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

特应性皮炎（AD，也称为湿疹）是一种皮肤病，其患病率和对患者的负面影响都被大大低估了。在经历严重湿疹“发作”时试图入睡的身体感觉，被比作穿上一件塞满荨麻的潜水衣，拉上拉链，然后躺下试图入睡。阿尔茨海默病首先影响非常小的人，症状通常出现在生命的前6个月，并持续整个学年。皮肤上有开放的、流泪的疮会导致孩子在学校出现严重的情绪问题，严重的夜间瘙痒会导致孩子睡眠不足，使他们疲惫不堪，无法集中注意力，从而无法跟上学习。在严重的情况下，自杀未遂并不罕见，甚至在10岁以下的儿童中也是如此。护理人员的负担类似于需要在家通过管子喂食的儿童。然而，阿尔茨海默氏症是一种非常常见的疾病，影响着英国多达30%的儿童和10%的成年人。英国是世界上阿尔茨海默病发病率最高的国家之一，这种疾病是人们向全科医生咨询皮肤问题的最常见原因。阿尔茨海默病是一种“现代世界的疾病”：自20世纪40年代以来，阿尔茨海默病的发病率急剧上升，这表明外部刺激物的增加是一个主要因素。AD与哮喘和花粉热一样，主要是一种“过敏”反应。阿尔茨海默病给卫生服务带来的经济负担，是因为它是“特应性病程”的第一步，患有阿尔茨海默病的儿童往往会发展为上述其他病症之一。尽管其潜在的严重性和高患病率，阿尔茨海默病一直被忽视作为开发治疗的优先事项。最常用的治疗方法（保湿霜和类固醇霜）已有50多年的历史了。类固醇药膏对缓解炎症和瘙痒非常有效，但也会带来严重的问题。患者可能会对它们产生依赖（类固醇成瘾），但同时它们也会逐渐损害皮肤（“皮肤变薄”）。许多护理人员患有“类固醇恐惧症”，儿童得不到充分治疗；这导致阿尔茨海默病的耀斑控制不佳，随后需要使用更多的类固醇霜。然而，在过去的5年里，这种令人遗憾的情况开始彻底改变。新的治疗方法正在推向市场，这些治疗方法可以控制炎症和瘙痒，而且副作用可能比类固醇药膏少得多。开发这些治疗方法的公司迫切需要客观的工具，可以在使用之前，期间和之后评估皮肤，以便他们可以可靠地测量治疗如何抑制AD耀斑并避免造成皮肤损伤。在之前的EPSRC项目中，我们将一种新兴的成像工具，光学相干断层扫描（OCT）应用于AD患者和正常志愿者，并发现它可能是实现这一目的的理想工具。大型制药公司对我们的工作很感兴趣，我们正在积极与他们合作，使用现有的OCT技术来评估3种新型AD治疗方法。与此同时，在谢菲尔德，我们在皮肤科医生和OCT工程师之间进行了独特的合作，他们可以看到更先进的OCT技术应用的更大潜力。这个HIPS项目是临床医生、工程师和制药公司之间的独特合作伙伴关系，他们将开发尖端的OCT工具，并评估其在评估新的AD治疗方法中的有效性。由于对这些新疗法的巨大需求，对医疗保健的潜在影响是巨大的。如果成功，我们将开发一种先进的OCT扫描仪，可以立即用于帮助临床评估这种高度痛苦的疾病的新疗法。

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.