atopic Dermatitis Severity in Children?

Background: Atopic dermatitis (AD) is a multifactorial disease with physical and mental triggers that commonly affects children. While medications have been studied extensively in reducing AD severity, the effect of psychological (such as cognitive behavioral therapy or habit reversal training) and educational interventions has not been fully elucidated.

Methods: We performed a systematic review of all studies evaluating the clinical efficacy of psychological and educational interventions in AD. MEDLINE, EMBASE, SCOPUS, LILACS, Cochrane, China National Knowledge Infrastructure, Taiwan electronic periodical services and CiNii were searched. At least two authors independently performed title/abstract review and data extraction.

Results: 12 studies were included in the review. The endpoints measured in these studies included: SCORing AD (SCORAD; n=8), Infants’ Dermatitis Quality of Life (IDQOL; n=4), Children’s Dermatology Life Quality Index (CDLQI; n=5), or other measurements (n=2); all were prospective. For SCORAD, educational (n=5) intervention showed greater improvement of SCORAD than psychological (n=1) or combined psychological and educational (n=2) intervention. For IDQOL, only educational (n=4) intervention was available and did not show a statistically significant increase in IDQOL. For CDLQI, educational (n=4) intervention showed greater improvement in CDLQI than psychological (n=1) intervention. As for other measurements, psychological and educational (n=1) intervention showed improvement in extent and total severity of AD. In comparison, educational (n=1) intervention showed mixed findings for improvement in measurement of severity of atopic dermatitis.

Conclusion: Educational and psychological interventions each reduced AD severity with the greatest benefit being seen in combined interventions. Future, larger-scale, well-designed RCTs are needed to confirm these findings and determine the most effective type of non-medication intervention and duration.