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The NIHR is the nation's largest funder of health and care research and provides the people, facilities and technology that enable research to thrive. We work in partnership with the NHS, universities, local government, other research funders (including industry and charities), patients and the public to improve the health and wealth of the nation.
In 2017-18, the NIHR spent £4.5 million on research studies into skin conditions. Last year (2018/2019), the NIHR Clinical Research Network supported 125 studies on dermatology, 63 of which were new studies, and recruited 12,786 patients to studies.
Psoriasis is a common, currently incurable skin disease. In addition to affecting the skin, psoriasis is also associated with an increased risk of depression, arthritis, cardiovascular disease, chronic kidney disease and reduced life span. Psoriasis affects nearly two million people in the UK - costing the NHS in the region of £1.5 billion per annum. Patients often require lifelong treatment to manage their disease, which may expose them to toxic and potentially fatal side effects.
Biologics are one type of psoriasis treatment licensed for use in the NHS. Prior to BADBIR, the main clinical evidence around biologics had been established through relatively short randomised controlled trials, powered to detect differences in efficacy rather than side effects related to long term use. Consequently, long term effects and risks of biologics were not well understood. The NIHR Clinical Research Network (CRN) supported BADBIR study set out to address these gaps in evidence by monitoring the long term safety of biologics - while comparing safety and efficacy with conventional oral systemic treatments.
BADBIR’s potential to improve care and treatment for patients through improving clinical knowledge around the safety and effectiveness of psoriasis therapies is significant. The study is not only providing vital data on the safety of biologic treatments (such as risk of serious infection and cancer), but also helping to identify predictors of response to a biologic therapy aligned with BADBIR’s sample resource of 6,000 patients who provided DNA and/or blood serum samples.
Bullous pemphigoid, a severe blistering skin condition, is a rare auto-immune disease affecting mainly elderly people. The patient’s immune system mistakenly makes antibodies against the area between the top layer of skin (epidermis) and the next layer (dermis). This causes painful skin erosions, itchy rashes and blisters on the body which can become infected if they burst. Between 20 and 40 percent of patients die within one year of diagnosis.
Oral steroid tablets are commonly used to treat bullous pemphigoid, they work well, but can cause long term harmful side effects including infection, high blood pressure, brittle bones, eye problems and diabetes. Antibiotic tablets are also used and are thought to work almost as well as oral steroids, but their side-effects are less serious.
The aim of the BLISTER study, funded by the NIHR Health Technology Assessment (HTA) Programme and supported by the NIHR CRN, was to find out whether starting treatment with a commonly-used antibiotic ‘doxycycline’ would be an effective and safer alternative to the current standard treatment of the oral steroid ‘prednisolone’.
Research supported by the NIHR Guy’s and St Thomas’ Biomedical Research Centre has shown that babies whose mothers had received support to breastfeed exclusively for a sustained period from birth had a 54% lower risk of eczema at the age of 16.
The study examined more than 13,000 teenagers enrolled in the PROmotion of Breastfeeding Intervention Trial (PROBIT) as new-born babies between June 1996 and December 1997.
Half of the maternity hospitals and paediatric clinics involved in the PROBIT study provided additional breastfeeding support, while the other half continued their usual practices. While the study found that the breastfeeding promotion intervention provided protection against eczema there was no reduction in the risk of developing asthma between groups.
You can find out more about dermatology studies in your area through the Be Part of Research website.
We provide world-class health service infrastructure - research support staff such as clinical research nurses, and research support services such as pharmacy, pathology and radiology - to support organisations seeking to conduct clinical research in the NHS in England. Some of this research is funded by the NIHR, but most of it is funded by NHS non-commercial partners and industry.
We support the set up and delivery of clinical research in the NHS through our Study Support Service and our Research Design Service helps researchers develop proposals to secure funding from our research programmes.
The Dermatology Specialty is one of over 31 specialties which bring together communities of clinical practice to provide national networks of research expertise. Our membership is made up of research-interested clinicians and practitioners at both national and local levels. Our job is to ensure that dermatology studies receive the right support to ensure they are delivered successfully.
We support and promote research in the following areas:
We also take the lead on research studies relating to wounds such as venous ulcers and pressure ulcers.
Prof Nick Levell, Dermatology National Specialty Lead, NIHR CRN said: "Dermatology research improves lives for patients. It brings in new treatments for difficult conditions and shows up drugs which are ineffective. Patients who get involved with clinical studies tend to stay healthier, so our team wishes to make research available for all. Research is best done in a team and the NIHR is working towards bringing doctors, patients, nurses and scientists together to make new discoveries available in the clinic and improve patient outcomes."
The NIHR (CRN) Clinical Research Network is made up of 15 localities. Each one has at least one nominated local lead for dermatology research. These clinicians lead research groups to promote and support dermatology research within the NHS Trusts in their area.
At a national level the local leads come together to manage the national dermatology research portfolio overall. This involves regularly reviewing the progress of studies, identifying barriers to recruitment, and coming up with solutions and strategies to help overcome those barriers. The national group work closely with with the UK Dermatology Clinical Trials Network and UK TREND, the UK Translational Research Network in Dermatology, as well as, the devolved nations to deliver high quality research and improve patient care.
Read our Dermatology Specialty Profile to find out how we can support your commercial study.
The CRN Dermatology National Specialty Group (NSG) has closely linked objectives and many connections with two key stakeholders: the British Association of Dermatologists (BAD) and the UKDCTN.
Dr Nick Levell, NIHR National Specialty Lead for Dermatology 'Dermatology research improves lives for patients. It brings in new treatments for difficult conditions and shows up drugs which are neffective. Patients who get involved with clinical studies tend to stay healthier, so our team wishes to make research available for all. Research is best done in a team and the NIHR is working towards bringing doctors, patients, nurses and scientists together to achieve what could never be done alone.'
UK Dermatology is a cohesive network. The professional organisation for dermatologists is the British Association of Dermatologists (BAD) which is a charity with objectives to improve patient care, education of health professionals dealing with skin disease and improve research into skin disease. BAD has produced a number of useful resources including Patient Information Sheets and NICE Accredited Clinical Guidelines for Dermatologists. The BAD organisation, UK TREND, run by Professor Nick Reynolds is a newly formed translational research network which reports into the CRN National Dermatology Specialty Group. The NIHR Clinical Research Network works in partnership with BAD to recognise the outstanding contribution of NHS consultants and trainees who are active in research through a yearly award scheme.
The UK Dermatology Clinical Trials Network (UKDCTN), an associated special interest research group of the BAD, have a joint executive and steering group meeting with the CRN National Dermatology Specialty Group (NSG). Several of the NSG members, including the Nick Levell the National Specialty Lead for Dermatology, are also members of the UKDCTN steering group and executive. The UKDCTN was set up by Professor Hywel Williams and is a charity with over 900 active members. These include doctors, patients, nurses and scientists. The UKDCTN sets up, obtains funding and runs clinical trials in many common skin diseases, often using ordinary low-cost drugs which would not be tested in commercial pharma studies, providing valuable evidence to guide treatment.
Professor Hywel Williams describes the impact of the research delivery support we provide:
“It has been such a joy for me to witness the continued progress of the dermatology CRN speciality group in providing first class support in delivering portfolio studies that will result in patient benefit. Being able to come to your meetings to tell you about our study pipeline and to then follow-on with our own UK Dermatology Clinical Trials Network meetings on the same day is a clever formula that strengthens the bond and dependencies between study development and delivery. And long may it continue”
All of the UKDCTN studies so far have been adopted by the NIHR portfolio providing a valuable library of evidence in dermatology. Other links between these three organisation include the Patient Support Group committee of the BAD, allowing valuable PPI into clinical studies.
The NIHR provides the support and facilities the NHS needs for first-class research by funding a range of infrastructure.
NIHR Biomedical Research Centres (BRCs), partnerships between England’s leading NHS organisations and universities, conduct translational research to transform scientific breakthroughs into life-saving treatments. The following BRC undertakes research in dermatology:
All of the NIHR facilities and centres are opening to working with the public, charities, industry and other partners. If you are interested in collaborating with the NIHR please contact the NIHR Office for Clinical Research infrastructure: email@example.com
Experts from the NIHR Clinical Research Network National Specialty Group can advise on delivering your dermatology study across health and care settings.
Prof Nick Levell is the NIHR Clinical Research Network National Specialty Lead for Dermatology.
Prof Levell is a Consultant Dermatologist for Dermatology at the Norfolk and Norwich University Hospital is National Clinical Lead for NHS Improvement, and was President of the British Association of Dermatologists (BAD) from 2016-18. He chairs the BAD Therapy and Guidelines Committee producing national clinical guidelines.
He has wide ranging research interests in clinical dermatology, skin cancer epidemiology, health service delivery and health economics. He is on the executive and steering committee of the UKDCTN, a productive Clinical Trials generation unit and network, based in Nottingham led by Professor Hywel Williams.
Nick hopes that as the NIHR Specialty National Lead for Dermatology he will be able to make research central to dermatology clinical practice.