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Impact of social media-based follow-up nursing on itch severity and self-care in atopic dermatitis patients: A randomised controlled trial
Corresponding author: Dr. Ruimin Wang, Department of Dermatology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China. 343111368@qq.com
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Received: ,
Accepted: ,
How to cite this article: Ren C, Wang R, Ma Y, Yang Y, Ma H, Liu C, et al. Impact of social media-based follow-up nursing on itch severity and self-care in atopic dermatitis patients: A randomised controlled trial. Indian J Dermatol Venereol Leprol. doi: 10.25259/IJDVL_595_2025
Abstract
Background
Atopic dermatitis (AD) is a chronic inflammatory skin disease requiring long-term management. Traditional care models often lack continuous support post-discharge.
Aim
To evaluate the impact of social media-based follow-up nursing on itch severity and self-care in AD patients.
Methods
This randomised controlled trial included 100 AD patients assigned to either a research group (n=49, received social media-based follow-up nursing) or a control group (n=49, received conventional nursing). Itch severity (numeric rating scale- NRS), eczema area and severity index (EASI), investigator’s global assessment (IGA) and self-care ability (exercise of self-care agency scale) were assessed at baseline and 6 months post-intervention. The primary endpoint was the between-group difference in the mean change of the NRS score from baseline.
Results
At 6 months, patients in the research group showed significantly greater improvement. The mean reduction in the NRS score was 0.93 points greater in the research group than in the control group (95% CI: 0.52 to 1.34; p < 0.001). The research group also demonstrated significantly higher post-intervention total self-care ability scores (138.3 ± 9.00 vs. 111.21 ± 8.99, p<0.001).
Limitations
This was a single-centre study with a relatively short follow-up period.
Conclusion
Social media-based follow-up nursing effectively reduces itch severity and improves self-care in AD patients, suggesting its potential as a valuable tool for chronic disease management.
Keywords
Atopic dermatitis
follow-up care
pruritus
randomised controlled trial
social media
Introduction
Atopic dermatitis (AD) is a chronic, pruritic inflammatory skin disease characterised by periods of exacerbation and remission, which significantly impacts patients’ quality of life.1,2 The impact of AD is not limited to cutaneous manifestations like persistent pruritus and eczematous lesions; it pervasively affects patients’ lives by causing significant sleep disruption, psychological comorbidities such as anxiety and depression and imposes a heavy financial burden on individuals and healthcare infrastructures.3 The rising global prevalence of AD accentuates the need for effective, sustainable long-term management strategies focused on mitigating symptoms, preventing exacerbations and enhancing overall patient well-being.4
Effective AD management is inherently complex, demanding a synergistic approach that combines patient education, unwavering adherence to therapeutic regimens and crucial lifestyle adjustments. Conventional outpatient care, frequently limited by time-constrained consultations, often fails to deliver the continuous, daily reinforcement required for optimal chronic disease management. This leaves patients to independently navigate their complex care plans, often resulting in diminished adherence and suboptimal clinical outcomes. In response, network-based follow-up nursing, utilising contemporary communication technologies, has surfaced as a viable solution to close this care gap, offering accessible and prolonged support by transcending geographical and temporal constraints.5,6
Social media platforms, in particular, have become ubiquitous and offer an accessible, low-cost and interactive means of delivering continuous education and personalised support.7 This paradigm facilitates real-time dialogue, fosters peer support networks and enables the dynamic distribution of multimedia educational resources, all of which can amplify patient engagement and empowerment.8 Despite the increasing adoption of digital health tools in dermatology, rigorous research on structured, social media-driven nursing interventions for AD is still scarce. A clear need exists to assess their influence on crucial patient-reported outcomes like itch severity and self-care agency. This study, therefore, was designed to investigate the effects of a social media-based follow-up nursing intervention on these key metrics in adult patients with AD. We hypothesised that participants receiving this continuous, interactive support would achieve clinically meaningful improvements in disease control and self-management capabilities compared to those undergoing standard care.
Methods
Study design and participants
This prospective, single-centre, randomised controlled trial was conducted at the dermatology outpatient clinic of our hospital from May 2022 to May 2024. We enrolled 100 adult patients diagnosed with atopic dermatitis. Using a computer-generated random number table, patients were randomly assigned in a 1:1 ratio to either the research group (n=50) or the control group (n=50). An independent statistician not involved in patient recruitment or care generated the allocation sequence. One patient from each group was lost to follow-up due to relocation, resulting in 49 patients per group for the final per-protocol analysis. The study protocol adhered to the principles of the Declaration of Helsinki and was approved by the hospital’s Institutional Review Board. Written informed consent was obtained from all participants. Inclusion criteria were: (1) age between 20 and 60 years; (2) a confirmed diagnosis of AD according to Williams diagnostic criteria; and (3) willingness to participate and provide informed consent.9 Exclusion criteria included severe, uncontrolled systemic diseases, pregnancy or lactation, presence of other concurrent inflammatory skin diseases or diagnosed mental health disorders that could interfere with participation.
Sample size calculation
The sample size was recalculated based on the primary outcome, the mean change in the itching severity numeric rating scale (NRS) score from baseline to 6 months. Drawing from previous research, we anticipated that the mean reduction in NRS score would be approximately 3.4 points in the research group and 2.5 points in the control group, with a common standard deviation for the change score of approximately 2.0 points.10 To detect a mean difference in change scores of 0.9 points with a statistical power (1-β) of 80% and a two-sided significance level (α) of 0.05, a sample size of 40 patients per group was required. To account for a potential dropout rate of approximately 20%, we aimed to enroll at least 50 patients in each group.
Trial registration
This study was registered with ClinicalTrials.gov (Identifier: NCT07142993).
Interventions
The control group (n=49) received conventional nursing care. At discharge, a nurse provided verbal health education on AD management and distributed standardised printed materials. Patients received weekly follow-up phone calls from a liaison nurse to briefly assess their condition, answer questions and reinforce self-care advice. These calls typically lasted 10-15 minutes.
The research group (n=49) received a social media-based networked follow-up nursing intervention for 6 months, in addition to standard care. A dedicated WeChat group was created, managed by a team including a dermatologist and two specialist nurses. The intervention components included: (1) Structured education: Weekly sharing of multimedia educational content (articles, short videos, infographics) on topics such as skin care, trigger avoidance and stress management; (2) Interactive support: Daily dedicated Q&A sessions (14:30-17:00) where patients could ask questions and receive timely, professional advice; (3) Personalised care: Development of individualised care plans addressing specific patient concerns (e.g., managing intense itch, dietary advice for food allergies); (4) Remote monitoring: patients were prompted to upload photos of their affected skin weekly for assessment with feedback and treatment adjustments provided via private message within 24 hours; and (5) Peer support: The group setting facilitated communication among patients, allowing them to share experiences and offer mutual encouragement under professional moderation.
Outcome measures
Outcomes were assessed at baseline (1 hour pre-intervention) and 6 months post-intervention by trained assessors who were blinded to group allocation. Itch severity was measured using the numeric rating scale (NRS), where patients rate their worst itch in the past 24 hours on an 11-point scale (0=no itch, 10=worst imaginable itch).9 Disease severity was assessed using the eczema area and severity index (EASI), which evaluates the severity of erythema, infiltration/papulation, excoriation and lichenification across four body regions, and the investigator’s global assessment (IGA), a 6-point static scale (0=clear to 5=very severe) for an overall assessment of AD severity.11 ,12 Self-care ability was evaluated using the 43-item exercise of self-care agency (ESCA) scale, a validated tool that measures a patient’s capacity for self-management across four dimensions: self-care skills, self-responsibility, self-concept and health knowledge. A higher total score indicates stronger self-care ability.13
Statistical analysis
Data were analysed using SPSS software, version 26.0. The normality of data distribution was checked using the Shapiro-Wilk test. Continuous variables are presented as mean ± standard deviation (SD) and were compared between groups using independent t-tests. Categorical variables are presented as frequency (n) and were compared using the chi-square test. To assess the primary outcome, the mean change from baseline (post-intervention score minus baseline score) for NRS, EASI and IGA was calculated for each patient. The difference in these mean changes between the two groups was then compared using an independent t-test with 95% confidence intervals (CIs) for the mean difference reported. A two-sided p-value < 0.05 was considered statistically significant.
Results
Baseline characteristics and scores
The two groups were well-matched at baseline with no statistically significant differences observed in demographic or clinical characteristics, including sex, age, smoking status, alcohol consumption, BMI and disease duration (all p > 0.05), as detailed in Table 1. Furthermore, baseline scores for all primary and secondary outcomes were comparable between the research and control groups, confirming successful randomisation. Specifically, there were no significant differences in baseline scores for itch severity (p=0.311), EASI (p=0.378), IGA (p=0.709) or total self-care ability (p=0.927).
| Item | Research group (n = 50) | Control group (n = 50) | t/χ2 | P |
|---|---|---|---|---|
| Sex (Male) (n) | 21 | 23 | 0.162 | 0.687 |
| Age (years), Mean ± SD | 44.22 ± 9.17 | 43.76 ± 9.27 | -0.249 | 0.804 |
| Smoking (n) | 5 | 8 | 0.796 | 0.372 |
| Drinking (n) | 8 | 10 | 0.271 | 0.603 |
| Body mass index (kg/m2), Mean ± SD | 23.65 ± 2.76 | 23.29 ± 2.65 | -0.665 | 0.507 |
| Disease duration (months), Mean ± SD | 15.34 ± 3.21 | 15.67 ± 3.45 | 0.495 | 0.622 |
The statistical significance threshold is P < 0.05. Data are presented as Mean ± SD. SD: Standard deviation
Post-intervention clinical outcomes
After the 6-month intervention period, patients in the research group demonstrated significantly greater improvements in clinical outcomes compared to the control group. The mean itch severity NRS score in the research group decreased to 2.06 ± 0.66, which was significantly lower than the 2.79 ± 0.55 observed in the control group (p < 0.001) [Table 2, Figure 1]. Similarly, the research group had a significantly lower mean EASI score (2.41 ± 0.64 vs. 2.89 ± 0.58; p < 0.001) and IGA score (1.23 ± 0.87 vs. 1.79 ± 0.82; p = 0.001), indicating a greater reduction in overall disease severity [Tables 3 and 4; Figures 2 and 3]. Within-group analysis also showed that both groups experienced significant improvements from baseline, but the magnitude of improvement was substantially larger in the research group.
| Time | Research group (n = 49) | Control group (n = 49) | t | P |
|---|---|---|---|---|
| Pre-intervention (Baseline) | 5.47 ± 1.03 | 5.27 ± 0.93 | -1.019 | 0.311 |
| 6 Months Post-intervention | 2.06 ± 0.66* | 2.79 ± 0.55* | 6.008 | <0.001 |
Data are presented as Mean ± SD. SD: Standara deviation, NRS, numeric rating scale. The symbol “*” signifies a statistically significant difference compared with the baseline within the same group. Yes, the asterisk correlates with the threshold value of P < 0.05.
- Comparison of itching severity scores between the two groups. This bar chart shows the mean NRS itch severity scores at baseline and 6 months post-intervention for the research and control groups. “*”P < 0.05 compared with baseline within the same group; #P < 0.05 compared between the two groups. (NRS: Numeric rating scale.)
| Time | Research group (n = 49) | Control group (n = 49) | t | P |
|---|---|---|---|---|
| Pre-intervention (Baseline) | 5.87 ± 1.07 | 5.69 ± 0.96 | -0.885 | 0.378 |
| 6 Months post-intervention | 2.41 ± 0.64* | 2.89 ± 0.58* | 3.930 | <0.001 |
Data are presented as Mean ± SD. SD: Standard deviation *P < 0.05 compared with baseline within the same group.
| Time | Research group (n = 49) | Control group (n = 49) | t | P |
|---|---|---|---|---|
| Pre-intervention (Baseline) | 3.78 ± 0.93 | 3.71 ± 0.94 | -0.374 | 0.709 |
| 6 Months post-intervention | 1.23 ± 0.87* | 1.79 ± 0.82* | 3.312 | 0.001 |
Data are presented as Mean ± SD. SD: Standard deviation *P < 0.05 compared with baseline within the same group.
- Comparison of eczema area and severity index (EASI) scores between the two groups. This bar chart displays the mean EASI scores at baseline and 6 months post-intervention. “*”P < 0.05 compared with baseline within the same group; #P < 0.05 compared between the two groups.
- Comparison of overall evaluation (IGA) scores between the two groups. This bar chart illustrates the mean IGA scores at baseline and 6 months post-intervention. “*”P < 0.05 compared with baseline within the same group; #P < 0.05 compared between the two groups.
Comparison of change from baseline (Effect size)
To provide a more robust assessment of the intervention’s superiority, we compared the mean change in clinical scores from baseline between the groups [Table 5, Figure 4]. Crucially, the mean reduction (improvement) in the NRS itch score was significantly greater in the research group (−3.41 ± 1.01) compared to the control group (−2.48 ± 0.90) (mean difference = 0.93; 95% CI: 0.52 to 1.34; p < 0.001). Similarly, the EASI score reduction was more pronounced in the research group (−3.46 ± 1.25) than in the control group (−2.80 ± 1.11) with a statistically significant mean difference of 0.66 (95% CI: 0.18 to 1.14; p = 0.008). The improvement in the IGA score was also significantly larger in the research group (−2.55 ± 1.13 vs. −1.92 ± 1.05; mean difference = 0.63, 95% CI: 0.20 to 1.06; p = 0.005). These results confirm a more profound therapeutic effect in the intervention arm.
| Outcome score | Research group (n = 49) Mean change ± SD | Control group (n = 49) Mean change ± SD | Mean difference (95% CI) | P |
|---|---|---|---|---|
| NRS itch score | -3.41 ± 1.01 | -2.48 ± 0.90 | 0.93 (0.52 to 1.34) | <0.001 |
| EASI score | -3.46 ± 1.25 | -2.80 ± 1.11 | 0.66 (0.18 to 1.14) | 0.008 |
| IGA score | -2.55 ± 1.13 | -1.92 ± 1.05 | 0.63 (0.20 to 1.06) | 0.005 |
Data are presented as Mean ± SD. Change score = (6-month post-intervention score) - (baseline score). A negative value indicates improvement. CI, Confidence Interval. The statistical significance threshold is P < 0.05. EASI: Eczema area and severity index, IGA: Investigator’s global assessment, NRS: Numeric rating scale, SD: Standard deviation.
- Comparison of mean change in clinical scores from baseline. This bar chart illustrates the mean reduction (improvement) in NRS, EASI and IGA scores from baseline to 6 months for both groups. Error bars represent the standard deviation. *P < 0.01 indicates a significant difference in the mean change between the two groups. (EASI: Eczema area and severity index, IGA: Investigator’s global assessment, NRS :Numeric rating scale, SD: Standard deviation.)
Post-intervention self-care ability
The social media-based intervention led to a marked enhancement in patients’ self-care ability. The research group’s mean total ESCA score at 6 months was 138.3 ± 9.00, significantly higher than the control group’s score of 111.21 ± 8.99 (p < 0.001). Analysis of the sub-dimensions revealed that the research group scored significantly higher in all four areas: self-concept, self-care responsibility, self-care skills, and health knowledge level (all p ≤ 0.005), as presented in Table 6 and Figure 5. This signifies a comprehensive improvement in patients’ capacity to manage their own health.
| Indicator | Time | Research group (n = 49) | Control group (n = 49) | t | P |
|---|---|---|---|---|---|
| Self-concept | Pre-intervention (Baseline) | 21.09 ± 2.31 | 21.39 ± 2.13 | 0.675 | 0.501 |
| 6 Months Post-intervention | 24.76 ± 2.42* | 23.37 ± 2.39* | 2.890 | 0.005 | |
| Self-care responsibility | Pre-intervention (Baseline) | 13.12 ± 2.13 | 13.09 ± 2.05 | -0.072 | 0.943 |
| 6 Months Post-intervention | 18.98 ± 2.07* | 15.34 ± 2.03* | 8.878 | <0.001 | |
| Self-care skills | Pre-intervention (Baseline) | 20.34 ± 2.01 | 20.17 ± 2.07 | -0.417 | 0.678 |
| 6 Months Post-intervention | 35.12 ± 2.32* | 30.23 ± 2.34* | 10.539 | <0.001 | |
| Health knowledge level | Pre-intervention (Baseline) | 31.09 ± 2.31 | 31.15 ± 2.29 | 0.130 | 0.897 |
| 6 Months Post-intervention | 46.32 ± 2.19* | 42.27 ± 2.23* | 9.163 | <0.001 | |
| Total score | Pre-intervention (Baseline) | 85.64 ± 8.76 | 85.80 ± 8.54 | 0.092 | 0.927 |
| 6 Months Post-intervention | 138.3 ± 9.00* | 111.21 ± 8.99* | 15.058 | <0.001 |
Data are presented as Mean ± SD. ESCA: Exercise of self-care agency scale. SD: Standard deviation *P < 0.05 compared with baseline within the same group.
- Comparison of self-care ability scores between the two groups. This bar chart compares the mean total ESCA self-care ability scores at baseline and 6 months post-intervention. The orange bars represent scores 1 hour before the intervention, and the green bars represent scores 6 months after the intervention. (ESCA: Exercise of self-care agency scale). * indicates P < 0.05 compared with the baseline within the same group, and # indicates P < 0.05 compared between the two groups.
Discussion
This randomised controlled trial provides strong evidence that a structured, social media-based follow-up nursing intervention is superior to conventional care for reducing disease severity and enhancing self-care capacity in adult patients with AD. Our results underscore the value of integrating digital health strategies into standard dermatological practice to offer continuous, dynamic patient support.
The superior reduction in itch severity, EASI and IGA scores in the intervention group represents a clinically meaningful outcome. Our in-depth analysis, focusing on the change from baseline, confirmed that the magnitude of improvement was significantly greater with the social media intervention. This enhanced clinical effect is likely due to the intervention’s multi-component design. Proactive, high-quality education equipped patients with the practical skills needed to manage triggers and maintain adherence to complex regimens, while the remote monitoring component enabled early intervention, potentially averting major flares. This finding is consistent with previous research indicating that structured patient education and sustained support improve outcomes in chronic skin diseases, and our study validates social media as a powerful platform for delivering this support.14,15
A primary strength of our study is the substantial improvement observed in self-care ability. The management of AD is intrinsically dependent on a patient’s capacity to execute daily self-care routines. The interactive and supportive milieu of the WeChat group appeared to cultivate a sense of empowerment and self-efficacy. Personalised feedback on patient-submitted photos reinforced correct techniques, while the peer-to-peer support network helped mitigate the sense of isolation often experienced by those with chronic conditions. This aligns with broader evidence on the positive impact of digital health interventions on self-efficacy and self-management behaviours across various chronic diseases.16,17 Better self-care is foundational to long-term AD control, contributing to fewer exacerbations, reduced healthcare utilisation and improved quality of life.
The social media model offers distinct advantages over traditional follow-up methods like phone calls. It is less intrusive, allows for asynchronous communication and facilitates the sharing of visual information (e.g., photos of rashes) and multimedia educational resources. The creation of a peer community provides psychosocial benefits that are often overlooked in standard care models. By fostering a collaborative partnership between patients and healthcare providers, this intervention model shifts from a passive receipt of care to active self-management.
Limitations
This study has several limitations that should be acknowledged. First, it was conducted at a single centre, which may limit the generalisability of the findings to other populations or healthcare settings. Second, the 6-month follow-up period may not be sufficient to assess the long-term sustainability of the observed effects on clinical outcomes and self-care behaviours. Third, the intervention’s reliance on a specific social media platform (WeChat) may affect its applicability in regions where this platform is not widely used. Finally, while outcome assessors were blinded, patients and care providers were not, which could introduce performance bias.
Conclusion
A social media-based follow-up nursing intervention is an effective, scalable and patient-centred strategy for managing atopic dermatitis. It significantly reduces itch and disease severity while substantially enhancing patients’ self-care abilities. The integration of such digital health models into standard dermatological care holds great promise for improving long-term outcomes for patients with chronic skin conditions.
Ethical approval
The research/study was approved by the Institutional Review Board at Ethics Committee of The Second Hospital of Hebei Medical University, number 2022-01-4A, dated 08/01/2022. This study was registered with ClinicalTrials.gov (Identifier: NCT07142993).
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given consent for clinical information to be reported in the journal. The patient understand that the patient’s names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Medical Science Research Project of Hebei (20242386).
Conflicts of interest
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
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