Skin diseases affect millions, yet doctors often lack clear evidence on which treatments work best. This research programme tackles that uncertainty head-on for four specific conditions: childhood eczema, vitiligo, squamous cell skin cancer, and pyoderma gangrenosum—a painful, ulcerating disease that has been largely neglected by researchers. The problem is straightforward: without reliable trials and systematic reviews, NHS commissioners and clinicians cannot make informed decisions about prevention or treatment. Patients and families are left guessing. The programme will fill these gaps by conducting Cochrane reviews, pilot studies, and a national randomised controlled trial for pyoderma gangrenosum. It will also run James Lind Alliance exercises to identify what patients and clinicians most need answered. If successful, the work will produce web-based decision aids for patients, treatment information resources for healthcare workers, and high-quality trial evidence that NHS commissioners can use to guide purchasing and care pathways. It will also train three health services researchers to PhD level, building the UK’s capacity to run dermatology trials. The programme does not aim to discover new drugs—it aims to give existing treatments the rigorous evidence they currently lack.
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AIMS AND OBJECTIVESOur research programme will set priorities and reduce uncertainties in the prevention and treatment of skin disease. BACKGROUNDSkin diseases are very common, yet there are large gaps in knowledge about their causes and treatment. We will focus on four diseases with contrasting perspectives: childhood eczema (a big problem for children and parents and increasing in the UK), vitiligo (white skin patches that can be particularly distressing for dark-skinned people), squamous cell skin cancer (a national priority which is common and increasing) and pyoderma gangrenosum (a neglected, painful, ulcerating, skin disease).RESEARCH PLAN A set of sequential research methodologies will address:1. PREVENTION OF ECZEMA: systematic review; pilot trial of eczema prevention; full trial proposal; web-based information resources for patients and health care workers2. TREATMENT OF ECZEMA: updated systematic review; trial prioritisation exercise; treatment information resources; and international collection of appraised trials 3. VITILIGO: updated Cochrane review, trial prioritisation exercise; pilot study; trial proposal; treatment and information resources4. SQUAMOUS CELL SKIN CANCER: new Cochrane review, pilot study; trial proposal; treatment information resources 5. PYODERMA GANGRENOSUM: national randomised controlled trial (RCT) and treatment information resources6. NHS capacity building in dermatologyRESEARCH TEAMOur multi-disciplinary team has a complimentary range of methodological skills (statistics, health economics, trial design/management, systematic reviews, writing information resources and research prioritisation) and content expertise in the four selected diseases. Our team also includes a healthcare user and 3 dermatology service commissioners to assist in translating our results into NHS practice. The team has worked together successfully over the last 5 years, winning over £4.7 million in non-commercial external funding, and publishing over 100 articles in peer reviewed journals. The programme has a tight management structure with a programme manager, small executive group and larger steering group, a lead for each work stream and a lead for liaison with industry. RESEARCH ENVIRONMENTThe Centre of Evidence Based Dermatology houses 17 staff, providing an excellent environment to support the work programme. The Centre is made up of three interlinking cogs (see Annexe 4): Cochrane systematic reviews (identify evidence gaps), the UK Dermatology Clinical Trials Network (address those gaps) and the National Library for Health Skin Disorders Specialist Library (disseminate evidence to its community of users). The Centre will build on existing successful collaborations for additional methodological skills, including the MRC Clinical Trials Unit, and CHaRT. OUTPUTS AND IMPACT OF RESEARCH FOR NHS / PUBLIC(i) 2 over-arching eczema systematic reviews (ii) a national collection of randomised controlled trials for eczema (iii) a new Cochrane review on treatments for squamous cell skin cancer (iv) an updated Cochrane review on vitiligo treatments (v) a James Lind Alliance exercise to identify trial priorities for vitiligo and eczema (vi) 3 feasibility studies for definitive trials on eczema, vitiligo and squamous cell skin cancer (vii) delivery of a multi-centre RCT on treatments for pyoderma gangrenosum (viii) web-based patient information resources and decision aids to support shared decision making on treatment options for patients on the four topics (ix) increased capacity to support NHS and industry-based clinical trials in dermatology in the UK (3 health services researchers trained to PhD level). Our programme provides a platform to efficiently deliver high quality trials on a national scale that could not be achieved by local groups. It will also give critical information for local and national NHS commissioners to guide rational purchasing decisions, for health care professionals to develop care pathways, and for he
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