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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.
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 investigating genetic and environmental interactions leading to skin barrier breakdown in atopic eczema has delivered health benefits by improving the prevention and treatment of this condition. We found that established emollient formulations (e.g. Aqueous Cream BP) containing the harsh emulsifier sodium lauryl sulphate (SLS) damage the skin barrier in patients with atopic eczema and identified an underlying molecular mechanism. Consequently, the NICE Quality Standard and Guidelines now reflect our advice that Aqueous Cream should not be used as a leave-on emollient, SLS has been removed from all emollient formulations in the UK and we have helped develop the next generation of `SLS-free' skin-care products. Medicines regulators including the Medicines and Healthcare products Regulatory Agency (MHRA) and New Zealand MedSafe have also issued new advice as a result of our research.
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%.
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.
The impact of research by the University of Southampton into global access to safe drinking water has: (i) provided important evidence for new policy initiatives by the World Health Organisation and UNICEF to promote home water treatment to reduce the 1.9 million deaths each year due to water- related infections, and (ii) stimulated debate among a range of stakeholders, including the media, advocacy groups and UN bodies, by challenging the accuracy of the assertion by the UN Secretary General that the UN Millennium Development Goal for safe water access has been met.