Chavigny J M, Adiceom F, Bernier C, Debons M, Stalder J F
Service de Dermatologie, CHU Hôtel-Dieu, 1, place Alexis Ricordeau, 44093 Nantes, France.
Ann Dermatol Venereol. 2002 Aug-Sep;129(8-9):1003-7.
The assessment of the educational management of 40 moderate to severe atopic patients was performed in the atopic dermatitis school created in Nantes (France) from November 2000 to May 2001.
Patients with moderate to severe atopic dermatitis (SCORAD >20) were selected according to the criteria of Hanifin and Rajka and included in an open pilot study including a specific educational program. Atopic training included consultations, demonstrations, interviews with both dermatologist and nurses and workshops organized in three subgroups according to the age of the patients. SCORAD index, educational diagnosis and at least one educational objective were established during the first consultation. Evaluation criteria were defined in accordance with the educational objectives. Specific educational tools were used for each objective.
Forty patients (mean age: 9 years) were followed during 6 months. At the beginning of the study the mean SCORAD was of 50.5. After a 6 months follow-up, the mean SCORAD was of 22 and improvement of the SCORAD was noted in 97 p. 100 of cases. Educational objectives were reached in 70.6 p. 100 of cases. One patient lost contact.
The educational approach of atopic dermatitis includes global assessment of the disease after identification of risk factors, disrupted quality of life, skin-damaging behavior, family stress. Educational diagnosis focusing on local treatment is a major step; topical treatment is either misunderstood or conducted erroneously or non-existent. Therapeutic education plays a key role in the compliance and efficacy of treatment. Pain management, demonstration and explanation of skin care by health care professionals, information on the disease in age-specific workshops provided good results in more than 70 p. 100 of cases. Severe atopic dermatitis in children can lead to major domestic conflicts when the parents are in charge of the treatment. Giving responsibilities to the children, by teaching them how to treat themselves, relieves the parents from their involvement and finally reduces the conflicts.
The difficulties encountered in treating refractory atopic dermatitis may be secondary to the severity of the disease, to poor compliance or to the extent of the psychological impact. Therapeutic education of the patient, as performed in the atopic dermatitis school, represents a major breakthrough in the care of such patients.
2000年11月至2001年5月期间，在法国南特创建的特应性皮炎学校对40例中度至重度特应性患者的教育管理进行了评估。
根据哈尼芬和拉伊卡的标准，选取中度至重度特应性皮炎（SCORAD＞20）患者，纳入一项包括特定教育项目的开放性试点研究。特应性培训包括会诊、示范、皮肤科医生和护士的访谈以及根据患者年龄分为三个亚组组织的工作坊。在首次会诊时确定SCORAD指数、教育诊断和至少一个教育目标。根据教育目标定义评估标准。针对每个目标使用特定的教育工具。
40例患者（平均年龄：9岁）随访6个月。研究开始时，平均SCORAD为50.5。经过6个月的随访，平均SCORAD为22，97%的病例SCORAD有所改善。70.6%的病例达到了教育目标。1例患者失去联系。
特应性皮炎的教育方法包括在识别危险因素、生活质量受损、皮肤损伤行为、家庭压力后对疾病进行全面评估。专注于局部治疗的教育诊断是一个重要步骤；局部治疗要么被误解，要么实施错误或根本不存在。治疗性教育在治疗的依从性和疗效方面起着关键作用。疼痛管理、医护人员对皮肤护理的示范和解释、在针对不同年龄段的工作坊中提供的疾病信息在70%以上的病例中取得了良好效果。当父母负责治疗时，儿童严重的特应性皮炎可能导致家庭重大冲突。通过教孩子如何自我治疗，让他们承担责任，减轻了父母的负担，最终减少了冲突。
治疗难治性特应性皮炎遇到的困难可能继发于疾病的严重程度、依从性差或心理影响的程度。如在特应性皮炎学校所开展的对患者的治疗性教育，是此类患者护理中的一项重大突破。
