on behalf of the Italian School of Atopy

1989

Prevalence of Atopic Dermatitis was increasing Prevalence of AD has risen progressively since 1940s1-4 35 30.8 30

27.3

Denmark3

Children (%)

25 20

17.3 16.7 Denmark3 12.2 11.9

15 10 5 0

Australia4

British birth cohort studies1 7.3 5.1 4.4 3.1 USA1 1 UK 1945

New Zealand1

8.3 UK1 5.6

Sweden1

Western Australia1

1955 1965 1975 Year of birth (median1/mean3,4)

1985

1995

1. Taylor B, et al. Lancet 1984; 2:1255–1257; 2. Diepgen TL. Is the prevalence of atopic dermatitis increasing? In: Atopic Dermatitis, 2000. Ed: Williams HC. Cambridge: Cambridge University Press; 3. Stensen L, et al. Allergy Asthma Proc 2008; 29:392–396; 4. Foley P, et al. Arch Dermatol 2001; 137:293–300.

Prevalence of Atopic Dermatitis in European countries

12-month prevalence of atopic dermatitis (%)

There is a significant burden of AD across Europe, particularly in infants and children1 Prevalence in five major EU countries2 20

15

10

5

0 France Germany UK Spain Italy (5 centres) (2 centres) (15 centres) (8 centres) (10 centres)

Data from children aged 13–14 yrs participating in ISAAC study

1. Levy RM, et al. Clinics in Dermatology 2003; 21:109–115; 2. ISAAC Steering Committee. Lancet 1998; 351:1225–1232; http://isaac.auckland.ac.nz/phases/phaseone/results/results.html.

Economic burden of Atopic Dermatitis • Most cases of atopic dermatitis are mild and are managed in primary care1 • However, moderate to severe atopic dermatitis causes over €2 billion in lost productivity in the EU2 every year

Proportion of patients (%)

100

Severe Moderate

50 Mild

0 Severity of atopic dermatitis 1. Emerson RM, et al. Br J Dermatol 1998; 139:73–76; 2. Zuberbier T, et al. J Allergy Clin Immunol 2006; 118:226–232.

Two different targets

doctors

patients

Challenges to achieving effective long-term management of Atopic Dermatitis Gaps in patient education

Gaps in physician education

• Confusion about AD aetiology • Search for a definite cure and lack of recognition of AD as a chronic disease • Lack of involvement in treatment decisions • Inadequate knowledge and self-management skills • Fear of short-term/long-term side effects

• Confusion about AD aetiology • Lack of recognition of AD as a chronic disease • Little awareness of psychosocial impact • Lack of expertise regarding treatment strategy and follow-up • Confusion about maintenance treatment concept • Lack of understanding of benefit/risk ratio of topical treatment

Low priority for AD Poor patient adherence Concept of maintenance treatment not adopted

Achieving effective long-term management of Atopic Dermatitis • Compliance – the degree to which the patient follows the medication regimen – is critical to outcomes1,2 • Adherence – the ability of patient and doctor to jointly decide the treatment strategy • Concordance – agreement about the medication regimen – places the patient at the centre of care and is central to adherence1,2 1. Ntuen E, et al. J Dermatol Treat 2010; 21:28–33; 2. Marinker M, et al. Br Med J 2003; 326:348–349.

How can adherence be optimised? • Adherence to topical therapies can be increased by: More frequent patient contact

Clear instructions

Education about the disease course

Education about the rationale for the therapeutic strategy

• Adherence to therapy may be poor, even in severe atopic dermatitis • Poor adherence may lead to treatment failure and substantial costs Patient education is the cornerstone of optimising adherence

Brown KL, et al. Dermatol Online J 2008; 14 (9):13.

Two different targets

doctors

patients

All (atopic) roads lead to Milan?

The Italian School of Atopy: 6 years of experiences • In 2005 the idea to create an Italian School of Atopy was launched. • The goal was to improve the management of patients affected by atopic dermatitis and other atopic disorders

The Italian School of Atopy: In 2006, the first national symposium “La Scuola dell’Atopia” was organized in Milan and attended by 200 people

2007

Acta of the 1st Italian Congress of the School of Atopy (2006)

All (atopic) roads starts from Milan?

The Italian School of Atopy: 6 years of experiences Milan Bologna Palermo Roma Padua Genoa

2008

Acta of the 2nd Italian Congress of the School of Atopy (2007)

The Italian School of Atopy network Milan Bologna Palermo Roma Padua Genoa

2008

La PRATICA dell’ ATOPIA in Italia Carlo Gelmetti

Unità Operativa di Dermatologia Pediatrica Istituto di Scienze Dermatologiche, Università degli Studi di Milano Fondazione IRCCS “Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena” Milano

The Italian School of Atopy: 6 years of experiences …and a scientific software (SCORAD card®) has been distributed to 30 reginal pediatric centers* in Italy to improve the data collection and recording for clinical studies

Pediatricians of the dermatologic network of the F.I.M.P (Federazione Italiana Medici Pediatri = Italian Federation of Pediatricians

2009

The Doctors’ Triangle dermatologist

pediatrician/ allergologist

psychologist

Two different targets

doctors

patients

different ages… infants parents

children

adolescents/adults

…differents age-specific tools infants parents

children

adolescents/adults

Milan

The Atopy watch

A tool used by a dermatologist to explain to caregivers how to behave during the day (and the year)… But also a pedagogic instrument to play with

The Atopy watch From the wakeup to sleeptime, the daily activities divided by the period of the day, are the occasion to give some advices and informations to caregivers

The Atopy watch Practical advices together with preventive informations are given to ameliorate the management of the atopic patients

The Atopy watch

This tool is particularly designed to children aged from 4 to 7. The last page of the cover will allow to play with the watch and to learn to read the time

The Year Planning for the Atopic

Pollen distribution in Italy

different cultures… infants parents

children

adolescents/adults

AD: a practical guide in 6 languages

2009

Italian, Arabic, Spanish, Rumenian, Chinese, English

Bologna

The School of Atopy in Bologna Contents of the Educational Program • • • • • • •

Epidemiology Diagnosis of atopic dermatitis Food allergy Treatment of atopic skin Itching and scratching Sleep problems in atopic children Infant massage

The School of Atopy in Bologna

Genoa

Padua

The School of Atopy in Padua

Dedicated Outpatient Service Twice a week 30 minutes per patient

The School of Atopy in Padua dermatologic visit • ANAMNESTIC FILE Mod. AMBDER010 Rev.0.doc • GRADING OF SEVERITY

• CBC, PRIST, RAST • Patch test • Allergologic visit

The School of Atopy in Padua

Availability: – N° of telephone – dedicated Email : [email protected] – Web site: www.pediatria.unipd.it (including pages dedicated to pediatric dermatology)

Rome

The School of Atopy in Rome study group (30 pts)

FLOW CHART

I visit: visit, info + booklet,

Control group (30 pts)

I visit: visit, info + booklet,

educational intervention questionnaire for caregivers (environment, cost) Compilation of the instruments by doctors

follow up visit: questionnaire for doctors and caregivers verification of educational intervention

questionnaire for caregivers (environment, cost) Compilation of the instruments by doctors

follow up visit: questionnaire for doctors and caregivers

Palermo

The School of Atopy in Palermo REGIONE SICILIANA AZIENDA DI RILIEVO NAZIONALE E DI ALTA SPECIALIZZAZIONE OSPEDALI: CIVICO E BENFRATELLI, G. DI CRISTINA, M. ASCOLI PALERMO U.O. DERMATOLOGIA

Il progetto “La Scuola dell’Atopia” [email protected]

The Doctors’ Pentangle ...in Palermo dermatologist

expert in education

pediatrician/ allergologist

nurse

psychologist

The School of Atopy in Palermo N° Session

Trainer 3 mos-4 yrs

5-18 yrs

Items

1

All

Parents

Parents & Sons

Introduction, infos, test

2

Ped+Derm Parents

Parents & Sons

Treatment, alternative tx, hygiene and hydration

3

Psy

Parents

Parents & Sons

Management of emotions, pruritus, sleep disturbances

4

All+Nurse

Parents

Parents & Sons

Allergic factors and therapeutic education Post test

The School of Atopy in Palermo

The School of Atopy in Palermo

didactic items as “tool” to explain

The School of Atopy in Palermo

The School of Atopy in Palermo

”.

Children receive their bag

The School of Atopy in Palermo

”.

All together!

Grazie per l’attenzione

Grazie per l’attenzione!

National Web-site

www.lascuoladellatopia.it

INTERNATIONAL COLLABORATIONS

2008 2009

PO-SCORAD Study (in coll. with ETFAD and Nantes)

We have translated into Italian the CDQLI

May 24 - 29, 2011

International Awards for Social Responsibility in Dermatology The Winner for Europe: The School of Atopy in Italy: a multitarget project Carlo Gelmetti

Thanks to: Fondation Dermatite Atopique (Pierre Fabre) Fondation Mustela (Expanscience) TPS Production (Scorad Card®) L’Oréal Galderma Rottapharm Dermana Giuliani Merz

4th National Meeting