Beneficial Effects of Natural Environment Therapy for Atopic Dermatitis

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J Korean Med. 2017;38(2):1-6

Publication date (electronic) : 2017 June 30

doi : https://doi.org/10.13048/jkm.17012

Seo Kyoung Suk¹, Chang-Gue Son^2,

¹Center of counseling, Daejeon oriental hospital in Daejeon University

²Liver and Immunology Research Center, Oriental Medical College in Daejeon University

Correspondence to: Chang-Gue Son, Liver and Immunology Research Center, Daejeon Oriental Hospital of Daejeon University, 176-9, Daeheung-ro, Jung-gu, Daejeon, 34929 Republic of Korea Tel: +82-42-229-6807, Fax: +82-42-257-6398, E-mail: ckson@dju.ac.kr

Received 2017 January 26; Revised 2017 May 25; Accepted 2017 May 25.

Abstract

Introduction

Atopic dermatitis (AD) is a chronic inflammation with the pruritic skin disorder. This disease has a high prevalence rate approximately 17.9% to 11.2% for children aged 6–14 years in Korea1), and the prevalence is continuously increasing especially in developed countries2). The etiology of AD is unclear, but the contributing factors include the genetic factor, frequent exposure to air pollutions, and westernized changes of food and housing3,4).

Atopic dermatitis seriously affects quality of life in patients as well as their families5), however no radical and effective conventional therapy exist at this moment6). The emollients, ultraviolet light exposure, and corticosteroids in severe cases are three common managements7). Therefore, adapted alternative and complementary therapies or various folk-remedies have received attention from patients with AD8). Although some herbal drugs significantly improved symptom severity of AD, still those drugs haven’t been approved as a commercial therapeutics for AD9,10).

On the other hand, it is well known that AD prevalence is higher in urban areas than rural11,12). The environmental-host interactions have influence on the risk of developing allergic diseases including AD13,14). In addition, there are reports that nature-staying atopy camp reduces the atopic symptoms and blood parameters15,16). These facts strongly propose that residence with natural environment would be an important option in management of AD.

This study was aimed to examine the beneficial effects of the natural environment therapy (termed herein for the staying in natural environments with smallest conventional therapeutics as much as possible) among patients with AD who have moved from metropolis into a designed village (called as Atopy-free village) in Geumsan of South Korea.

Participants and methods

Results

1. Characteristics of participants

The average duration of staying at Atopy-free village was 27.7±19.8 months (male 20.9±16.2 and female 37.8±21.4 months). Seventy-five percent of children had at least one parent with allergic disorders including AD, allergic rhinitis or asthma respectively. In case they had brother or sister, 88.9% of children had a sibling with one of above allergic disorders (Table 1).

Table 1

Subject Characteristics

2. Improvement of pruritus and sleeping difficulty

The NRS average score for pruritus was 6.2±2.8 (male 7.2±2.4 and female 4.6±2.8), whereas the pruritus severity was significantly improved into 4.8±1.8 (p<0.05, male 4.9±2.1 and female 4.5±1.4) respectively. The sleeping difficulty was also improved significantly from 5.7±2.9 (male 7.1±2.3 and female 3.8±1.8) to 4.3±2.2 (p<0.05, male 4.6± 2.4 and female 3.5±2.5) respectively (Fig. 1).

Fig. 1

NRS score between before and after of movement into Atopy-free village. For pruritus and sleeping difficulty, patients scored the changes of symptoms using a numerical self-rating scale (NRS) between before movement and during recent one month. *indicates p<0.05 using pared t-test.

Discussion

AD has profound impacts on patient and family quality of life, however no satisfactory preventive or treatment strategy exist. The exploration of linkage between modern urban life and various diseases resulted in attending natural environments as one of therpeutics17). Several Korean studies presented that forest activity-based atopy camps reduced AD symptoms and induced immunomodulation18,19). One survey study in Korea reported that many parents having children suffering from AD expected the beneficial effects of natural environment therapy, and 55.2 % of parents had considered moving to a rural area20).

In order to get a clue for the clinical benefit of staying in natural environments without any conventional therapeutics as much as possible (termed as natural environment therapy in this study), the present study examined the improvement of AD symptoms. The average residence period at Atopy-free village was 27.7±19.8 months (ranging from 2 to 55 months, Table 1). The pruritus is a typical symptom of AD, and it usually becomes worse at night, resulting in sleep disturbance21). The changes of pruritus and sleeping status therefore could be proper parameters for clinical assessment in AD patients. In the present study, parents reported that both pruritus and sleeping difficulty significantly reduced after movement into Atopy-free village (Fig. 1). AD generally occurs in children, which impairs the emotional and intellectual development, and then be very stressful to their parents22). Accordingly, the assessment by parents in current study would be convincing. In fact, half of AD is known to disappear in cases of early onset and mild severity, however likely present study cases, family history of atopy and severe AD are associated with poor prognosis23). The patients in our study showed high rate of family history for allergic disorders; 75% of parents as well as 88.9% of sibling (Table 1).

The Atopy-free village was founded by Geumsan city, a Korean local government. The basic strategy is living within natural environments at a countryside surrounded by mountains, and mud-timber buildings and organic food in housing and school life. The relationship between diets with incidence of AD is well known, and then organic food is believed to reduce the risk of AD24,25). All patients in present study had moved into the village from metropolises for their severe AD. They were not satisfied with conventional therapies, and quitted them. The uncontrolled AD impairs the life’s quality of patients as well as their families26,27), which they would sometimes prefer to move to a countryside.

Above findings proposes the potential of environmental therapy for children with AD. The forest environment-based programs showed partially positive effectiveness in the management in alcoholics and elderly hypertensive patients28,29). Our previous studies also observed the reduction of pruritus in children with AD during short-term environment-based atopy camp and long-term residence in Atopy-free village15,30). For assessment of the changes of AD symptoms, above studies adapted the objective tools and parameters such as score of SCORAD and EASI or serum IgE concentration respectively. In present study, the parents assessed the changes of two typical AD symptoms, pruritus and sleeping difficulty. This would be a week point of our study along with the relatively small number of participants. The parents’ assessment after observation for long term however could present the alternative evaluation of AD symptoms comparing to an examination at certain time point, because AD-related symptoms and biomarkers would be changeable depending on the time points.

Taken together, this study provides important clinical information for development of the natural environment therapy for parents of AD. There are, however, still large tasks to be done, including multiple scientific studies to extend evidence for clinical effect as well as its mechanisms.

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