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Statement against the use of Borax for the treatment of lichen sclerosus

Comment from Dr Nevianna Bordet of the British Association of Dermatologists:

Borax (also known as sodium tetraborate) is a salt of boric acid. It is generally used as an insecticide and can be found in household products such as washing powder. It is not for use on the skin or to be ingested. Repeat or prolonged excessive exposure to the skin can result in irritation.

I do not recommend that patients with lichen sclerosus apply it to the skin nor ingest it. Instead, they should see their doctor or dermatologist for further advice. lichen sclerosus carries a risk of developing vulval cancer and therefore, needs to be managed and monitored by a medical professional. Treatment for lichen sclerosus should only be discontinued on the advice of a doctor.

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Male genital piercing – a sensitive subject

Men who undergo genital piercing, the most common being the ‘Prince Albert’, are at risk of painful allergic reactions, scarring and infection, according to a study being presented at the British Association of Dermatologists’ Annual Conference in Birmingham this week.

The warning is being issued by doctors from Burnley General Hospital, who reviewed a number of studies looking at dermatological complications arising from male genital piercing.

They found that between 10 and 23 per cent of men with genital piercings develop hypersensitivity dermatitis, which is irritation of the skin caused by an allergic reaction to a particular substance. This can be painful, itchy and unsightly.

However, this is not the only complication arising from the piercings. Between seven and 18 per cent of men in the studies developed a similar reaction called irritant dermatitis, which is a type of rash that develops when the skin is in contact with irritant substances.

Between four and eight per cent suffered from keloid formation, a type of scar that grows too much and can become larger than the original wound, and between three and eight per cent experienced an infection.

In addition to these, there have been two reports of squamous cell carcinoma, a type of skin cancer, developing at the site of glans piercings in patients infected with HIV.

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The ‘Prince Albert’

The ‘Prince Albert’ style of piercing involves an insertion through the external urethra and exits at the base of the frenulum, where the head of the penis meets the shaft. This ring style piercing was popularised during the 1970s, and is considered the most common form of male genital piercing.

The reason for the name ‘Prince Albert’ is unclear, claims have been made that this style of piercing was used to secure the penis when wearing the particularly tight trousers that were in fashion during the Victorian era – hence the link with the Queen’s Prince Consort. However, there is no evidence to suggest that this is anything other than an urban legend.

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A 2008 study* on the prevalence of various piercing sites, other than the earlobe, found that 0.3 per cent of English men had undergone genital piercing, compared to 0.2 per cent of English women. The same study also demonstrated that genital piercings are becoming increasingly popular, with 0.8 per cent of 16 to 24 year olds having ever had a genital piercing compared to 0.2 per cent of over 25s (both genders).

Dr Adam Daunton, one of the authors of the study, said: “Whilst there is a good level of awareness within the dermatology community and indeed amongst the general public of the sorts of complications that can ensue from piercings at commonly pierced sites such as the earlobe, there is much less awareness of potential complications arising from penile piercings. Thus far, there have not been any studies focusing specifically upon the types and rates of dermatological complications experienced by men who undergo these piercings. Our review attempts to extract and synthesise information from a range of other studies in a systematic fashion to give estimates of the rates of potential complications. We hope this information will be of value in helping men to make informed decisions, as well as for healthcare professionals”.

Matthew Gass of the British Association of Dermatologists said: “Statistics seem to show that penis piercings are on the rise in Western cultures. As with any form of body modification, people need to be made aware of the potential risks. This is particularly important as we are talking about a particularly sensitive part of the male anatomy, which could have an impact on your health, wellbeing, and future relationships.

“Although this is the sort of subject that people may make light of, it is important that men considering this procedure know what they might be getting themselves into. It is our hope that this warning will get people talking, and raise awareness around the potential risks.”

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Notes to editors:

If using this study, please ensure you mention that the study was released at the British Association of Dermatologists’ Annual Conference.

The conference will be held at the Birmingham ICC from July 5th to 7th and is attended by approximately 1,200 UK and worldwide dermatologists.

For more information please contact the media team: comms@bad.org.uk, 0207 391 6084. Website: www.bad.org.uk.

Study Information:

A systematic review of dermatological complications following male genital piercing
A. Daunton and M. Shah
Department of Dermatology, Burnley General Hospital, Burnley, Lancashire, U.K.
Male genital piercing is becoming increasingly popular in Western culture. Estimates of prevalence vary from 0.4% of all British men aged > 16 years, to 2% of American men aged 18–50 years. The commonest type of male genital piercing (the ‘Price Albert’) involves insertion through the external urethra and exits at the base of the frenulum. Medical complications arising from genital piercing are managed by a range of specialities, including urology, dermatology and genitourinary medicine. While complications have received attention within urology and primary care, they remain largely unknown within the dermatology literature. We performed a systematic literature review searching the Medline and Embase databases using the medical subject heading keywords, ‘genital piercing’, ‘urethral piercing’, ‘body piercing’ and ‘genital modification’. This yielded a total of 3867 articles. Exclusion of duplicates and articles not available in English left 2425 articles. Interrogation of the titles and abstracts of these articles was performed by two dermatology professionals, to review them for relevance. Articles focusing exclusively upon female genital piercing were excluded. This yielded a total of 156 full-text articles, distributed across general medicine, urology, genitourinary medicine and primary-care journals. Full-text articles were interrogated using a standardized pro forma, and information was extracted on dermatological complications of piercings including postinsertion infection, hypersensitivity dermatitis, irritant dermatitis, keloid scar formation, lichen sclerosus and association with malignancy. No studies had been designed specifically to categorize and record dermatological complications. Most articles comprised studies of piercings across all body sites. However, two cross-sectional studies examining self-reported complication rates in patients with male genital piercings were identified, encompassing a total of 494 men, alongside 16 individual case reports describing complications. Estimates of postinsertion infection rates ranged from 3% to 8%. Symptoms consistent with hypersensitivity dermatitis were exhibited in 10–23%. Irritant dermatitis occurred in 7–18%, while keloid formation occurred in 4–8%. There are no reports of lichen sclerosus following genital piercing. There have been two reports of squamous cell carcinoma developing at the site of glans piercings in patients infected with HIV. This review highlights the need for dermatology-focused recording of complications following male genital piercing, as no studies thus far have been undertaken by dermatologists. It also highlights the need for studies utilizing objective, physician-measured outcome data, rather than self-reported measures.

*Bone A, Ncube F, Nichols T, Noah D. Body piercing in England: a survey of piercing sites other than earlobe. BMJ 2008; 336:1426-1428: http://www.bmj.com/content/336/7658/1426

About us:
The British Association of Dermatologists is the central association of practising UK dermatologists. Our aim is to continually improve the treatment and understanding of skin disease. For further information about the charity, visit www.bad.org.uk
 

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One in five women with a vulval health condition contemplate self-harm or suicide

One in five patients with a condition affecting more than 300,000 women in the UK have considered suicide or self-harm, according to a survey of women with vulval health conditions released today.

Vulval health conditions are common in the UK, with a conservative estimate suggesting that 1 in every 100 women in the UK suffers from Lichen Sclerosus. This is just one of a range of vulval disorders and affects 63 per cent of the respondents to this survey.

The survey conducted by the British Association of Dermatologists (BAD), together with the Association of Lichen Sclerosis and Vulval Health, showed the extent of the social, professional and emotional damage that vulval health conditions can have on lives.

44 per cent of women with a vulval condition surveyed stated that it was difficult to access medical treatment for their condition. Reasons for the difficulties experienced included misdiagnoses, waiting times, not knowing who to speak to and embarrassment at seeking treatment.

Further to this, 89 per cent of those surveyed said that their condition had affected their emotional and mental wellbeing, 42 per cent said that it had affected their social life, 79 per cent said that it had affected personal relationships, and 39 per cent said that it had affected their work life.

The severity of this impact should not be underestimated. 22 per cent had suicidal thoughts or thoughts of self-harm. 17 per cent felt that their condition had been responsible for the break-up of a relationship, partnership, or marriage. 63 per cent felt that their condition had prevented, or made difficult, romantic or sexual relationships. One respondent said her condition made her feel “less of a woman”, another that she felt like “a freak”.

Many of the respondents said their condition made everyday tasks difficult, unpleasant, or impossible, including:

• Walking: 38 per cent
• Urinating: 50 per cent
• Wearing underwear or trousers: 60 per cent
• Engaging in sexual activities: 84 per cent
• Sleeping: 36 per cent

Dr Karen Gibbon of the British Association of Dermatologists said, “Embarrassment, emotional trauma, and physical pain are common themes amongst women with vulval health conditions. It’s important that women are able to talk about vulval conditions without fear of stigma. Greater awareness and education around vulval health will not only help mitigate emotional distress but will also help women get the treatment they need sooner.”

Dr Nevianna Tomson, Consultant Dermatologist said, “Vulval health conditions can be difficult for people to talk about, but it’s important that we overcome that discomfort. It shouldn’t be necessary for women across the country to suffer in silence. For many of these conditions there is no cure, but there are treatments that can help and there is a heavy psychological burden which we can lessen.

“Women should not be trapped inside their own heads thinking that they are less of friend, partner, employee or woman because of a condition. Being able to talk openly about health is the first step to improving the lives of patients and helping them get access to treatment.”

Fabia Brackenbury of the Association of Lichen Sclerosis and Vulval Health said, “I have been living with lichen sclerosus for over 20 years. It was a contributing factor to the loss of my 30 year marriage. The challenges never end. You go into old age with this condition. A woman deserves an Indian Summer, not a Winter of Discontent.

“A much higher profile needs to be established for vulval disease, not only amongst medical professionals but also researchers and the media. My own campaign for awareness started well with media interest but over the years has been dropped in favour of other health issues.

“Those who suffer, long to enjoy the high profile that is seen in other conditions, and none more so than those with vulval cancer. So many women have told me that at least if they had breast cancer, they could talk to people about it.

“If awareness equality was possible, women would feel more able to come forward and seek help. Awareness and education for everyone is essential if we are to improve the lives of the small girls who are diagnosed as young as two years old with lichen sclerosus and who will live a life sentence of shame, despair and uncertainty.

“We live in an unequal world where some people's health issues are more important than others and this is the root of much suffering for those who struggle for recognition.”

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Notes to editors:
For more information, please email: john.major@bad.org.uk

Interview opportunities available with Dr Karen Gibbon, Dr Nevianna Tomson and Fabia Brackenbury. For more information contact john.major@bad.org.uk

Vulval health conditions include, but are not limited to, Lichen Sclerosus, Vulval Cancer, Vulvodynia, Lichen Planus, Ulcers, Cysts and Lichen Simplex. None of these are sexually transmitted diseases.

The British Association of Dermatologists is the central association of practising UK dermatologists. Our aim is to continually improve the treatment and understanding of skin disease.

The British Association of Dermatologists’ Vulval Health Survey 2015 was completed by 325 women suffering with vulval health conditions. For details of the full survey contact: John.Major@bad.org.uk

Dr Karen Gibbon is a consultant dermatologist who works both in the NHS for Barts Health NHS Trust and privately in Essex. She runs specialist vulval clinics for girls and women of all ages. She is also a member of the clinical services unit at the BAD.

Dr Nevianna Tomson is a consultant dermatologist who works both in the NHS for West Suffolk Hospital and privately. At NHS West Suffolk she is the lead clinician for vulval disease. More about Nevianna can be found here: www.suffolkskin.co.uk

Fabia Brackenbury is the founder of the Association for Lichen Sclerosus and Vulval Health. She has been living with Lichen Sclerosus since 1994.

Other patient support groups for vulval health include the Vulval Pain Society and the British Society for the Study of Vulval Disease (BSSVD)
 

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