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Atopic eczema and associated conditions — asthma, food allergy and hay fever — affect ~40% of the population in developed nations. They cause significant morbidity and create a multibillion-pound global healthcare burden. The discovery that loss-of-function mutations in the gene encoding filaggrin represent a strong risk factor for eczema, asthma and peanut allergy has defined a key pathological mechanism in atopic disease. This breakthrough in understanding has brought new focus on the skin barrier. It has shown impact in treatment approaches to maintain barrier function, translational research targeting epithelial dysfunction and improved public and professional awareness of the role of skin in atopic disease.
Atopic eczema affects approximately 30% of children, causing suffering at a crucial time in their development. An increasing prevalence has raised concern that newborn skin care may be a factor. University of Manchester (UoM) research explored the effect of a range of products including commercial baby skin care products on skin integrity. We identified harmful practices related to topical oil use; established that a specially formulated newborn cleansing product was safe; and demonstrated increased maternal-reported nappy rash, when cotton wool and water, as opposed to baby wipes, were used. The findings have: changed the attitudes of healthcare professionals to baby skin care practices; informed the guidance provided to parents of newborns, allowing them to make informed choices (a YouTube video featuring the research has been viewed almost 400,000 times); and increased sales of Johnson & Johnson baby skin care products by 15%.
Our research has shown that water softeners are not effective in reducing the symptoms of moderate to severe eczema in children, and that their use provides no additional benefit over usual care. This finding has had an impact on Healthcare practitioners ensuring they are now able to offer the evidence-based advice to patients that the use of water softeners will not alleviate the symptoms of eczema. This advice not only eliminates false hope in patient groups but also results in significant cost savings for families of children with moderate to severe eczema who might otherwise have purchased water softeners.
Atopic eczema is a disabling long-term skin condition affecting ~2% of the UK adult population. The mainstay of treatment remains topical steroids and moisturisers, but many adult patients with atopic eczema have resistant disease that can significantly impair quality of life. Newcastle University researchers conducted clinical trials that showed both whole-body ultraviolet B phototherapy and systemic (tablet) treatment with the immunosuppressant drug azathioprine were effective treatments for adults with atopic eczema resistant to standard topical treatments. UK and European guidelines written after 2008 recommend UVB phototherapy and azathioprine for atopic eczema, and survey data indicate that both are now widely used to treat the disease in the UK.
Research in the Centre of Evidence Based Dermatology at the University of Nottingham has improved the lives of children with eczema throughout the world. This has been achieved by improving the evidence base for clinical care through identifying treatments that work and those that do not, thus reducing the burden of disease for patients and reducing costs for patients and the NHS. Clinical care has been improved, economic benefits have been realised and Government policy informed.
Keratins are major cytoskeletal proteins of epithelial cells. Pioneering research at the University of Dundee led by Prof Irwin McLean FRSE and Prof Birgit Lane FRSE showed the association of keratin mutations with genetic skin fragility disorders. This has dramatically changed the diagnosis of inherited skin disorders and has directly translated into improved clinical management of patients both in the UK and internationally. Further work on this disease has resulted in the first clinical trial using siRNA for a skin condition.
Extensible fibrillin-rich microfibrils are the template for elastic fibres that endow dynamic tissues with elastic recoil. Researchers at the University of Manchester (UoM) showed that microfibrils are degraded in photoaged skin. We developed a rapid in vivo assay, `The Manchester Patch Test Assay', which predicts the potential of anti-ageing products to restore microfibrils in photoaged skin. The assay was used to demonstrate the efficacy of a Boots Healthcare anti-ageing product and was showcased on the BBC's Horizon in 2007. Impacts include: dramatically increased sales for Boots, investment and changes to the product development strategies of more than 10 international personal care companies, which have used our assay to support product claims.