Improving the lives of countless people suffering from skin disease
Skin is the largest organ of our body. It is important for temperature and water regulation, defence against pathogens and UV light, sensation and vitamin D synthesis. It’s also a vital organ of social communication.
Over a thousand skin conditions exist and are among the most common reasons to visit your GP. Skin disease is often trivialised as “just a few spots” or a “bit of eczema” but a chronic skin condition can have a devastating impact on day-to-day life. The skin can become painful or itchy, affect psychological wellbeing, how we sleep, socialise and interact with others, what we wear and where we live and work.
Some skin conditions, such as melanoma skin cancer, can be fatal. For other conditions, the treatments needed to control the disease can cause side-effects, such as increased risk of infections .
Our research starts with the patients and carers living with a skin condition and understanding what is important to them. We answer questions that they ask, which are rarely addressed by pharmaceutical companies, such as “How do two commonly used treatments compare against each other?”, or “What’s the evidence that commonly prescribed treatments actually benefit the patient?”
Dermatology treatment is heavily influenced by pharmaceutical companies. Some of their products have transformed the lives of patients, but and many “new” and costly treatments are not that great when compared with what we have got already. There is a need for at least one completely independent voice in the world that champions the questions that are important to patients and health care practitioners, who want to know how available treatments compare against each other.
Our independent, large, randomised and controlled clinical trials test whether different skin treatments or strategies for preventing skin disease actually work and at what cost, in terms of side effects and value for money. We ensure that all trial results are reported clearly and openly and we involve people with skin disease throughout.
Our work is made possible through the dedication and support of hundreds of clinicians, nurses, researchers and patients who work together through our UK Dermatology Clinical Trials Network to deliver these large, practice-changing trials. It is the completely independent nature of our work that has attracted so many people to want to work with us.
"Knowing that our research has a direct and immediate effect in changing clinical practice, allowing better informed treatment decisions and ultimately improving patients’ lives, is hugely inspiring."
The network was first established by Professor Hywel Williams from the University of Nottingham almost 20 years ago. This network has transformed how pragmatic skin research is conducted in the UK, and we’ve contributed to large clinical trials in collaboration with hospitals and GPs across the country. Our approach has also inspired dermatology trial networks internationally, including those in Canada, Italy and the Netherlands.
With Hywel and our Centre of Evidence Based Dermatology colleague, Senior Research Fellow Joanne Chalmers, we have completed 12 multi-centre randomised control trials (RCTs).
Trials of treatments for childhood eczemai ii, skin canceriii, cellulitisiv v, bullous pemphigoidvi (an itchy blistering skin condition on the increase in prevalence in elderly people) and pyoderma gangrenosumvii (a painful, mutilating skin disease) have in particular had a truly significant impact.
These trials alone have informed at least 29 national and international guidelines, resulting in the adoption of new, effective treatments and a reduction in prescribing of ineffective treatments.
Knowing that our research has a direct and immediate effect in changing clinical practice, allowing better informed treatment decisions and ultimately improving patients’ lives, is hugely inspiring.
Overall, we’ve helped reduce deaths and serious side-effects from skin disease, improved the health and wellbeing of countless patients and saved the NHS millions of pounds.
With so many different skin conditions, we don’t yet know the answers to all the potential questions about how to treat them. What I find more challenging, is the fact that there are still large gaps in our understanding of how best to use even the most well-established and commonly used skin treatments, such as topical corticosteroids for eczema, which have been used for more than 60 years.
Kim Thomas is Professor of Applied Dermatology Research and Co-Director of the Centre of Evidence Based Dermatology, Faculty of Medicine and Health Sciences.
This work has been carried out in collaboration with Professor Hywel Williams (Professor of Dermato-epidemiology), Dr Joanne Chalmers (Senior Research Fellow), Prof Alan Montgommery (Director of Nottingham Clinical Trials Unit), Ms Eleanor Mitchell (Associate Professor of Clinical Trials), Dr Karen Harman (Clinical Associate Professor), Ms Mara Ozolins (Trial Statistician), Ms Lucy Bradshaw (Trial Statistician), Prof Miriam Santer (Prof of Primary Care Research) and Dr Jonathan Batchelor (Consultant Dermatologist)
BMJ 2018, Thomas KS, Williams HC, et al: Emollient bath additives for the treatment of childhood eczema (BATHE): multicentre pragmatic parallel group randomised controlled trial of clinical and cost effectiveness
PLoS Med 2017, Thomas KS, Batchelor JM, Haines RH, Williams HC, Llewellyn J, Mitchell EJ, et al: Silk garments plus standard care compared with standard care for treating eczema in children: A randomised, controlled, observer-blind, pragmatic trial (CLOTHES Trial)
Lancet Oncol 2014, Bath-Hextall F, Ozolins M, Armstrong SJ, Williams HC, et al: Surgical excision versus imiquimod 5% cream for nodular and superficial basal-cell carcinoma (SINS): a multicentre, non-inferiority, randomised controlled trial
N Engl J Med 2013, Thomas KS, Foster KA, Chalmers JR, Williams HC, et al: Penicillin to prevent recurrent leg cellulitis
PLos One 2014, Mason JM, et al: Prophylactic antibiotics to prevent cellulitis of the leg: economic analysis of the PATCH I & II trials
Lancet 2017, Williams HC, Chalmers JR, Whitham D, et al: Doxycycline versus prednisolone as an initial treatment strategy for bullous pemphigoid: a pragmatic, non-inferiority, randomised controlled trial
BMJ 2015, Thomas KS, Mitchell E, Williams HC, et al: Comparison of the two most commonly used treatments for pyoderma gangrenosum: results of the STOP GAP randomised controlled trial