Atopic dermatitis (AD) is a common, chronically relapsing inflammatory skin disease caused by multiple genetic and environmental factors1. Long-term and persistent management of AD is necessary; therefore, AD families and society experience a significant economic burden2. The chronically relapsing nature of this disease and unsatisfactory treatment experiences cause frustration and disappointment in patients and their family members, which in turn may negatively influence the course of the disease3. However, AD families frequently do not know much about the illness or its consequences. From this point of view, one of the most important considerations is family education in the proper treatment of AD. In addition, children with AD have a fear of hospitals. Therefore, for children, it is important to reduce the fear of hospital visits.

We herein introduce an annual half-day, family-engaged educational program entitled "AD School in Daegu-Gyeongbuk, South Korea" with the slogan, "Enjoy with AD Families!" Our AD school has three characteristics that differentiate it from other AD educational programs. First, not just one organization but all of the local university hospitals came together for this program. This enabled us to easily recruit patients with AD and their family members, and to develop a sense of cooperation. Second, for maximum efficiency, educational sessions were conducted for parents only and entertainment was designed specifically for children with AD. Third, we performed on-site surveys and follow-up telephone surveys (years later) for the purpose of evaluating and improving our program. The purpose of this study is to introduce our half-day educational program for pediatric patients with AD and their family members, and to evaluate the impact of our program based on the on-site and telephone surveys.

Educational interventions have long been recommended and used as a critical adjunctive treatment method for patients with AD to enhance the effectiveness of therapy2. There are some international studies about educational programs for the management of childhood AD. The Berlin model is a well-known educational program for parents of children with AD. This program aims to improve parents' management skills with regard to their child, and to positively impact the course of the disease as well as the family's quality of life. The program consists of six 2-hour group sessions conducted at weekly intervals. Group sessions are guided by a multi-professional team of pediatricians, psychologists, and dieticians4. The Italian model is another educational program for parents of children with AD. This program consists of six 90-minute weekly meetings involving a pediatric allergist, a dermatologist, and a psychologist5. A 2-hour educational program based on the Australian model was evaluated by comparing a randomized educational intervention group with a control group, with the goal of measuring outcomes of educational interventions including severity of eczema and patient quality of life6. In addition, another Korean study showed positive effects of programmed education delivered by dermatology specialists on the management and knowledge of AD7. Overall, the aforementioned studies are positive because educational programs were shown to contribute toward a comprehensive, family-oriented approach to the management of childhood AD, and are a helpful adjunct to dermatological treatment. However, these programs were family oriented, but not family engaged.

Our AD school is a short half-day educational program for pediatric patients with AD and their families. The main purpose of our AD program is to improve knowledge about the disease, improve parents' management skills with regard to their child with AD, and to positively impact the course of the disease and the family's quality of life. Our AD school became a popular local annual event in Daegu-Gyeongbuk. Through the prick test and emollient education, children with AD and their family members received information about what to avoid and how to correctly use the emollients, which could be helpful in daily life. Educational lectures were provided to adult family members by a multidisciplinary team including dermatologists, pediatricians, psychologists, and dieticians. In contrast with other educational models, we prepared several entertaining programs for children with AD. While parents listened to educational lectures, children enjoyed a drawing contest, a movie, and snacks in another room. Because of this additional program, family members were able to concentrate on the educational lectures and children with AD were able to get to know one another better. The magic show was also prepared to encourage participation and present a positive image for the AD school.

Through on-site surveys, we verified that most participants were satisfied with our program, but that the emollient education session was not perceived as positively as the other sessions. This may be due to people being able to easily get information on how to use emollients correctly, underestimating of its importance, or dis-satisfaction with the explanation. Results from the follow-up telephone survey about overall satisfaction showed that the AD school was helpful, and 94.8% found it enjoyable. Especially in terms of management and comprehension of AD, the disease improved compared to its status before the AD school. This may be because family members not only received information from a variety of professionals, but could also ask any questions about AD. Most of the responses to the follow-up telephone survey about overall effect on life and disease progression were positive, but several parts of the questionnaire showed a pattern of neutral responding (e.g., using complementary and alternative medicine, learning attitude and ability, and the patient's relationship with friends and family members). With regard to the results about complementary and alternative medicines, almost 60% of the total Korean population has been treated by traditional Korean medicine for chronic intractable diseases like AD8. This may be because many Korean people still believe that Oriental medicine is safer than Western medicine.

There are some limitations of our AD school evaluation. First, we did not consider each patient's disease severity, so we could not evaluate improvements in the severity of the disease after AD school. Second, we did not offer a tailored program for each age group, because a relatively wide range of ages (3 to 10 years) participated in the AD school. Third, our educational team, mainly composed of dermatologists, should have been composed of professionals from a greater variety of fields. Adequate educational programs are of great value when offered in cooperation with dermatologists as well as pediatricians, dieticians, psychologists, and nursing staff2. Fourth, the follow-up telephone survey had a low response rate, but we still believe that having this follow-up is valuable. Fifth, because AD school is held only once a year, it may be difficult to change the ingrained habits of families of children with AD. To solve these problems, we are planning to utilize online communication.

In conclusion, even though our AD school for children with AD and their family members is a short half-day program, it contributes to a comprehensive, family-engaged approach to the management of AD and is a helpful adjunct to conventional, stepwise AD treatment.

Our educational program creates an ongoing and comprehensive system for promoting family engagement and improving AD treatment. Therefore, such programs should be considered for integration into routine care.