Date of Completion

5-1-2023

Document Type

Open Access Capstone

Degree Name

Doctor of Nursing Practice (DNP)

Faculty Advisor

Eileen Stuart-Shor

Site Advisor

Rebecca Greco

Second Reader

Christine Salvucci

Abstract

Background: There is emerging interest in alternative approaches to treating children with eczema because there is currently no allopathic cure. Non-pharmacological approaches are regarded as generally safe, well tolerated, and cost effective. Eczema is a chronic, relapsing inflammatory, itchy skin condition that adversely affects quality of life in many individuals, including children. Eczema interferes with sleep, leads to secondary skin infections, and causes intractable itching. Topical steroids are the current standard of practice in treating patients but, evidence suggests that they can cause unwanted side effects and can lead to serious systemic reactions. The purpose of this quality improvement project was to improve the quality of life and symptom management in children in the pediatric outpatient setting who have sub-optimally controlled eczema by implementing an eczema pathway that standardizes the use of probiotics as treatment.

Methods: Based on available knowledge, the most frequently identified alternative treatment modality to introduce for eczema patients in the literature was probiotics. The project was carried out at a holistic pediatric practice in an urban setting in Texas.

Intervention: Probiotics were introduced to pediatric patients (ages 0-15 years) with sub-optimally controlled eczema. To evaluate patient symptoms, quality of life, and adherence, a modified Patient Oriented Eczema Measure (POEM) questionnaire was completed by the parent/child dyads before the intervention and every four weeks during the 12-week implementation period.

Results: During the 12-week implementation period, 17 pediatric patients participated in the project. There were more males (n=10, 58.8%) than females (n=7, 41.2%). A baseline POEM questionnaire was obtained to track clinical progress, and a pre/post change score and percent improvement were calculated at the end of the project. The overall mean percent improvement in symptoms was 64%.

Conclusion: The initiation of probiotics was accompanied by a reduction in self-reported eczema symptoms and an improvement in quality of life in 82% of the participants. Ninety-four percent of patients took the probiotic without any noted side effects. The greatest improvement occurred in children with moderate to very severe symptom burden at baseline.

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