reviewed by
Sigríður Lára Guðmundsdóttir and Judit Mészáros
Living with Atopic Dermatitis
It is estimated that more than 26 million Americans suffer with AD and the disease can cause not only debilitating pruritus, but also disturbed sleep patterns and mental distress. These knock-on effects can have substantial socioeconomic implications too: up to half of all adults with AD say they experience lifestyle limitations and/or have had their work or education negatively impacted by the burden of the disease.
Sidekick recognizes the widespread implications for a patient diagnosed with AD and that dermatological conditions require sustained, holistic support to achieve effective control and comfort for the patient, but limited data are currently available regarding the feasibility and effectiveness of digitally delivered lifestyle intervention for AD patients.
Sidekick has therefore developed a holistic DTx and lifestyle program to support healthy lifestyle behavioral change and to empower patients with AD to manage and ultimately improve their symptoms. The program is delivered via a smartphone app and provides education and medication reminders, allows the user to track symptoms, and offers communication with a lifestyle coach and dermatology nurse.
Initial results from a pilot study presented at the Revolutionizing Atopic Dermatitis Conference are positive and demonstrate feasibility of this digital therapeutic solution, and show real promise for real-world use.
Study Design
- A single arm, interventional feasibility study over six weeks.
- A cohort of 21 adult patients with mild to severe AD were recruited, who were all using some form of topical medication (e.g. corticosteroid containing creams and emollients).
- Patients were asked to use a therapeutic program delivered via a smartphone app that provided daily medication reminders, symptom tracking, one-to-one communication with a dermatology nurse and lifestyle coach, and disease and trigger education to support positive habit formations.
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Outcome Measurements
Engagement, retention and PROs relating to sleep, stress and energy levels were gathered in the app throughout the six-week period. Sleep, stress and energy levels were measured three times per week.
Clinical outcomes were also measured via several questionnaires and scoring indices at baseline and post-treatment:
- Eczema extension and severity and subjective problems with itching and sleep were assessed by dermatologist and scored according to the Scoring Atopic Dermatitis (SCORAD)
- Frequency and subjective severity of AD related symptoms were measured by Patient-Oriented Eczema Measure (POEM)
- Quality of life was measured by Dermatology Life Quality Index (DLQI)
- Adherence to guidelines and preventive measures was evaluated by a six-question survey
At follow up, patients were also asked on their experience of the usability of the app using the MAUQ User Satisfaction Questionnaire.
Results
The participants were on average relatively healthy young adults (median age of 31, mean BMI of 25.7, 95% non-smokers, and 71% university-educated). They were also highly engaged as they used the app nearly every day (median of 6.5 days per week). Over the six weeks, Sidekick users saw on average:
- an improvement in eczema severity,
- an improvement in symptom severity,
- a significant improvement in overall quality of life, and
- an improvement in energy levels as measured in-app.
We also found an overall increase in adherence to treatments and preventive measures, as patients reported using skincare medication and avoiding triggers more regularly. Importantly, those patients who reported never learning methods for relaxation, seeking AD-related advice or education at baseline, changed their behavior to do these activities more regularly after the program. Patients who paid more attention to their skincare saw significantly larger improvements in their symptoms and they also tended to have higher program engagement.
Patient-centric education and support programmes are immensely important for the holistic management of patients with dermatological disease, especially programmes which recognize the importance of patients’ psychological wellbeing. The app developed by Sidekick is a great way of empowering patients through the app’s programmes and modules.
Prof. Anthony Bewley BA (Hons) FRCP (UK)
Conclusion
Patients with AD showed high engagement with the Sidekick app in this six-week study. Our findings suggest that an AD-specific digital therapeutic can help with behavioral change through disease and trigger education and increased awareness, which then may lead to improved clinical outcomes. Thus, patients can benefit from a multidisciplinary approach offered by Sidekick – one that targets multiple elements of disease management such as nutrition, sleep, stress, medication, mindfulness, and more.
Following the success of this pilot study, further clinical trials will be planned to bolster data on the use of the program in supporting people diagnosed with AD. The pilot study has identified areas for refinement of the DTx program to improve clinical efficacy, and has provided opportunities for future randomized controlled trials.
Sidekick is confident that the positive initial results from this study will help realize our vision for the rollout of an AD DTx and lifestyle program as a core therapeutic, empowering patients to monitor and manage their skin condition and overall health. With a comprehensive treatment plan in place, focusing on more than just pharmacological suppression of physical symptoms, the psychological wellbeing of patients can be improved too, boosting their overall quality of life.
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About the author
Nessie Riley is a medical writer, veterinarian, and advocate for accessible healthcare for all.
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