Abstract
Aim: To examine the association between childhood atopic dermatitis (AD) severity and family impact at baseline and after an intervention by a physician specialist, using validated measures of both severity and family impact.
Methods: Cross sectional self administered survey of parent–caregivers of 49 randomly selected children with AD; 35 parents were available for follow up. Family impact was measured using a modified AD Family Impact Scale completed by the parent–caregiver. The child's disease severity was measured using both the investigator's assessment via the Eczema Area and Severity Index (EASI) and the caregiver's assessment via the recently validated Self Assessment Eczema Area and Severity Index (SA-EASI).
Results: The parent–caregiver's assessment of severity of the child was the most significant correlate of the family impact of the child's AD (p = 0.65 at baseline and p = 0.38 at follow up). In multivariate regression models, the parent–caregiver's estimate of severity remained the single strongest predictor of family impact before and after receipt of dermatologist care, as well as the difference in impact between pre and post-dermatologist care.
Conclusions: There is evidence to support the ability of parent–caregivers of children with AD to accurately determine severity of their child's AD; perceived severity is the driver of the family impact of this condition. Treatment of a child by a physician specialist is associated with reductions in both perceived severity, as well as family impact of this condition.
Full Text
The Full Text of this article is available as a PDF (105.0 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Balkrishnan Rajesh, Housman Tamara S., Grummer Sarah, Rapp Stephen R., Clarke Jan, Feldman Steven R., Fleischer Alan B., Jr The family impact of atopic dermatitis in children: the role of the parent caregiver. Pediatr Dermatol. 2003 Jan-Feb;20(1):5–10. doi: 10.1046/j.1525-1470.2003.03002.x. [DOI] [PubMed] [Google Scholar]
- Balkrishnan Rajesh, Naughton Michelle, Smith Beth P., Manuel Janeen, Koman L. Andrew. Parent caregiver-related predictors of health care service utilization by children with cerebral palsy enrolled in Medicaid. J Pediatr Health Care. 2002 Mar-Apr;16(2):73–78. [PubMed] [Google Scholar]
- Boguniewicz M., Fiedler V. C., Raimer S., Lawrence I. D., Leung D. Y., Hanifin J. M. A randomized, vehicle-controlled trial of tacrolimus ointment for treatment of atopic dermatitis in children. Pediatric Tacrolimus Study Group. J Allergy Clin Immunol. 1998 Oct;102(4 Pt 1):637–644. doi: 10.1016/s0091-6749(98)70281-7. [DOI] [PubMed] [Google Scholar]
- Daud L. R., Garralda M. E., David T. J. Psychosocial adjustment in preschool children with atopic eczema. Arch Dis Child. 1993 Dec;69(6):670–676. doi: 10.1136/adc.69.6.670. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Fennessy M., Coupland S., Popay J., Naysmith K. The epidemiology and experience of atopic eczema during childhood: a discussion paper on the implications of current knowledge for health care, public health policy and research. J Epidemiol Community Health. 2000 Aug;54(8):581–589. doi: 10.1136/jech.54.8.581. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hanifin J. M., Thurston M., Omoto M., Cherill R., Tofte S. J., Graeber M. The eczema area and severity index (EASI): assessment of reliability in atopic dermatitis. EASI Evaluator Group. Exp Dermatol. 2001 Feb;10(1):11–18. doi: 10.1034/j.1600-0625.2001.100102.x. [DOI] [PubMed] [Google Scholar]
- Helmbold P., Gaisbauer G., Kupfer J., Haustein U. F. Longitudinal case analysis in atopic dermatitis. Acta Derm Venereol. 2000 Sep-Oct;80(5):348–352. doi: 10.1080/000155500459286. [DOI] [PubMed] [Google Scholar]
- Housman T. S., Patel M. J., Camacho F., Feldman S. R., Fleischer A. B., Jr, Balkrishnan R. Use of the Self-Administered Eczema Area and Severity Index by parent caregivers: results of a validation study. Br J Dermatol. 2002 Dec;147(6):1192–1198. doi: 10.1046/j.1365-2133.2002.05031.x. [DOI] [PubMed] [Google Scholar]
- Howlett S. Emotional dysfunction, child-family relationships and childhood atopic dermatitis. Br J Dermatol. 1999 Mar;140(3):381–384. doi: 10.1046/j.1365-2133.1999.02696.x. [DOI] [PubMed] [Google Scholar]
- Lapidus C. S., Schwarz D. F., Honig P. J. Atopic dermatitis in children: who cares? Who pays? J Am Acad Dermatol. 1993 May;28(5 Pt 1):699–703. doi: 10.1016/0190-9622(93)70096-c. [DOI] [PubMed] [Google Scholar]
- Lawson V., Lewis-Jones M. S., Finlay A. Y., Reid P., Owens R. G. The family impact of childhood atopic dermatitis: the Dermatitis Family Impact Questionnaire. Br J Dermatol. 1998 Jan;138(1):107–113. doi: 10.1046/j.1365-2133.1998.02034.x. [DOI] [PubMed] [Google Scholar]
- Melnyk B. M., Feinstein N. F., Moldenhouer Z., Small L. Coping in parents of children who are chronically ill: strategies for assessment and intervention. Pediatr Nurs. 2001 Nov-Dec;27(6):548–558. [PubMed] [Google Scholar]
- Pauli-Pott U., Darui A., Beckmann D. Infants with atopic dermatitis: maternal hopelessness, child-rearing attitudes and perceived infant temperament. Psychother Psychosom. 1999;68(1):39–45. doi: 10.1159/000012309. [DOI] [PubMed] [Google Scholar]
- Reitamo S., Wollenberg A., Schöpf E., Perrot J. L., Marks R., Ruzicka T., Christophers E., Kapp A., Lahfa M., Rubins A. Safety and efficacy of 1 year of tacrolimus ointment monotherapy in adults with atopic dermatitis. The European Tacrolimus Ointment Study Group. Arch Dermatol. 2000 Aug;136(8):999–1006. doi: 10.1001/archderm.136.8.999. [DOI] [PubMed] [Google Scholar]
- Shapiro J. Family reactions and coping strategies in response to the physically ill or handicapped child: a review. Soc Sci Med. 1983;17(14):913–931. doi: 10.1016/0277-9536(83)90218-6. [DOI] [PubMed] [Google Scholar]
- Su J. C., Kemp A. S., Varigos G. A., Nolan T. M. Atopic eczema: its impact on the family and financial cost. Arch Dis Child. 1997 Feb;76(2):159–162. doi: 10.1136/adc.76.2.159. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Tam Alda L., Camberos Alfonso, Applebaum Harry. Surgical decision making in necrotizing enterocolitis and focal intestinal perforation: predictive value of radiologic findings. J Pediatr Surg. 2002 Dec;37(12):1688–1691. doi: 10.1053/jpsu.2002.36696. [DOI] [PubMed] [Google Scholar]
- Williams H. C., Strachan D. P. The natural history of childhood eczema: observations from the British 1958 birth cohort study. Br J Dermatol. 1998 Nov;139(5):834–839. doi: 10.1046/j.1365-2133.1998.02509.x. [DOI] [PubMed] [Google Scholar]