Atopic dermatitis (AD) is a complex, chronic inflammatory skin disease, and management is largely dependent on long-term adherence to over-the-counter and prescription treatments, as well as the avoidance of environmental triggers and lifestyle stressors. Medications typically prescribed for AD address only the physical discomfort and appearance of the condition despite the fact that there are numerous comorbidities and/or triggers that lead to exacerbations. Sleep, stress, mental health status, fitness and nutrition all contribute meaningfully to patient outcomes and quality of life.
Goals in the management of AD include improving skin condition, minimizing exacerbations, and reducing comorbidities and symptom burden (i.e. sleep deprivation, the itch-scratch cycle, and mental distress). Interventions aimed at educating patients on avoiding triggers, improving the skin barrier, and reducing inflammation are central to meeting these goals.
Sidekick Health is exploring new ways to improve lifestyle and treatment adherence, and has published a protocol for a non-randomized, single arm, interventional trial assessing the feasibility and efficacy of an AD digital therapeutic and lifestyle program delivered via a mobile app. Results of this pilot study will be published at the Revolutionizing Atopic Dermatitis Conference in April 2022.
Sidekick’s AD Program Design
Sidekick’s holistic digital therapeutic program is patient-centric by design and aims to empower adults to manage and ultimately improve their mild to severe AD symptoms. Our patent-pending Adaptive CarePath™means that patients can choose their program pathway giving them a tailored, dynamic journey that supports their treatment of AD as well as other conditions they may have. Patients are empowered through education and positive habit creation to reduce symptoms and enhance their quality of life. The primary goals of the program are as follows:
Symptom Monitoring and Treatment Adherence
Because treatment adherence is the single-most important factor in reducing symptoms of AD, Sidekick’s AD program uses education and behavior-change techniques to help patients understand the importance of treatment care, as well as the connection between triggers and symptoms. The program offers treatment and medication reminders, as well as education on how critical treatment and medication adherence is.
Patients are also given the opportunity to track their day-to-day symptoms through patient-reported outcomes and a symptom tracker built into the program. Collected data can be shared with their healthcare professional, facilitating a deeper understanding of how the patient is responding to treatment in real time and in their home environment.
Atopic Dermatitis has a powerful effect on the quality of life and mental health of our patients, and psychological and lifestyle factors can also strongly influence the condition. The optimal care of Atopic Dermatitis is therefore holistic in nature, but the limited time available makes this difficult to achieve in standard clinics. The Sidekick app helps to address all of these important, wider aspects of care and so will complement and enhance medical treatments. The programme is enjoyable to use and full of useful information, and I believe it will be hugely beneficial for patients.
Dr. Natasha Harper MBChB (Hons) MRCP (Derm) (UK)
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Reducing Stress, Anxiety, and Depression
Patients with atopic dermatitis are prone to depression and anxiety, which is often linked to decreased quality of life due to sleep deprivation from the intense pruritus. Stress is also a trigger for exacerbations and can lead to increased pruritus and changes in the permeability and homeostasis of the skin.
Sidekick’s AD program is designed to address these factors through cognitive-behavioral tasks which promote stress management and thought restructuring (for example, learning to utilize stress as a benefit). Patients are taught somatic stress management techniques which include meditation and breathing exercises. The program also offers tailored self-control behavior training and habit reversal techniques for the itch-scratch cycle.
The AD program allows for two-way communication and support from coaches, as well as a community feed where patients can interact with each other should they desire to do so. Patients are educated on dealing with negative feelings and stigma and are given the tools to cope with their condition.
Improving Sleep
Sleep deprivation is a significant and often under-recognized consequence of atopic dermatitis, but the effect can be devastating for a patient. Lack of sleep can lead to attention and learning difficulties, mood disorders, daytime fatigue, and more. Sidekick’s AD program supports sleep disturbances by providing patients with relaxation therapy through mediation tasks and videos as well as comprehensive education on what to expect when nighttime itching occurs. Patients are educated on the importance of good sleep hygiene which includes using topical creams, wearing pajamas made of AD-friendly fabrics, and building a healthy sleep routine.
Helpful Nutrition
Diet plays an important part in managing inflammation. Although there is no specific diet to prevent AD symptoms, patients are encouraged to eat a healthy and balanced diet. Within the program, patients can receive feedback on nutrition through Sidekick’s food journal, with comments and recommendations from a lifestyle coach. Additionally, patients are educated on nutrition, food sensitivities and allergies, and the link to metabolic health.
Encouraging Physical Activity
AD patients tend to have a reduced exercise capacity due to stressors and daytime fatigue resulting from sleep deprivation and nighttime itching. Motivation to do physical exercise can be low. Sidekick’s AD program encourages behavior change by helping patients to identify the obstacles to doing physical activities and by providing realistic plans on how to overcome said obstacles. In-app workouts, step tracking, and active goal setting empower patients to make incremental changes and to move more.
Conclusion
Sidekick is committed to providing clinical evidence that demonstrates how a digital skin solution such as ours can support AD patients towards better health outcomes. We plan to conduct additional studies to further investigate how an AD digital therapeutic program can drive better health outcomes for AD patients.
Resources
1 Weidinger S, Beck LA, Bieber T, Kabashima K, Irvine AD. Atopic dermatitis. Nat Rev Dis Primers. 2018;4(1):1. doi:10.1038/s41572-018-0001-z
2 Boguniewicz M, Fonacier L, Guttman-Yassky E, Ong PY, Silverberg J, Farrar JR. Atopic dermatitis yardstick: practical recommendations for an evolving therapeutic landscape. Ann Allergy Asthma Immunol. 2018;120(1):10-22.e2. doi:10.1016/j.anai.2017.10.039
3 Eichenfield LF, Tom WL, Chamlin SL, Feldman SR, Hanifin JM, Simpson EL, Sidbury R. Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol, 2014;70(**2), 338-351. https://doi.org/10.1016/j.jaad.2013.10.010
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