'Not all researchers wear white coats' A mum and her son cooking.

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Researchers always wear white lab coats? Obviously, that is a stereotype, which is seldom correct.  They are generally indistinguishable for the rest of the population.  Open minded, curious, careful and rigorous.  And with this “citizen science” project, the researchers can be anybody who has lived experience of eczema.

Amazement, disbelief and excitement hit all of us when we heard this plan, which had already taken two years to put together, to spend the next 5 years doing as yet to be determined high quality research into ways of managing eczema had been funded by the NHS’s research body, [NIHR](https://www.nihr.ac.uk/).  The NIHR does not give funding without being very sure that their money is being appropriately used.  And yet because the research is going to be decided by those living with eczema, the precise research is yet to be decided.

Patients and carers in the eczema community come in all shapes and sizes.  No person’s experience is quite like another’s.  But there are common experiences for all or segments of the community.  We need to find those commonalities and those differences – so every person who joins with us will be so important to help understand where the current management practice works well and where it does not.

Integrity, reliability and proven track record, in delivering high quality trials, of the researchers and health care professionals who are going to help patients and carers deliver this ambitious project were key in helping the NIHR choose this project.

Distribution of the knowledge generated by this project to all interested parties will be as soon and as thorough as possible.  We will not be waiting until the end of the five years project.  We want this project to be making a difference as it goes along.

**Written by Amanda Roberts
Patient-researcher co-lead of the RAPID project
August 2022**

Originally published at [blogs.nottingham.ac.uk](https://blogs.nottingham.ac.uk/medschoollife/2022/08/23/what-is-the-rapid-eczema-trials-project/)



Not all researchers wear white coats

Research Natalie stands outside on Jubilee Campus speaking to the camera.

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[Link to video](https://mediaspace.nottingham.ac.uk/id/1_8ipd1ycj)

Transcript: 
Hi everyone. I'm Natalie and I'm a researcher at the Rapid Eczema Trials team. And we wanted to find out what the community and those with eczema want to know when it comes to bathing. 
So we release a survey, a bathing survey, in which we received 120 responses from all ages and all ethnicities. 
And the results were the following: 
Number one, 50% of respondents wanted to know how often they should shower or bathe when it comes to having eczema. 
Thirty-four percent wanted to find out if they should use biological or non-biological washing powders. 
And twenty per cent wanted to know if they should avoid using soaps when bathing or showering with eczema. 
And so if you've decided to follow through with the top question and we are going to do a trial looking into the frequency of bathing. 
We look forward to sharing these results with you, and why don't you check out our website In the meantime.



Survey results: prioritising questions about bathing

Picture of Tressa Davey (RAPID Eczema Trials citizen scientist)

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**The RAPID Eczema Trials team involves researchers, healthcare professionals and citizen scientists (people with eczema and parents of children with eczema) working together to answer important questions about eczema by designing and running clinical trials together. The first question we are answering is about bathing, so our citizen scientist Tressa Davey has been looking into the varied bathing practices through history and around the world…**

Bathing is such a part of our lives that we don’t often stop to think about the reasons behind our bathing habits. All sorts of influences can affect people’s bathing routine: personal, social, commercial, environmental, therapeutic, religious and cultural.

Around the world there are fascinating bathing rituals that reflect local history, religion and customs. To name a few: Japanese Onsen baths, Korean Jjimjilbang, Russian Banya, Turkish Hamams, Native American sweat lodges, Sudanese Dukhan (barbecuing the body!), Mexican Temazca, Balinese flower baths and Calistoga mud baths!

Looking at the frequency of bathing around the world, it seems that the modern world in general is pretty clean, with Brazilians in the lead, showering 14 times a week – with the average of the rest of the world around 5 times a week. In the UK, the average is 6 a week.

But I wondered about the history behind human bathing and how we went from the super-clean Roman times to the less clean (understatement) Middles Ages and then to the present time where we mostly shower frequently and ‘elbow greet’ to avoid passing germs.

First-century Romans would take three-hour soaks in public baths while scraping their bodies with miniature rakes, and finish with a final application of oil.

Around the time of the Black Death people stopped bathing so much because they believed they’d be more likely to get the plague if they had a bath because the warm water would open the pores and let germs in.

By the mid-19th Century, there was a growing understanding of germ theory with the influence of Florence Nightingale in the Crimean war who found that people less likely to die of infection if they were clean.

Affordable soap took a long time to develop effectively (don’t ask what gross ingredients were in early soaps!) but by the late 19th Century we had Palmolive soap, which was the world’s best-selling soap, helped along by some aggressive ‘you-will-grossly-offend-if-you-don’t-use-our-soap’ marketing (we are manipulated much more subtly these days).

Today, especially after the Covid pandemic, we are back to living in a clean, deodorised world and hygiene and cleanliness seem to have been conflated.

But, the pandemic aside, is our underlying attitude to bathing changing again? A question has floated around for quite a few years now asking “Are we too clean?”.

In fact, in the late 1980s a doctor in Berlin noticed that affluent children who were able to keep clean developed more allergies than poorer children who could not. She theorised that being ‘too clean’ meant that our immune system didn’t get chance to develop and strengthen. Some medical professionals do now believe that our skin might benefit from a few more “healthy” germs.

So, all of this illustrates just how complex our attitudes to bathing are and how hard it might be to change our bathing habits.

Nonetheless, we will be asking people to temporarily change their bathing habits to try to answer our first trial question which is ….

“_For people living with eczema, is it better to bathe/shower every day or less frequently?_”

**By Tressa Davey (RAPID Eczema Trials citizen scientist).**

Originally published at [blogs.nottingham.ac.uk](https://blogs.nottingham.ac.uk/medschoollife/2023/03/09/we-all-bathe-differently/)



We all bathe differently

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Rapid Eczema Trials team have been deciding which questions about washing are most important to people with eczema. But what does research already tell us about eczema and washing?

For people with eczema, there are lots of question marks over how to wash. And as it turns out… very little evidence to guide them! As a result, people often go through a ‘trial and error’ process to work out what works for them.

Science is about more than trial and error. It is about well-designed studies that help us learn what works for **most people, most of the time**. That doesn’t mean it will work for everyone – but it gives us a better chance of starting with the best option. To do this, we use ‘randomised controlled trials’. Trials randomly allocate people to treatments or strategies, and then look to see how outcomes in the groups receiving different treatment or strategies compare to each other. Laura (one of our researchers) and Devin (one of our citizen scientists) have teamed up to share with you what we’ve learnt about the evidence on bathing and eczema…

**First up, here is Laura’s run-down of the randomised controlled trial evidence for the top three burning questions about eczema and bathing prioritised by the Rapid Eczema Trials community:**

**How often to wash?**

Does anyone else remember the childhood torture of ‘bath day’? I still remember the exasperated faces of my parents as they wrestled me and my sister into the bath. For us, once a week was one bath too many, so I was surprised to learn from others in the Rapid Eczema Trials team that there can be a ‘mothers’ guilt’ if not bathing children daily. These days I am more partial to a bath and use an evening soak to unwind at the end of the day. How we wash is influenced by both cultural and familial practices, and I was really fascinated to hear from dermatologist Dr Michael Perkins who joined us one evening and spoke of how regular washing is a modern phenomenon – our ancestors wouldn’t be washing hardly as much. But what does this do to our skin?

Dr Van Halewijn and colleagues(1) found that international eczema guidelines offer conflicting advice. Whilst some guidelines suggest regular bathing to cleanse and moisturise skin, others caution that it can dehydrate the skin and cause irritation. Dr Koutroulis and colleagues[2]) published a study in 2014 that asked children (6 months to 10 years) with eczema to either wash twice a week or daily for 2 weeks. They found no difference in the children’s eczema, but we can’t take too much from these results as there was only 28 children included in the study. A more recent study by Dr Cardona(3) and colleagues in 2019 found that children (6 months – 11 years) twice daily washing followed by moisturising made eczema symptoms better compared to less frequent washing (twice weekly followed by moisturiser). Again, this is quite a small study with only 42 children taking part. We also have the extra question of whether it was more frequent washing or more frequent moisturising that helped improve the eczema.

**What to wash my clothes with?**

I always use non-bio, I don’t have eczema, but my mum told me that when I was a kid my skin would react to bio – so I have avoided it since. Member of the Rapid Eczema Trials team also had strong preferences for washing powders – this didn’t necessarily fall into camp bio or camp non-bio though, and seemed to be something that was personal, and everyone found a particular brand or type that worked for them and stuck to it.

A study by Dr Anderson and colleagues(4) asked adults with eczema (people taking part were white, mostly female and severe eczema was excluded) to use either bio or non-bio washing powder for 1 month and then they switched over to the other for a month and found that it made no difference to eczema symptoms or how often people needed to use their eczema treatment. Again, this was a small study of 25 people.

**Use soap?**

Based on conventional wisdom and guidance(5), lots of people with eczema tend to feel like they should avoid soap, and doctors will often recommend this too, but we haven’t come across any clinical trials that have tested whether this is true.

**Here are some reflections on what this evidence means to Devin as a person living with eczema:**

There is a very good chance that if you do not suffer from eczema yourself then you almost certainly know someone who does. So, with it being such a common issue, not just in the UK but globally, and it being widely reported that bathing has a likely effect on the skin and its condition, you might think there would be extensive research and guidance out there to help us. To the surprise of myself and the rest of the Rapid Eczema Trials team there unfortunately was not. Instead, the advice and information we found seemed to be contradicting and unclear, due to a lack of evidence backed information.

For some people, bathing is a regular part of their lives and it is part of their daily routine whether they have a shower, bath or a strip wash. The lack of clear answers means some of us could be making our condition worse without realising it. This is why it is so very important that the eczema community have evidence backed guidance to improve our wellbeing. With so much time and energy being spent on avoiding triggers to flare-ups, it would be amazing to have to worry about one less thing.

**So where does this leave us?**

The Rapid Eczema Trials team were left with a wide variety of choices when it came to designing their own research about bathing – previous studies haven’t been enough to provide conclusive answers and there are so many unanswered questions! Over the coming months, we will be working together to design an online trial that will answer at least one of these questions in a large, high-quality clinical trial – so do [sign-up to receive](http://eepurl.com/h9TMZD) our Rapid Eczema Trials news updates and keep in touch if you would like to find out more.

**Written by Laura Howells (Senior Research Fellow at the Centre of Evidence Based Dermatology) and Devin Patel (RAPID Eczema Trials Citizen Scientist)**

Originally published at [blogs.nottingham.ac.uk](https://blogs.nottingham.ac.uk/medschoollife/2023/04/21/scrub-a-dub-dub-eczema-in-the-tub-what-does-the-research-say/)

## References

1. Van Halewijn, K. F., et al. (2022). “Recommendations for emollients, bathing and topical corticosteroids for the treatment of atopic dermatitis: a systematic review of guidelines.” European Journal of Dermatology 32(1): 113-123.

2. Koutroulis I, Petrova K, Kratimenos P, Gaughan J. Frequency of Bathing in the Management of Atopic Dermatitis: To Bathe or Not to Bathe? (2014) Clinical Pediatrics 53(7):677-681. doi:10.1177/0009922814526980

3. Cardona, I. D., et al. (2020). “Frequent Versus Infrequent Bathing in Pediatric Atopic Dermatitis: A Randomized Clinical Trial.” J Allergy Clin Immunol Pract 8(3): 1014-1021.

4. Andersen, P. H., et al. (1998). “Skin symptoms in patients with atopic dermatitis using enzyme-containing detergents. A placebo-controlled study.” Acta Derm Venereol 78(1): 60-62.

5. National Institute for Health and Care Excellence (2007). “Atopic eczema in under 12s: diagnosis and management.” Retrieved 22 November 2022, from https://www.nice.org.uk/guidance/cg57.

Blog

.css-1hnz6hu{position:static;}.css-1hnz6hu::before{content:'';cursor:inherit;display:block;position:absolute;top:0px;left:0px;z-index:0;width:100%;height:100%;}Scrub a dub dub, eczema in the tub – what does the research say?

We all bathe differently

Survey results: prioritising questions about bathing

Not all researchers wear white coats

Scrub a dub dub, eczema in the tub – what does the research say?