‘Scritch’ is a patient-centric measurement system that consists of an ergonomically designed wearable device and software application that objectively measures levels of itchiness and helps those battling chronic skin disorders manage their condition. Itchiness is a subjective sensation that ranges from mild to severe depending on the individual. ‘Scritch’ collects data to analyze an individual’s itching patterns, determines how factors such as prescription medication, environmental factors and stress levels could affect symptoms and future outbreaks.

Atopic eczema is a chronic, non-contagious, inflammatory skin condition that affects approximately 10 to 20 percent of the world population. Due to changes in our modern day lifestyles, it’s become 2 to 3 times more prevalent today than compared to 40 years ago. It can be inherited, caused by environmental factors or a combination of both; there is no single cause of eczema. An incremental lifestyle change is believed to improve one’s condition but correlating behavioral changes with itchiness severity is difficult to measure, highly subjective and often overlooked. Eczema is not only excruciating but can also be frustrating for a patient when communication is difficult with their doctor. Despite these challenges, behavioral changes need to be well documented and monitored to assess efficacy of a treatment. A patient can scratch as many as 100 to 1,000 times a day with each scratch causing an even stronger need to continue scratching. This vicious ‘scratch itch cycle’ can worsen existing rashes and increase risk of infection from openings on the skin. Subconscious scratching occurs during sleep which results in loss of quality sleep, limiting one’s physical ability, lifestyle choices, social behaviors and even relationships. If levels of itchiness could be documented and objectively measured through technical methods, can communication between patient and doctor improve significantly? I believe a well designed tool and monitoring system can accurately record behavior, encourage constructive discussions and in turn, allow doctors to easily identify factors that can drastically improve a patient’s condition.

As an individual having suffered from atopic eczema for over 30 years, for my master’s thesis project, I chose to design a tool that would improve lives of those struggling with similar chronic skin disorders. Sharing perspectives of both end user and designer, I had the unique advantage of addressing the user’s immediate needs as well as finding design opportunities in micro-macro scale. The intent of this project was to develop a tool that objectively measures levels of itchiness (a subjective sensation) but also, to devise a method that encourages productive communication between patient and doctor. Just as a fever is measured in temperature units, levels of itchiness can be recorded in ‘scritch score’ units. Putting a ‘scritch score’ on to a level of itchiness can empower patients by giving them the ability to self-monitor their condition, communicate the cause and effects of their condition and drastically improve the quality of their life. As an added benefit, the large quantities of data collected by patients can be used by pharmaceutical companies for further R&D and clinical trials.

‘Scritch’ is the result of a design process consisting of 4 design phases; Research, Challenge, Ideation, and Implementation. Research Following a period of self-reflection of my own medical history and conducting extensive online research on atopic eczema, I arranged personal interviews and co-creation sessions with 5 patients and 6 medical professionals. Medical professionals included 2 dermatologists, 2 scientists and 2 researchers from a leading pharmaceutical company specializing in dermatology. The strategy of the project was generated through the above mentioned activities and key insights fround such as: • existing medical situations and environments, • difficulty in measuring levels of itchiness, • difficulties in communication between patient and doctor, • missed opportunities to point out incremental lifestyle changes and, • expensive medication costs Challenges As crucial milestone in guiding the direction of this project, this phase focused on addressing all challenges associated to measuring levels of itchiness, a highly subjective matter! Key insights found during the research phase allowed me to build an eco-system that’s revolved around a patient centric measurement system. Ideation After several brainstorming sessions, I created prototypes ranging from very hands-on analogue prototypes to more intricate prototypes. The first prototype I created was to test on myself. I glued red crayons on to each finger of a pair of gloves to see if red crayon markings could be left where I scratched during my sleep. I wore white clothes and the prototype gloves to sleep and the results were astonishing. The markings of the red crayons correlated directly with the location where I had severe itching. Following the initial test, I created a more intricate prototype that explored a combination of sensing technologies such as motion, sound, and visuals and also a medium that could either be wearable or as a fixed device. Before testing on participants, I tested these models on myself to narrow down on design directions. Then to validate design concepts, I chose 3 to 4 prototypes and tested with 2 patients and 3 medical professionals. As a result of multiple explorations, reiterations and testing, the wearable device seemed to be most effective as it allowed detection of accelerated movements of the middle finger when the user was scratching during his or her sleep. This monitoring method is based on an ergonomic study of observing scratching in a state of unconsciousness. I believe in this state an accurate level of itchiness can be measured and data used for further discussions. Implementation The final functional prototype was a result of customizing and crafting technology using tangible materials, all of which were allergy-free materials. Pattern recognition was used to detect acceleration of the middle finger then data was wirelessly transferred to a laptop. A 3-axis accelerometer was included in the 3D-printed ring with Arduino Fio and Xbee inside a cotton wristband. The algorithm was coded using Arduino and Processing. To collect a data set, the final prototype was tested on myself for 10 nights.

‘Scritch’’s ecosystem has the potential to transform the current paradigm in dermatology as it collects and monitors a patient’s scratching patterns while using collected data to analyze efficacy of treatments. Value for patients: The ‘Scritch’ device is designed to be simple and comfortable to wear. The number of scratches while sleeping in a state of unconsciousness can measure the levels of itchiness and help identify scratching patterns. By using ‘Scritch’, the patient can avoid usual frustrations associated with miscommunications with doctor yet doctor’s can accurately analyze the patient’s condition. Different variables such as environmental factors, food, and medication can also be added to analyze a patient’s condition and efficacy of their treatments. Value for family: The ability to share ‘scritch scores’ provides an alternative method of communication. This can especially be helpful for children and the elderly who have difficulty explaining the severity of their itching and itching patterns Value in the Smart Home: ‘Scritch’ can work within the Smart Home and make small incremental changes in lifestyle such as regulating room temperature, humidity, and air quality. Value for doctors: The data collected on ‘Scritch’ is easily understood and analyzed by the doctor because of its objective method of measuring and monitoring patient’s behavioral patterns. Value for pharmaceutical companies: Real-time data can be donated to pharmaceutical companies for R&D and clinical trials. There’s also potential for creating medication tailored to each individual’s condition. In exchange to receiving personal data, pharmaceutical companies could give patients discounted incentives towards future prescription medications.

The project was the result of thorough research and validation with patients, their families and medical professionals. I myself have engaged in this experience firsthand as a person living with atopic eczema for 30 years. The final concept was well received when presented to different stakeholders and believe the project eco-system can bring great value to those affected by the condition as well as those in the pharmaceutical industry.

The ecosystem of this project aims to generate economic sustainability. Sharing and donating data is beneficial for both patients and pharmaceutical companies. • Patients can receive discounted or tailored medication by sharing and donating their personal data within the community. • Pharmaceutical companies can have access to large quantities of real-time patient data. This data will bring great value and efficiency to their R&D process. Other reasons: • The need for better medication to treat atopic eczema has drastically increased over the past 10 years. In addition, the market of wearable devices for the quantifying-self is being well received in all consumer markets. These devices will be readily affordable in the near future as production costs decline. • ’Scritch’ can also be used to treat other chronic skin disorders associated with itchiness such as psoriasis and burn-injuries.