Mindfulness, Self-compassion Effective AD Treatment Options

Investigators evaluated the safety and effectiveness of online mindfulness and self-compassion in the setting of atopic dermatitis (AD), finding that the alternative treatment options were effective for use against the chronic skin condition.

Findings published in JAMA Dermatology demonstrate outcomes from a comparison of 2 randomized patient groups: The 56 patients in the intervention group received eight 90-minute weekly group sessions and the 51 patients in the control group were placed on a waiting list; in addition, the intervention group had access to a 5.5-hour meditation retreat or a 2-hour Zoom videoconferencing booster session, both optional. The interventions were led by a licensed clinical psychologist and encompassed mindfulness-based stress reduction and self-compassion.

This randomized clinical trial took place between March 2019 and October 2022, and the participants included all had Dermatology Life Quality Index (DLQI) score above 6. The DLQI score ranges from 0 (disease has no effect on life) to 30 (has an extremely large effect), and the DLQI was administered at baseline, midintervention (week 4), post intervention (week 9), and 4 weeks later.

The primary study outcome was change in DLQI score from baseline to week 13, and secondary outcomes included eczema severity, itch- and scratching-related visual analog scales, self-compassion, mindfulness, and psychological symptoms. Most participants were female patients (79.4%), mean (SD) patient age was 36.3 (10.5) years, and mean AD duration was 26.6 (11.7) years.

“Quality of life of patients with AD is reported to be the lowest among skin diseases,” the study authors wrote. “To our knowledge, mindfulness and self-compassion training has not been evaluated for adults with AD.”

Ninety-eight percent of the intervention group completed at least 75% of the 90-minute group sessions during the study period, and at the 13- week mark, 98.1% completed the final study assessment. Within both groups, at least 54% had a college education, 52% were single/never married, 51% worked full time, and 51% reported at least 1 outpatient clinic visit in 3 months. An overall 74.8% reported attending outpatient dermatology clinics.

The most common dermatologic treatments were moisturizer in 76.8% of the intervention group and 76.5% of the waiting list group; a topical steroid in 64.3% and 60.8%, respectively; and an antiallergic oral medication in 55.4% and 52.9%.

At the intention-to-treat analysis at 13 weeks, there was a significantly greater DLQI improvement in the intervention vs the control group: –6.34 (95% CI, –8.27 to –4.41; P < .001). In addition, quality of life in the intervention group continuously improved for the duration of the study, whereas it plateaued at week 9 for the waiting list group, for a standardized effect size at week 13 of –1.06 (95% CI, –1.39 to –0.74). A clinically important difference in DLQI score was seen in 81.5% (95% CI, 68.6%-90.7%) of the intervention group vs 33.3% (95% CI, 20.8%-47.9%) of the waiting list group, also at week 13. The intervention group also demonstrated greater adherence to medical treatment plans, being more likely to follow dermatologists’ plans.

For the secondary outcomes, all showed significant improvement in the intervention group over the waiting list group at week 13 (all least-squares mean estimates):

• Patient-Oriented Eczema Measure: 10.64 (95% CI, 8.94-12.35) vs 16.39 (95% CI, 14.63-18.16)
• Itching intensity before sleep: 2.47 (95% CI, 1.83-3.12) vs 4.72 (95% CI, 4.06- 5.38)
• Scratching intensity: 3.14 (95% CI, 2.48-3.79) vs 5.11 (95% CI, 4.43-5.78)
• Itch bothersomeness: 2.41 (95% CI, 1.77-3.06) vs 4.49 (95% CI, 3.83-5.15)
• Freiburg Mindfulness Inventory: 39.06 (95% CI, 37.18-40.94) vs 31.55 (95% CI, 29.60-33.49)
• Hospital Anxiety and Depression Scale: 4.61 (95% CI, 3.55-5.66) vs 8.16 (95% CI, 7.07-9.24)
• Internalized Shame Scale shame: 31.27 (95% CI, 27.01-35.54) vs 49.22 (95% CI, 44.79-53.64)
• Internalized Shame Scale self-esteem: 15.47 (95% CI, 14.26-16.69) vs 11.88 (95% CI, 10.62-13.15)

Only 1 serious adverse event was reported, but the investigators noted it was unrelated to the study intervention: early-stage endometrial cancer diagnosed from a surgery before their analysis.

“The present study is the first, to our knowledge, to show that group-format mindfulness and self-compassion enhances the quality of life for adults with AD,” the study authors concluded. “The mindfulness and self-compassion intervention combined with usual care enabled physiological symptoms to improve.”

Still, they see further studies as being necessary to apply the current findings to a wider audience.

“We understand the importance of a detailed path analysis for the intervention effect, and this will be within the scope of future studies,” they emphasized.

Reference

Kishimoto S, Watanabe N, Yamamoto Y, et al. Efficacy of integrated online mindfulness and self-compassion training for adults with atopic dermatitis: a randomized clinical trial. JAMA Dermatol. Published online May 10, 2023. doi:10.1001/jamadermatol.2023.0975