Multi-band optical coherence tomography platform for the development of novel atopic dermatitis treatments.

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Atopic dermatitis (AD - also known as eczema) is a skin disease that is greatly underestimated both in its prevalence and in its negative effects both on sufferers. The physical sensation of trying to sleep whilst experiencing a severe eczema "flare" has been likened to putting on a wet-suit that is stuffed with stinging nettles, zipping it up and then lying down to try to sleep. AD first affects the very young, with symptoms often appearing in the first 6 months of life and persisting through school years. Having open, weeping sores on the skin can cause children to have serious emotional problems at school and the lack of sleep from severe nighttime itching leaves children exhausted, unable to concentrate and thus unable to keep up. In severe attempted suicide is not uncommon, even in children under 10 years of age. The burden on carers is similar to that from children who need e.g. to be fed through a tube at home. Yet AD is a very common condition, affecting up to 30% of children in the UK and up to 10% of all adults. The UK has one of the highest rates of AD in the world and the disease is the commonest reason for consulting a GP about a skin complaint. AD is a "disease of the modern world": rates of AD have increased dramatically since the 1940's, suggesting that an increase in external irritants is a major factor. AD belongs with asthma and hay fever in being primarily an "allergic" reaction. The financial burden of AD on the health service arises because it is the first step along the "atopic march", where a child with AD very often progresses on to one of these other conditions. Despite its potential severity and high prevalence, AD has been neglected as a priority for developing treatments. The most commonly prescribed treatments (moisturizing creams and steroid creams) are over 50 years old. Steroid creams are very effective for calming inflammation and itching but come with serious problems. Sufferers can become dependent on them (steroid addiction) but at the same time they gradually damage the skin ("skin thinning"). Many carers suffer from "steroid phobia" and under-treat children; this causes AD flares to be poorly controlled which then requires even more steroid cream to be used later. The last 5 years has seen this regretable situation begin to completely transform however. New treatments are being brought to market which control inflammation and itching with potentially far fewer side-effects than steroid creams. The companies developing these treatments urgently require objective tools that can assess the skin before, during and after use so that they can reliably measure how well the treatments suppress AD flares and avoid causing skin damage. During a previous EPSRC project we applied an emerging imaging tool, optical coherence tomography (OCT), to AD patients and normal volunteers and found it to be potentially an ideal tool for this purpose. Such was the interest in our work from major drug companies that we are actively collaborating with them to use existing OCT techniques to evaluate 3 new types of AD treatment. At the same time at Sheffield we have a unique collaboration between dermatologists and OCT engineers who can see even greater potential for more advanced OCT techniques to be applied. This HIPS project is a unique partnership between clinicians, engineers and drug companies which will develop cutting edge OCT tools and assess their effectiveness in assessing new AD treatments. The potential impact in healthcare is enormous because of the huge demand for these new treatments. If successful we will develop an advanced OCT scanner that can immediately be used to help in the clinical evaluation of new and emerging treatments for this highly distressing disease.