Eczema studies aim to improve life for adults and young people

•    ‘Mind and skin’ programme aims to investigate the impact that eczema often has on sleep and mental health in 12 to 18 year olds 
•    BEACON trial will directly compare three of the most commonly prescribed eczema treatments for the first time to determine which is the most effective

Two major eczema studies are underway at Guy’s and St Thomas’ which will help improve the quality of life for people who have this common, often debilitating skin condition.  

Eczema is the commonest inflammatory skin condition, affecting around 20 per cent of children and adolescents and 10 per cent of adults in the UK. It is strongly linked to severe impacts on quality of life, as well as psychological and psychiatric illnesses, such as anxiety and depression.

The ‘Mind and Skin’ programme is bringing the modern sleep lab into patients’ own homes to investigate the profound impact that eczema often has on sleep and mental health in children and young people.

Led by Professor Carsten Flohr, the study will compare datasets from three groups of 12 to 18 year olds: healthy adolescents, those with eczema who only receive treatments which are applied to the skin (such as creams), and those with severe eczema who take drug treatments that change the body's immune response (known as immunomodulatory medication).

Participants in the study will have one night of polysomnography testing, the gold standard for diagnosing sleep disorders. This is then followed by 10 nights of sleep monitoring using sleep devices at home which can be easily worn.

Alongside the sleep assessments, researchers will use functional MRI scans to investigate whether brain structure and function and thought processes are affected by eczema-related sleep disturbance and inflammation. Participants will undergo measurements of brain activity, an IQ test, skin barrier assessments and attention span tests amongst others.

Professor Flohr, honorary consultant in dermatology at St John’s Institute of Dermatology at Guy’s and St Thomas’, said: “Our ‘Mind and Skin’ study will investigate how eczema and itching causes sleep disruption and a disrupted body clock and how this might lead to inflammation in the blood stream and even in the brain. This may then also explain why so many of our patients have anxiety and depression.” 

The study is funded by the Medical Research Foundation and brings together a unique range of collaborators from dermatology, children’s sleep medicine and brain imaging, as well as experts in circadian rhythm, cognitive function and brain inflammation from the Institute of Psychiatry, Psychology and Neuroscience at King’s College London, the Universities of Surrey and Oxford. 
 
The long-term aim is to develop new strategies to help better manage eczema and the related sleep disturbance, and potentially prevent the knock-on psychological effects. 
 
Jasmine, 15, is one of the participants in the study. She has had eczema for as long as she can remember.
 
She said: “Eczema has impacted on every part of my life so I thought it would be nice to help find out more about it. I am keen to find out about the correlation between the different aspects of my eczema – both the itching I experience as well as the problems that this is causing with my sleep.”

The BEACON trial, led by Professor Catherine Smith and Dr Andrew Pink from Guy’s and St Thomas’ and King’s College London, will directly compare the three most commonly prescribed oral and injection eczema treatments (known as systemic treatments) for the first time to determine which is the most effective, has the least side effects and is most cost-effective for the NHS. More than 400 participants will take part in the trial, which has been designed in collaboration with eczema patients and the National Eczema Society (NES) and will include more than 30 hospitals across the UK, from Exeter to Dundee.

The trial will compare a tablet treatment, ciclosporin, and two injection treatments, methotrexate and dupilumab (the latter of which has only been available in the NHS for a few years), in adults with moderate to severe eczema.

Each participant will be randomly assigned one of the treatments for 12 months. Although they will know which treatment they are receiving, the clinician assessing their eczema will not, to avoid bias. Participants will attend 7 hospital check-ups throughout the year and will increase and decrease doses and switch treatments during the trial, in line with routine clinical care. The success of different treatments will be determined by examining the skin and asking participants about key symptoms (e.g. itching) and impact on quality of life, daily function and mood.

BEACON has been designed so that it can become a ‘platform’ trial, meaning that new systemic treatments can be incorporated over time. 

Dr Pink, consultant dermatologist at St John’s Institute of Dermatology, which is based in Guy’s Hospital, said: “This ambitious trial will provide a comprehensive comparison of the effectiveness of three key drugs used to treat more severe eczema and enable the addition of emerging therapies in the future. The results have the potential to transform treatment pathways for eczema patients by helping to determine the best treatment first time and minimise switching between drugs.”

Tim Burton, who has had severe atopic eczema for more than three decades, has helped shape the trial as part of the patient involvement panel. 

He said: “This trial will take out some of the guesswork that comes with prescribing as it will mean clinicians can better understand what the most appropriate drug is for each patient.” 

The trial is funded by the National Institute for Health Research (NIHR) and brings together experts from Guy’s and St. Thomas’, Kings College London, UCL Clinical Trials Unit, University of Nottingham and the UK Dermatology Clinical Trials Network. 

Both eczema studies are looking for volunteers to take part. The Mind and Skin researchers are seeking healthy 12 to 18 year olds who have no diagnosis of eczema, do not wear braces and no history of sleep disorders for their control group. For more details, email [email protected].

The BEACON team are looking for adults with more severe eczema requiring systemic treatment (those taken by mouth or injection). Patients do not need a GP or specialist dermatology referral to take part. They can self-refer by visiting www.beacontrial.org/contact and the central study team will refer them to their nearest participating hospital.