For children and young people, skin conditions can have a devastating impact on physical and mental well-being, but effective treatments are scarce.
That’s why the Medical Research Foundation is committing £1 million in new funding to help advance scientific understanding of these conditions, which could ultimately lead to better support and treatment for children and young people with skin conditions.
Skin conditions can negatively impact all aspects of life, from schooling and relationships to career and lifestyle choices. Adolescence, in particular, is a time of self-consciousness, self-doubt, and excessive concern about appearance and physical attractiveness. It represents a critical period in physical and psychological development, which is why skin conditions – which are common in this age group – can have such a lasting impact.
According to a 2020 survey by the All Parliamentary Group on Skin, 98 percent of patients with a skin condition report that their condition affects their emotional and psychological well-being, while only 18 percent have received some form of psychological support.
New research, led by scientists from King’s College London and Newcastle University, will examine two skin conditions in particular – eczema and ichthyosis – that are known to have a profound impact on quality of life.
Understanding the link between severe itching, sleep disturbance and brain function in eczema – Professor Carsten Flohr, Chair in Dermatology and Population Health Sciences at King’s College London and Honorary Consultant in Dermatology at St John’s Institute of Dermatology, Guy’s and St Thomas’ NHS Foundation Trust
Eczema is an inflammatory skin disease that affects 20 percent of children and 8 percent of adults. It is strongly linked to serious impacts on quality of life, as well as psychological and psychiatric illnesses such as anxiety, depression and ADHD (attention deficit hyperactivity disorder).
Eczema often starts before age two, and affected babies can develop poor sleep habits early. Eczema persists into adolescence or adulthood in about 30 percent of cases, meaning people with eczema can suffer from itchy skin and disrupted sleep for much of their lives.
Poor quality sleep affects memory, concentration and mood, and poor quality sleep has been associated with poorer educational outcomes in healthy children and young people.
Crucially, children and adolescents with eczema who do not have a sleep disorder do not have a significantly higher risk of ADHD than the general population, while for children and adolescents with eczema and sleep disorder, the risk of ADHD is 40-50 per year. cents higher than those without eczema. This suggests that sleep disturbances themselves may be associated with psychological and cognitive problems.
However, researchers do not fully understand the links between eczema, itching and psychological problems. Professor Flohr and colleagues propose that chronic inflammation in the skin and blood, leading to sleep disturbances and inflammation in the brain, is likely a major cause of these psychological problems.
To test this theory, Professor Flohr will study patients aged 12-18 from the Pediatrics Severe Eczema Clinic at St Thomas’ Hospital and King’s College London, comparing adolescents with eczema to healthy adolescents and to children and young people with ADHD.
The researchers will investigate whether brain structure and function, and thought processes, are influenced by sleep disorders and inflammation. This includes assessments using sleep diaries and gadgets, brain activity measurements and blood tests to measure changes in the circadian rhythm (the body’s natural clock). Professor Flohr and colleagues will also examine the lived experience of sleep disturbances associated with eczema, as well as its cognitive and psychosocial impact.
We think the mental health problems seen in children and young people with eczema may be partly explained by chronic inflammation in the skin and blood, leading to sleep disturbances and inflammation in the brain. Thanks to funding from the Foundation, we will be able to address this theory, with the aim of developing long-term strategies to better manage sleep disorders. This could potentially prevent the domino-psychological effects we see in children and young people with eczema.”
Professor Carsten Flohr, Chair of Dermatology and Population Health Sciences at King’s College London
Research into severe forms of the genetic condition ‘ichthyosis’ – Dr. Neil Rajan, Senior Lecturer and Honorary Consultant Dermatologist, Newcastle University
There are many different types of ichthyosis, but all have the development of inflamed, scaly skin.
Ichthyosis can be inherited (genetically) or acquired during life. The inherited forms are rare, generally present from childhood, and are usually lifelong conditions. Acquired ichthyosis can develop at any age due to a number of medical problems, such as kidney disease.
Unlike skin conditions such as eczema, which is often blotchy and comes and goes with time, in ichthyosis the scaling is present throughout life and usually affects the entire body. Ichthyosis patients can face harassment, discrimination and uncomfortable symptoms that are often relieved only by time-consuming treatments — all of which can have a marked impact on mental health.
Researchers know that genetic ichthyosis can be caused by changes in DNA that affect skin cells, but little is known about how such DNA changes cause skin to become scaly and inflamed. In some cases, skin cells form faster than necessary and build up on the skin’s surface, causing the skin to thicken. In other forms, the cells are produced at the normal rate, but instead of brushing off when they reach the surface, they cannot detach from the cells below and so they build up in layers (https://www.ichthyosis.org.uk/†
In collaboration with Professor Muzlifah Haniffa from Newcastle University and the Wellcome Sanger Institute, and Professor Edel O’Toole from Queen Mary University of London, Dr. Rajan investigate how skin cells in patients with severe forms of ichthyosis differ from normal skin cells, and why the protective barrier in the skin is weakened. He wants to investigate how the immune system responds to this weakness in the skin barrier, looking at these differences across different layers of the skin.
The researchers hope this will help them find changes in the skin of patients with ichthyosis that could potentially be improved by new treatments. To test possible treatments, they will grow skin cells in the lab so they can see if such drugs can “treat” ichthyosis in the lab.
dr. Rajan said: “Adolescence is a time of self-consciousness, self-doubt and exaggerated concern about appearance and physical attractiveness — all of which can make ichthyosis a particularly painful experience for teenagers. By studying skin samples taken from ichthyosis patients, we can hope to reveal more about the genetics underlying the condition, which are needed to develop much-needed new treatments for adolescents with ichthyosis.”
Co-investigator, Professor Edel O’Toole of Queen Mary University of London, is an expert on ichthyosis and chairs the medical advisory board of the Ichthyosis Support Group. Professor O’Toole said: “Young people with severe ichthyosis really suffer and I hope this research will provide new insights that will lead to advances in treatment.”
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