The OASIS project: SRUK-funded research builds evidence for new methods of skin assessment in Scleroderma

A recently completed SRUK-funded research project, led by Dr Peter Worsley at the University of Southampton, has built evidence for the use of new non-invasive tools which can accurately measure the health of the skin in Scleroderma.  

The findings of the project, known as ‘the OASIS project’, have the potential to drive forward the use of new, non-invasive skin assessment methods, using tools employed in the assessment of other conditions that affect the skin. Because of the importance of skin assessments in the identification and care of Scleroderma, the project could be an important step towards improving the diagnosis and monitoring of the condition.

The findings will also form part of the basis of a further three-year research project, led by Dr Worsley and funded by the Medical Research Council, which will continue to investigate the use of new tools and technologies used to monitor skin health. This has the potential to bring further benefit to individuals living with Scleroderma in the near future, by improving the methods used in routine clinical monitoring and self-management of the condition.

Read on to find out more about the OASIS project!

Skin Assessment & ‘The SRUK / EPSRC Hackathon’

Because one of the characteristic symptoms of Scleroderma is thickening and tightening of the skin, the ability to accurately assess and measure skin health is a crucial part of effectively diagnosing and monitoring the condition. The modified Rodnan Skin Score (mRSS) involves a clinician ‘pinching’ a patients skin in order to measure it’s thickness and is used by clinicians to measure the activity of a person’s scleroderma and how well treatments may be working.  It requires extensive training and due to the subjective nature of the test, can result in variability of results between clinicians.  As such, SRUK identified a need for new methods of measuring the skin of patients during diagnostic and routine assessments, which are required in order to monitor changes in a patient’s scleroderma and the extent to which the skin is tightening or thickening. 

In February 2020, SRUK and the Engineering and Physical Sciences Research Council (EPSRC) partnered to co-host a three-day event entitled ‘The SRUK / EPSRC Hackathon’. The event brought together clinicians, bioengineers, data scientists and bioscientists from universities and industry to produce ideas for new devices which could easily and objectively measure the skin, to improve the diagnosis and monitoring of the effects of Scleroderma.

The OASIS Project

Four of the projects which were developed during the Hackathon event submitted applications for funding, totalling £418,000. Out of these, two teams were selected for funding – one of which was co-funded by SRUK and the EPSRC, whilst the other was solely funded by SRUK. The successful application funded by SRUK was led by Dr Peter Worsley, an Associate Professor of Health Sciences at the University of Southampton, who specialises in skin and soft tissue health, as well as healthcare technologies.

Dr Worsley said that at the event, “we were able to meet fellow academic researchers, clinicians and industrialists interested in skin health research. Of particular interest were the talks provided by individuals with Scleroderma, and hearing their experiences of current clinical assessment and treatment. I was personally interested in how skin is assessed and what improvements could be made through technologies”.

Dr Worsley brought together Professor Francesco Del Galdo, a clinician from Leeds, Dr Ashleigh Boyd from University College London, Dr David Childs from the University of Glasgow, and Dr Rodney Gush from Moor Instruments (a world leader in the design, manufacture and distribution of medical monitoring and imaging systems), to form the OASIS team and create the ‘Objective Assessment of Scleroderma Skin Tissues (OASIS)’ project. The project aimed to assess whether non-invasive tools developed for skin assessment in other medical and scientific fields, which can measure factors such as water loss, hydration, and stiffness of skin, could be repurposed to monitor the skin of individuals with Scleroderma, and a provide a means for patients to self-monitor changes in skin health.

To do this, the OASIS team’s first task was to determine which skin factors could give clinically useful information on a person’s scleroderma, and how they could best be measured. These factors could then be used to assess the effectiveness and reliability of the potential skin measurement tools in measuring Scleroderma-affected skin. After doing this, the performance of these tools to identify differences between skin which is thick and thin was tested in a lab at the University of Southampton with healthy volunteers, by assessing how reliably the tools could differentiate between the skin on different parts of the body with varying thickness (such as the sole of the foot and the forearm).

After the most reliable of the candidate tools were identified, the OASIS team then collaborated with the clinical team in Leeds, led by Dr Francesco Del Galdo, to assess the clinical utility of the tools within a cohort of individuals with SSc, who are part of the ongoing ‘STRIKE’ study. By assessing factors such as the clinical characteristics of the skin of members of the cohort, as well as the presence of inflammatory biomarkers in the sebum, the team were able to evaluate how accurately the range of candidate tools could measure the skin of individuals with Scleroderma.

What did the team find?

Describing the project’s findings, Dr Worsley outlined that the OASIS team “successfully evaluated a range of non-invasive tools to monitor skin health both in the lab (Southampton) and clinical setting (Leeds) and demonstrated that these skin measurements could be used reliably, and that the corresponding information was highly related to clinical tests of skin”.

In particular, one of the tools called the MyotonePRO demonstrated strong reliability, sensitivity to detect different skin sites, and a high correlation with the modified Rodnan scale score, suggesting it can accurately measure the skin in individuals with Scleroderma. The tool, which is a non-invasive hand-held device which measures the stiffness of tissue, is easily used and does not cause any pain to the patient being assessed.

What are the outcomes of the project, and how might they benefit patients?

The findings of the OASIS project have given strong evidential backing for the use of a new, non-invasive tool that could be used to improve assessment of the skin in the diagnosis and monitoring of Scleroderma. This has the potential to make routine clinical assessments less invasive and painful for patients, and, given the reliability of the test in assessing the thickness and stiffness of the skin, could even enable clinicians to recognise the signs and symptoms of Scleroderma earlier, and with more accuracy and reliability.

Equally, tools and technologies that are non-invasive and easy to use could enable the use of home-based and wearable monitoring equipment for Scleroderma. Devices which can be easily used by the patient to self-monitor their skin health has the potential to enable patients, carers and clinicians to predict and prevent events that would otherwise have led to the worsening of symptoms or even a hospital admission (for example, due to skin ulceration). As such, continuing the introduction of new tools and technology that enable improved monitoring of the condition could be one of the keys to improving the care and quality of life of those living with Scleroderma.

Moving forward: Future research in skin health and technologies

In exciting news, Dr Worsley will now undertake a further three-year research project funded by the Medical Research Council, entitled ‘Temperature modulation of skin tolerance to applied mechanical loading and shear’. This project will investigate therapeutic cooling and heating to support skin health – the results of which could be applied to a number of conditions, including Scleroderma and Raynaud’s to support the design of garments and devices to maintain skin health.

Dr Worsley told SRUK that to further investigate some of the themes and concepts involved in the SRUK-funded OASIS project, he and his team at Southampton “now plan to further explore how we can use technologies to monitor the changes in skin health, with funding secured from the Medical Research Council (2023-2026). We hope that our ongoing work will result in benefit to individuals with Scleroderma, to support routine clinical monitoring and self-management”.