Home | Register | Login | Inquiries | Alerts | Sitemap |  


Advanced Search
JKM > Volume 35(2); 2014 > Article
Son: Demand Survey for Application of Environmental Therapy for Atopic Dermatitis

Abstract

Objective:

This study aimed to investigate the demand for natural environment therapy among parents of patients with atopic dermatitis.

Methods:

The questionnaire-based survey was conducted on the parents of 310 patients with atopic dermatitis (158 male and 152 female, median age 8 years, ranging from 2 to 21 years). The questionnaire consisted of 10 questions including demographic information, preference of environmental therapy and related choices.

Results:

Regardless of illness severity or gender, parents agreed with the importance of environmental therapy in treatment for atopic dermatitis. 55.2% of parents had considered moving to the countryside for their children with atopic dermatitis. 74.5% of parents answered positively to the possibility of movement to an atopy-free village, and this rate was significantly higher in parents of patients with severe symptoms (p < 0.05). Educational facilities and eco-environment were considered to be the most important factors in their decision. In addition, parents opted for organic food cooperatives, which was also felt necessary for their children suffering from atopic dermatitis.

Conclusions:

This study is the first report suggesting the extent of demand for environmental therapies among patients with atopic dermatitis. This information will be helpful in developing therapeutics using the natural environment in Korean medicine.

Introduction

Atopic dermatitis is a chronic inflammation with a pruritic skin disorder, which seriously affects quality of life in patients as well as their families1). The prevalence rate of atopic dermatitis is 17.9% for children aged 6–7 years and 11.2% for children aged 13–14 years in Korea, and it is widely increasing worldwide2). The etiology is unclear, but genetic factors, frequent exposure to air pollutions, limited breast-feeding, and especially westernized lifestyle including food and housing have been speculated to be contributing factors for the high incidence rate of atopic dermatitis3,4). The prevalence of atopic dermatitis is higher in urban areas than rural5,6).
At present, there are several managements; emollients, ultraviolet light exposure, and corticosteroids in severe cases7), but there is no radical and effective conventional therapy8). Accordingly, many patients adapted a complementary alternative medicine or various folk-remedies for the treatment of atopic dermatitis9). Some herbal drugs have shown positive effects by reducing the symptoms and improving the quality of life, but still those drugs haven’t been approved as a standard therapeutics for atopic dermatitis10,11).
These facts strongly indicate that atopic dermatitis is a typical environmental disease for which we should consider the therapeutics using natural environmental factors. Recently, natural environment-based atopy camps organized by regional governments and some companies have received attention1214). Moreover, some Oriental doctors showed the clinical effect of those atopy camps on reducing the atopic symptoms and blood parameters15,16). The natural environmental therapy would be valuable for patients with atopic dermatitis, which could be well adapted as a therapeutic of Korean medicine in the future.
This study aimed to investigate the demand for nature-based environmental therapy among patients with atopic dermatitis, to provide basic data helpful in the development of Korean medicine derived novel therapeutics.

Subjects and methods

1. Subjects

310 mothers (median age 40 years, ranging from 29 to 56 years) of patients previously diagnosed with atopic dermatitis were enrolled. The children consisted of 158 male (median age 8 years, ranging from 2~21 years) and 152 female (median age 8 years, ranging from 2~19 years) who lived in Gyeonggi province.

2. Methods

The questionnaires with answers were obtained from the mothers who attended atopy-school held at borough offices in Gyeonggi province between October and December 2013. The questionnaire consisted of 10 questions including the preference of nature, environmental therapy, and the related choices (Table 1). From each parent consents were obtained before answering the questionnaire.

3. Statistical analysis

The data were analyzed whether the answers were different depending on the sex or symptom severity of patients with x2 test or unpaired t-test using PASW Statistics 17 program. Statistical significance was considered when p value was less than 0.05.

Results

1. Characteristics of patients

The average period suffered from atopic dermatitis was 2.9 ± 2.9 years (male 2.9 ± 2.5 and female 2.9 ± 3.3 years). The average symptom severity justified by effect on patient’s daily life (minimum 1 to maximum 10) was 3.9 ± 2.0 (male 3.8 ± 2.0 and female 3.9 ± 2.1). No statistical difference between male and female was observed.

2. Agreement degree for the importance of environmental treatment

The average score of the agreement degree for the importance of environmental treatment was 8.7 ± 1.7 (male 8.7 ± 1.7 and female 8.6 ± 1.3). Two groups of relatively mild or severe symptoms showed similar levels of scores (8.8 ± 1.6 vs. 8.6 ± 1.9 in male, and 8.6 ± 1.8 vs. 8.8 ± 1.7 in female, Table 2).

3. Consideration of movement into the rural area and atopy-free village

55.2% of mothers had considered moving to the countryside for patients with atopic dermatitis (male 58.9% and female 51.3%). The group with severe symptoms showed higher preferences than the group with mild symptoms (62.0% vs. 58.1% in male, and 60.0% vs. 48.7% in female), while the differences were not statistically significant (p > 0.05). Regarding the movement into an atopy-free village equipped by the local government, 74.5% of parents reported that they could move to the village (male 72.8% and female 76.3%). The group with severe symptoms showed higher preferences than the group with mild symptoms (69.8% vs. 86.2% in male, p > 0.05; 71.8% vs. 91.4% in female, p < 0.05; and 70.7% vs. 89.1% in total, p < 0.01 respectively, Table 2).

4. Consideration factors in cases of movement to the atopy-free village

Regarding relocation to a country village, 94.2% of parents wanted to move there with patients, and this response pattern was the same regardless sex or symptom severity of patients (Table 2). They pointed out the educational facilities (male 50.0% and female 48.7%) and eco-environment (male 34.2% and female 37.5%) over housing facilities (male 10.1% and female 10.5%) and medical services (male 5.7% and female 3.3%) as the important factors in the decision of relocation to an atopy-free village (Fig 1). Around 70% of parents answered that they could stay in an atopy-free village for more than 1 year. No statistical difference was observed between males and females (Fig 2).

5. Need for cooperative union of organic foods

Over 90% of parents agreed with the necessity of a specialized store with organic foods for patients suffering from atopic dermatitis, and they were willing to use the store. No statistical differences were observed between males and females (Fig 3).

Discussion

Atopic dermatitis has become a frequently-discussed medical issue due to its tenacious symptoms affecting daily life but lack of effective conventional therapies. Therapeutic methods using natural environments have been growing in the late 20th century owing to the exploration of linkages between modern urban life and various diseases17). Several types of atopy camps featuring activities in forests have shown positive effects on both clinical symptoms of atopic dermatitis and immunomodulation18,19). These environment-based atopy camps have drawn major attention; however there was no survey or study to reveal the general demand for those natural therapies for families with atopic dermatitis patients.
The current study surveyed the demand for environmental therapy from the parents of atopic dermatitis patients. All parents were mothers, and most of their children were elementary school students. Regardless the sex of patients or severity of symptoms, most mothers believed that natural therapy is crucial and helpful in treating atopic dermatitis. The complex etiology and lack of eradicative treatment might have led them to be familiar with environmental therapies for atopic dermatitis. In fact, relatively nature-friendly therapies including Korean medicine are adapted for patients with atopic dermatitis20,21).
In this survey, 55.2 % of parents had considered moving to a rural area, while 74.5% of parents showed the possibility of movement to an atopy-free village which is well found in public facilities. Atopic dermatitis is generally observed in children to impair their emotional and intellectual development22). Severe symptoms impair the quality of life in children as well as their families23,24). Accordingly, incurable atopic dermatitis of children must be very stressful to their parents, thus they would prefer to move to the countryside or an atopy-free village. In regard of shifting to a new rural region, educational facilities and eco-environment are more major factors than housing facilities or medical services. Some local governments have founded atopy-free villages in the countryside, or they have conducted forest-environment therapy programs25,26). In the current survey, the preferential tendency of parents for settlement in a rural area was higher if their children’s disease status was severe, and approximately 70% of them were willing to stay there for more than one year. The severity of atopic dermatitis is generally calculated as SCORAD index by a doctor, however the information for children’ symptom of this study was obtained from their mother using a 10-point numeric scale.
On the other hand, the relationship between diet and incidence of atopic dermatitis is well known27,28). A study from the United Kingdom reported that 75% of parents who have children with atopic dermatitis opted for selective foods such as organic food29). The current survey also showed similar results in that 90% of mothers were interested to use an organic foods cooperative.
Above findings indicate the high interest in environmental therapy among parents of children with atopic dermatitis. Some therapy programs using a forest environment have shown partially positive effectiveness in the management of depression in alcoholics and quality of life in elderly hypertensive patients30,31). Two studies observed the reduction of pruritus in children with atopic dermatitis during their short stay in environment-based atopy camp or long halt in atopy free villages in the countryside15,32). In order to develop environmental therapy as an effective treatment for atopic dermatitis, there are still many tasks to be done, including multiple scientific studies for better extended evidence for clinical effect as well as its limitations.
Taken together, this study for the first time presents basic information about the demand for environmental therapy among the parents of children affected with atopic dermatitis, and this report will be helpful in developing therapeutics using the natural environment in Korean medicine.

ACKNOWLEDGMENTS

This study was supported by a grant from the Korea Institute of Oriental Medicine (KIOM, # K14272), Republic of Korea.

Fig. 1.
Factors of consideration regarding movement to an atopy-free village.
jkm-35-2-34f1.tif
Fig. 2.
Period for tenants’ residence in an atopy-free village
jkm-35-2-34f2.tif
Fig. 3.
Need of (left) and intension to use (right) organic foods cooperative
jkm-35-2-34f3.tif
Table 1.
Question Lists
1. How long your child has been suffering from atopic dermatitis?
2. How does the atopic dermatitis affect the daily life of the patient? 10-point scale; 1 indicates “not at all” while 10 “unbearably severe”
3. How do you agree with the following quote “Nature-based environmental treatment is important for atopic dermatitis” 10-point scale; 1 indicates “not at all” while 10 does “completely”
4. Have you ever considered moving to the countryside for your patient with atopic dermatitis? Yes or No
5. Would you move to a new rural area where an atopy free village is built? Yes or No
6. Do you prefer to move to the countryside with the patient? Yes or No
7. What is the most important consideration when you decide to move to an atopy-free village? 1) Educational facilities 2) Housing facilities 3) Eco-environment 4) Medical services
8. How long could you stay in an atopy-free village? 1) < 3 months 2) 3 to 6 months 3) 6 to 12 months 4) > one year
9. Do you agree that cooperative organic foods are necessary for patients with atopic dermatitis? Yes or No
10. Do you prefer to buy products from an organic foods cooperative if it is present? Yes or No
Table 2.
Subject Characteristics and Preference for Environment Therapy
Sex Number (%) Median age (range) Illness duration (year) Illness severity
Male 158(51) 8 (2~21) 2.9 ± 2.5 3.8 ± 2.0
Female 152(49) 8 (2~19) 2.9 ± 3.3 3.9 ± 2.1
Total 310(100) 8 (2~21) 2.9 ± 2.9 3.9 ± 2.0


Sex Symptom severity (≤5 or 6≥) Importance of environmental treatment Movement to countryside Movement to atopy-free village** Movement with parents

Male ≤ 5: 129 8.8 ± 1.6 58.1% 69.8% 91.5%
6 ≥: 29 8.6 ± 1.9 62.0% 86.2% 100%
Sum: 158 8.7 ± 1.7 58.9% 72.8% 93.0%

Female ≤ 5: 117 8.6 ± 1.8 48.7% 71.8% 94.9%
6 ≥: 35 8.8 ± 1.7 60.0% 91.4%* 97.1%
Sum: 152 8.6 ± 1.3 51.3% 76.3% 95.4%

Total 310 8.7 ± 1.7 55.2% 74.5% 94.2%

* indicates p < 0.05 between female ≤ 5 and 6 ≥, and

** indicates p < 0.01 between total ≤ 5 and 6 ≥ respectively.

References

1. Sturgill S, Bernard LA. Atopic dermatitis update. Curr Opin Pediatr. 2004; 16:396–401.
crossref pmid

2. Ahn K, Kim J, Kwon HJ, Chae Y, Hahm MI, Lee KJ, et al. The prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in Korean children: Nationwide cross-sectional survey using complex sampling design. J Korean Med Assoc. 2011; 54:7. 769–78.
crossref

3. Benn CS, Melbye M, Wohlfahrt J. Cohort study of sibling effect, infectious disease, and risk of atopic dermatitis during first 18 months of life. BMJ. 2004; 150:284–90.
crossref pmid pmc

4. Baek JO, Hong S, Son DK, Lee JR, Roh JY, Kwon HJ. Analysis of the prevalence of and risk factors for atopic dermatitis using an ISAAC questionnaire in 8,750 Korean children. Int Arch Allergy Immunol. 2013; 162:1. 79–85.
crossref pmid

5. Saaga-Pylak M, Pikua A, Janowska J, Jasinska A, Barnas E, Borzecki A. The occurrence of allergic illnesses among children at the pre-school age in the rural and urban area. Ann Univ Mariae Curie Sklodowska Med. 2004; 59:1. 321–4.
pmid

6. Lee SY, Kwon JW, Seo JH, Song YH, Kim BJ, Yu J, et al. Prevalence of atopy and allergic diseases in Korean children: associations with a farming environment and rural lifestyle. Int Arch Allergy Immunol. 2012; 158:2. 168–74.
crossref pmid

7. Forte WC, Sumita JM, Rodrigues AG, Liuson D, Tanaka E. Rebound phenomenon to systemic corticosteroid in atopic dermatitis. Allergol Immunopathol (Madr). 2005; 33:6. 307–11.
crossref pmid

8. O’Toole A, Thomas B, Thomas R. The care triangle: determining the gaps in the management of atopic dermatitis. J Cutan Med Surg. 2013; 17:4. 276–82.
crossref pmid

9. Kim HB, Cho YJ, Yoo KH, Kim DY, Kim JH, Kim HJ, et al. Survey on the management of atopic dermatitis. J Asthma and allergy. 2012; 32:1. 16–20.


10. Zhang W, Leonard T, Bath-Hextall F, Chambers CA, Lee C, Humphreys R, et al. Chinese herbal medicine for atopic eczema. Cochrane Database Syst Rev. 2. 2005; CD002291
crossref pmid

11. Lee J, Bielory L. Complementary and alternative interventions in atopic dermatitis. Immunol Allergy Clin North Am. 2010; 30:3. 411–24.
crossref pmid

12. Available at: http://www.recruit.news1.kr/articles/1299883


13. Available at URL: http://biz.heraldm.com/common/Detail.jsp?newsMLId=20101008000730


14. Available at URL: http://pharmnews.co.kr/news/news_content.asp?sno=45966


15. Lee NR, Kim HG, Seo KS, Son CG. Therapeutic potential of atopy-camp: a pilot study. J Korean Oriental Medicine. 2010; 31:6. 40–6.


16. Shin OS, Han MH, Park G, Jang JY. The Effect of Family Participated Healing Camps with the Application of Family Life Habit Improvement on Atopic Dermatitis. J Korean Institute of Forest Recreation. 2013; 17:3. 75–83.


17. Shin YK, Baik JH, Chae JH. Application of Environmental Therapy: Focused on Forest Therapy and Hydrotherapy. Korean J Stress Research. 2010; 18:2. 167–79.


18. Lee SI, Ahn KM, Lee KS, Kwon HG, Cho HJ, Kim JH. The Influence of National Park Healing Camp on Patients with Atopic Dermatitis. J Korean Institute of Forest Recreation. 2010; 14:2. 45–50.


19. Seo JC, Dong SH, Kang IS, Yeun KN, Cheong JT, Yoo Y, et al. The Clinical Effects of Forest Camp on Children with Atopic Dermatitis. J Korean Institute of Forest Recreation. 2012; 16:3. 21–31.


20. Lee SH, Yum HY. Complementary Medicine of Atopic Dermatitis. Pediatr Allergy Respir Dis. 2008; 18:4. 326–38.


21. Bo KK, Lee HJ, Kim DJ, Ha SJ, Ha HJ, Park YM, et al. Alternative Therapy for Atopic Dermatitis. Korea J Dermatol. 2001; 39:1. 16–21.


22. Gupta MA, Gupta AK, Schork NJ, Ellis CN. Depression modulates pruritus perception: a study of pruritus in psoriasis, atopic dermatitis, and chronic idiopathic urticaria. Psychosom Med. 1994; 56:36–40.
crossref pmid

23. Ben-Gashir MA, Seed PT, Hay RJ. Quality of life and disease severity are correlated in children with atopic dermatitis. Br J Dermatol. 2004; 150:284–90.
crossref pmid

24. Kim DH. Factors Associated with Parenting Stress of Mothers of School-aged Children with Atopic Dermatitis. Korean J Stress Research. 2011; 19:2. 115–21.


25. Bergmann MM, Caubet JC, Boguniewicz M, Eigenmann PA. Evaluation of food allergy in patients with atopic dermatitis. J Allergy Clin Immunol Pract. 2013; 1:1. 22–8.
crossref pmid

26. Available at URL: http://news.hankooki.com/lpage/society/200912/h2009120622044074990.htm


27. Available at URL: http://www.anewsa.com/print_paper.php?news_article=news_article&number=27319


28. Bergmann MM, Caubet JC, Boguniewicz M, Eigenmann PA. Evaluation of food allergy in patients with atopic dermatitis. J Allergy Clin Immunol Pract. 2013; 1:1. 22–8.
crossref pmid

29. Kummeling I, Thijs C, Huber M, van de Vijver LP, Snijders BE, Penders J, et al. Consumption of organic foods and risk of atopic disease during the first 2 years of life in the Netherlands. Br J Nutr. 2008; 99:3. 598–605.
crossref pmid

30. Johnston GA, Bilbao RM, Graham-Brown RA. The use of dietary manipulation by parents of children with atopic dermatitis. Br J Dermatol. 2004; 150:6. 1186–9.
crossref pmid

31. Shin WS, Shin CS, Yeoun PS. The influence of forest therapy camp on depression in alcoholics. Environ Health Prev Med. 2012; 17:1. 73–6.
crossref pmid pmc

32. Sung J, Woo JM, Kim W, Lim SK, Chung EJ. The effect of cognitive behavior therapy-based “forest therapy” program on blood pressure, salivary cortisol level, and quality of life in elderly hypertensive patients. Clin Exp Hypertens. 2012; 34:1. 1–7.
crossref pmid

33. Sung HK, Seo KS, Son CG. A Observational Study on Children with Atopic Dermatitis in Atopic-Free Village. J Pediatr Korean Med. February. 2014; 28:1. 01–06.
crossref

Editorial office contact information
3F, #26-27 Gayang-dong, Gangseo-gu Seoul, 157-200 Seoul, Korea
The Society of Korean Medicine
Tel : +82-2-2658-3614   Fax : +82-2-2658-3631   E-mail : skom1953@daum.net
About |  Browse Articles |  Current Issue |  For Authors and Reviewers
powerd by m2community