Treatment Adherence in Pediatric Atopic Dermatitis: A Systematic Review

Caitlyn B Dagenet; Lauren Gawey; Sahar Davoudi; Elaine Ma; Charlotte Jeong; Swetha Atluri; Jay M Kincannon; Jennifer L Hsiao; Steven R Feldman; Vivian Y Shi

doi:10.1111/pde.15771

Treatment Adherence in Pediatric Atopic Dermatitis: A Systematic Review

Pediatr Dermatol. 2024 Nov-Dec;41(6):1077-1090. doi: 10.1111/pde.15771. Epub 2024 Oct 4.

Authors

Affiliations

¹ University of Arizona College of Medicine, Tucson, Arizona, USA.
² University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
³ Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
⁴ College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
⁵ Department of Internal Medicine, Brown University, Providence, Rhode Island, USA.
⁶ Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
⁷ Department of Dermatology, University of Southern California, Los Angeles, California, USA.
⁸ Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
⁹ Department of Dermatology, University of Washington, Seattle, Washington, USA.

PMID: 39364670
DOI: 10.1111/pde.15771

Abstract

Introduction: Adherence to pediatric atopic dermatitis (AD) treatment regimens can be complex and a major challenge to optimizing treatment outcome. We aimed to review factors associated with nonadherence in pediatric AD and propose interventions to improve adherence.

Methods: PubMed and EMBASE databases were systematically searched for articles from 2000 to February 2023 related to AD and adherence, with an additional update in December 2023. Non-human studies, reviews, commentaries, and meta-analyses were excluded. Articles were sorted into pediatric versus adult study population based on volume. Herein, we examine the results of papers discussing adherence factors related to pediatric patients.

Results: A total of 62 studies met inclusion criteria. Thirty-six studies surveyed patients and caregivers (N = 10,268) to identify barriers to treatment adherence. None of the included studies were specific to systemic medications. Barriers included poor caregiver quality of life, inadequate AD-related education, topical corticosteroid (TCS) phobia, unclear therapy-related instructions, and dissatisfaction with physician interaction. Five studies solely measured adherence using medication electronic monitoring systems, Morisky medication adherence scale, or self-reported adherence to measure adherence to topical medications. Twenty-one studies described interventions involving nurse-led or web-based education programs, text message or email reminders, and TCS education. Adherence was improved with caregiver education programs, daily text-message reminders, eczema action plans, TCS potency "traffic light" color system, and frequent follow-up visits.

Conclusion: Adherence to pediatric AD treatment poses a multifactorial challenge for caregivers and patients. This study provides an index of strategies to optimize adherence, as it is essential for prevention of long-term sequela associated with AD in children. As the AD treatment landscape rapidly expands, further studies are vital to assess pediatric adherence to new topical, oral, and injectable medications.

Trial registration: PROSPERO: CRD42023488557.

Publication types

Systematic Review

MeSH terms

Caregivers / psychology
Child
Dermatitis, Atopic* / drug therapy
Humans
Medication Adherence* / statistics & numerical data