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Associated Measures

Dietary Diversification:

• We recommend carrying out dietary diversification for all foods as recommended for the general pediatric population, and as early as possible, starting at 4 months. Preventive avoidance should not be practiced. To date, there is no defined protocol for the introduction of different foods in children with AD.

Allergies:

• Do not perform routine allergy testing or systematic diets as part of atopic dermatitis management.
• An allergy work-up is recommended in the event of an immediate IgE-mediated reaction, potentially followed by an exacerbation of AD.
• It is only suggested in cases of moderate or severe AD with suspicion of worsening after food intake, without an initial immediate reaction. This work-up must be exhaustive: detailed clinical history, specific IgE testing, skin tests, and oral food challenges.

In the event of an immediate allergic reaction and a positive allergy work-up, the responsible foods must be avoided, and the progression of the allergy regularly reassessed.

• In case of allergy, limit exposure to identified allergens (aeroallergens, food allergens, contact allergens).

Seek an allergist's opinion in case of suspicion of worsening after food intake, without an initial immediate reaction.

Psychological Management:

• Quality of life should be regularly assessed, and psychological support should be offered to patients with atopic dermatitis and their close circle, especially in cases of severe disease.
• Training in emotional processing strategies and stress management can be offered.

The quality of life of patients with AD can be assessed using various scores, including the DLQI, SF-36, or EQ-5D, and the CDLQI and IDQOL for children.

• Take into account the increased risk of depression, anxiety, and suicidal behavior in patients with atopic dermatitis.

If depressive symptoms are detected, an evaluation by the primary care physician or in a specialized setting is recommended. In the case of high suicidal risk, the patient must be referred to an emergency department.

• Evaluate the impact on family life. Family impact is assessed by the DFI (Dermatitis Family Index). Parents of children with AD report feelings of guilt and failure because they feel unable to prevent AD flares and fear the disease will lead to stigmatization of their child and decrease their self-esteem.

The direct economic impact (purchase of specific clothing, hygiene products, emollients) and indirect impact (parental leave days) should also be taken into account.

TPE (Therapeutic Patient Education):

• Implement therapeutic education programs for children and adults with atopic dermatitis.

TPE programs should not be standardized but adapted to the needs of patients, taking into account their socio-educational level and cultural background. They should contain a list of activities and a predefined program provided by a multidisciplinary healthcare team.

The composition of a TPE program varies and may include:

• individual sessions,
• group sessions,
• videos,
• written action plans.

NB.

Online TPE models (e-health) have a similar impact to individual sessions at reduced costs.

See the toolbox: useful links for therapeutic education

Avoid Tobacco:

• Tobacco avoidance for patients with atopic dermatitis and their circle.

Avoid Irritating Clothing:

• Avoid irritating clothing (e.g., wool) to prevent worsening of atopic dermatitis.

➜ Tool box ➜ Recherche des Comorbidités pour tous les Patients

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