Childhood eczema

Eczema in childhood is common and distressing. It affects an estimated 1 in 8 school children in the UK.(1) This red, itchy skin condition can cause significant suffering, but treatment options are limited. The most severely affected children have to be bandaged with cotton dressings from head to foot. Researchers are investigating the genetic basis of childhood eczema - a vital step in the development of new treatments.

What's the problem and who does it affect?

Feelings of tiredness, misery and embarrassment

An estimated 1.7 million children in the UK have eczema, and the numbers appear to be rising.(2) Chronic itching can severely reduce their quality of life. Children can find it so difficult to sleep at night, for example, that they lie awake scratching until their skin bleeds. Indeed, sleep deprivation can affect the whole family.

Many children and their families are also very distressed by the appearance of affected skin. The skin is red and scaly, sometimes blistered and weeping, or bleeding and prone to infection.

There is no cure for eczema. Treatment options are limited, with some having unwanted side effects. The two main options are emollient therapy - moisturisers - and steroid creams, which suppress the skin's immune response.

Treatment can be very time-consuming, sometimes dominating day-to-day routines. Children need regular applications of thick ointments, often many times a day. Some have to be bandaged with cotton dressings to protect the skin and help the ointment soak in.

Sadly, many children say their eczema makes them feel exhausted, miserable, ashamed or embarrassed.

What is the project trying to achieve?

Unravelling the causes of eczema

We do not fully understand what causes eczema. Genetic factors are known to play a key role, because eczema often runs in families. A range of environmental factors are also thought to be important in triggering eczema.

In 2006, scientists made an important breakthrough - they discovered that changes in a gene called filaggrin are associated with severe eczema. The researchers working on this project are investigating whether changes in this gene also put children at risk of developing milder cases of eczema, which are much more common.

Around 1,000 school children, aged 7 to 9 years, are taking part in the study. Some have atopic eczema - the most common type of eczema in childhood.

Researchers are establishing which children have changes in the filaggrin gene by studying DNA samples. The team is also identifying which children have eczema by sending an experienced dermatologist to assess their skin and asking parents to complete a questionnaire.

What are the researchers' credentials?

The Project Leader, Professor Heather Cordell, is a leading expert in analysing the genetics of complex diseases - that is, diseases, such as eczema, which seem to result from several different genetic and environmental factors. Her expertise in statistics puts her in a strong position to estimate how changes in a particular gene increase our risk of developing a particular disease.

Professor Cordell is working with Professor Nick Reynolds, a clinical academic and leading expert in inflammatory skin diseases such as eczema, and Dr Sara Brown, an experienced hospital dermatologist with a special interest in childhood eczema.

The laboratory work will take place at the Institute of Human Genetics at Newcastle University - a world-class centre of excellence for biomedical research, which was awarded the top, 5-star rating in the most recent government assessment. The team is using up to 1,500 DNA samples taken from babies born in Whitehaven, Cumbria, between 1996 and 2003 - samples that are outstandingly useful for this study.

Who stands to benefit from this research and how?

Protecting children at risk of eczema

The researchers suspect that changes in the filaggrin gene put children at risk of developing atopic eczema if they are exposed to environmental triggers. If the researchers are right, then in the future we might be able to start testing babies for these genetic changes. Babies with the altered version of the filaggrin gene could then be given early treatment.

The ultimate aim would be to find treatments that stop these babies from developing eczema in the first place. Researchers hope their work will also help in the development of better treatments for children who do develop eczema - treatments designed specifically to correct the problems caused by faults in the filaggrin gene.

Possible benefits in asthma and hay fever

Many children with atopic eczema go on to develop asthma or hay fever in later life. All three conditions seem to have a hereditary element and they all involve an allergic response to environmental triggers. Researchers believe it is possible that finding a way to prevent atopic eczema in childhood might also help stop people from going on to develop asthma and hay fever.

References

1. Williams HC, Wuthrich B. The natural history of atopic dermatitis. In: Atopic Dermatitis. The epidemiology, causes and prevention of atopic eczema. (Williams HC, ed): Cambridge University Press. 2000; 41-59.

2. Shamssain M. Trends in the prevalence and severity of asthma, rhinitis and atopic eczema in 6- to 7- and 13- to 14-yr-old children from the north-east of England. Pediatr Allergy Immunol 2007; 18: 149-53.