We determined which educational and/or psychological interventions were most effective in atopic dermatitis (AD). A systematic review of published studies evaluated the effectiveness of educational and/or psychological interventions in MEDLINE, Embase, SCOPUS, LILACS, Cochrane, China National Knowledge Infrastructure, Taiwan Electronic Periodical Services, and CiNii. Two reviewers conducted title/abstract, full-text review, and data extraction. Twenty-four prospective studies were included, including 20 randomized controlled trials. Educational (4/7 studies) and combined educational and psychological (5/6 studies) interventions reduced AD severity; psychological (10/11 studies) interventions showed the greatest benefit. The most commonly studied psychological intervention was habit reversal training (8/11 studies), which was most frequently incorporated in studies that reduced AD severity (8/10 studies). The most commonly studied educational interventions were education on AD triggers (7/7 studies) and skin care (7/7 studies); they were incorporated in all studies that reduced AD severity. Different psychological and/or educational interventions successfully reduced AD severity, especially habit reversal training.
Get full access to this article
View all access options for this article.
References
1.
KarimkhaniC, DellavalleRP, CoffengLE, et al.Global skin disease morbidity and mortality: an update from the global burden of disease study 2013. JAMA Dermatol, 2017; 153(5):406–412.
2.
SilverbergJI, GelfandJM, MargolisDJ, et al.Health utility scores of atopic dermatitis in US adults. J Allergy Clin Immunol Pract, 2019; 7(4):1246–1252.e1.
3.
SilverbergJI, GelfandJM, MargolisDJ, et al.Patient burden and quality of life in atopic dermatitis in US adults: a population-based cross-sectional study. Ann Allergy Asthma Immunol, 2018; 121(3):340–347.
4.
VakhariaPP, ChopraR, SacotteR, et al.Burden of skin pain in atopic dermatitis. Ann Allergy Asthma Immunol, 2017; 119(6):548–552.e3 e543.
5.
HongMR, LeiD, YousafM, et al.A real-world study of the longitudinal course of skin pain in adult atopic dermatitis. J Am Acad Dermatol, 2021.
6.
FishbeinAB, VitaternaO, HaughIM, et al.Nocturnal eczema: review of sleep and circadian rhythms in children with atopic dermatitis and future research directions. J Allergy Clin Immunol, 2015; 136(5):1170–1177.
7.
YuSH, AttarianH, ZeeP, et al.Burden of sleep and fatigue in US adults with atopic dermatitis. Dermatitis, 2016; 27(2):50–58.
8.
LiJC, FishbeinA, SingamV, et al.Sleep disturbance and sleep-related impairment in adults with atopic dermatitis: a cross-sectional study. Dermatitis, 2018; 29(5):270–277.
9.
SilverbergJI, Chiesa-FuxenchZ, MargolisD, et al.Sleep disturbances in atopic dermatitis in US adults. Dermatitis, 2021.
10.
McKenzieC, SilverbergJI. Maternal depression and atopic dermatitis in American children and adolescents. Dermatitis, 2020; 31(1):75–80.
11.
SilverbergJI. Public health burden and epidemiology of atopic dermatitis. Dermatol Clin, 2017; 35(3):283–289.
12.
SilverbergJI, PallerAS. Association between eczema and stature in 9 US population-based studies. JAMA Dermatol, 2015; 151(4):401–409.
13.
YuSH, SilverbergJI. Association between atopic dermatitis and depression in US adults. J Invest Dermatol, 2015; 135(12):3183–3186.
14.
ChengBT, SilverbergJI. Depression and psychological distress in US adults with atopic dermatitis. Ann Allergy Asthma Immunol, 2019; 123(2):179–185.
15.
HsuDY, SmithB, SilverbergJI. Atopic dermatitis and hospitalization for mental health disorders in the United States. Dermatitis, 2019; 30(1):54–61.
16.
PatelKR, ImmaneniS, SingamV, et al.Association between atopic dermatitis, depression, and suicidal ideation: a systematic review and meta-analysis. J Am Acad Dermatol, 2019; 80(2):402–410.
17.
ChengBT, SilverbergJI. Association between atopic dermatitis and lower health utility scores in US adults. Ann Allergy Asthma Immunol, 2020; 124(1):88–89.
18.
BoguniewiczM, FonacierL, Guttman-YasskyE, et al.Atopic dermatitis yardstick: practical recommendations for an evolving therapeutic landscape. Ann Allergy Asthma Immunol, 2018; 120(1):10–22.e2.
19.
WollenbergA, Christen-ZächS, TaiebA, et al.ETFAD/EADV eczema task force 2020 position paper on diagnosis and treatment of atopic dermatitis in adults and children. J Eur Acad Dermatol Venereol, 2020; 34(12):2717–2744.
20.
SilverbergJI, LeeB, LeiD, et al.Measurement properties of patient health questionnaire 9 and patient health questionnaire 2 in adult patients with atopic dermatitis. Dermatitis, 2021; 32:225–231.
21.
ChinnDJ, PoynerT, SibleyG. Randomized controlled trial of a single dermatology nurse consultation in primary care on the quality of life of children with atopic eczema. Br J Dermatol, 2002; 146(3):432–439.
22.
ShawM, MorrellDS, GoldsmithLA. A study of targeted enhanced patient care for pediatric atopic dermatitis (STEP PAD). Pediatr Dermatol, 2008; 25(1):19–24.
23.
MooreEJ, WilliamsA, ManiasE, et al.Eczema workshops reduce severity of childhood atopic eczema. Australas J Dermatol, 2009; 50(2):100–106.
24.
EversAW, DullerP, de JongEM, et al.Effectiveness of a multidisciplinary itch-coping training programme in adults with atopic dermatitis. Acta Derm Venereol, 2009; 89(1):57–63.
25.
SchuttelaarML, VermeulenKM, DrukkerN, et al.A randomized controlled trial in children with eczema: nurse practitioner vs. dermatologist. Br J Dermatol, 2010; 162(1):162–170.
26.
FutamuraM, MasukoI, HayashiK, et al.Effects of a short-term parental education program on childhood atopic dermatitis: a randomized controlled trial. Pediatr Dermatol, 2013; 30(4):438–443.
27.
PustisekN, SitumM, Vurnek ZivkovicM, et al.The significance of structured parental educational intervention on childhood atopic dermatitis: a randomized controlled trial. J Eur Acad Dermatol Venereol, 2016; 30(5):806–812.
28.
SidburyR, DavisDM, CohenDE, et al.Guidelines of care for the management of atopic dermatitis: section 3. Management and treatment with phototherapy and systemic agents. J Am Acad Dermatol, 2014; 71(2):327–349.
29.
FrazierW, BhardwajN. Atopic dermatitis: diagnosis and treatment. Am Fam Physician, 2020; 101(10):590–598.
30.
WatsonDL, TharpRG, KrisbergJ. Case study in self-modification: suppression of inflammatory scratching while awake and asleep. J Behav Ther Exp Psychiatry, 1972; 3(3):213–215.
31.
RosenbaumMS, AyllonT. The behavioral treatment of neurodermatitis through habit-reversal. Behav Res Ther, 1981; 19(4):313–318.
32.
MelinL, FrederiksenT, NorenP, et al.Behavioural treatment of scratching in patients with atopic dermatitis. Br J Dermatol, 1986; 115(4):467–474.
33.
HorneDJ, WhiteAE, VarigosGA. A preliminary study of psychological therapy in the management of atopic eczema. Br J Med Psychol, 1989; 62(Pt 3):241–248.
34.
NorenP, MelinL. The effect of combined topical steroids and habit-reversal treatment in patients with atopic dermatitis. Br J Dermatol, 1989; 121(3):359–366.
35.
EhlersA, StangierU, GielerU. Treatment of atopic dermatitis: a comparison of psychological and dermatological approaches to relapse prevention. J Consult Clin Psychol, 1995; 63(4):624–635.
JaspersJPC, SpanL, MolierL, et al.A multimodal education and treatment program for young adults with atopic dermatitis: a randomized controlled trial. Dermatol Psychosomatics, 2000; 1(4):148–153.
38.
NorenP, HagstromerL, AlimohammadiM, et al.The positive effects of habit reversal treatment of scratching in children with atopic dermatitis: a randomized controlled study. Br J Dermatol, 2018; 178(3):665–673.
39.
ColeWC, RothHL, SachsLB. Group psychotherapy as an aid in the medical treatment of eczema. J Am Acad Dermatol, 1988; 18(2 Pt 1):286–291.
40.
HimleMB, WoodsDW, PiacentiniJC, et al.Brief review of habit reversal training for Tourette syndrome. J Child Neurol, 2006; 21(8):719–725.
41.
MoutonSG, StanleyMA. Habit reversal training for trichotillomania: a group approach. Cogn Behav Pract, 1996; 3(1):159–182.
42.
DeRubeisRJ, GelfandLA, TangTZ, et al.Medications versus cognitive behavior therapy for severely depressed outpatients: mega-analysis of four randomized comparisons. Am J Psychiatry, 1999; 156(7):1007–1013.
43.
MoritzS, FrickeS, TreszlA, et al.Do it yourself! Evaluation of self-help habit reversal training versus decoupling in pathological skin picking: a pilot study. J Obsessive Compuls Relat Disord, 2012; 1(1):41–47.
44.
HardenRN, OaklanderAL, BurtonAW, et al.Complex regional pain syndrome: practical diagnostic and treatment guidelines, 4th edition. Pain Med, 2013; 14(2):180–229.
45.
HollonSD, SheltonRC. Treatment guidelines for major depressive disorder. Behav Ther, 2001; 32(2):235–258.
46.
BandelowB, ZoharJ, HollanderE, et al.World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the pharmacological treatment of anxiety, obsessive-compulsive and post-traumatic stress disorders—first revision. World J Biol Psychiatry, 2008; 9(4):248–312.
47.
ChidaY, SteptoeA, HirakawaN, et al.The effects of psychological intervention on atopic dermatitis. A systematic review and meta-analysis. Int Arch Allergy Immunol, 2007; 144(1):1–9.
48.
ErsserSJ, LatterS, SibleyA, et al.Psychological and educational interventions for atopic eczema in children. Cochrane Database Syst Rev, 2007 (3):Cd004054.
49.
ZhaoM, LiangY, ShenC, et al.Patient education programs in pediatric atopic dermatitis: a systematic review of randomized controlled trials and meta-analysis. Dermatol Ther (Heidelb), 2020; 10(3):449–464.
50.
LiY, HanT, LiW, et al.Efficacy of health education on treatment of children with atopic dermatitis: a meta-analysis of randomized controlled trials. Arch Dermatol Res, 2020; 312(10):685–695.
51.
AyasseMT, AhmedA, EspinosaML, et al.What are the highest yielding search strategy terms for systematic reviews in atopic dermatitis? A systematic review. Arch Dermatol Res, 2021; 313:737–750.
52.
NankervisH, PynnEV, BoyleRJ, et al.House dust mite reduction and avoidance measures for treating eczema. Cochrane Database Syst Rev, 2015; 1:CD008426.
53.
GA. WellsBS, O'ConnellD, PetersonJ, et al.The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analysis. 2000. Available at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Accessed March 4, 2022.
54.
Huwiler-MüntenerK, JüniP, JunkerC, et al.Quality of reporting of randomized trials as a measure of methodologic quality. JAMA, 2002; 287(21):2801–2804.
55.
BrobergA, KalimoK, LindbladB, et al.Parental education in the treatment of childhood atopic eczema. Acta Derm Venereol, 1990; 70(6):495–499.
56.
StaabD, Von RuedenU, KehrtR, et al.Evaluation of a parental training program for the management of childhood atopic dermatitis. Pediatr Allergy Immunol, 2002; 13(2):84–90.
57.
StaabD, DiepgenTL, FartaschM, et al.Age related, structured educational programmes for the management of atopic dermatitis in children and adolescents: multicentre, randomised controlled trial. BMJ, 2006; 332(7547):933–938.
58.
GrilloM, GassnerL, MarshmanG, et al.Pediatric atopic eczema: the impact of an educational intervention. Pediatr Dermatol, 2006; 23(5):428–436.
59.
WeberMB, Fontes Neto PdeT, 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.
60.
LinnetJ, JemecGB. Anxiety level and severity of skin condition predicts outcome of psychotherapy in atopic dermatitis patients. Int J Dermatol, 2001; 40(10):632–636.
61.
SchutC, WeikU, TewsN, et al.Psychophysiological effects of stress management in patients with atopic dermatitis: a randomized controlled trial. Acta Derm Venereol, 2013; 93(1):57–61.
62.
BoyéT, BoraleviF, BuzenetC, et al.Education and atopic dermatitis. The Bordeaux University Hospital Pediatric Dermatology Unit experience. Ann Dermatol Venereol, 2003; 130(2 Pt 2):285–289.
63.
ChavignyJM, AdiceomF, BernierC, et al.Assessment of an educational program in an “Atopic School”: pilot study in 40 patients [in French]. Ann Dermatol Venereol, 2002; 129(8–9):1003–1007.
64.
DagregorioG, GuilletG. Educational seminars for adults with atopic dermatitis: preliminary report about 103 patients. Allergy, 2005; 60(4):540–541.
65.
KatayamaI, AiharaM, OhyaY, et al.Japanese guidelines for atopic dermatitis 2017. Allergol Int, 2017; 66(2):230–247.
66.
WollenbergA, BarbarotS, BieberT, et al.Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part II. J Eur Acad Dermatol Venereol, 2018; 32(6):850–878.
67.
KuhnH, MennellaC, MagidM, et al.Psychocutaneous disease: clinical perspectives. J Am Acad Dermatol, 2017; 76(5):779–791.
68.
TengEJ, WoodsDW, TwohigMP. Habit reversal as a treatment for chronic skin picking: a pilot investigation. Behav Modif, 2006; 30(4):411–422.
69.
BlochMH, Landeros-WeisenbergerA, DombrowskiP, et al.Systematic review: pharmacological and behavioral treatment for trichotillomania. Biol Psychiatry, 2007; 62(8):839–846.
70.
BridgettC. Habit reversal therapy: a behavioural approach to atopic eczema and other skin conditions. In: Bewley A, Taylor RE, Reichenberg JS, et al, eds. Practical Psychodermatology. Chichester: Wiley & Sons Ltd; 2014:66–71.
