Chapter 4. Addressing Psychosocial Issues
Atopic dermatitis has a significant impact on the quality of life of patients and families, and addressing the psychosocial aspects of this chronic disease can be as important as prescribing medication.
Sleep disruption is often a significant problem not only for patients, but also for the caregiver. Fragmented sleep can result in daytime fatigue, impacting patients’ school performance along with job performance of adolescent patients or caregivers. Patients may have significant school absenteeism or even drop out of school while caregivers may be forced to give up their jobs creating additional stress in the household and contributing to the high economic burden of this disease.
Despite the importance of sleep disturbance, caregivers often report that this issue is overlooked in patient evaluation and treatment. Sedating antihistamines, sedatives or hypnotics may all be appropriate, and even hospitalization may be necessary especially in the acute setting. In addition, counseling, relaxation, massage therapy or bio-feedback may all be helpful, especially in patients with habitual scratching.
Patients with chronic atopic dermatitis who have a learned behavior component perpetuating their itch-scratch cycle may benefit from habit reversal. This involves introduction of an alternative or competing behavior in place of the undesirable one, for example, patting the skin, applying a moisturizer or a cool washcloth instead of scratching. Involving the patients and caregivers in this process will help promote self-esteem and assist in the development of skills beneficial to long-term self-management.