Identification of translational dermatology research priorities in the U.K.: results of an electronic Delphi exercise

Healy, Eugene; Brown, Sara J.; Langan, Sinéad; Nicholls, Stuart G.; Shams, Kave; Reynolds, Nick J.

doi:10.1111/bjd.14022

Cited by 12 publications

(20 citation statements)

References 36 publications

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“…This, combined with the low response rate, potentially limits the statistical generalizability of our findings. On the other hand, in areas of overlap with previously published surveys, our data appear consistent and aligned …”

Section: Discussionsupporting

confidence: 90%

“…Our findings also align with a recently published eDelphi exercise performed by U.K. TREND that highlighted identification of novel systemic treatments for adult eczema as one of the top 10 translational research questions in inflammatory skin disease …”

Section: Discussionsupporting

confidence: 89%

“…On the other hand, in areas of overlap with previously published surveys, our data appear consistent and aligned. 2,19,20 Our finding that > 90% of the responding U.K. dermatologists would choose narrowband UVB as their first-line phototherapy modality is in line with evidence from RCTs 4 and recently published European guidelines. 21 However, it is interesting that respondents' own clinical experience and knowledge of acute and chronic side-effect profiles (rather than their knowledge of the evidence base for treatment efficacy) appeared to be the major factors influencing their choice.…”

Section: Discussionsupporting

confidence: 81%

“…TREND that highlighted identification of novel systemic treatments for adult eczema as one of the top 10 translational research questions in inflammatory skin disease. 20 We sought the views of our respondents on RCTs they would like to see conducted. Comparative studies between two systemic treatments or between a systemic treatment and phototherapy were identified as the most important RCTs that should be performed, followed by single-agent placebo-controlled studies.…”

Section: Discussionmentioning

confidence: 99%

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Treatment of moderate-to-severe atopic eczema in adults within the U.K.: results of a national survey of dermatologists

et al. 2017

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SummaryBackgroundLittle is known about U.K. dermatologists' treatment approaches towards adult patients with recalcitrant moderate‐to‐severe atopic eczema.ObjectivesWe wanted to learn about (i) treatment approaches used for this disease in the U.K.; (ii) factors that influence treatment decisions and (iii) perceived gaps in evidence on treatment safety and efficacy, and priorities for future trials.MethodsWe conducted an online survey of consultant‐level dermatologists in the U.K.ResultsSixty‐one respondents from over 30 centres reported on management of moderate‐to‐severe atopic eczema in adults, outwith the context of an acute flare. Phototherapy or psoralen–ultraviolet A was the most common therapeutic modality chosen first line (46%), and this was usually narrowband ultraviolet B. Systemic therapy was chosen as a first‐line approach by 36% of dermatologists. Azathioprine was the commonest drug reported being used as first line followed by oral corticosteroids, ciclosporin and methotrexate. Methotrexate was the most common second‐line treatment of respondents. The key factors that influenced decision making on the use of phototherapy and systemic agents were the respondent's clinical experience, results of baseline tests (systemic agents) and knowledge of both efficacy and acute and chronic side‐effect profiles. The most important evidence gaps identified were the relative effectiveness of treatments, the alternatives to current approaches and the safety of long‐term maintenance treatment. With regard to future trials, respondents suggested that priority should be given to studies involving methotrexate.ConclusionsWhile survey study designs have limitations, we found that phototherapy, in particular narrowband ultraviolet B, was respondents' preferred first‐line treatment for adults with recalcitrant moderate‐to‐severe atopic eczema, perhaps reflecting access to, and clinical experience of, this approach. Azathioprine is widely used as a longer‐term maintenance treatment.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Treatment of moderate-to-severe atopic eczema in adults within the U.K.: results of a national survey of dermatologists

et al. 2017

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“…However, the current principal treatment, topical corticosteroid, can have detrimental effects (e.g., perioral dermatitis and skin atrophy), and individuals becoming refractory to topical application require systemic treatment, with potentially severe adverse effects (Schakel et al., 2014). Development of interventions to restore barrier integrity was recently identified by researchers, clinicians, patients, and policymakers as a top-10 translational dermatology research priority in an e-Delphi exercise (Healy et al., 2015). Our data show that interventional approaches aimed at promoting endogenous hBD2 expression and/or the therapeutic application of hBD2 (or synthetic analogues) may have the potential to enhance/restore skin barrier integrity, protect against S. aureus V8 protease-mediated damage, and reduce reliance on corticosteroids.…”

Section: Discussionmentioning

confidence: 99%

IL-1β–Induced Protection of Keratinocytes against Staphylococcus aureus-Secreted Proteases Is Mediated by Human β-Defensin 2

Wang

McHugh

Qureshi

et al. 2017

Journal of Investigative Dermatology

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Atopic dermatitis (AD) is a common chronic inflammatory skin disease that results in significant morbidity. A hallmark of AD is disruption of the critical barrier function of upper epidermal layers, causatively linked to environmental stimuli, genetics, and infection, and a critical current target for the development of new therapeutic and prophylactic interventions. Staphylococcus aureus is an AD-associated pathogen producing virulence factors that induce skin barrier disruption in vivo and contribute to AD pathogenesis. We show, using immortalized and primary keratinocytes, that S. aureus protease SspA/V8 is the dominant secreted factor (in laboratory and AD clinical strains of S. aureus) inducing barrier integrity impairment and tight junction damage. V8-induced integrity damage was inhibited by an IL-1β–mediated mechanism, independent of effects on claudin-1. Induction of keratinocyte expression of the antimicrobial/host defense peptide human β-defensin 2 (hBD2) was found to be the mechanism underpinning this protective effect. Endogenous hBD2 expression was required and sufficient for protection against V8 protease-mediated integrity damage, and exogenous application of hBD2 was protective. This modulatory property of hBD2, unrelated to antibacterial effects, gives new significance to the defective induction of hBD2 in the barrier-defective skin lesions of AD and indicates therapeutic potential.

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Nationwide Incidence of Metastatic Cutaneous Squamous Cell Carcinoma in England

et al. 2019

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IMPORTANCE Cutaneous squamous cell carcinoma (cSCC) is the most common skin cancer with metastatic potential, but epidemiologic data are poor. Changes to the National Cancer Registration and Analysis Service (NCRAS) in England have allowed more accurate data analysis of primary and metastatic cSCC since 2013. OBJECTIVE To assess the national incidence of cSCC and metastatic cSCC (mcSCC) in England from 2013 through 2015.

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Identification of translational dermatology research priorities in the U.K.: results of an electronic Delphi exercise

Abstract: It is predicted that this list of PRQs will help to provide a strategic direction for translational dermatology research in the U.K. and that addressing this list of questions will ultimately provide clinical benefit for substantial numbers of patients with skin disorders.

Cited by 12 publications

References 36 publications

Treatment of moderate-to-severe atopic eczema in adults within the U.K.: results of a national survey of dermatologists

Treatment of moderate-to-severe atopic eczema in adults within the U.K.: results of a national survey of dermatologists

IL-1β–Induced Protection of Keratinocytes against Staphylococcus aureus-Secreted Proteases Is Mediated by Human β-Defensin 2

Nationwide Incidence of Metastatic Cutaneous Squamous Cell Carcinoma in England

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