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Effects of Treatments on Atopic Dermatitis

Primary Purpose

Eczema, Dermatitis, Skin Diseases, Genetic

Status
Recruiting
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Trimethoprim/sulfamethoxazole (TMP/SMZ)
Cephalexin
Doxycycline
Sodium hypochlorite
Placebo capsules
Placebo Sodium hypochlorite
Sponsored by
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Eczema focused on measuring Investigator-Blinded, Skin Biopsy, Randomized, Antibiotics, Topical

Eligibility Criteria

2 Years - 50 Years (Child, Adult)All SexesAccepts Healthy Volunteers
  • INCLUSION CRITERIA:

Cohorts 1 and 2: Healthy Volunteers

Males and females aged 18-50 years.

  • Subjects must participate fully and be willing to comply with the procedures of the protocol
  • Subjects must be co-enrolled in NIH protocol 08-HG-0059
  • Ability of subject to understand and provide written informed consent.
  • Access to bathing facilities
  • Ability to swallow capsules or tablets

Cohort 3: Atopic Dermatitis Patients

  • Subjects must be aged 2-50 years.
  • Subjects must be co-enrolled in NIH protocol 08-HG-0059
  • Subjects must have a diagnosis of atopic dermatitis on the basis of the criteria defined by UK Working Party s Diagnostic Criteria for Atopic Dermatitis
  • Subjects must have a primary care provider
  • Subjects must have an Objective SCORAD (SCORing Atopic Dermatitis) of greater than or equal to 15 indicating AD severity of moderate to severe
  • Prior to initiation of randomized treatment, subjects must have signs of bacterial skin infections (skin weeping, crusting, and/or pustules)
  • Access to bathing facilities
  • All subjects and/or their Legally Authorized Representative (LAR) must have the ability and agree to participate fully and comply with

the procedures of the protocol and provide informed consent. Pediatric patients will be included in age appropriate discussions and

age appropriate assent will be obtained in accordance with NIH guidelines.

EXCLUSION CRITERIA:

Cohorts 1 and 2: Healthy Volunteers

  • Does not meet inclusion criteria
  • Any female with symptoms and/or serum hormone levels consistent with perimenopause
  • Use of systemic antibiotics in 12 months preceding baseline sampling
  • Use of swimming pools, hot tubs, or whirlpools in 7 days preceding baseline sampling
  • Use of topical or oral complementary/alternative medicine (CAM) agents within 4 weeks of initiation of treatment
  • Known allergic reaction to sulfa, beta-lactam, or tetracycline class drugs; or lidocaine or epinephrine
  • Family history of toxic epidermal necrolysis
  • Known allergy or sensitivity to sodium hypochlorite (NaOCl)
  • History of AD and asthma
  • Inability to comply with the requirements of the protocol
  • Pregnant or lactating
  • Subjects with a primary or acquired immunodeficiency, including HIV seropositiviy
  • Any chronic past or present medical illness, including chronic skin diseases like psoriasis
  • Subjects receiving or planning to receive an IND agent, ultraviolet light therapy, monoclonal antibodies, or systemic immunosuppressants
  • Subjects who provide direct healthcare or reside in healthcare facilities or in non-hospital settings such as clinics, assisted living facilities, homeless shelters, jails and prisons as well as subjects with frequent exposure to laboratory animals

Cohort 3: Atopic Dermatitis Patients

  • Does not meet inclusion criteria
  • Any female with symptoms and/or serum hormone levels consistent with perimenopause
  • Known allergic reaction to beta-lactam class drugs, lidocaine, or epinephrine
  • Family history of toxic epidermal necrolysis
  • Known allergic reaction to sodium hypochlorite (NaOCl)
  • Use of systemic antibiotics within 8 weeks, or topical antibiotics on intended sampling sites within 3 weeks, prior to baseline sampling
  • Use of topical corticosteroids on all intended sampling sites within 7 days, prior to baseline sampling
  • Use of topical or oral CAM agents within 4 weeks of initiation of treatment
  • Subjects with known primary or acquired immunodeficiency
  • Subjects with unstable or uncontrolled medical conditions that could require hospitalization during the initial month of the study or who have been hospitalized for treatment of these conditions in the one month prior to baseline sampling
  • Subjects receiving or planning to receive an IND agent, ultraviolet light therapy, monoclonal antibodies, or systemic immunosuppressants within 7 days or 5 half-lives (whichever is the longer time period) of initiating treatment on this protocol
  • Subjects who are currently receiving or have received chemotherapy or radiation for treatment of malignancies within the previous 6 months
  • Pregnancy or lactating
  • Pregnant or lactating females in all cohorts are excluded from participating due to the potential effects of the above listed antimicrobials on the developing human fetus or nursing infant; listed in Sections 11.1 through 11.5. Females of childbearing potential must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while she is participating in this study, she should inform her treating physician immediately. Lactating mothers will discontinue breastfeeding prior to study enrollment.
  • Smokers and subjects who use smokeless tobacco products are excluded in all cohorts due to tobacco s unknown impact on human oral mucosa and microflora.

Sites / Locations

  • National Institutes of Health Clinical CenterRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm 5

Arm 6

Arm 7

Arm 8

Arm 9

Arm 10

Arm Type

Active Comparator

Active Comparator

Active Comparator

Active Comparator

Active Comparator

Placebo Comparator

Placebo Comparator

Placebo Comparator

Active Comparator

Placebo Comparator

Arm Label

1A/Cephalexin

1B/TMP/SMX

1C/Doxycycline 100

1D/Doxycycline 20

2A/Cephalexin + Dilute bleach

2B/Cephalexin + Placebo bleach

2C/Placebo capsules + Dilute bleach

2D/Placebo capsules + Placebo bleach

3A/Cephalexin + Dilute bleach

3B/Cephalexin + Placebo bleach

Arm Description

Cephalexin + Placebo bleach

TMP/SMZ DS 800 /160 orally every 12 hours for 14 days

Doxycycline 100 mg orally every 12 hours for 56 days

Doxycycline 20 mg orally every 12 hours for 56 days

Systemic antibiotics (Cephalexin) + dilute bleach study bath liquid

Systemic antibiotics (Cephalexin) + placebo study bath liquid

Placebo capsules + dilute bleach study bath liquid

Placebo capsules + placebo study bath liquid

Systemic antibiotics (Cephalexin) + dilute bleach study bath liquid

Systemic antibiotics (Cephalexin) + placebo study bath liquid

Outcomes

Primary Outcome Measures

Characterize microbiome alterations
Difference in Shannon Diversity Indices (SDI) from baseline to day 14.

Secondary Outcome Measures

Full Information

First Posted
June 28, 2012
Last Updated
September 20, 2023
Sponsor
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
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1. Study Identification

Unique Protocol Identification Number
NCT01631617
Brief Title
Effects of Treatments on Atopic Dermatitis
Official Title
Effects of Treatments on the Microbiome in Healthy Volunteers and Patients With Atopic Dermatitis
Study Type
Interventional

2. Study Status

Record Verification Date
June 27, 2023
Overall Recruitment Status
Recruiting
Study Start Date
September 18, 2012 (Actual)
Primary Completion Date
January 1, 2024 (Anticipated)
Study Completion Date
January 1, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No

5. Study Description

Brief Summary
Background: - Atopic dermatitis, or eczema, is a chronic skin disorder. Patients sometimes have infections with S. aureus bacteria. Researchers want to study how eczema treatments affect the number and the type of bacteria on the skin. Objectives: - To study the effect of eczema treatments on skin bacteria. Eligibility: Individuals between 2 and 25 years of age who have moderate to severe atopic dermatitis. Healthy volunteers between 18 and 40 years of age with no history of eczema. Design: Participants will be screened with a physical exam and medical history. Research samples will be collected. Skin biopsies may also be performed. All participants will be assigned to one of several study groups. This study will last for up to 1 year. Healthy volunteers must not have taken antibiotics in the year before the start of the study. All participants will have regular study visits during their 1-year participation. More research samples will be collected at these visits.
Detailed Description
BACKGROUND: The use of antibiotics has revolutionized medicine, yet the impact of antimicrobials on the human microbiome is incompletely understood. Antimicrobial treatments, including topical and systemic antibiotics, are highly effective and are frequently used to manage disease flares of AD. Concomitant use of dilute bleach baths reduces the clinical severity of AD in patients with clinical signs of bacterial skin infections. The longitudinal impact of various antimicrobials on the human microbiome, particularly in skin, has not been systematically investigated. OBJECTIVES: Primary: -To characterize microbiome alterations in healthy adult volunteers (Cohorts 1 and 2) and patients with AD (Cohort 3) after antimicrobial treatments. ELIGIBILITY: All subjects must be co-enrolled in NIH protocol 08-HG-0059 (Cohorts 1 and 2) Healthy volunteers aged 18 to 50 years with no history of AD (Cohort 1 and 2) No prior use of systemic antibiotics in preceding 12 months (Cohort 3) Subjects 2-50 years with atopic dermatitis with symptoms of active bacterial infection (Cohort 3) Objective SCORAD (SCORing Atopic Dermatitis) score of greater than or equal to 15 indicating moderate-to-severe disease DESIGN: A prospective, interventional, longitudinal study examining changes in microbiome resulting from randomized, placebo-controlled, investigator-blinded antimicrobial treatments. Subjects in Cohort 1 will be randomized to take one of 4 open label antibiotic regimens. Subjects from Cohort 2 will be will be randomized to one of four possible blinded treatment combinations of study baths and antibiotics. Subjects in Cohort 3 will be randomized to a cephalexin regimen with or without study baths. All subjects will undergo longitudinal microbiome sampling. AD patients will undergo clinical assessment to determine responses of skin infections to treatment.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Eczema, Dermatitis, Skin Diseases, Genetic, Dermatitis, Atopic, Skin Diseases
Keywords
Investigator-Blinded, Skin Biopsy, Randomized, Antibiotics, Topical

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
Investigator
Allocation
Randomized
Enrollment
130 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
1A/Cephalexin
Arm Type
Active Comparator
Arm Description
Cephalexin + Placebo bleach
Arm Title
1B/TMP/SMX
Arm Type
Active Comparator
Arm Description
TMP/SMZ DS 800 /160 orally every 12 hours for 14 days
Arm Title
1C/Doxycycline 100
Arm Type
Active Comparator
Arm Description
Doxycycline 100 mg orally every 12 hours for 56 days
Arm Title
1D/Doxycycline 20
Arm Type
Active Comparator
Arm Description
Doxycycline 20 mg orally every 12 hours for 56 days
Arm Title
2A/Cephalexin + Dilute bleach
Arm Type
Active Comparator
Arm Description
Systemic antibiotics (Cephalexin) + dilute bleach study bath liquid
Arm Title
2B/Cephalexin + Placebo bleach
Arm Type
Placebo Comparator
Arm Description
Systemic antibiotics (Cephalexin) + placebo study bath liquid
Arm Title
2C/Placebo capsules + Dilute bleach
Arm Type
Placebo Comparator
Arm Description
Placebo capsules + dilute bleach study bath liquid
Arm Title
2D/Placebo capsules + Placebo bleach
Arm Type
Placebo Comparator
Arm Description
Placebo capsules + placebo study bath liquid
Arm Title
3A/Cephalexin + Dilute bleach
Arm Type
Active Comparator
Arm Description
Systemic antibiotics (Cephalexin) + dilute bleach study bath liquid
Arm Title
3B/Cephalexin + Placebo bleach
Arm Type
Placebo Comparator
Arm Description
Systemic antibiotics (Cephalexin) + placebo study bath liquid
Intervention Type
Drug
Intervention Name(s)
Trimethoprim/sulfamethoxazole (TMP/SMZ)
Intervention Description
800/160 orally every 12 hours for 14 days
Intervention Type
Drug
Intervention Name(s)
Cephalexin
Intervention Description
500 mg orally every 8 hours for 14 days
Intervention Type
Drug
Intervention Name(s)
Doxycycline
Intervention Description
20 mg orally every 12 hours for 56 days or 100 mg orally every 12 hours for 56 days
Intervention Type
Other
Intervention Name(s)
Sodium hypochlorite
Intervention Description
6 % dilute bleach
Intervention Type
Other
Intervention Name(s)
Placebo capsules
Intervention Description
Capsule orally every 8 hours daily for 14 days
Intervention Type
Other
Intervention Name(s)
Placebo Sodium hypochlorite
Intervention Description
Three times a week for 14 days
Primary Outcome Measure Information:
Title
Characterize microbiome alterations
Description
Difference in Shannon Diversity Indices (SDI) from baseline to day 14.
Time Frame
2 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
2 Years
Maximum Age & Unit of Time
50 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
INCLUSION CRITERIA: Cohorts 1 and 2: Healthy Volunteers Males and females aged 18-50 years. Subjects must participate fully and be willing to comply with the procedures of the protocol Subjects must be co-enrolled in NIH protocol 08-HG-0059 Ability of subject to understand and provide written informed consent. Access to bathing facilities Ability to swallow capsules or tablets Cohort 3: Atopic Dermatitis Patients Subjects must be aged 2-50 years. Subjects must be co-enrolled in NIH protocol 08-HG-0059 Subjects must have a diagnosis of atopic dermatitis on the basis of the criteria defined by UK Working Party s Diagnostic Criteria for Atopic Dermatitis Subjects must have a primary care provider Subjects must have an Objective SCORAD (SCORing Atopic Dermatitis) of greater than or equal to 15 indicating AD severity of moderate to severe Prior to initiation of randomized treatment, subjects must have signs of bacterial skin infections (skin weeping, crusting, and/or pustules) Access to bathing facilities All subjects and/or their Legally Authorized Representative (LAR) must have the ability and agree to participate fully and comply with the procedures of the protocol and provide informed consent. Pediatric patients will be included in age appropriate discussions and age appropriate assent will be obtained in accordance with NIH guidelines. EXCLUSION CRITERIA: Cohorts 1 and 2: Healthy Volunteers Does not meet inclusion criteria Any female with symptoms and/or serum hormone levels consistent with perimenopause Use of systemic antibiotics in 12 months preceding baseline sampling Use of swimming pools, hot tubs, or whirlpools in 7 days preceding baseline sampling Use of topical or oral complementary/alternative medicine (CAM) agents within 4 weeks of initiation of treatment Known allergic reaction to sulfa, beta-lactam, or tetracycline class drugs; or lidocaine or epinephrine Family history of toxic epidermal necrolysis Known allergy or sensitivity to sodium hypochlorite (NaOCl) History of AD and asthma Inability to comply with the requirements of the protocol Pregnant or lactating Subjects with a primary or acquired immunodeficiency, including HIV seropositiviy Any chronic past or present medical illness, including chronic skin diseases like psoriasis Subjects receiving or planning to receive an IND agent, ultraviolet light therapy, monoclonal antibodies, or systemic immunosuppressants Subjects who provide direct healthcare or reside in healthcare facilities or in non-hospital settings such as clinics, assisted living facilities, homeless shelters, jails and prisons as well as subjects with frequent exposure to laboratory animals Cohort 3: Atopic Dermatitis Patients Does not meet inclusion criteria Any female with symptoms and/or serum hormone levels consistent with perimenopause Known allergic reaction to beta-lactam class drugs, lidocaine, or epinephrine Family history of toxic epidermal necrolysis Known allergic reaction to sodium hypochlorite (NaOCl) Use of systemic antibiotics within 8 weeks, or topical antibiotics on intended sampling sites within 3 weeks, prior to baseline sampling Use of topical corticosteroids on all intended sampling sites within 7 days, prior to baseline sampling Use of topical or oral CAM agents within 4 weeks of initiation of treatment Subjects with known primary or acquired immunodeficiency Subjects with unstable or uncontrolled medical conditions that could require hospitalization during the initial month of the study or who have been hospitalized for treatment of these conditions in the one month prior to baseline sampling Subjects receiving or planning to receive an IND agent, ultraviolet light therapy, monoclonal antibodies, or systemic immunosuppressants within 7 days or 5 half-lives (whichever is the longer time period) of initiating treatment on this protocol Subjects who are currently receiving or have received chemotherapy or radiation for treatment of malignancies within the previous 6 months Pregnancy or lactating Pregnant or lactating females in all cohorts are excluded from participating due to the potential effects of the above listed antimicrobials on the developing human fetus or nursing infant; listed in Sections 11.1 through 11.5. Females of childbearing potential must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while she is participating in this study, she should inform her treating physician immediately. Lactating mothers will discontinue breastfeeding prior to study enrollment. Smokers and subjects who use smokeless tobacco products are excluded in all cohorts due to tobacco s unknown impact on human oral mucosa and microflora.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Glenna Banania
Phone
(301) 402-6225
Email
glenna.banania@nih.gov
First Name & Middle Initial & Last Name or Official Title & Degree
Heidi H Kong, M.D.
Phone
(301) 827-2460
Email
konghe@mail.nih.gov
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Heidi H Kong, M.D.
Organizational Affiliation
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Official's Role
Principal Investigator
Facility Information:
Facility Name
National Institutes of Health Clinical Center
City
Bethesda
State/Province
Maryland
ZIP/Postal Code
20892
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
For more information at the NIH Clinical Center contact Office of Patient Recruitment (OPR)
Phone
800-411-1222
Ext
TTY8664111010
Email
prpl@cc.nih.gov

12. IPD Sharing Statement

Links:
URL
https://clinicalstudies.info.nih.gov/cgi/detail.cgi?A_2012-AR-0159.html
Description
NIH Clinical Center Detailed Web Page

Learn more about this trial

Effects of Treatments on Atopic Dermatitis

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