Bathing frequency recommendations for pediatric atopic dermatitis: Are we adding to parental frustration?

摘要

Bathing is an activity of daily living frequently addressed by providers as part of a treatment plan for patients with atopic dermatitis (AD). However, studies evaluating bathing frequency in pediatric AD are limited.1"4 Consequently, the jury remains out on this topic. Hence, there is likely to be confusion when AD guidelines have not provided clear and consistent evidence-based advice in this area.5"8 Two recent practice guidelines from the United States5 and Europe6 fail to comment entirely on bathing frequency. Instead they focus on duration of bathing based on expert opinion: US guidelines recommend at least 10-minute soaking baths,5 and European guidelines recommend short, 5-minute baths.6 Our goal was to determine what parents of children with AD interpret from their providers concerning bathing frequency. Given the lack of clarity in AD guidelines, we hypothesized that advice received by parents concerning bathing frequency in AD would lack consistency and subsequently contribute to further confusion and frustration in this often difficult to manage disease.In testing this hypothesis, an online institutional review board—approved 7-question survey was posted to the National Eczema Association (NEA) website, quarterly electronic newsletter, and Facebook page. The NEA is a nonprofit organization dedicated to AD research, education, and advocacy. Membership includes parents of pediatric patients with AD. The survey was posted for a period of 6 weeks in the spring of 2012, and members of the NEA were invited to participate voluntarily and anonymously by clicking a SurveyMonkey link (www.surveymonkey.com). Participation implied consent. The survey questions can be found in Table 1. Confidence intervals (CIs) were calculated using an online statistical computation tool available through Vassar Stats (http://www. vassarstats.net/propl.html).A total of 354 NEA members responded to the survey. Basic demographics were gathered on which health care providers parents see for their child's AD. The focus was on frequency, not method of bathing; showers vs soaking baths were not distinguished, although this too remains an area of uncertainty.9 With regard to moisturizing, there is general agreement within AD guidelines that emollients should serve as first-line therapy. We chose to focus on the area of bathing frequency, where the guidelines were lacking.