Atopic Dermatitis Better Handled with Multidisciplinary Approach

A study presented at the 2021 ACAAI annual scientific meeting shows data demonstrating severe atopic dermatitis in pediatric patients is better controlled through multidisciplinary clinics.

An e-poster at the 2021 American College of Allergy, Asthma & Immunology annual scientific meeting, held November 4 to 8 in New Orleans, Louisiana, and virtual, tested the effectiveness of the Multidisciplinary Atopic Dermatitis Program (MADP) in difficult to control pediatric atopic dermatitis (AD).1 

“The MADP has taken an evidence-based approach in order to treat these patients involving coordination across specialties and the collaborative and integrative clinic environment,” the posters authors explained.

The clinic has equal involvement by both an allergist/immunologist and a dermatologist to help increase efficiency and provide better communication between the specialties. The MADP includes the following at every visit:

  • Concurrent team-based evaluation of patient
  • Case conferences
  • Creation of outcome metrics
  • Dissemination of results to influence policy and procedures

Also, every patient was seen and evaluated by an allergist, dermatologist, and clinical pharmacist at each visit with patient and provider reported outcomes measured at baseline and follow up visits. Eczema Area and Severity Index (EASI), Body Surface Area (BSA), validated Investigator Global Assessment (vIGA), Pruritus score, Patient Oriented Eczema Measure (POEM), and Children's Dermatology Life Quality Index (CDLQI) were all included in the outcomes and the study utilized the Eczema Association website.

A paired t-test was utilized to calculate the mean difference in provider and patient reported outcomes between visits, according to the poster. Out of 26 patients, it was found that 85% achieved EASI 50 within a year and 77% of patients achievied it within 6 months. Also, 58% of patients achieved an EASI 75 within a year with 53.85% achieving it within 6 months. 

EASI scores declined over each visit with a mean decrease of 13.09 at the second visit and the greatest mean decrease of 20.16 at the fourth. BSA also trended negatively with the mean decreases of 19.69% at visit 2, 34.43% at visit 3, and 38.30% at visit 4. The vIGA reached its greatest mean decrease of 1.82 by visit 4 with PEOM and CDLQI decreasing significantly up to visit 3. The only outcome that did not achieve clinical significance was pruritus.

“Coordination between specialties in a multidisciplinary setting has led to improved outcomes, quality of life adherence decision making, and satisfaction,” the authors concluded. “A more extended dataset will help elucidate longer term trends.”

Disclosures:

The authors listed no relevant disclosures.

Reference:

1. Loop. L, Geng, B. Tracy, A. Bhatti, S, et al. Achieving Disease Improvement in Severe And Difficult To Control Atopic Dermatitis Through A Multidisciplinary Approach. ePoster abstract presented at: 2021 American College of Allergy, Asthma & Immunology annual scientific meeting, November 4-8. Poster ID: P170.