Development of Objective Measurements of Scratching as a Proxy of Atopic Dermatitis-A Review

Eczema, or atopic dermatitis (AD), is a chronic inflammatory skin condition characterized by persistent itching and scratching, significantly impacting patients' quality of life. Effective monitoring of scratching behaviour is crucial for assessing disease severity, treatment efficacy, and understanding the relationship between itch and sleep disturbances. This review explores current technological approaches for detecting and monitoring scratching and itching in AD patients, categorising them into contact-based and non-contact-based methods. Contact-based methods primarily involve wearable sensors, such as accelerometers, electromyography (EMG), and piezoelectric sensors, which track limb movements and muscle activity associated with scratching. Non-contact methods include video-based motion tracking, thermal imaging, and acoustic analysis, commonly employed in sleep clinics and controlled environments to assess nocturnal scratching. Furthermore, emerging artificial intelligence (AI)-driven approaches leveraging machine learning for automated scratch detection are discussed. The advantages, limitations, and validation challenges of these technologies, including accuracy, user comfort, data privacy, and real-world applicability, are critically analysed. Finally, we outline future research directions, emphasizing the integration of multimodal monitoring, real-time data analysis, and patient-centric wearable solutions to improve disease management. This review serves as a comprehensive resource for clinicians, researchers, and technology developers seeking to advance objective itch and scratch monitoring in AD patients.