Atopic dermatitis (AD) is a chronic inflammatory dermatosis presenting with inflamed and itchy skin. Recent studies have shown an inverse relationship between socioeconomic status and the severity of AD. Low socioeconomic status (LSES) individuals with AD face specific barriers that may impede management. These include forgoing doctor's appointments due to transportation costs, inability to take time off from work, and lack of affordable childcare services. Unaffordable medications and over-the-counter products for managing AD further present as significant challenges for LSES patients. This article aims to offer practical and affordable recommendations to help mitigate the challenges faced by LSES patients with AD and thereby alleviate disease burden and improve treatment outcomes.
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References
1.
AhnC, HuangW. Clinical presentation of atopic dermatitis. Adv Exp Med Biol, 2017; 1027:39–46.
2.
DaVeigaSP.Epidemiology of atopic dermatitis: a review. Allergy Asthma Proc, 2012; 33(3):227–234. Available at: https://www.ncbi.nlm.nih.gov/pubmed/22584191. Accessed January9, 2020.
3.
KolbL, Ferrer-BrukerS.Atopic dermatitis. StatPearls [Internet] 2019. Updated November 6, 2019. Available at: https://www.ncbi.nlm.nih.gov/books/NBK448071/. Accessed January9, 2020.
4.
WilliamsH, StewartA, von MutiusE, et al.Is eczema really on the increase worldwide?. J Allergy Clin Immunol, 2008; 121(4):947–54.e15.
5.
NunesBP, ThuméE, TomasiE, et al.Socioeconomic inequalities in the access to and quality of health care services. Rev Saude Publica, 2014; 48:968–976.
6.
AdlerNE, NewmanK. Socioeconomic disparities in health: pathways and policies. Health Aff, 2002; 21(2):60–76.
7.
SilverbergJI.Health care utilization, patient costs, and access to care in US adults with eczema: a population-based study. JAMA Dermatol, 2015; 151(7):743–752.
8.
HitchmanSC, FongGT, ZannaMP, et al.Socioeconomic status and smokers' number of smoking friends: findings from the International Tobacco Control (ITC) four country survey. Drug Alcohol Depend, 2014; 143:158–166.
9.
XuF, YanS, ZhengQ. Residential risk factors for atopic dermatitis in 3- to 6-year old children: a cross-sectional study in Shanghai, China. Int J Environ Res Public Health, 2016; 13(6). pii:537.
10.
PyunBY.Natural history and risk factors of atopic dermatitis in children. Allergy Asthma Immunol Res, 2015; 7(2):101–105.
11.
PerkinMR, CravenJ, LoganK, et al.Association between domestic water hardness, chlorine, and atopic dermatitis risk in early life: a population-based cross-sectional study. J Allergy Clin Immunol, 2016; 138(2):509–516.
12.
NorbäckD, LuC, ZhangY, et al.Sources of indoor particulate matter (PM) and outdoor air pollution in China in relation to asthma, wheeze, rhinitis and eczema among pre-school children: synergistic effects between antibiotics use and PM10 and second hand smoke. Environ Int, 2019; 125:252–260.
13.
SilverbergJI, SimpsonEL. Associations of childhood eczema severity: a US population-based study. Dermatitis, 2015; 25(3):107–114.
14.
ShawTE, CurrieGP, KoudelkaCW, et al.Eczema prevalence in the United States: data from the 2003 National Survey of Children's Health. J Invest Dermatol, 2011; 131(1):67–73.
15.
PavlisJ, YosipovitchG. Management of itch in atopic dermatitis. Am J Clin Dermatol, 2018; 19(3):319–332.
16.
WeinickRM, ByronSC, BiermanAS. Who can't pay for health care?. J Gen Intern Med, 2005; 20(6):504–509.
17.
LeonardT, HughesAE, PruittSL. Understanding how low-socioeconomic status households cope with health shocks: an analysis of multi-sector linked data. Ann Am Acad Pol Soc Sci, 2017; 669(1):125–145.
18.
ShiVY, FooladN, OrnelasJN, et al.Comparing the effect of bleach and water baths on skin barrier function in atopic dermatitis: a split-body randomized controlled trial. Br J Dermatol, 2016; 175(1):212–214.
19.
HongJ, BuddenkotteJ, BergerTG, et al.Management of itch in atopic dermatitis. Semin Cutan Med Surg, 2011; 30(2):71–86.
20.
LinTK, ZhongL, SantiagoJL. Anti-inflammatory and skin barrier repair effects of topical application of some plant oils. Int J Mol Sci, 2017; 19(1): pii:70.
21.
LeeKC, KeyesA, HensleyJR, et al.Effectiveness of acupressure on pruritus and lichenification associated with atopic dermatitis: a pilot trial. Acupunct Med, 2012; 30(1):8–11.
22.
ZinkAGS, ArentsB, Fink-WagnerA, et al.Out-of-pocket costs for individuals with atopic eczema: a cross-sectional study in nine European countries. Acta Derm Venereol, 2019; 99(3):263–267.
23.
NolanK, MarmurE. Moisturizers: reality and the skin benefits. Dermatol Ther, 2012; 25(3):229–233.
24.
XuS, ImmaneniS, HazenGB, et al.Cost-effectiveness of prophylactic moisturization for atopic dermatitis. JAMA Pediatr, 2017; 171(2):e163909.
25.
van ZuurenEJ, FedorowiczZ, ChristensenR, et al.Emollients and moisturisers for eczema. Cochrane Database Syst Rev, 2017; 2:CD012119.
26.
SimpsonEL, ChalmersJR, HanifinJM, et al.Emollient enhancement of the skin barrier from birth offers effective atopic dermatitis prevention. J Allergy Clin Immunol, 2014; 134(4):818–823.
27.
ThomasKS, BradshawLE, SachTH, et al.Randomised controlled trial of silk therapeutic garments for the management of atopic eczema in children: the CLOTHES trial. Health Technol Assess, 2017; 21(16):1–260.
28.
NicolNH, BoguniewiczM. Wet wrap therapy in moderate to severe atopic dermatitis. Immunol Allergy Clin North Am, 2017; 37(1):123–139.
DesaiC.Online pharmacies: a boon or bane?. Indian J Pharmacol, 2016; 48(6):615–616.
31.
CadmusSD, SebastianKR, WarrenD, et al.Efficacy and patient opinion of wet-wrap dressings using 0.1% triamcinolone acetonide ointment vs cream in the treatment of pediatric atopic dermatitis: a randomized split-body control study. Pediatr Dermatol, 2019; 36(4):437–441.
32.
LibermanJN, GirdishC. Recent trends in the dispensing of 90-day-supply prescriptions at retail pharmacies: implications for improved convenience and access. Am Health Drug Benefits, 2011; 4(2):95–100.
33.
Al-JazairiAS, BharethS, EqtefanIS, et al.Brand and generic medications: are they interchangeable?. Ann Saudi Med, 2008; 28(1):33–41.
34.
SyedST, GerberBS, SharpLK. Traveling towards disease: transportation barriers to health care access. J Community Health, 2013; 38(5):976–993.
35.
FowlerJF, DuhMS, RovbaL, et al.The direct and indirect cost burden of atopic dermatitis: an employer-payer perspective. Manag Care Interface, 2007; 20(10):26–32.
36.
von KobyletzkiLB, BornehagCG, HasselgrenM, et al.Eczema in early childhood is strongly associated with the development of asthma and rhinitis in a prospective cohort. BMC Dermatol, 2012; 12(1):11.
37.
CoxLS, CupertinoAP, TercyakKP. Interest in participating in smoking cessation treatment among Latino primary care patients. J Clin Psychol Med Settings, 2011; 18(4):392–399.
38.
KourisA, ArmyraK, ChristodoulouC, et al.Quality of life, anxiety, depression and obsessive-compulsive tendencies in patients with chronic hand eczema. Contact Dermatitis, 2015; 72(6):367–370.
39.
HodgkinsonS, GodoyL, BeersLS, et al.Improving mental health access for low-income children and families in the primary care setting. Pediatrics, 2017; 139(1):e2015–1175.
40.
WeberMB, Fontes Neto P deT, PratiC, et al.Improvement of pruritus and quality of life of children with atopic dermatitis and their families after joining support groups. J Eur Acad Dermatol Venereol, 2008; 22(8):992–997.
41.
LeeBW, DetzelPR. Treatment of childhood atopic dermatitis and economic burden of illness in Asia Pacific countries. Ann Nutr Metab, 2015; 66(1):18–24.
42.
AdamsonAS.The economics burden of atopic dermatitis. Adv Exp Med Biol, 2017; 1027:79–92.
43.
PowellK, Le RouxE, BanksJP, et al.Developing a written action plan for children with eczema: a qualitative study. Br J Gen Pract, 2018; 68(667):e81–e89.
44.
ShiVY, NandaS, LeeK, et al.Improving patient education with an eczema action plan: a randomized controlled trial. JAMA Dermatol, 2013; 149(4):481–483.
45.
NtuenE, TaylorSL, KinneyM, et al.Physicians' perceptions of an eczema action plan for atopic dermatitis. J Dermatolog Treat, 2010; 21(1):28–33.
46.
TairaDA.Improving the health and health care of non–English-speaking patients. J Gen Intern Med, 1999; 14(5):322–323.
47.
TocherTM, LarsonEB. Do physicians spend more time with non–English-speaking patients?. J Gen Intern Med, 1999; 14(5):303–309.
