title: Effects of structured patient education in adults with atopic dermatitis: Multicenter randomized controlled trial.
abstract: BACKGROUND
  Atopic dermatitis (AD) is a chronic relapsing skin disease prevalent in 1% to 3% of adults in Western industrialized countries.
  
  
  OBJECTIVE
  We sought to investigate the effectiveness of educational training in an outpatient setting on coping with the disease, quality of life, symptoms, and severity in adults with AD.
  
  
  METHODS
  In this German prospective, randomized controlled multicenter study, adult patients with moderate-to-severe AD were educated by referring to a comprehensive 12-hour training manual consented by a multiprofessional study group from different centers (Arbeitsgemeinschaft Neurodermitisschulung für Erwachsene [ARNE]). Patients were randomly allocated to the intervention or waiting control groups. Study visits were performed at baseline and after 1 year (1 year of follow-up). Primary outcomes were defined as a decrease in (1) "catastrophizing cognitions" with respect to itching (Juckreiz-Kognitions-Fragebogen questionnaire), (2) "social anxiety" (Marburger Hautfragebogen questionnaire), (3) subjective burden by symptoms of the disease (Skindex-29 questionnaire), and (4) improvement of disease signs and symptoms assessed by using the SCORAD index at 1 year of follow-up. Data were analyzed on an intention-to-treat basis.
  
  
  RESULTS
  At 1 year of follow-up, patients from the intervention group (n = 168) showed a significantly better improvement compared with the waiting group (n = 147) in the following defined primary study outcomes: coping behavior with respect to itching (P < .001), quality of life assessed by using the Skindex-29 questionnaire (P < .001), and the SCORAD index (P < .001).
  
  
  CONCLUSIONS
  This is the first randomized, controlled multicenter study on patient education in adult AD. The ARNE training program shows significant beneficial effects on a variety of psychosocial parameters, as well as AD severity.
authors.affiliation: Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany. Electronic address: Heratizadeh.Annice@mh-hannover.de.
authors.forename: Annice
authors.initials: A
authors.lastname: Heratizadeh
authors.affiliation: Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Werfel
authors.affiliation: Department of Dermatology and Allergy, Ludwig-Maximilian-Universität Munich, Munich, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Wollenberg
authors.affiliation: Department of Dermatology, Medical Faculty Carl-Gustav-Carus, Technical University of Dresden, Dresden, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Abraham
authors.affiliation: Department of Dermatology and Allergology, Vital Klinik GmbH & Co. KG, Alzenau, Germany.
authors.forename: Sibylle
authors.initials: S
authors.lastname: Plank-Habibi
authors.affiliation: Department of Dermatology and Allergology Biederstein, Technical University Munich, Munich, Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Schnopp
authors.affiliation: Department of Dermatology, Universitätsklinikum Erlangen, Erlangen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Sticherling
authors.affiliation: Department of Clinical Social Medicine, University Hospital Heidelberg, Heidelberg, Germany; Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Apfelbacher
authors.affiliation: Department of Dermatology and Allergology Biederstein, Technical University Munich, Munich, Germany; Department of Dermatology, Eberhard Karls University, Tübingen, Germany.
authors.forename: Tilo
authors.initials: T
authors.lastname: Biedermann
authors.affiliation: Department of Allergology and Occupational Dermatology, Dermatologikum Hamburg, Hamburg, Germany.
authors.forename: Kristine
authors.initials: K
authors.lastname: Breuer
authors.affiliation: Dermatology Centre of Rehabilitation and Prevention GmbH Bad Soden, Bad Soden, Germany.
authors.forename: Isabel
authors.initials: I
authors.lastname: Fell
authors.affiliation: Department of Dermatology, Universitätsklinikum Schleswig-Holstein, Campus Kiel Dermatologie, Venerologie und Allergologie, Kiel, Germany.
authors.forename: Regina
authors.initials: R
authors.lastname: Fölster-Holst
authors.affiliation: Department of Dermatology and Allergy, Campus Mitte, Charité Universitätsmedizin, Berlin, Germany.
authors.forename: Guido
authors.initials: G
authors.lastname: Heine
authors.affiliation: Dermatologisches Zentrum Buxtehude, Buxtehude, Germany.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Grimm
authors.affiliation: Psychological Practice, Academy of Neurodermatitis Hessen, Hessen, Germany.
authors.forename: Lars
authors.initials: L
authors.lastname: Hennighausen
authors.affiliation: Department of Dermatology and Allergology Biederstein, Technical University Munich, Munich, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Kugler
authors.affiliation: Nutrition Counselling Allergology, Munich, Germany.
authors.forename: Imke
authors.initials: I
authors.lastname: Reese
authors.affiliation: Department of Dermatology and Allergology Biederstein, Technical University Munich, Munich, Germany; Christine Kuehne Center for Allergy Research and Education (CK-CARE), Davos, Switzerland.
authors.forename: Johannes
authors.initials: J
authors.lastname: Ring
authors.affiliation: Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Knut
authors.initials: K
authors.lastname: Schäkel
authors.affiliation: Center for Evidence-based Healthcare, Medizinische Fakultät Carl Gustav Carus, TU Dresden, Dresden, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Schmitt
authors.affiliation: Department of Psychosomatic Medicine, University Leipzig, Leipzig, Germany.
authors.forename: Kurt
authors.initials: K
authors.lastname: Seikowski
authors.affiliation: Department of Dermatology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany.
authors.forename: Esther
authors.initials: E
authors.lastname: von Stebut
authors.affiliation: Klinikum Darmstadt Bereich Eberstadt Hautklinik, Darmstadt, Germany.
authors.forename: Nicola
authors.initials: N
authors.lastname: Wagner
authors.affiliation: Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany.
authors.forename: Anja
authors.initials: A
authors.lastname: Waßmann-Otto
authors.affiliation: Department of Dermatology and Allergology, Vital Klinik GmbH & Co. KG, Alzenau, Germany.
authors.forename: Ute
authors.initials: U
authors.lastname: Wienke-Graul
authors.affiliation: Department of Clinical Social Medicine, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Elke
authors.initials: E
authors.lastname: Weisshaar
authors.affiliation: Department of Dermatology and Allergy, Campus Mitte, Charité Universitätsmedizin, Berlin, Germany.
authors.forename: Margitta
authors.initials: M
authors.lastname: Worm
authors.affiliation: Department of Dermatology and Allergology, Justus-Liebig-University Giessen, Giessen, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Gieler
authors.affiliation: Institute of Medical Psychology, Justus-Liebig-University Giessen, Giessen, Germany.
authors.forename: Joerg
authors.initials: J
authors.lastname: Kupfer
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D003876:Dermatitis, Atopic / Q000523:psychology* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D011788:Quality of Life; D012720:Severity of Illness Index; D055815:Young Adult
keywords: Atopic dermatitis; adulthood; coping; disease severity; multi-professional; patient education; psychosocial; quality of life