Eczema Treatment

Do you suffer from Eczema (with symptoms such as dry skin, itchy skin or redness)?

Would you like to try a new investigational drug for Atopic Dermatitis or Eczema at no cost to you?

Sign up and we will notify you of clinical trials in your area that need volunteers with Atopic Dermatitis.

Volunteers who take part in the study may be compensated for your travel and time in the study.

No health insurance is required to participate. All study-related visits, and study drug will be provided at no cost. In addition, compensation for study-related travel may be provided. The study will involve visits to a study site in your area.

What happens if I sign up?

You may be eligible for an Atopic Dermatitis clinical research study, also known as a clinical trial in your area. Someone from the study team or research site conducting the trial will contact you to explain more about this research study before you make your decision about participating.

Sign Up

Fields marked with an * are required.

First Name *

Last Name *

Phone Number *

Date of Birth MM/DD/YYYY *

ZIP or Postal Code *

Have you been diagnosed with Atopic Dermatitis/Eczema? *

How long have you suffered from Atopic Dermatitis/Eczema? *

When was your Atopic Dermatitis/Eczema diagnosed? *

Does your Atopic Dermatitis/Eczema cover 10%, or more than 10% of your body? *
Note: The palm of your hand (no fingers) is approximately 1% of your body surface area.

Do you have any other major health conditions? *
Please list them below, or type ‘none’.

Have you received a vaccine for smallpox, chickenpox, measles, shingles, rotavirus, herpes, polio or yellow fever in the last 12 weeks? *

Have you received a vaccine for Meningococcal disease (to protect you from becoming infected with bacteria that cause meningitis) in the past 4 years? *
(Names for these vaccines include Menactra®, Menveo®, Bexsero®, Trumenba®)

Have you received a vaccine for prevention of Tetanus in the past 5 years? *
(Names for these vaccines include Tenivac®, Boostrix®, Adacel®)

Would you be willing to receive two common approved vaccines as part of the study procedures? *

Have you been diagnosed with cancer (not including cancer of the skin or cervix) within the past 5 years? *

Are you HIV positive? *

Do you have chronic or active hepatitis? *

Are you taking any medications for atopic dermatitis? *
Please list them below, or type ‘none’.

If you are taking any medications for other health conditions, please list below or type ‘none’.

If female, are you currently pregnant, breastfeeding or planning to become pregnant in the next 15 months?

Are you currently enrolled or have you participated in a Clinical Trial within the last 60 days? *

What is the best day/time to reach you via telephone (we know you are busy)?
Please note that most of our study site/research centers are open Monday to Friday 8am – 5pm. If possible, please provide availability in this time window. Our study sites will do their best to accommodate your request, however they may not be able to reach out outside of their regular business hours.

Would you like to be contacted about taking part in a Clinical Trial? *

Yes

The information you are providing here will only be used to match you or a family member to a clinical research study in your area. This information will be used to contact you to see if you would like to participate. Please note the information you enter will be kept private, except when ordered by law, and only accessible to our Clinical Research Partners and affiliates and applicable regulatory agencies. If you have any questions regarding the handling of the information you have provided to autocruitment.com, or if you would like to make any changes, please contact us at info@autocruitment.com.