| Popis: |
Modern therapeutic concepts for atopic eczema reflect the multifactorial background by individual, complex and interdisciplinary measures. Aim of the present study was to determine long-term effects in patients who were treated according to the Schwelm concept by taking objective and subjective outcomes into account. The concept of the Schwelm therapeutic model is based on an ambulant group therapy focussing on areas of allergy, nutrition, education and prevention, and psychotherapy. Between 1990 and 1991, a total of 70 patients were treated in Schwelm. Fourty-four of these patients (response 63%, 25 children < 14 years) could be followed for up to 9 years. At all points of examination (TO = inclusion, T1 -3 = after 1, 4 and 9 years), extent as well as severity of typical morphological changes and itching were recorded. In addition, use of the medication for the examination intervals was determined. Relevant blood parameters like total IgE, leukocytes and eosinophilic granulocytes were determined at inclusion and after 1 year. Non-parametric statistics for paired samples were used. In the group of children, the percentage of affected skin surface decreased from 46% in the beginning to 14% after I and 6% after 9 years (p < 0.001 ). Similarly, the results for itching (5.8, 1.4, 1.0), erythema (6.5, 1.8, 1.3), scaling (4.0, 1.5, 0.4), erosion (5.4, 1.8, 1.5) and infiltration (6.0, 1.9, 0.6) were significantly reduced after 1, 4 and 9 years, respectively (p < 0.01). The use of external corticosteroids decreased from 50% to 8.3% over the entire observation period (p = 0.002). Similarly, the use of anthistamines decreased from 16.7% to 12.5%, but without statistical significance. In the group of adults, the affected skin surface decreased from 43% (TO) to 3% (Tl) (p < 0.01) after 1 year and increased slightly thereafter (14%, T3, n.s.). The results for itching (9.8, 1.5, 1.8), erythema (7.1, 1.1. 1, 1.7), scaling (5.9, 3.0, 0.8), erosion (4.7. 0.9, 1.7), and infiltration (4.6, 0.4, 1.5) decreased also significantly after 1, 4 and 9 years, respectively (p < 0. 01). A marked reduction of the use of external (58% vs. 16%, p = 0.02) and internal corticosteroids (21% vs. 5%, n.s.) was reported. The use of antihistamines in adults remained unchanged over the observation period (21%). No significant change was observed for any of the laboratory parameters. The interdisciplinary therapeutic concept yielded a significant and long-lasting reduction of objective and subjective symptoms of atopic eczema and could thereby reduce the need for side medication. |
