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Therapeutic patient education is a new way to approach atopic dermatitis
(AD) resulting from poor adherence to treatment.
The aim of TPE, a multidisciplinary approach to caring for and managing AD, is to improve patient and caregiver adherence to physician-directed treatments through education and to improve quality of life, according to several presenters who spoke at a pediatric dermatology meeting sponsored by Rady Children’s Hospital–San Diego and University of California, San Diego. They reviewed the approach to using TPE in chronic disease states, demonstrating this state-of-the-art approach to educating patients, families, and health care providers about AD management, and allowing for the exchange of ideas for best practices on AD therapeutic education programs and use in the U.S. health care environment.
Other successful meetings on TPE in Europe, Asia, and South America inspired this meeting, the first in the United States aimed to train health care professionals in TPE principles for AD. The meeting was sponsored by the Fondation Dermatite Atopique (Atopic Dermatitis Foundation for Research and Education), Rady’s Eczema and Inflammatory Skin Disease Center, and UCSD.
TPE is defined by the World Health Organization as an approach to help patients with chronic illness acquire or maintain the skills necessary to manage their life and illness in the best way possible. TPE involves patient preferences, shared decision-making, organized activities, psychosocial support, hospital organization and procedures, and health- and disease-related behaviors.
Sébastien Barbarot, MD, of the departments of dermatology and pediatric dermatology, Nantes (France) University Hospital, said that there are four main components to the TPE process:
• Assessing and understanding the patient’s knowledge and values.
• Developing age-appropriate personalized educational objectives.
• Transferring the necessary skills to the patient or caregiver.
• Assessing the effectiveness of the educational program.
Lawrence Eichenfield, MD, chief of pediatric and adolescent dermatology at Rady Children’s Hospital–San Diego and professor of dermatology and pediatrics at UCSD, discussed how to conduct the initial visit with potential candidates for TPE. At the new patient visit, the pediatric patient and their caregivers should first be presented with the concept of TPE, which includes proposing a personalized education approach. Next, explain the goals and benefits of TPE (with a time and location for the sessions), provide educational materials, allow time for questions, and establish the patient’s consent to participate.
The certain skills that patients should acquire fall under three main categories: knowledge of the disease, practical skills, and relational skills.
Alain Golay, MD, professor and chief of the department of therapeutic education in chronic diseases at the Geneva University Hospital, said that patients and caregivers should be familiar with the pathophysiology and natural history of the disease, as well as with aggravating factors and the rationale behind elements of the treatment plan – and they should understand a reasonable timeline for treatment responses.
Learning how to properly apply the treatment is among the practical skills that the patient needs to acquire. In terms of relational skills, patients should know enough about their disease to be able to explain it to others. Educational methods can include interactive presentations, case studies, roundtable meetings, workshops, and role play. Other tools that can be used as a resource include written action plans, posters, informational videos, reminders, and booklets. Nurse-led educational sessions that increase teaching time is another modality. Multidisciplinary clinics should include an allergist, dermatologist, psychologist, dietitian, and nurse. These clinics also can form workshops or teaching groups. This allows for smaller groups where ideas can be exchanged, and can be targeted specifically based on the audiences’ needs, he said.
Dr. Barbarot outlined the fourth step of TPE, which involves assessment of effectiveness. Several outcome measures can be used, including clinical outcomes, quality of life, patient global assessment, and knowledge questionnaires.
(AD) resulting from poor adherence to treatment.
The aim of TPE, a multidisciplinary approach to caring for and managing AD, is to improve patient and caregiver adherence to physician-directed treatments through education and to improve quality of life, according to several presenters who spoke at a pediatric dermatology meeting sponsored by Rady Children’s Hospital–San Diego and University of California, San Diego. They reviewed the approach to using TPE in chronic disease states, demonstrating this state-of-the-art approach to educating patients, families, and health care providers about AD management, and allowing for the exchange of ideas for best practices on AD therapeutic education programs and use in the U.S. health care environment.
Other successful meetings on TPE in Europe, Asia, and South America inspired this meeting, the first in the United States aimed to train health care professionals in TPE principles for AD. The meeting was sponsored by the Fondation Dermatite Atopique (Atopic Dermatitis Foundation for Research and Education), Rady’s Eczema and Inflammatory Skin Disease Center, and UCSD.
TPE is defined by the World Health Organization as an approach to help patients with chronic illness acquire or maintain the skills necessary to manage their life and illness in the best way possible. TPE involves patient preferences, shared decision-making, organized activities, psychosocial support, hospital organization and procedures, and health- and disease-related behaviors.
Sébastien Barbarot, MD, of the departments of dermatology and pediatric dermatology, Nantes (France) University Hospital, said that there are four main components to the TPE process:
• Assessing and understanding the patient’s knowledge and values.
• Developing age-appropriate personalized educational objectives.
• Transferring the necessary skills to the patient or caregiver.
• Assessing the effectiveness of the educational program.
Lawrence Eichenfield, MD, chief of pediatric and adolescent dermatology at Rady Children’s Hospital–San Diego and professor of dermatology and pediatrics at UCSD, discussed how to conduct the initial visit with potential candidates for TPE. At the new patient visit, the pediatric patient and their caregivers should first be presented with the concept of TPE, which includes proposing a personalized education approach. Next, explain the goals and benefits of TPE (with a time and location for the sessions), provide educational materials, allow time for questions, and establish the patient’s consent to participate.
The certain skills that patients should acquire fall under three main categories: knowledge of the disease, practical skills, and relational skills.
Alain Golay, MD, professor and chief of the department of therapeutic education in chronic diseases at the Geneva University Hospital, said that patients and caregivers should be familiar with the pathophysiology and natural history of the disease, as well as with aggravating factors and the rationale behind elements of the treatment plan – and they should understand a reasonable timeline for treatment responses.
Learning how to properly apply the treatment is among the practical skills that the patient needs to acquire. In terms of relational skills, patients should know enough about their disease to be able to explain it to others. Educational methods can include interactive presentations, case studies, roundtable meetings, workshops, and role play. Other tools that can be used as a resource include written action plans, posters, informational videos, reminders, and booklets. Nurse-led educational sessions that increase teaching time is another modality. Multidisciplinary clinics should include an allergist, dermatologist, psychologist, dietitian, and nurse. These clinics also can form workshops or teaching groups. This allows for smaller groups where ideas can be exchanged, and can be targeted specifically based on the audiences’ needs, he said.
Dr. Barbarot outlined the fourth step of TPE, which involves assessment of effectiveness. Several outcome measures can be used, including clinical outcomes, quality of life, patient global assessment, and knowledge questionnaires.
(AD) resulting from poor adherence to treatment.
The aim of TPE, a multidisciplinary approach to caring for and managing AD, is to improve patient and caregiver adherence to physician-directed treatments through education and to improve quality of life, according to several presenters who spoke at a pediatric dermatology meeting sponsored by Rady Children’s Hospital–San Diego and University of California, San Diego. They reviewed the approach to using TPE in chronic disease states, demonstrating this state-of-the-art approach to educating patients, families, and health care providers about AD management, and allowing for the exchange of ideas for best practices on AD therapeutic education programs and use in the U.S. health care environment.
Other successful meetings on TPE in Europe, Asia, and South America inspired this meeting, the first in the United States aimed to train health care professionals in TPE principles for AD. The meeting was sponsored by the Fondation Dermatite Atopique (Atopic Dermatitis Foundation for Research and Education), Rady’s Eczema and Inflammatory Skin Disease Center, and UCSD.
TPE is defined by the World Health Organization as an approach to help patients with chronic illness acquire or maintain the skills necessary to manage their life and illness in the best way possible. TPE involves patient preferences, shared decision-making, organized activities, psychosocial support, hospital organization and procedures, and health- and disease-related behaviors.
Sébastien Barbarot, MD, of the departments of dermatology and pediatric dermatology, Nantes (France) University Hospital, said that there are four main components to the TPE process:
• Assessing and understanding the patient’s knowledge and values.
• Developing age-appropriate personalized educational objectives.
• Transferring the necessary skills to the patient or caregiver.
• Assessing the effectiveness of the educational program.
Lawrence Eichenfield, MD, chief of pediatric and adolescent dermatology at Rady Children’s Hospital–San Diego and professor of dermatology and pediatrics at UCSD, discussed how to conduct the initial visit with potential candidates for TPE. At the new patient visit, the pediatric patient and their caregivers should first be presented with the concept of TPE, which includes proposing a personalized education approach. Next, explain the goals and benefits of TPE (with a time and location for the sessions), provide educational materials, allow time for questions, and establish the patient’s consent to participate.
The certain skills that patients should acquire fall under three main categories: knowledge of the disease, practical skills, and relational skills.
Alain Golay, MD, professor and chief of the department of therapeutic education in chronic diseases at the Geneva University Hospital, said that patients and caregivers should be familiar with the pathophysiology and natural history of the disease, as well as with aggravating factors and the rationale behind elements of the treatment plan – and they should understand a reasonable timeline for treatment responses.
Learning how to properly apply the treatment is among the practical skills that the patient needs to acquire. In terms of relational skills, patients should know enough about their disease to be able to explain it to others. Educational methods can include interactive presentations, case studies, roundtable meetings, workshops, and role play. Other tools that can be used as a resource include written action plans, posters, informational videos, reminders, and booklets. Nurse-led educational sessions that increase teaching time is another modality. Multidisciplinary clinics should include an allergist, dermatologist, psychologist, dietitian, and nurse. These clinics also can form workshops or teaching groups. This allows for smaller groups where ideas can be exchanged, and can be targeted specifically based on the audiences’ needs, he said.
Dr. Barbarot outlined the fourth step of TPE, which involves assessment of effectiveness. Several outcome measures can be used, including clinical outcomes, quality of life, patient global assessment, and knowledge questionnaires.
Recognizing and treating pediatric bug infestations
Pruritic bug infestations are a common problem among school-age children, Albert C. Yan, MD, said at a pediatric dermatology meeting sponsored by Rady Children’s Hospital-San Diego and UC San Diego School of Medicine.
– and it is essential for you to be able to recognize and treat these appropriately. You also need to know resistance patterns, and how to counsel patient on full treatment protocol.
Carpet beetle dermatitis presents in children with a history of spending lots of time on a carpet, presenting with nondescript itchy patches on skin areas that were in contact with the carpet. Carpet beetle dermatitis is becoming more common on the east coast. Patients can actually find these beetles, which have tiger-striped coloring and have little prickly hairs that stick out of them, in their carpets. The beetles do not bite; rather, the rash is a reaction from exposure to insect blood or the larval hairs. The adult beetles tend to feed on carpet fabrics, wool, grains of food products, animal material, or nectar and pollen in flowers. The treatment is to get rid of the beetles. To rid the house of the beetles, it is recommended to vacuum, remove contaminated food sources, freeze stuffed animals for 10-14 days, and have an exterminator visit the home. Bringing in fresh cut flowers from the garden without rinsing them may bring the beetles into the house.
Scabies tends to be an itchy, widespread dermatosis. It is associated with extensive small skin papules scattered across the body with linear or curvilinear burrows, and tends to present from the elbows or knees distally, and especially in webbed areas, such as between the fingers. Keeping these geographic locations in mind makes it easier to differentiate scabies from hand dermatitis and eczema, said Dr. Yan, chief of pediatric dermatology at Children’s Hospital of Philadelphia and professor of pediatrics and dermatology at the University of Pennsylvania, Philadelphia.
To help diagnose this infestation, scrape the lesion and visualize the mite, the scybala or mite feces, or the oval eggs under the microscope.
The treatment is a “permethrin party.” Luckily, the scabies mite has very little documented resistance to permethrin 5% cream. However, with recurrent treatment, resistance starts to develop, he said. Proper administration is critical in controlling the infestation. For an adult, use 3 ounces or one tube, and for a child, use about 1.5 ounces for a child or one-half a tube. Apply it to the skin from neck down, leave it on for 8 hours overnight. Treat the patient and family members or close contacts. Repeat this application in 1 week. Oral ivermectin is effective and is useful in older kids who may not adhere to the permethrin.
A commonly encountered problem is apparent treatment failure. The scabies may be identified, treated, and then they appear to recur. Some patients have persistent postscabetic itch – the patients are still itchy afterward, but the lesions look excoriated and different than the original scabies lesions. The patient does not need retreatment, Dr. Yan emphasized. Rather, use topical corticosteroids or antihistamines to treat the itch.
Another explanation is improper use of medication – for instance, only certain parts of the skin were treated or all family members had not been treated. In this case, everyone needs to be retreated, he said. Reinfection is possible, but resistance is unlikely. Patients with scabies sometimes develop scabetic nodules or hypersensitivity nodules. Often, these are leftover areas of inflammation that can remain for up to 1 year. Dr. Yan recommends treating these areas with low-dose topical steroids.
The last phenomena presents with recurrent crops of pustules in the acral area, which is acropustulosis of infancy or postscabetic pustulosis. This is a variant of acropustulosis of infancy, in that it is more likely to involve the torso than is traditional acropustulosis and tends to be cyclical in that it reappears every few weeks.
Recently, the Journal of Medical Entomology published study findings in which head lice genetics were assessed, raising the concern about the development of “super lice.” However, this information has not yet brought treatment changes.
The conventional treatments include Nix, Rid, Triple X, but there can be a fair amount of resistance with these OTC treatment. Other options include mayonnaise and olive oil, however, not much data support the efficacy of this treatment. There are three prescription medications available: benzyl alcohol lotion, spinosad topical suspension, and ivermectin lotion. Start with these treatments quickly when dealing with lice that are resistant. Oral ivermectin also is effective. Dr. Yan concluded his lecture with discussion of other techniques that have been Food and Drug Administration–cleared, such as blowing drying them off the head, if one is okay with them landing in the office!
Dr. Yan reported no relevant financial disclosures.
Pruritic bug infestations are a common problem among school-age children, Albert C. Yan, MD, said at a pediatric dermatology meeting sponsored by Rady Children’s Hospital-San Diego and UC San Diego School of Medicine.
– and it is essential for you to be able to recognize and treat these appropriately. You also need to know resistance patterns, and how to counsel patient on full treatment protocol.
Carpet beetle dermatitis presents in children with a history of spending lots of time on a carpet, presenting with nondescript itchy patches on skin areas that were in contact with the carpet. Carpet beetle dermatitis is becoming more common on the east coast. Patients can actually find these beetles, which have tiger-striped coloring and have little prickly hairs that stick out of them, in their carpets. The beetles do not bite; rather, the rash is a reaction from exposure to insect blood or the larval hairs. The adult beetles tend to feed on carpet fabrics, wool, grains of food products, animal material, or nectar and pollen in flowers. The treatment is to get rid of the beetles. To rid the house of the beetles, it is recommended to vacuum, remove contaminated food sources, freeze stuffed animals for 10-14 days, and have an exterminator visit the home. Bringing in fresh cut flowers from the garden without rinsing them may bring the beetles into the house.
Scabies tends to be an itchy, widespread dermatosis. It is associated with extensive small skin papules scattered across the body with linear or curvilinear burrows, and tends to present from the elbows or knees distally, and especially in webbed areas, such as between the fingers. Keeping these geographic locations in mind makes it easier to differentiate scabies from hand dermatitis and eczema, said Dr. Yan, chief of pediatric dermatology at Children’s Hospital of Philadelphia and professor of pediatrics and dermatology at the University of Pennsylvania, Philadelphia.
To help diagnose this infestation, scrape the lesion and visualize the mite, the scybala or mite feces, or the oval eggs under the microscope.
The treatment is a “permethrin party.” Luckily, the scabies mite has very little documented resistance to permethrin 5% cream. However, with recurrent treatment, resistance starts to develop, he said. Proper administration is critical in controlling the infestation. For an adult, use 3 ounces or one tube, and for a child, use about 1.5 ounces for a child or one-half a tube. Apply it to the skin from neck down, leave it on for 8 hours overnight. Treat the patient and family members or close contacts. Repeat this application in 1 week. Oral ivermectin is effective and is useful in older kids who may not adhere to the permethrin.
A commonly encountered problem is apparent treatment failure. The scabies may be identified, treated, and then they appear to recur. Some patients have persistent postscabetic itch – the patients are still itchy afterward, but the lesions look excoriated and different than the original scabies lesions. The patient does not need retreatment, Dr. Yan emphasized. Rather, use topical corticosteroids or antihistamines to treat the itch.
Another explanation is improper use of medication – for instance, only certain parts of the skin were treated or all family members had not been treated. In this case, everyone needs to be retreated, he said. Reinfection is possible, but resistance is unlikely. Patients with scabies sometimes develop scabetic nodules or hypersensitivity nodules. Often, these are leftover areas of inflammation that can remain for up to 1 year. Dr. Yan recommends treating these areas with low-dose topical steroids.
The last phenomena presents with recurrent crops of pustules in the acral area, which is acropustulosis of infancy or postscabetic pustulosis. This is a variant of acropustulosis of infancy, in that it is more likely to involve the torso than is traditional acropustulosis and tends to be cyclical in that it reappears every few weeks.
Recently, the Journal of Medical Entomology published study findings in which head lice genetics were assessed, raising the concern about the development of “super lice.” However, this information has not yet brought treatment changes.
The conventional treatments include Nix, Rid, Triple X, but there can be a fair amount of resistance with these OTC treatment. Other options include mayonnaise and olive oil, however, not much data support the efficacy of this treatment. There are three prescription medications available: benzyl alcohol lotion, spinosad topical suspension, and ivermectin lotion. Start with these treatments quickly when dealing with lice that are resistant. Oral ivermectin also is effective. Dr. Yan concluded his lecture with discussion of other techniques that have been Food and Drug Administration–cleared, such as blowing drying them off the head, if one is okay with them landing in the office!
Dr. Yan reported no relevant financial disclosures.
Pruritic bug infestations are a common problem among school-age children, Albert C. Yan, MD, said at a pediatric dermatology meeting sponsored by Rady Children’s Hospital-San Diego and UC San Diego School of Medicine.
– and it is essential for you to be able to recognize and treat these appropriately. You also need to know resistance patterns, and how to counsel patient on full treatment protocol.
Carpet beetle dermatitis presents in children with a history of spending lots of time on a carpet, presenting with nondescript itchy patches on skin areas that were in contact with the carpet. Carpet beetle dermatitis is becoming more common on the east coast. Patients can actually find these beetles, which have tiger-striped coloring and have little prickly hairs that stick out of them, in their carpets. The beetles do not bite; rather, the rash is a reaction from exposure to insect blood or the larval hairs. The adult beetles tend to feed on carpet fabrics, wool, grains of food products, animal material, or nectar and pollen in flowers. The treatment is to get rid of the beetles. To rid the house of the beetles, it is recommended to vacuum, remove contaminated food sources, freeze stuffed animals for 10-14 days, and have an exterminator visit the home. Bringing in fresh cut flowers from the garden without rinsing them may bring the beetles into the house.
Scabies tends to be an itchy, widespread dermatosis. It is associated with extensive small skin papules scattered across the body with linear or curvilinear burrows, and tends to present from the elbows or knees distally, and especially in webbed areas, such as between the fingers. Keeping these geographic locations in mind makes it easier to differentiate scabies from hand dermatitis and eczema, said Dr. Yan, chief of pediatric dermatology at Children’s Hospital of Philadelphia and professor of pediatrics and dermatology at the University of Pennsylvania, Philadelphia.
To help diagnose this infestation, scrape the lesion and visualize the mite, the scybala or mite feces, or the oval eggs under the microscope.
The treatment is a “permethrin party.” Luckily, the scabies mite has very little documented resistance to permethrin 5% cream. However, with recurrent treatment, resistance starts to develop, he said. Proper administration is critical in controlling the infestation. For an adult, use 3 ounces or one tube, and for a child, use about 1.5 ounces for a child or one-half a tube. Apply it to the skin from neck down, leave it on for 8 hours overnight. Treat the patient and family members or close contacts. Repeat this application in 1 week. Oral ivermectin is effective and is useful in older kids who may not adhere to the permethrin.
A commonly encountered problem is apparent treatment failure. The scabies may be identified, treated, and then they appear to recur. Some patients have persistent postscabetic itch – the patients are still itchy afterward, but the lesions look excoriated and different than the original scabies lesions. The patient does not need retreatment, Dr. Yan emphasized. Rather, use topical corticosteroids or antihistamines to treat the itch.
Another explanation is improper use of medication – for instance, only certain parts of the skin were treated or all family members had not been treated. In this case, everyone needs to be retreated, he said. Reinfection is possible, but resistance is unlikely. Patients with scabies sometimes develop scabetic nodules or hypersensitivity nodules. Often, these are leftover areas of inflammation that can remain for up to 1 year. Dr. Yan recommends treating these areas with low-dose topical steroids.
The last phenomena presents with recurrent crops of pustules in the acral area, which is acropustulosis of infancy or postscabetic pustulosis. This is a variant of acropustulosis of infancy, in that it is more likely to involve the torso than is traditional acropustulosis and tends to be cyclical in that it reappears every few weeks.
Recently, the Journal of Medical Entomology published study findings in which head lice genetics were assessed, raising the concern about the development of “super lice.” However, this information has not yet brought treatment changes.
The conventional treatments include Nix, Rid, Triple X, but there can be a fair amount of resistance with these OTC treatment. Other options include mayonnaise and olive oil, however, not much data support the efficacy of this treatment. There are three prescription medications available: benzyl alcohol lotion, spinosad topical suspension, and ivermectin lotion. Start with these treatments quickly when dealing with lice that are resistant. Oral ivermectin also is effective. Dr. Yan concluded his lecture with discussion of other techniques that have been Food and Drug Administration–cleared, such as blowing drying them off the head, if one is okay with them landing in the office!
Dr. Yan reported no relevant financial disclosures.