Successful Strategies in Atopic Dermatitis Management
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OFFICIAL JOURNAL OF THE DERMATOLOGY NURSES' ASSOCIATION October 2008 SUPPLEMENT Successful Strategies In Atopic Dermatitis Management Publication of this Supplement is made possible through an educational grant from Earn 1.5 Contact Hours and 75 Minutes Of Pharmacology Hours — Free! www.dermatologynursing.net A supplement to Dermatology Nursing OFFICIAL JOURNAL OF THE DERMATOLOGY NURSES' ASSOCIATION Supplement ® October 2008 Successful Strategies in Atopic Dermatitis Management Publication of this Supplement is made possible through an educational grant from SUPPLEMENT Successful Strategies in Atopic Dermatitis Management . 3 Noreen Heer Nicol and Mark Boguniewicz CNE Answer/Evaluation Form. 19 Earn 1.5 Contact Hours and 75 Minutes of Pharmacology Hours — Free! Disclosures Noreen Heer Nicol, MS, RN, FNP, disclosed that she is a consultant and on the presenters’ bureau for Unilever and OrthoNeutrogena. 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DERMATOLOGY NURSING Successful Strategies in Atopic Dermatitis Management Noreen Heer Nicol Mark Boguniewicz Successful strategies for OBJECTIVES managing atopic dermatitis Objectives This continuing nursing educational (CNE) activity is designed for nurs- require an accurate diagnosis, es and other health care providers who care for and educate patients and identification and elimination their families regarding atopic dermatitis. For those wishing to obtain CNE credit, an evaluation follows. After studying the information presented in this of exacerbating factors including article, the nurse will be able to: irritants and allergens, adequate 1. Heighten his/her awareness of the prevalence of atopic dermatitis, its impact on quality of life, and association with asthma and allergies. hydration of the skin, control of 2. Examine a multi-faceted approach to management of patients with pruritus and infections, and atopic dermatitis including non-pharmacologic and pharmacologic appropriate use of topical anti- interventions. 3. Summarize common interventions including hydration, moisturiz- inflammatory and other ers, and pharmaceutical agents. medications. Proper patient 4. Discuss appropriate safety issues related to topical and systemic ther- education increases the chances apies. of successful therapy. s the Dermatology Nursing jour- given them confusing information or nal celebrates its 20th anniver- conflicting treatment plans. Frus- sary, the authors of this review trated, they come to the next evalua- Acelebrate working together for tion hoping not only for consistency 20 years caring for patients with atopic and answers, but also a cure. If a dermatitis (AD). Over the past 2 patient has had AD for months or decades, a great deal of progress has years, it is important that he/she Noreen Heer Nicol, MS, RN, FNP, is a been made in the understanding of understands that current treatment is Dermatology Nurse Practitioner, National Jewish Health, and Clinical Senior Instructor, AD. Atopic dermatitis remains the focused on levels of control, not a University of Colorado School of Nursing, most common chronic, relapsing skin cure. Learning about the chronic Denver, CO. disorder of infants and children, but relapsing nature of atopic dermatitis, can affect patients of any age. The exacerbating factors, and appropriate Mark Boguniewicz, MD, is a Professor, prevalence of AD has increased glob- treatment options is important for Pediatric Allergy and Immunology, National Jewish Health, University of Colorado School of ally and more than half of these both patients and family members Medicine, Denver, CO. patients go on to develop asthma and (Nicol & Boguniewicz, 1999). The allergies (Kapoor et al., 2008). Atopic purpose of this article is to review a Acknowledgments: The authors thank dermatitis places a significant eco- treatment model developed and uti- Barry Silverstein for taking photos of patients nomic burden on the patient, family, lized by the Atopic Dermatitis and techniques in the Atopic Dermatitis Program at National Jewish for the past 2 and society (Boguniewicz et al., 2007). Program (ADP) at National Jewish decades. They also thank the many nurses and Successful strategies, particularly in Health in Denver, Colorado for more staff working with patients experiencing atopic those patients with moderate-to- than 20 years. dermatitis for their caring, dedication, and severe disease, have been dependent teaching atopic dermatitis class every week. on the commitment and expertise of Epidemiology: Too Much Hygiene? Additionally, they thank Gabriele Cheathan for the multidisciplinary approach led by The prevalence of atopic dermati- her assistance with manuscript preparation. physicians and nurses (Boguniewicz, tis has increased more than three-fold Nicol, Kelsay, & Leung, 2008; Nicol, since the 1960s (Schultz-Larsen & 1990) (see Figures 1a, 1b, 1c, & 1d). This article and the CNE answer/ Hanifin, 2002). Atopic dermatitis is a evaluation form are also available The patient and family with chronic global public health problem, with online at AD have usually seen multiple health prevalence up to 20% in children and www.dermatologynursing.net care providers who at times have approximately 3% of adults in the Complimentary CNE for this Supplement is available on page 19 and at www.dermatologynursing.net DERMATOLOGY NURSING/October 2008/Supplement 3 DERMATOLOGY NURSING Figures 1a & 1b. Figures 1c & 1d. Adolescent male with severe atopic dermatitis on Same patient as in Figures 1a & 1b after 1 week in admission to ADP. ADP using wet-wrap therapy. United States and other industrialized allergic diseases, often prior to age 3 hypothesis” suggests that allergic dis- countries (Williams et al., 1999). There (Kapoor et al., 2008). Since wide vari- eases (“T helper-2-type”) might result is also a female preponderance for ations in prevalence have been from a lack of infections in early child- AD, with an overall female/male ratio observed within countries inhabited hood (Leung, Boguniewicz, Howell, of 1.3:1. There is evidence that atopy by similar ethnic groups, environmen- Nomura, & Hamid, 2004). More comes before the appearance of AD tal factors seem to play a key role in recently, this theory has been modi- and that the skin disorder often pre- determining disease expression. Some fied to account for the concomitant cedes the development of other atopic of the potential risk factors that have increase in autoimmune (“T helper-1- diseases including asthma and allergic been associated with the rise in AD type”) diseases, and abnormalities in rhinitis, known as the “atopic march” include small family size, increased regulatory T cells (Chatila, 2005). (Boguniewicz, Eichenfield, & Hultsch, income and education, migration Although the outcome of AD 2003; Nicol, 2005a). Epidemiologic from rural to urban environments, may be difficult to predict in any studies indicate that more than 50%