Download - New Developments in Atopic Dermatitis · New Developments in Atopic Dermatitis Education in Adults 2nd Int.Workshops of Therapeutic Education on Atopic Dermatitis Fondation pour la

Transcript
Page 1: New Developments in Atopic Dermatitis · New Developments in Atopic Dermatitis Education in Adults 2nd Int.Workshops of Therapeutic Education on Atopic Dermatitis Fondation pour la
Page 2: New Developments in Atopic Dermatitis · New Developments in Atopic Dermatitis Education in Adults 2nd Int.Workshops of Therapeutic Education on Atopic Dermatitis Fondation pour la

Prof. Dr. Uwe GielerDr. Isabel Fell

PD Dr. Dipl.-Psych. Jörg KupferPsychodermatology

Dept. of Psychosomatic and Psychotherapy

Justus-Liebig-Universität Gießen - Germany

New Developments in Atopic DermatitisEducation in Adults

2nd Int.Workshops of Therapeutic Education on Atopic D ermatitis

Fondation pour la Dermatite Atopique – Rom 2011

Uwe Gieler - JLU Giessen

Basic Theory of Atopic Dermatitis Education

Long-Term-Follow-up of AD Education

New Developments:

Integration of Avene Massage

Adult Groups

Train-the-Trainer

Workshops

Page 3: New Developments in Atopic Dermatitis · New Developments in Atopic Dermatitis Education in Adults 2nd Int.Workshops of Therapeutic Education on Atopic Dermatitis Fondation pour la

Psychoeducation in Dermatology

…EducationProgrammes

In Dermatology

•…Atopic Dermatitis School

•…Occupationalinduced eczemaschool

•…Skleroderma-School

• …Psoriasis-Education

•…AGATE –Anaphylaxis School

•??…

Uwe Gieler - JLU Giessen

2nd Int.Workshops of Therapeutic Education on Atopic D ermatitis

Fondation pour la Dermatite Atopique – Rom 2011

Page 4: New Developments in Atopic Dermatitis · New Developments in Atopic Dermatitis Education in Adults 2nd Int.Workshops of Therapeutic Education on Atopic Dermatitis Fondation pour la

Atopic Dermatitis Education Programs in the World

2008 ISAD Atopic Dermatitis EducationPrograms Pre-Congress-Meeting

Uwe Gieler - JLU Giessen

2nd Int.Workshops of Therapeutic Education on Atopic D ermatitis

Fondation pour la Dermatite Atopique – Rom 2011

Page 5: New Developments in Atopic Dermatitis · New Developments in Atopic Dermatitis Education in Adults 2nd Int.Workshops of Therapeutic Education on Atopic Dermatitis Fondation pour la

Uwe Gieler - JLU Giessen

2nd Int.Workshops of Therapeutic Education on Atopic D ermatitis

Fondation pour la Dermatite Atopique – Rom 2011

Basic Theory of Atopic Dermatitis Education

Long-Term-Follow-up of AD Education

New Developments:

Integration of Avene Massage

Adult Groups

Train-the-Trainer

Workshops

Page 6: New Developments in Atopic Dermatitis · New Developments in Atopic Dermatitis Education in Adults 2nd Int.Workshops of Therapeutic Education on Atopic Dermatitis Fondation pour la

Genetics

Environment Psyche

Filaggrin-Hypothesis

Extrinsic-Intrinsic

IgE-Level

Dry Skin

Allergens / Toxicity / Climate / Social / Employment

Coping

Life-Events

Sense of Coherence

Support by family

Conflicts

Self-Esteem

Uwe Gieler - JLU Giessen

2nd Int.Workshops of Therapeutic Education on Atopic D ermatitis

Fondation pour la Dermatite Atopique – Rom 2011

Page 7: New Developments in Atopic Dermatitis · New Developments in Atopic Dermatitis Education in Adults 2nd Int.Workshops of Therapeutic Education on Atopic Dermatitis Fondation pour la

Uwe Gieler - JLU Giessen

Psychosomatic Aspects of atopic dermatitis –what is known?

• No aspects of really psychogenetic causesexcept single cases!

• More depression and anxiety as copingbehaviour of atopic dermatitis

• Severily impaired life quality and suicidalideations

• Disstress factors as risc factors – neurogenicinflammation

• Coping behaviour negatively influenced

• Negative communication with parents, partnersand doctors

• Additional psychotherapy approach and schoolprograms are effective

2nd Int.Workshops of Therapeutic Education on Atopic D ermatitis

Fondation pour la Dermatite Atopique – Rom 2011

Basic Theory of Atopic Dermatitis Education

Long-Term-Follow-up of AD Education

New Developments:

Integration of Avene Massage

Adult Groups

Train-the-Trainer

Workshops

Page 8: New Developments in Atopic Dermatitis · New Developments in Atopic Dermatitis Education in Adults 2nd Int.Workshops of Therapeutic Education on Atopic Dermatitis Fondation pour la

75%of patients felt effective control of AD would be s ingle most important improvement in quality of life

67 nights average disturbed sleep per year during flares

86%of patients avoided at least one type of everyday activity during flare (e.g. bathing, wearing skirts /shorts)

> 50%of patients ‘always’ or ‘sometimes’ worried about next flare

39%of children aged 8–17 years had experienced bullyin g because of AD

International Study Of Life with Atopic Eczema (ISOLAT E)

• First large-scale study to assess effect of atopic dermatitis (AD) on lives of patients and on society

• 2,200 patients (aged > 13 years) and caregivers of children withmoderate to severe AD from eight countries

Zuberbier T, et al. J Allergy Clin Immunol 2006; 118:226–232.

Uwe Gieler - JLU Giessen

2nd Int.Workshops of Therapeutic Education on Atopic D ermatitis

Fondation pour la Dermatite Atopique – Rom 2011

Page 9: New Developments in Atopic Dermatitis · New Developments in Atopic Dermatitis Education in Adults 2nd Int.Workshops of Therapeutic Education on Atopic Dermatitis Fondation pour la

Uwe Gieler - JLU Giessen

Atopic Dermatitis School Programm in Germany (AGNES and ADP)

Payed by Insurance Companies (mostly)

0 – 7 yearsParents

18 yearsAdults

8 – 12 yearsChildren +

Parents13 – 18 yearsYouth only

2nd Int.Workshops of Therapeutic Education on Atopic D ermatitis

Fondation pour la Dermatite Atopique – Rom 2011

Page 10: New Developments in Atopic Dermatitis · New Developments in Atopic Dermatitis Education in Adults 2nd Int.Workshops of Therapeutic Education on Atopic Dermatitis Fondation pour la

BASELINE

Basic Therapy

MILD: SCORAD ≤15 /Atopic dermatitis withflare ups

MODERATE: SCORAD 15-40 /Recurrent atopic dermatitis

Severe:

SCORAD >40 /

Chronic eczema

Atopic Dermatitis Management Guidelines (Germany: DDG + DGKJ)

• in every stage: additional therapy options possible

• additional antiseptics / antibiotics in case of superinfections

• If therapy fails ask yourself about

compliance and adherence

Inpatient treatment, systemictherapy with Corticosteroids, CYA, PUVA, MTX, Azathioprin, Mycophenolate Mofetil

TCS and TCI, sedativeantihistaminics (doxepin, hydroxyzine), UV therapy (UVB 311 nm, UVA1),Psychosomatic Counselling, Climate Therapy

Topical emollients with specificdrugs, antiseptics, clothes (silver?)

(sedative and non-sedativeantihistaminics)

Education Programme, emollients, oil baths, elimination diet if clearfood allergy present, avoidprovocating factors

Uwe Gieler - JLU Giessen

Werfel et al: German Guidelines of Atopic Dermatitis – S2 – JDDG 2010

2nd Int.Workshops of Therapeutic Education on Atopic D ermatitis

Fondation pour la Dermatite Atopique – Rom 2011

Page 11: New Developments in Atopic Dermatitis · New Developments in Atopic Dermatitis Education in Adults 2nd Int.Workshops of Therapeutic Education on Atopic Dermatitis Fondation pour la

Step 1: Complete emollient therapy+ Education

Step 2: Identification and avoidance of allergens/triggers+ Education

Step 3: Treatment of flares with TCS/TCI+ Education

Step 4: Prevention of flares with tacrolimus ointment (or fluticasone propionate twice weekly for up to 16 weeks)*

New paradigm: Four steps of atopic dermatitis prevention and treatment

TCS = topical corticosteroid; TCI = topical calcine urin inhibitor* This may vary according to the local product lice nce Adapted with kind permission of Professor Michael Cork, S heffield

+ Education

Uwe Gieler - JLU Giessen

2nd Int.Workshops of Therapeutic Education on Atopic D ermatitis

Fondation pour la Dermatite Atopique – Rom 2011

Page 12: New Developments in Atopic Dermatitis · New Developments in Atopic Dermatitis Education in Adults 2nd Int.Workshops of Therapeutic Education on Atopic Dermatitis Fondation pour la

Uwe Gieler - JLU Giessen

Itch-Scratch - circle

More tension

Increase itch

More Scratch

helples Avoidance

Scratching

Adult Atopic Dermatitis School

2nd Int.Workshops of Therapeutic Education on Atopic D ermatitis

Fondation pour la Dermatite Atopique – Rom 2011

Basic Theory of Atopic Dermatitis Education

Long-Term-Follow-up of AD Education

New Developments:

Integration of Avene Massage

Adult Groups

Train-the-Trainer

Workshops

Page 13: New Developments in Atopic Dermatitis · New Developments in Atopic Dermatitis Education in Adults 2nd Int.Workshops of Therapeutic Education on Atopic Dermatitis Fondation pour la

Participation centers in Germany (09/2009)University Clinics:Berlin/Charité, Dresden, Erlangen, Hamburg (UKE), Giessen, Hannover, Heidelberg, Kiel, Leipzig,MainzMarburgMünchen (LMU und TU), MünsterTübingen

Other Centers:AlzenauElbekliniken BuxtehudeDermatologikum HamburgDarmstadtBad Soden, Mainz

2nd Int.Workshops of Therapeutic Education on Atopic D ermatitis

Fondation pour la Dermatite Atopique – Rom 2011

Basic Theory of Atopic Dermatitis Education

Long-Term-Follow-up of AD Education

New Developments:

Integration of Avene Massage

Adult Groups

Train-the-Trainer

Workshops

Page 14: New Developments in Atopic Dermatitis · New Developments in Atopic Dermatitis Education in Adults 2nd Int.Workshops of Therapeutic Education on Atopic Dermatitis Fondation pour la

Main goal criteria:• Coping strategies with the

disease (CSQ = CopingSkin Questionnaire; Stangier et al)

• Skindex-29 (Chren et al)• Itch Catastrophizing scale

(Itch CognitionQuestionnaire – JKF; Kupfer et al)

2nd Int.Workshops of Therapeutic Education on Atopic D ermatitis

Fondation pour la Dermatite Atopique – Rom 2011

Basic Theory of Atopic Dermatitis Education

Long-Term-Follow-up of AD Education

New Developments:

Integration of Avene Massage

Adult Groups

Train-the-Trainer

Workshops

Page 15: New Developments in Atopic Dermatitis · New Developments in Atopic Dermatitis Education in Adults 2nd Int.Workshops of Therapeutic Education on Atopic Dermatitis Fondation pour la

Neurodermitis-Schulung

Konzept der Schulung

Organisation der Schulung + Therapie

Wissenschaftliche Studien zur Schulung

Other hypothesis:(1.) Improvement of severity in the edcuation group

(SCORAD, PO-SCORAD, POEM) (2.) Increasing Knowledge of practical skills for atopic dermatitis

(Knowledge Questionnaire, Nutrition Questionnaire (new)(3.) Increasing Quality of life, Self Confidence with the disease,

Anxieties and Depression, Touch, Shame, Disgust(DLQI, HADS-S, Patient Benefit Index, TSD-Q: Touch-Shame-Disgust-Questionnaire (Gieler et al)

(4.) Increasing Work Possibilities (Work Limitation Index)(5.) Lower direct and indirect costs

2nd Int.Workshops of Therapeutic Education on Atopic D ermatitis

Fondation pour la Dermatite Atopique – Rom 2011

Page 16: New Developments in Atopic Dermatitis · New Developments in Atopic Dermatitis Education in Adults 2nd Int.Workshops of Therapeutic Education on Atopic Dermatitis Fondation pour la

Economy Hypothesis:• Number of doctors are lower in the education

group• Lower complimentary medicine treatment• Lower number of hospital inpatient

treatments in the education group• Lower number of rehabilitation treatments• Decreasing direct costs (doctor and drugs) • Lower work lost days and time for body

treatment decreased

2nd Int.Workshops of Therapeutic Education on Atopic D ermatitis

Fondation pour la Dermatite Atopique – Rom 2011

Basic Theory of Atopic Dermatitis Education

Long-Term-Follow-up of AD Education

New Developments:

Integration of Avene Massage

Adult Groups

Train-the-Trainer

Workshops

Page 17: New Developments in Atopic Dermatitis · New Developments in Atopic Dermatitis Education in Adults 2nd Int.Workshops of Therapeutic Education on Atopic Dermatitis Fondation pour la

Study -Design ARNE

?

?

210-240

310 - 350

100100

Exclusion criteria

Drop-Out after

Intention to treat

Waiting controlgroup

Education group

Follow-up

after 1 year

Uwe Gieler - JLU Giessen

2nd Int.Workshops of Therapeutic Education on Atopic D ermatitis

Fondation pour la Dermatite Atopique – Rom 2011

Page 18: New Developments in Atopic Dermatitis · New Developments in Atopic Dermatitis Education in Adults 2nd Int.Workshops of Therapeutic Education on Atopic Dermatitis Fondation pour la

ARNE Study –Germany 2010-2012Recruitment of patietns

n >250

Intention to treatRandomization

Education group6 x 2 hours weekly

Waiting control group

Follow-up after education3 Monate

Follow-up after 1 year

Uwe Gieler - JLU Giessen

2nd Int.Workshops of Therapeutic Education on Atopic D ermatitis

Fondation pour la Dermatite Atopique – Rom 2011

Page 19: New Developments in Atopic Dermatitis · New Developments in Atopic Dermatitis Education in Adults 2nd Int.Workshops of Therapeutic Education on Atopic Dermatitis Fondation pour la

Uwe Gieler - JLU Giessen

Conclusion

• Atopic eczema school is in comparisonwith a randomized waiting control group in nearly all variables significant better

• The differences are long-lasting after 1 year follow-up and show a better diseasemanagement with less relapse also after 5 years

• Atopic eczema school is sufficient in all age groups

• Since 2007 the programme was allowed to run by all health insurance companies in Germany when quality from the GADIS project is used.

Basic Theory of Atopic Dermatitis Education

Long-Term-Follow-up of AD Education

New Developments:

Integration of Avene Massage

Adult Groups

Train-the-Trainer

Workshops

2nd Int.Workshops of Therapeutic Education on Atopic D ermatitis

Fondation pour la Dermatite Atopique – Rom 2011

Page 20: New Developments in Atopic Dermatitis · New Developments in Atopic Dermatitis Education in Adults 2nd Int.Workshops of Therapeutic Education on Atopic Dermatitis Fondation pour la

Uwe Gieler - JLU Giessen

Train the trainer workshops

40 h train the trainer

Education workshop

+hospitation + supervision

2011: > 2.000 trainers in Germany

2nd Int.Workshops of Therapeutic Education on Atopic D ermatitis

Fondation pour la Dermatite Atopique – Rom 2011

Basic Theory of Atopic Dermatitis Education

Long-Term-Follow-up of AD Education

New Developments:

Integration of Avene Massage

Adult Groups

Train-the-Trainer

Workshops

Page 21: New Developments in Atopic Dermatitis · New Developments in Atopic Dermatitis Education in Adults 2nd Int.Workshops of Therapeutic Education on Atopic Dermatitis Fondation pour la

Train the Trainer Workshops

„Basics Trainer Competence“Theory: 20 UE

Hospitationspecific Indication

Supervisionfor at least one

indicationSpecific Indication

Theory forspecific Indication

(XX UE)

Uwe Gieler - JLU Giessen

2nd Int.Workshops of Therapeutic Education on Atopic D ermatitis

Fondation pour la Dermatite Atopique – Rom 2011

Page 22: New Developments in Atopic Dermatitis · New Developments in Atopic Dermatitis Education in Adults 2nd Int.Workshops of Therapeutic Education on Atopic Dermatitis Fondation pour la

The interdisciplinary Approach of the German Eczema School Programm

…National Group of Atopic Dermatitis EducationAnnual congress for Education (> 400 members)

…10 Academies in Germany (Train-the-Trainers)

…Quality management programme in every countryin Germany (responsible for education)

…Atopic Dermatitis Education centers (> 250)

…Special Education for nutrition specialists(1 day course)

…Standardized manual book for every trainer

1

2

3

4

5

6

AGNESManaging

AtopicDermatitis

Education

Programme in Germany

Uwe Gieler - JLU Giessen

ARNE = Adults

AGATE =

Anaphylaxis

2nd Int.Workshops of Therapeutic Education on Atopic D ermatitis

Fondation pour la Dermatite Atopique – Rom 2011

Page 23: New Developments in Atopic Dermatitis · New Developments in Atopic Dermatitis Education in Adults 2nd Int.Workshops of Therapeutic Education on Atopic Dermatitis Fondation pour la

Psychodermatology Research Team – Giessen/Germany

Clinic for Psychosomatics and Psychotherapy– JLU Giessen - Germany:

PD Dr. Dipl.-Psych. Jörg Kupfer

Dipl.-Psych. S.Schallmayer

PD Dr. Volker Niemeier

Frau Sigrun Kleinwort (Sekretary)

Uwe Gieler - JLU Giessen

Page 24: New Developments in Atopic Dermatitis · New Developments in Atopic Dermatitis Education in Adults 2nd Int.Workshops of Therapeutic Education on Atopic Dermatitis Fondation pour la

Uwe Gieler - JLU Giessen

Cochrane Database Syst Rev. 2007 Jul 18;(3):CD004054. Links

Psychological and educational interventions for atopic eczema in children.

Ersser SJ , Latter S , Sibley A , Satherley PA , Welbourne S .

RCTs of psychological or educational interventions, or both, used to manage children with atopic eczema.

DATA COLLECTION AND ANALYSIS: Two authors independently applied eligibility criteria, assessed trial quality and extracted data. A lack of comparable data prevented data

synthesis.

MAIN RESULTS: Five RCTs met the inclusion criteria.

2nd Int.Workshops of Therapeutic Education on Atopic D ermatitis

Fondation pour la Dermatite Atopique – Rom 2011

Basic Theory of Atopic Dermatitis Education

Long-Term-Follow-up of AD Education

New Developments:

Integration of Avene Massage

Adult Groups

Train-the-Trainer

Workshops