Smartphone-Based Education Reduces Short-Term Relapse in Pediatric Atopic Dermatitis

Atopic dermatitis (AD) affects up to 20% of children worldwide and places a substantial burden on families and health systems.¹ Digital health tools offer a potential solution to increasing eczema education, but high-quality evidence supporting their use in pediatric patients has been limited. To help address this, a recent trial evaluated whether a smartphone-based educational program could reduce relapse in children aged 0 to 6 years with moderate to severe AD.²

Methods and Materials

This multicenter, parallel-group, randomized controlled trial was conducted across 12 tertiary pediatric dermatology centers in China. A total of 615 children with moderate to severe disease (SCORAD ≥25, Investigator’s Global Assessment [IGA] ≥3) were randomized 1:1 to receive either a structured smartphone-based digital education program plus standard care or standard care alone. All participants first underwent a 2-week guideline-based acute treatment phase with topical anti-inflammatory therapy and emollients, followed by a maintenance phase using age-appropriate topical corticosteroids or tacrolimus and regular emollient use.

The digital intervention was delivered through a WeChat-based platform (“Skin Care E-Station”) and designed specifically for caregivers of young children. It consisted of a dynamic electronic action plan tailored to the child’s age and disease phase, delivered 3 times weekly for 12 weeks. It also included 54 structured multimedia modules covering AD pathophysiology, daily care routines, trigger avoidance, treatment use, lifestyle modification, and psychosocial support. Content was delivered in short, accessible formats including illustrated text, videos, and animated stories. The platform also provided rapid-access clinician support during flares. The control group received conventional outpatient counseling during clinic visits without access to the educational content.

The primary outcome was relapse at 12 weeks after completion of the acute treatment phase, defined as an increase of ≥10 points in SCORAD (SCORing Atopic Dermatitis). Secondary outcomes included changes in disease severity via SCORAD, Peak Pruritus Numerical Rating Scale, and Patient-Oriented Eczema Measure, and quality of life via Children’s Dermatology Life Quality Index/Infant’s Dermatitis Quality of Life Index and Dermatitis Family Impact. Assessments were conducted at 4, 8, 12, 24, 36, and 52 weeks.

Results

At 12 weeks, relapse occurred significantly less often in the digital education group than in controls (16.6% vs 24.0%; relative risk 0.69; 95% CI, 0.50–0.96; p = 0.02). Kaplan–Meier analysis over the first 100 days confirmed superior relapse-free survival in the intervention arm (hazard ratio 0.69; p = 0.03), an effect that remained significant after adjustment for age and sex. However, differences in relapse rates at later time points up to 52 weeks were not statistically significant. Similarly, no significant between-group differences were observed in longitudinal changes in disease severity or quality-of-life scores.

Engagement with the digital platform was high as 58% of caregivers maintained regular weekly use, and more than one-quarter accessed rapid clinician consultation during flares. Attrition at 12 weeks was lower in the digital group than in controls, suggesting improved retention with the intervention. The benefit of this program is likely mediated by improved caregiver recognition of early disease worsening and more timely intervention, rather than by modification of the underlying inflammatory course.

Future Directions

Compared with traditional educational models, smartphone-based platforms can deliver frequent, personalized reinforcement without substantial demands on clinic resources. However, as the authors noted, the findings “highlight a common challenge: achieving long-term disease modulation with brief interventions is difficult.” Sustained engagement strategies would be needed.

The trial itself did have some limitations, including the reliance on smartphone access, which may limit generalizability to digitally underserved populations, and substantial long-term attrition. Caregiver understanding of content was not directly assessed, and unmeasured socioeconomic factors may have influenced engagement. The researchers emphasize that these 5 actions should be prioritized in future literature:

• Developing hybrid models that integrate digital education with targeted in-person support to enhance emotional connection and engagement
• Designing strategies for sustained engagement, such as “booster” modules and adaptive content
• Ensuring digital accessibility for underserved populations to address health equity
• Conducting rigorous economic evaluations
• Conducting head-to-head comparisons of different digital features and mechanistic studies to identify the active ingredients of digital education

References

1. Nutten S. Atopic dermatitis: global epidemiology and risk factors. Ann Nutr Metab. 2015;66 Suppl 1:8-16. doi:10.1159/000370220

2. Yang H, Shu H, Wang LH, et al. Smartphone-Based Digital Eczema Education Program for Atopic Dermatitis in Children Aged 0 to 6 Years: Multicenter, Randomized, Parallel Controlled Clinical Study. J Med Internet Res. 2026;28:e79559. Published 2026 Jan 7. doi:10.2196/79559