Educational Interventions for the Management of Children with Dry Skin

Abstract

This chapter highlights the importance of the education of patients and parents of children with dry skin, especially when chronic. Education is the primary means to address the problems of treatment adherence and the common lack of knowledge, skill and confidence required to largely self-manage this problem. The need to give attention to appropriate daily skin care routine of the parent/child and integrate moisturizer use within this practice is highlighted. The chapter reinforces the importance of structured education, parental involvement within the educational process and their confidence in the process as key success elements. The nature of educational interventions is examined, including the format, timing, rationale and location of the educational process with illustrations of common and new practices, resources and key messages. A summary is given of some of the key evidence on the educational process related to managing dry skin, especially in the case of eczema. Evidence-based education for effective moisturiser use the treatment of dry skin in the absence of other skin disease. Some suggestions for further research are given. Finally, the key learning points are summarised.

Appendices

Appendix 1

Guidance on reducing skin irritation through effective skin care
Wash all new clothes before wearing them. This removes irritating chemicals, such as formaldehyde
Add a second rinse cycle to ensure removal of detergent. Residual laundry detergent, particularly accompanying perfume or dye, may be irritating when it remains in the clothing. Changing to a liquid and fragrance-free, dye-free detergent may be helpful. Some liquid detergents are branded as being suitable for ‘sensitive skin’ but such claims needed to be tested in practice for the individual
Wear garments that allow air to pass freely to your skin. Open weave, loose-fitting, cotton-blend clothing may be most comfortable
Work and sleep in comfortable surroundings with a fairly constant temperature and humidity level. Adequate ventilation is important
Fingernails should be kept very short and smooth to help prevent damage due to scratching
Carry a small tube of moisturizer/sunscreen at all times. Such a separate supply of moisturizer enables regular access for application throughout the day when at school or work. For young children, other carers, such as those at play group, need to be instructed in effective application
Shower or bathe after swimming in chlorinated pool or using hot tub using a gentle cleanser to remove irritating chemicals and then apply moisturizer

Adapted from National Jewish Atopic Dermatitis Program Step-Care ‘AD Action’ Plan. ([24], p. 8)

Take Home Messages

• Behaviour of the parent and their child who have dry skin has a significant impact on the effectiveness of moisturizer use, especially when the condition is chronic.

• Consumers with dry skin are often unsure how to effectively manage their condition.

• Planned and systematic education is an essential preparation for the effective self-management to ensure parents and or their children with dry skin have the knowledge, skill and confidence that underpins effective treatment adherence.

• Generic information invariably needs to be adapted for the individual child and family.

• Management of dry skin, especially when chronic, requires moisturization to become a part of routine skin care and hygiene.

• Effective adherence to the use of moisturizers depends on the adoption of a concordance approach to consultations in which patient beliefs and preferences are taken into account in the decision-making process.

• Educational interventions vary according to how they are delivered (format), when, why and where this takes palace. Each element requires consideration within the planning of the educational process.

• Parent’s self-efficacy, akin to confidence in the management process, is an important factor affecting their effective use of moisturisers.

• Evidence on the educational process related to moisturiser use is limited – but indicates the different models by which health professionals can deliver education and variation on the components described above (how, when, etc.). Attention needs to be given to the importance in the variation of these components (e.g. technological versus paper-based) and a comparison of different service delivery models within the health system, when managing chronic dry skin.