Dr Langan is studying what environmental factors cause “flares” of eczema.

We set out to explore the effects of a number of factors on the severity of eczema. We found worsening of eczema with nylon clothing next to the skin, exposure to unfamiliar pets, sweating, swimming, dust and shampoo exposure.

The effects of shampoo were worse in cold weather. Nylon clothing was associated with worsening on covered sites while worsening of hand eczema was seen with pet exposure. Worsening in summer was associated with filaggrin mutations (the mutation which leads to the skin barrier not working properly).

We did not find any other associations with these mutations, but as only 10 people had these mutations, we may have missed other associations. People responded differently to the following factors: dust, grass pollen and hot outdoor temperature, with some getting worse and other better. A combination of any three of seven likely exposures (dust, pet exposure, shampoo, sweating, swimming, nylon clothing next to the skin and a change in mean temperature of more than 3°C from the previous weekly average) was associated with worsening of eczema across all children.

The findings of this study suggest that clothing and certain irritants, including sweating shampoo and swimming may be important in causing disease worsening. Other factors such as dust, contact with unfamiliar pets and nylon clothing were also associated with disease worsening.

The study also implies that children with eczema respond in different ways to certain exposures such as dust, grass pollen and hot outdoor temperature. Preliminary study also suggests that it is the combination of exposures that is associated with disease worsening rather than individual exposures, although this theory requires further study.

The Centre of Evidence Based Dermatology has received funding from the National Institute of Health Research for 5 years to conduct research into several skin diseases, including eczema. As part of this grant, Helen Nankervis is working on updating an important systematic review of clinical trials (www.ncchta.org/execsumm/summ437.htm) conducted nine years ago which covers all treatments for atopic eczema. This will help to bring together all the up to date, good quality evidence about each different treatment for eczema and identify areas where future research could be directed.

She will also be creating a database of information from all the clinical trials on eczema treatment. This will be freely available to the public, with the aim of helping researchers trying to answer specific questions about eczema treatment in the future (for example by writing a systematic review).

Helen will then facilitate a James Lind Alliance (www.lindalliance.org) prioritisation exercise for eczema treatment, which aims to collect as many of the unanswered questions about the treatment of eczema as possible from patients, consumers, clinicians, health professionals and carers. These unanswered questions will be prioritised by representatives from all the interested parties to produce a list of the top 10 unanswered questions about eczema treatment. This will then help to direct future eczema research.

Helen will also be developing patient decision aids. These can help a patient and clinician (such as a dermatologist) come to a difficult treatment decision based on the current evidence about each treatment option. Plain language summaries of systematic reviews of eczema treatment will also be written, in order to make them as widely accessible as possible.

If you are interested in learning more about this research, you can email sprusd@nottingham.ac.uk