From the Journals

Naturopaths emphasize role of diet in atopic dermatitis



Allopathic and naturopathic providers use similar strategies to diagnose atopic dermatitis (AD) in children, including distribution, morphology, and pruritus, but they diverge when it comes to treatment, based on data from a small survey of the two.

Data from previous studies show that more than half of patients with AD have used complementary and alternative medicine in addition to allopathic care, but providers may be unaware of each other’s treatment approaches and confuse patients, wrote Julie Dhossche, MD, of Oregon Health & Science University, Portland, and her colleagues.

In a study published in Pediatric Dermatology, the researchers assessed results of an 11-question, free-text survey of 30 allopathic providers and 21 naturopathic providers about AD. The survey included questions on patient education and evaluation, skin care, and treatment.

Overall, both allopathic and naturopathic providers recommended skin care protocols involving moisturization and “soak and seal” bathing. However, allopathic providers were more likely to prescribe topical corticosteroids for mild to moderate disease (100% vs. 19%), followed by phototherapy and systemic treatments in more severe cases. Naturopathic providers were more likely than allopathic providers to choose topical botanicals, oils, or probiotics (52% vs. 0%) for mild to moderate disease, as well stress relief and acupuncture. Naturopathic providers favored topical corticosteroids and referrals to dermatologists for second- or third-line treatment.

Of note, 85% of naturopathic providers said they thought diet had a probable or definite role in AD, compared with 3% of allopathic providers.

In addition, naturopathic providers differed in their response to an optional question on the use of additional education about food and diet. A total of 11 of 19 naturopathic providers (58%) recommended dietary changes, including “remove potential food allergens/reduce sugar” and “emphasize anti-inflammatory diet,” the researchers said.

“Confusion regarding the role of food in AD management is a common source of frustration for patients, and perhaps a consensus statement from both fields regarding the role of food allergy in AD management could be aspired toward in the name of reducing patient confusion,” they wrote.

The study findings were limited by several factors, including the small sample size and self-selection bias, as well as the subjective nature of an open-ended survey, the researchers noted. However, the results provide evidence of differences in treatment approaches between allopathic and naturopathic providers and suggest that “respectful collaboration between allopathic and naturopathic providers will help practitioners find common ground, decrease patient confusion, and improve patient outcomes,” they concluded.

The researchers had no financial conflicts to disclose.

SOURCE: Dhossche J et al. Ped Dermatol. 2019 Nov 19. doi: 10.1111/pde.14036.

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