Impact of an online intervention to address the itch-scratch cycle on eczema symptoms, quality of life, disease control and patient enablement in children and adults with eczema: two online, superiority, randomised controlled trials
Eczema in people aged 8 years and older
INTERVENTION: A 3-part online programme to support management of itch and scratch for people with eczema plus usual care. CONTROL: Usual eczema care alone. The intervention is adapted from the ‘Kids in Control’ intervention developed by Dr Susannah Baron and team at King’s College London (https://ppopderm.org/project/kids-in-control/). Kids in Control uses a combined approach that educates on how to use eczema treatments alongside habit reversal techniques from behavioural psychology (raising awareness of scratching behaviour and replacing the behaviour). The Kids in Control intervention was designed to be delivered by a healthcare professional in an online group setting for 8-12-year-olds. Therefore, to make it suitable for evaluation in this study, we have adapted the intervention (with user testing through think-aloud interviews) to make it suitable for stand-alone self-directed online use and to create a version suitable for older children and adults aged 13+ years. The online programme is divided into 3 parts. It is self-directed, but it is suggested that each part is completed a week apart, with activities completed between sessions to put the learning into practice: Part 1: Individuals learn more about eczema and how to use the two main topical treatments for eczema (emollients and topical corticosteroids). Part 2: Individuals learn about the itch-scratch cycle in eczema and how to become aware of their scratching. They are encouraged to use a scratching diary to track their scratching. Part 3: Individuals learn a series of new activities they can try out to replace their scratching behaviour. They are encouraged to keep tracking their progress. Randomisation will be carried out by the participant using a secure, online system. Participants will be randomised 1:1 to either the intervention group (Scratch Less programme) or control group (usual care alone) separately for the two age groups (8-12 years and 13 years and over) using a minimisation algorit
1. Aged ≥8 years with self-report of eczema (syn. atopic dermatitis, atopic eczema) 2. Able and willing to participate in the online intervention 3. Usual residence in the UK 4. Able and willing to give informed consent (or parent/legal guardian able and willing to give informed consent for children under 16 years)
1. Diagnosis unlikely to be atopic eczema: only present on hands (likely to be hand eczema or contact dermatitis); limited to locations where skin is exposed to nickel, e.g. jewellery (likely to be contact dermatitis); eczema only around varicose veins (likely to be varicose eczema) 2. Taking part in another eczema intervention trial 3. Member of household has already agreed to take part in the Scratch Less trial