title: Predictors of clinical success in a multidisciplinary model of atopic dermatitis treatment.
abstract: Atopic dermatitis (AD) is one of the most common pediatric skin disorders. Because treatment involves allergen avoidance, dietary changes, and behavior modification, multidisciplinary treatment models have been used to complement conventional medication therapy. However, predictors  of clinical response in these multidisciplinary models have not been studied. This study examined factors associated with a reduction in AD severity in a multidisciplinary outpatient pediatric AD treatment program providing medical, nutritional, and behavioral support. Data were collected  from 170 patients between 2001 and 2006. The Eczema Area and Severity Index (EASI) score was determined at the time of each visit. Using a logistic regression model, we investigated the association of baseline demographic and clinical characteristics with clinical outcome. We also analyzed  the association between improvement in the EASI score and behavioral changes. One hundred thirty-eight patients had significantly improved EASI scores, and 32 patients were nonresponders. Responders had a median improvement of 79% in their EASI score, whereas nonresponders had a 53% worsening  of their EASI score (p < 0.0001) and a significantly worse absolute EASI score (p < 0.001). Predictors of clinical success included baseline EASI score, baseline age, and improved parental adherence to treatment recommendations. Improvement in the EASI score significantly correlated  with quality-of-life measures: decreased itching and scratching, difficulty sleeping, and parental concerns about side effects. A multidisciplinary model of AD treatment has the best clinical outcomes in younger patients with severe AD. Ensuring parental compliance with treatment recommendations  is important for clinical response.
authors.affiliation: Division of Immunology, Children's Hospital Boston, Massachusetts, 02115, USA. janet.chou@childrens.harvard.edu
authors.forename: Janet S
authors.initials: JS
authors.lastname: Chou
authors.forename: Jennifer
authors.initials: J
authors.lastname: LeBovidge
authors.forename: Karol
authors.initials: K
authors.lastname: Timmons
authors.forename: Wendy
authors.initials: W
authors.lastname: Elverson
authors.forename: Jaclyn
authors.initials: J
authors.lastname: Morrill
authors.forename: Lynda C
authors.initials: LC
authors.lastname: Schneider
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003876:Dermatitis, Atopic / Q000628:therapy*; D004485:Eczema / Q000628:therapy; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011379:Prognosis; D012720:Severity of Illness Index