The views of children and young people on the use of silk garments for the treatment of eczema: a nested qualitative study within the CLOTHing for the relief of Eczema Symptoms (CLOTHES) randomized controlled trial

Summary

Background

Many children suffer with skin diseases but to date most dermatological research has been done ‘on’ rather than ‘with’ children; in this study we actively sought the experiences of children and young people. Atopic eczema ( AE) is a chronic, itchy, inflammatory skin condition that affects around 20% of children and can impact on the health and wellbeing of children and their families. The role of specialist clothing in the management of AE is poorly understood.

Objectives

The aim of this study, which was nested in a randomized controlled trial, was to qualitatively examine child participants’ experiences of using silk garments for the treatment of AE.

Methods

Eighteen children aged 5–15 years, who took part in the CLOTHing for the relief of Eczema Symptoms ( CLOTHES) trial, participated in age‐appropriate individual interviews or focus groups.

Results

Thematic analysis generated four themes directly related to the silk garments: (i) expectations of the garments; (ii) wearing the garments; (iii) asking if the garments helped; and (iv) thoughts about the garments. The conclusions from this nested qualitative study are that there was some limited improvement in eczema for some children but that the hoped‐for ‘miracle cure’ did not transpire. A mixed picture of knowledge, beliefs and experiences of using the silk garments emerged.

Conclusions

Engaging children in the evaluation of the garments provided first‐hand nuanced insights that enhanced understanding of the CLOTHES study as a whole. This nested study demonstrates that children can and indeed want to be engaged in dermatological research in meaningful ways that add to our understanding of treatment options.

Abstract

What's already known about this topic?

• Eczema affects around 20% of children and can have a detrimental effect on the child and their family.

• Adherence with topical treatments is often poor and can lead to treatment failure.

• Although children are often end‐users of eczema treatments, they are rarely engaged in research involving these products beyond completing questionnaires.

What does this study add?

• Children and young people can be meaningfully engaged in dermatology research and add new dimensions of understanding that would not be gained by proxy data.

• Children told us about their expectations of the garments and their views once they had worn them.

• The added value of child data lies in enhancing understanding of reasons for adherence and nonadherence, in facilitating interpretation of the trial results, and in ensuring selected objective outcome measures include factors important to children.

What are the clinical implications of the work?

• This study illustrates the need to communicate effectively with children and young people to ascertain their thoughts and beliefs about treatment regimens and assess the likelihood of adherence.

Linked Comment:  Teasdale. Br J Dermatol 2018; 178:25–26 .

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