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Childhood eczema is an inflammatory skin disease that causes major disruption of the quality of life of children and their parent caregivers. Repeated relapse and unpredictable outbreak of the disease not only create emotional disturbance for children, but also induce tremendous stress and caregiving burden for the parents. Although previous research studies suggest that disease management and psychosocial support programs can significantly improve the situation, the outcome of the interventions remain inconclusive. One major reason is the accuracy of the measurement tools as all existing programs rely on self-administered questionnaires completed by parents and children. Despite the effect of social desirability, literacy and education level of children can further fabricate the veracity of the measurement tools, hence the result of the research studies.
The current study aims to identify a biomarker measurement mechanism based on blood sample of children with eczema when assessing the severity of the disease, and examine its relationship with the quality of life of the children and their parent caregivers.
Methods
A total of 219 children with mild to moderate level of eczema and their parent caregivers were invited to complete an inventory of questionnaires on their psychosocial conditions. For children participants, Patient Oriented Eczema Measure (POEM), Paediatric Allergic Disease Quality of Life Questionnaire (PADQLQ), Children’s Dermatology Life Quality Index (CDLQI) were used to measure their disease severity and overall quality of life. For parent participants, Dermatitis Family Impact (DFI), Perceived Stress Scale (PSS), Patient Health Questionnaire (PHQ9), Generalised Anxiety Disorder (GAD7) and Holistic Wellbeing Scale (HWS) were used to measure their stress, depression and anxiety level, family function and overall quality of life. Furthermore, blood samples were drawn from the children participants, and six inflammatory biomarkers including Immunoglobulin E (IgE), Interleukin1 beta (IL1beta), Interleukin 4 (IL4), Interleukin 6 (IL6), Interleukin 10 (IL10), and Transforming Growth Factor-beta 1 (TGF-beta1) were examined with the psychosocial parameters.
Results
Significant associations were identified between IgE and POEM (r=0.2689, p<.05), IL4 and CDLQI_school (r= -0.2155, p<.05), IL4 and CDLQI_relationship (r= -0.2360, p<.05), IL4 and POEM (r= -0.2321, p<.05), IL6 and CDLQI_sleep (r=-0.2795, p<.05), IL6 and HWS_non-attachment (r=0.2067, p<.05). Further analysis using Linear Mixed Model suggested a strong association between POEM and IgE (p<.05), IL4 (p<05) and IL10 (p<0.5). Marginal associations were also found between IgE and CDLQI (p=.089), PADQLQ (p=.055) and DFI (p=.078). Multiple linear regression, however did not report any predictors for the quality of life of children and parents.
Conclusions and Implications
The inflammatory biomarkers are found to be associated with the quality of life of children, family functioning and parents’ quality of life. Result of this research study identifies a more objective and accurate measurement of the severity of disease and the psychosocial parameters for children which can reduce the biases due to self-reporting questionnaire. The association between children biomarkers and parents’ quality of life also indicates the interdependence of the psychosocial wellbeing between children and parents, which should be carefully considered when designing social work intervention programs for children with eczema in future.