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Dermatologists welcome recommendation by cosmetics trade association to remove MI from leave-on products

Dermatologists today welcomed the recommendation by Cosmetics Europe, the European cosmetics trade association, to all its members that the preservative Methylisothiazolinone (MI or MIT) should be immediately removed from all leave-on skin products and personal care products, including cosmetic wet wipes, without waiting for action from regulators.

Today’s statement follows discussions with European Society of Contact Dermatitis (ESCD) after fears of a contact allergy epidemic caused by MI were raised at the British Association of Dermatologists’ (BAD) annual conference.

Dr David Orton, President of the British Society of Cutaneous Allergy said:

“This is a promising step forward, and I welcome this demonstration of responsibility by Cosmetics Europe to pre-empt regulation on the use of MI. I hope that this recommendation will be adhered to by the association’s members and will go some way towards protecting UK and European consumers.

“Nevertheless, as it currently stands, this recommendation falls short of calling for the removal or a reduction of MI levels in rinse-off cosmetics, such as shower gels or shampoos. We still have concerns that its continued use at present concentrations in such products will elicit allergic reactions in those that are already sensitised. This is a matter which we are hoping to reach agreement on in future planned discussions.”

Open letter to Dr Dan Poulter MP from the BAD, BAAPS, and BAPRAS regarding cosmetic interventions

Open letter to:
Dr Dan Poulter MP
Parliamentary Under-Secretary of State for Health
Richmond House
79 Whitehall,
London,
SW1A 2NS


Dear Dr Poulter

The Government Response to the Sir Bruce Keogh Review of the Regulation of Cosmetic Interventions

The British Association of Dermatologists (BAD), The British Association of Aesthetic Plastic Surgeons (BAAPS) and the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) welcome any action taken by the Government to regulate Cosmetic Interventions and prevent future harm to the British public. As you know our three organisations have worked closely with Sir Bruce Keogh’s team at the Department of Health and submitted evidence and expert opinion to the Review Panel. We were therefore alarmed at the report in the Mail on Sunday alleging that the Government had decided not to proceed with the recommendation for a compulsory register for all those carrying out non-surgical cosmetic procedures and proposed instead a voluntary register. If this is the case we would ask the Government to please think again.


Without a compulsory and comprehensive register for all non-surgical cosmetic practitioners the public will be prey to a two tier system: good practice by well qualified professionals on one level, which will almost certainly cost the consumer more; and on another level a cut-price, budget approach provided by untrained practitioners with little consideration of risk or redress if complications arise.
Such a system is unlikely to address the concerns raised in the original Review around unregulated non-surgical cosmetic interventions.


Whilst acknowledging that complications arising from botched cosmetic surgery may well be more serious and potentially life-threatening – surgery is a procedure that can only be carried out by medical professionals in regulated premises. Additional regulation is therefore much easier to implement within the existing framework. The complications which occur from non-surgical cosmetic interventions such as injectable fillers and lasers/IPL can be equally distressing and debilitating, yet these procedures can be administered by practitioners with no medical knowledge or understanding of potential risks.


The market for cosmetic interventions is well advanced and whilst the BAD, BAPRAS & BAAPS acknowledge the challenges of ‘skilling-up’ a large number of non-medical practitioners and that a staged approach to establishing a register may be necessary, we also believe it is the only way to ensure future safety for consumers. Simply because it is difficult, does not mean it should not be done.

We would also ask again, in this letter, to be given information on the timetable of publication and to receive confirmation that we will be allowed to see an embargoed copy of the report prior to publication.


Yours sincerely

Professor C Bunker

President of the BAD

Mr R Grover

President of BAAPS

Mr G Perks

President of BAPRAS 

British Association of Dermatologists, Response to Francis Inquiry

Background
The British Association of Dermatologists is a charity funded by the subscriptions and activities of its Members. Its objects concern the teaching, training, research and practice of Dermatology to benefit patient care.
Robert Francis QC chaired a public inquiry into the failings at Mid Staffordshire NHS Foundation Trust; his report was published in February 2013. The key failures identified were:
• Professional disengagement
• Patients not heard (complaints)
• Poor governance
• Lack of focus on standards of service
• Inadequate risk assessment of staff reduction
• (Poor) Nursing standards and performance
• Wrong priorities (of finances over quality of care)

Officers of the BAD met with Mr Francis in June 2013 and this document is the BAD's response to his report and its recommendations.


Response to relevant recommendations
“All commissioning, service provision, regulatory and ancillary organisations in healthcare should consider the findings and recommendations of this report and decide how to apply them to their own work”
“No provider should provide, and there must be zero tolerance of, any service that does not comply with fundamental standards of service. Standards need to be formulated to promote the likelihood of the service being delivered safely and effectively, to be clear about what has to be done to comply, to be informed by an evidence base and to be effectively measurable.”
Through its clinical services unit, the BAD has been supporting Dermatologists in challenging poor commissioning that could potentially lead to services not fit for purpose. BAD has published a 'Lessons learned' document highlighting the problems encountered and the response and outcome of intervention. The BAD has started to formulate service standards for core Dermatology services and continues to work with NICE and other stakeholders to develop these further.
The BAD has been developing and financing enhanced data collection and outcome measures including patient reported outcomes (PROMs).
The BAD has been developing and financing radical models of service redesign to deal with the demands of ageing demographics, chronic disease and comorbidities (including psychological) with quality, compassion and continuity of care at the heart of evidence-based diagnostic and therapeutic services.
“There should be an increased focus in nurse training, education and professional development on the practical requirements of delivering compassionate care in addition to the theory.”
The BAD has worked with and supported the British Dermatology Nursing Group over many years and will continue to work with the BDNG in supporting training education and professional development.
“Any organisation which in the course of a review, inspection or other performance of its duties, identifies concerns potentially relevant to the acceptability of training provided by a healthcare provider, must be required to inform the relevant training regulator of those concerns.”
There is Trainee representation on the Executive Committee of the BAD. The BAD also provides training and educational days for specialist registrars, other trainees and medical students. These educational events provide an opportunity for trainees to voice any concerns about training.
Response to Key Failures
Professional disengagement
• BAD will explore a programme of peer reviewing hospital departments/teams with a view to identifying excellence and spreading good management/practice.
• BAD will fund a 'Department of the Year' award to give an incentive to good management/practice.

 Patients not heard (complaints)
• BAD will use its relationship with patient support groups to help patient voices to be heard including the use of its publicity mechanisms to highlight areas of concern.

Poor governance
• BAD will support its Members in tackling concerns over poor governance through its Clinical Services Unit

Lack of focus on standards of service
• BAD will continue the process of developing standards of service for core and specialist Dermatology through updating the clinical services specification document and the publishing of service standards in specialist Dermatology.
• The BAD will continue its efforts in enhancing data collection and developing credible quality based outcome measures including PROMs.

Inadequate risk assessment of staff reduction
• BAD will work with Royal College of Physicians to collect census data on staff shortages and continue to highlight areas of concern including the use of long term locums.

(Poor) Nursing standards and performance
• BAD will continue to support nursing colleagues in developing standards and will support the BDNG in a 'dermatology nurse team of the year' award.

Wrong priorities (of finances over quality of care)
• BAD will continue to challenge poor commissioning decisions which prioritise finances over quality of care and will support its members in such issues.

Training
• BAD will make the evaluation of professionalism an important part of the training day for trainers and STC chairs
• BAD will continue to make the case for a 'Dermatology Deanery' to Health Education England in order to promote best practice in leadership/management as well as clinical skills.

Response from Chris Bunker, President of the BAD, to Global Burden of Skin Disease in 2010: An Analysis of the Prevalence and Impact of Skin Conditions

This is a fascinating study demonstrating the true impact of skin disease, which is often perceived by those responsible for providing healthcare services as a trivial health concern. In the UK alone, around 24% of the population consult their GP with a skin condition each year, making it the most common reason for people to see their GP with a new issue. However, we have an insufficient number of Dermatologists - if we were to have the same provision as the USA, Germany, Italy or France, we would need around 6,000 Consultant Dermatologists, currently we have 684. The problem is exacerbated by the fact that GPs have very little training in Dermatology, around six days on average. This leads to extra referrals in hospitals, or delays in treatment and diagnosis.

Studies like these should be used by health providers when deciding on training and budget allocation for different medical specialties.

World Psoriasis Day – the UK situation

An audit conducted by the British Association of Dermatologists (BAD), looking at the way in which newly published NICE guidelines on assessment and management of psoriasis patients are being implemented across the UK, is being released to mark World Psoriasis Day on Tuesday (29th October 2013).

On the whole the results were very positive. However, despite NICE prioritising holistic assessment of people with psoriasis, the audit revealed that psychological support for psoriasis patients in Britain has more than halved in the past six years compared to a similar audit in 2007. Where psychological support is available, psoriasis patients commented that waiting lists were often lengthy with actual access to treatment being sparse. Furthermore, psoriasis patients are often presented with issues of fairness when seeking psychological assistance, with limited resources being reserved for the most severe cases.

The British Association of Dermatologists, representing UK dermatologists, undertakes audits of services for psoriasis patients to make sure that they are getting the right treatments and that guidelines are being followed. In many respects, the UK is a world-leader in psoriasis treatment with dermatologists in the UK producing world class research into the disease and its treatment. However the audit highlights some important areas for improvement, most notably in the area of psychological support. This is an area of concern for the BAD which is currently in the process of creating a government-funded website to provide psychological support for people with skin conditions, in addition to this the association runs a web-based register of biologic and conventional therapies for psoriasis (BADBIR).

The BAD has also frequently raised the issue of an insufficiency in the number of dermatologists compared to the number of people requiring treatment for skin diseases, including psoriasis. If we were to have the same provision as the USA, Germany, Italy or France we would need around 6,000 consultant dermatologists, currently we have 684.

The problem is exacerbated by the fact that GPs – who see around 13 million people each year presenting with a skin problem – have very little training in dermatology, around six days on average. This leads to extra referrals to hospitals, or delays in treatment and diagnosis. Lack of training and awareness of psoriasis in primary care is also recognised as a key barrier to effective implementation of the NICE guidelines. The British Association of Dermatologists has raised these concerns with the Department of Health, the Royal College of GPs and Health Education England.

Psoriasis is a common autoimmune disease that affects 2% of the UK population. The condition causes rapid skin cell growth, most frequently appearing as raised, red, scaly plaques. Ranging in severity, psoriasis is a chronic and often painful condition which affects all age groups and both sexes. People with psoriasis may also develop psoriatic arthritis.

Beyond the physical implications, the debilitating effects of psoriasis are known to expand into the realms of depression, anxiety and suicide. In a recent national study 10,400 psoriasis patients in the UK were found to suffer from depression, 7,100 from anxiety and 350 from suicidal tendencies*. UK psoriasis patients are 39% more likely to succumb to depression than non-sufferers, with those who are severely inflicted being 72% more likely to possess mental health issues.

In spite of this, state provided psychological care for psoriasis patients in the UK appears to have decreased in the past six years (as discovered in the BAD’s ‘The assessment and management of patients with psoriasis – where are we?’ - conducted 2013 with over 1000 respondents), having fallen from 44% of hospitals providing dermatological psychological support to just 20%. The situation is further exacerbated by the fact that just over half of hospitals record psoriasis sufferer’s Dermatology Life Quality Index (DLQI) – the benchmarking system which ranks and monitors skin condition sufferers’ current life satisfaction, serving as a warning signal when a ranking crosses the threshold.

Positive steps

• In March 2013 The British Association of Dermatologists (BAD) was awarded government funding for a groundbreaking project that will bring together two major areas of healthcare, to benefit the lives of millions of people. The Department of Health Innovation, Excellence & Strategic Development Fund grant, of £97,000 over three years, will enable the BAD to develop a website that will act as a hub for psychological support specifically targeted at skin disease patients. The project will be the first of its kind to unite the specialties of dermatology and mental health, which have a significant overlap.

The causal link between mental health issues and skin disease is twofold – skin disorders cause psychological traumas, and conversely, psychological factors like stress can trigger or worsen certain skin diseases. However, Psycho-dermatology services (which provide emotional support specifically for skin disease patients) are extremely limited in the UK and very few dermatology departments even have direct access to general psychiatrists. The website will bring together, and link to, existing disease specific resources, support groups, forums and help-lines.

• The British Association of Dermatologists’ Biologic Interventions Register (BADBIR), a web-based register of biologic and conventional systemic therapies for psoriasis. Many patients find that conventional topical and systemic treatments will help them to control their psoriasis, however, for some with moderate or severe psoriasis these treatments are ineffective. New therapies called biologics have been developed by pharmaceutical companies to help control these more severe cases of psoriasis. As with most drugs, there are risks and side effects. Because this type of drug is new these risks and side effects need to be monitored carefully. Five years ago the British Association of Dermatologists set up BADBIR to do just that.
It currently involves over 7551 patients and 140 dermatology departments. The data it will provide over the coming years will be invaluable for the safe use of biologics in clinical practice. A UK and Ireland-wide dermatology clinical research network has been established that provides a framework for future studies in other diseases. The patient database also provides a useful resource for further research into psoriasis and some new studies have already begun as a result of this.


Nina Goad, of the British Association of Dermatologists said: “More often than not treatments of skin conditions focus on the visible symptoms, completely overlooking the equally impactful psychological consequences of disease. It is increasingly evident that the UK is in serious need of a robust psycho-dermatological infrastructure where patients suffering with psychological conditions originating from skin disease can seek accessible, comprehensive care. Currently the opposite is occurring, and whilst organisations such as the BAD are taking action, more needs to be done across the public health system. Specifically, funding needs to be allocated for Clinical Psychologists dedicated to dermatology patients.”

World Psoriasis Day is on the 29th of October.
*OLIVIER C, ROBERT P, DAIHUNG D, et al. The Risk of Depression, Anxiety, and Suicidality in Patients With Psoriasis: A Population-Based Cohort Study. Arch Dermatol. 2010;146(8):891-895. doi:10.1001/archdermatol.2010.186.

-ENDS-

For more information please contact the British Association of Dermatologists’ Press Office
Email: comms@bad.org.uk Tel: 0207 391 6084 / 6094 

Dermatologists develop non-surgical treatment to reduce unwanted chin fat

Scientists have developed a pioneering way to remove unsightly chin fat without the need for surgery,according to research released today in the British Journal of Dermatology.

The novel treatment targets aesthetically unappealing fat deposits underneath the chin, otherwise known as submental fat, or more colloquially as a ‘double chin’.

Dermatologists from the UK, France, Germany, Belgium and Spain have investigated a potential new treatment involving the injection of ATX-101 (a specific, synthetically derived formulation of deoxycholic acid) into submental fat. ATX-101 reduces submental fat by irreversibly disrupting fat cell membranes and causing adipocytolysis (destruction of fat cells). Following injection of ATX-101, an inflammatory response is induced, triggering the recruitment of highly specialised cells (macrophages) which remove the cellular debris resulting from destruction of the fat cells over time.

Submental fat deposits under the chin can be treated effectively with neck and face lifts or with liposuction. However, these treatments are not suitable for everyone, and the need for anaesthesia, an operating room and qualified staff substantially increases costs and risks. There are other non-surgical treatments for submental fat, but there is limited clinical evidence to prove their effectiveness.

The study included 363 men and women aged 18 to 65. Only those who presented with moderate to severe submental fat and expressed dissatisfaction with the appearance of their face and chin were eligible to take part. All the patients agreed to undergo clinical evaluations and laboratory tests and to maintain stable body weight, diet and exercise practices during the study.

The primary goals of the trial were to demonstrate at least a one point improvement in submental fat on the 5-point Clinician-Reported Submental Fat Rating Scale and for patients to show satisfaction with their face and chin appearance on the 7-point Subject Self-Rating Scale (SSRS).

On both the clinician and patient scales (above), significantly more ATX-101 recipients met the primary goals of the trial than a group receiving a placebo treatment. The trial used two different dosages of ATX-101 (1 mg cm-2 and 2 mg cm-2) as well as a placebo.

With the higher dosage of ATX-101, 65.3% of patients had a reduction in submental fat of at least one point on the Clinician-Reported Submental Fat Rating Scale compared with 23.0% with the placebo, and 66.1% of patients were happy with their face and chin appearance, versus 28.7% for the placebo.
In addition, calliper measurements showed a significant reduction in submental fat, with no apparent worsening of skin laxity. Following treatment, patients also reported a reduction in the psychological impact they felt due to the appearance of their face and chin. The treatment was found to invoke just a mild inflammatory response and the procedure was well tolerated by patients.

Matt Gass, of the British Association of Dermatologists, said: “This research is a very exciting step towards a safe and non-surgical solution to removing unwanted chin fat. For people experiencing negative psychological effects of this unwanted fat on their appearance, this procedure, if approved, may open up the option of minimally invasive treatment with proven efficacy.”

Professor Berthold Rzany (Berlin, Germany), the lead author, said: “This study demonstrates that subcutaneous injections with ATX-101 yield a clinically meaningful and statistically significant reduction in unwanted submental fat, decrease the psychological impact on patients, and are well tolerated. This study and three additional phase III clinical trials of ATX-101 will provide the first true evidence base for non-surgical submental fat reduction.”


-Ends-
Notes to editors:

If using this study, please ensure you mention that the study was published in the British Journal of Dermatology.
For more information please contact: Matt Gass, Communications Officer, Phone: 0207 391 6084, or Nina Goad, Head of Communications, 0207 391 6094, Email: comms@bad.org.uk, Website: www.bad.org.uk.

Study details: “Reduction of unwanted submental fat with ATX-101, an adipocytolytic injectable treatment: results from a phase III, randomized, placebo-controlled study”;
B. Rzany,a T. Griffiths,b P. Walker,c, S. Lippert,d, J. McDiarmid,e, B. Havlickovad
aDivision of Evidence-Based Medicine in Dermatology, Charité-Universitätsmedizin, and
RZANY & HUND, Privatpraxis und klinisches Studienzentrum für Dermatologie, Berlin,
Germany;
bSalford Royal NHS Foundation Trust and Dermatopharmacology Unit, Faculty of
Medical and Human Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK;
cKYTHERA Biopharmaceuticals, Inc., Calabasas, CA, USA;
dGlobal Clinical Development Dermatology, Bayer HealthCare, Berlin, Germany;
eMcDiarmid-Hall Clinic, Derriford, Plymouth, UK DOI: 10.1111/bjd.12695
This study was one of two identically designed phase III clinical trials of ATX-101 conducted in Europe

The article in the BJD can be viewed online: http://onlinelibrary.wiley.com/doi/10.1111/bjd.12695/abstract
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
Wiley-Blackwell, created in February 2007 by merging Blackwell Publishing with Wiley's Global Scientific, Technical, and Medical business, is now one of the world's foremost academic and professional publishers and the largest society publisher. With a combined list of more than 1,400 scholarly peer-reviewed journals and an extensive collection of books with global appeal, this new business sets the standard for publishing in the life and physical sciences, medicine and allied health, engineering, humanities and social sciences. For more information visit www.wiley.com 

President of the British Association of Dermatologists, Professor Chris Bunker's response to the Future Hospital Commission report

While we warmly welcome the overall message of the report, we take exception to the recommendation that participation in general medicine will be mandatory for those training in all medical specialties. We recognise the crisis facing hospital services generally, however a viable solution should not be one that undermines the work of individual departments. Also it is imperative that training the right number of specialists with the right skills in the right place is a protected priority, and that the effectiveness of this training is not diluted to fight fires in other areas of hospital services.

In many specialties, trainees provide a large part of the service. Dermatology training is already challenged by the needs of paediatrics and surgery. Forcing Dermatology and other specialty trainees to fill the gaps in general medicine denies specialist patients of the care they require. Furthermore, these trainees may not have maintained the required level of skills to serve the needs of general medical patients. We cannot support this aspect of an otherwise laudable report that will not only be deleterious to specialty training and patient care in Dermatology, but may also have minimal impact on the crisis in the acute setting.

Professional societies jointly condemn BBC Apprentice winner's business scheme

The main professional bodies for plastic surgery and dermatology today jointly and unequivocally condemn BBC Apprentice winner Dr Leah Totton’s capacity to set up and run a chain of outlets offering injectable facial treatments such as Botox and fillers. Not only the British Association of Dermatologists (www.bad.org.uk), the British Association of Aesthetic Plastic Surgeons (www.baaps.org.uk) and the British Association of Plastic, Reconstructive and Aesthetic Surgeons (www.bapras.org.uk) but a whole host of high-profile clinicians have taken to social media in a Twitter storm denouncing the junior doctor’s dangerously inadequate credentials for the project.

The extensive independent Review of Regulation on Cosmetic Interventions led by Sir Bruce Keogh (which issued its report earlier this year) highlighted problems within the non-surgical cosmetic sector and called for urgent development of an accredited training framework by Health Education England. The recommendations of the Review were welcomed by specialist professional groups who emphasise patient and public safety must be put ahead of commercial interests. They continue to urge rapid Parliamentary approval in order to take the recommendations forward and ensure that proficient implementation and improved patient care is in place – but in the meantime, the public remain at risk.

Mr Graeme Perks, President of the British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS) says
“At a time when all professionals are collaborating with Sir Bruce Keogh to improve cosmetic surgery practice and protect the vulnerable, it is a concern that a very junior doctor can make claims to be an authority in this field and provide the direction and clinical judgement that only comes with experience. The results of BBC Apprentice provide yet another demonstration of why Parliament must act fast.”

Prof Chris Bunker, President of the British Association of Dermatologists states
“We are seeing more and more complications at the hands of inadequately trained practitioners and counterfeit products. These adverse events can be permanent and life-ruining, and there are even reports of blindness being caused by inappropriate injection of fillers. Many patients require continued treatment and support on the NHS.”

According to Rajiv Grover, consultant plastic surgeon and BAAPS President“
What this debate needs is a strong injection of common sense – if Dr Leah Totton were training to be a GP she would not be able to work unsupervised for another four years after qualifying. Yet in the private sector she is setting herself up to train others. Having a stab at running a business shouldn’t be taken literally.”

According to Dr Tamara Griffiths, dermatology representative on the European Committee for Standardisation (CEN) which has been developing EU-wide standards for cosmetic surgery
“Dr Totton is a very junior doctor and her claim to be an expert in the field of cosmetic procedures may not measure up to the review by the European Committee for Standardisation, where international consensus has been reached regarding the imperative of adequate and accredited training.”


ENDS

About BAD
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. For media queries email comms@bad.org.uk or call 0207 391 6094.

About BAAPS
The BAAPS (www.baaps.org.uk), based at the Royal College of Surgeons, is a not-for-profit organisation, established for the advancement of education and practice of Aesthetic Plastic Surgery for public benefit. Members undergo thorough background screening before they can join. Information about specific procedures and surgeons’ contact details can be found on the web site, or by contacting their advice line at 020 7405 2234. Further materials can be posted to members of the public seeking specialised information. BAAPS is also on Twitter: www.twitter.com/BAAPSMedia and Facebook: www.facebook.com/BritishAssociationofAestheticPlasticSurgeons
For all media enquiries, please contact Tingy Simoes on 020 7549 2863 or email tsimoes@wavelengthgroup.com

About BAPRAS
BAPRAS, the British Association of Plastic, Reconstructive and Aesthetic Surgery, is the voice of plastic surgery in the UK. It aims to increase the understanding of the professional specialty and scope of plastic surgery, promoting innovation in teaching, learning and research.
Founded in 1946 (originally as the British Association of Plastic Surgeons), today BAPRAS has over 800 members and is the professional representative body for reconstructive and aesthetic plastic surgeons providing services to patients on the NHS and privately in the UK. www.bapras.org.uk
For more information please contact Luke Guinness or Laura Buller on 020 7403 2230 or 07711 444549, email baprasteam@forster.co.uk 

Self service phototherapy?

New ways of delivering a well-tried treatment – two studies presented at the British Association of Dermatologists’ Annual Meeting 8-11 July 2013, Liverpool

A lot of time can be used up waiting at the hospital to have regular phototherapy sessions for skin disease. This is a treatment that is often used for common conditions such as psoriasis and eczema. Usually this treatment is given in hospital-based phototherapy units and because travel or regular attendance can be a problem, some people, for whom this would be an ideal approach, cannot get the treatment they need.

Two studies presented at the British Association of Dermatologists Annual Meeting will look at the pros and cons of providing phototherapy in alternative ways or in alternative settings that would help to address that need.

A group from NHS Tayside, who have provided a home ultraviolet B (UVB) phototherapy service for the past 15 years, looked at the feasibility of patients self-administering phototherapy in a hospital outpatient department (1). They underook a pilot project where a group of patients were given a two day training programme. In subsequent monitoring of these patients and comparing the outcomes to a group having the same therapy administered by nurses, similar results were found for efficacy and rate of adverse effects.

Most patients and staff viewed self-administration of phototherapy positively, although it was clear that this approach is only suitable for some patients. The indications from the pilot study suggested that it would be a safe and effective service that would require around 50 per cent less nurse input. The team are now looking at developing this further and hope that it will further increase access and availability of phototherapy for patients whislt freeing up nurse time to provide other patient services.

The other study, undertaken by a team based in Wales (at Cardiff University, Welsh Insitute of Dermatology, Cardiff, Aneurin Bevan Health Board, St Woolos Hospital, Newport) took the findings from the PLUTO study as their starting point . This study found that home phototherapy for psoriasis is safe and as effective as phototherapy administed in hospital, in their own study they aimed to find out what local knowledge and attitudes to home phototherapy might be.

Home phototherapy is widely available in the Netherlands, Germany and the United States and the health economic analysis from the PLUTO study showed that it was cost neutral compared with hospital phototherapy. Using semi-structured interviews the researchers found that 75 per cent of consultants, 100 per cent of registrars, 100 per cent of nurse specialists and 78 per cent of patients thought that home phototherapy was a good idea.

Dermatology professionals gave the main reason for this as ‘less waste of patient time and less travelling’ and the main perceived barrier was ‘cost’. For patients the main reason for supporting home phototherapy was similar being ‘convenience’, ‘less time travelling’ and ‘transport logistics’.

Dr Salako, one of the team said:
“Although there was scepticism about home phototherapy from some of the dermatology professionals we think our findings, in this local sample, are widely representative and they suggest that more should be done to make the case for home phototherapy in the UK.”

-Ends-
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 ACC Liverpool from July 9th to 11th 2013, and is attended by approximately 1,300 UK and worldwide dermatologists and dermatology nurses.

For more information please contact: Nina Goad, Head of Communications, 0207 391 6094 (or mobile 07825567717 during conference week only) or Deborah Mason, Communications Manager, Phone: 0207 391 6355, Email: comms@bad.org.uk, Website: www.bad.org.uk

Study details:
1. Self-administration of hospital-based narrowband UVB (TL-01) phototherapy: a feasibility study in an
outpatient setting
S. Yule,1 S. Sanyal,1 S. Ibbotson,2 H. Moseley1 and R.S. Dawe1
1NHS Tayside, Dundee, U.K., 2University of Dundee, Dundee, U.K.

2. Evaluation of patients’ and healthcare professionals’ knowledge and views about home phototherapy
S. Lumley,1 K. Salako2 and Alex V. Anstey3
1School of Medicine, Cardiff University, Cardiff, U.K., 2Welsh Institute of Dermatology, Cardiff, U.K. and 3Aneurin Bevan Health Board, Academic Dermatology, St. Woolos Hospital, Newport, U.K.


ABSTRACTS:

1. Self-administration of hospital-based narrowband UVB (TL-01) phototherapy: a feasibility study in an outpatient setting
S. Yule,1 S. Sanyal,1 S. Ibbotson,2 H. Moseley1 and R.S. Dawe1
1NHS Tayside, Dundee, U.K., 2University of Dundee, Dundee, U.K.

Narrowband (TL01 lamp) ultraviolet B (UVB) is used to treat a variety of dermatoses, including the common conditions of psoriasis and atopic eczema. This treatment is most often given in hospital-based phototherapy units; difficulty in
attending such units regularly means that some people, for whom this would otherwise be an ideal approach, cannot easily attend for this effective and safe treatment. There are a variety of approaches to increase availability of this treatment, including supervised home phototherapy. Some patients cannot easily attend hospital phototherapy units when they are open. For some of these, home phototherapy is an appropriate option; for others it is not practicable (for example, some may have inadequate space in their homes for home phototherapy equipment). Self-administration of UVB phototherapy by outpatients might be appropriate for some. We wanted to assess the feasibility of outpatients self-administering UVB phototherapy in a hospital outpatient setting. A pilot project was commenced in November 2011. A total of 27 patients with psoriasis (n = 20) and atopic eczema (n = 7), (17 women, mean age 32 years, range 17–56) were recruited.
Our home phototherapy training programme was adapted. Patients underwent a 2-day training programme, which
included a minimal erythema dose (MED) test and supervised treatment. Patient and staff questionnaires were used to gather feedback. Treatment data were collected for 26 patients. The mean number of exposures was 23 (SD 9), and the mean cumulative dose was 15 J cm_2 (SD 11). Efficacy and rate of adverse effects were found to be similar to those of patients having nurse-administered treatment. Self–administration of treatment by outpatients required ~50% less nursing input than for conventional nurse-administered phototherapy. Most patients and staff viewed this model of care positively. Early indications suggest that this is a safe and effective service development that provides a patient-centred approach to care.
Having a group of patients trained to self–administer treatment empowers them to take a more active role in their treatment as part of their chronic disease management, and could free up nursing time to provide other patient services. We are planning further to develop this service by piloting the use of a dedicated unit on our dermatology ward for self-administration of treatment by outpatients. This service development would further increase access and availability of phototherapy for patients.

2. Evaluation of patients’ and healthcare professionals’ knowledge and views about home phototherapy
S. Lumley,1 K. Salako2 and Alex V. Anstey3
1School of Medicine, Cardiff University, Cardiff, U.K., 2Welsh Institute of Dermatology, Cardiff, U.K. and 3Aneurin Bevan Health Board, Academic Dermatology, St. Woolos Hospital, Newport, U.K.

The PLUTO study (Koek MB, Buskens E, van Weelden H et al. Home versus outpatient ultraviolet B phototherapy for mild to severe psoriasis: pragmatic multicentre randomised controlled non-inferiority trial (PLUTO study). BMJ 2009; 338: 1542) showed that home phototherapy for psoriasis is as safe and effective as phototherapy administered in hospital. Furthermore, health economic analysis from this study showed that home phototherapy is cost-neutral compared with hospital phototherapy. Home phototherapy is now widely available in the Netherlands, Germany and the United States, but provision remains limited in the U.K. Our aim was to explore local knowledge and attitudes about home phototherapy to better understand potential barriers to the introduction of home phototherapy. Semi-structured interviews were carried out on a cross-sectional sample of 18 patients with psoriasis and 18 dermatology healthcare professionals. Awareness by dermatology professionals of the PLUTO study was as follows: 75% of consultants; 57% of registrars; 29% of dermatology specialist nurses. However, just 50% of the dermatology professionals were able to state the conclusions or take-home message from this study. Awareness of the 1998 BAD guidelines on home phototherapy was as follows: 25% of consultants; 57% of registrars; 43% of specialist nurses. When asked for their views on whether or not home phototherapy was a good idea, the rate of positive responses was: 75% of consultants; 100% of registrars; 100% of nurse specialists. When asked to explain why it was a good idea the main reason cited by 83% was ‘less waste of patient time and less travelling’. ‘Cost’ was the main perceived barrier preventing the introduction of home phototherapy on the NHS, cited as follows: 75% of consultants; 86% of registrars; 100% of nurses. Of patients, 78%
preferred the idea of home phototherapy for reasons such as ‘convenience’, ‘less time spent travelling’ and ‘transport logistics’.
In summary, the 18 dermatology professionals had a generally poor understanding of home UVB. Furthermore,
scepticism about home phototherapy was apparent in some. Patients and dermatology nurses were the most positive about the concept of home phototherapy. If our findings in this local sample are widely representative they suggest that more should now be done to make the case for home phototherapy in the U.K. Wider provision of home phototherapy would improve patient choice, widen access to phototherapy and reduce the burden of treatment for our patients. Research is now needed to determine how this innovative model for phototherapy can be integrated into existing frameworks of care.


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. 

Rise in skin disease due to false nails, dermatologists warn

The fashion for acrylic nails may be behind a rise in allergies being treated by dermatologists, according to research presented at the British Association of Dermatologists’ Annual Conference in Liverpool this week.

A team of researchers from Chapel Allerton Hospital in Leeds, Centre for Occupational and Environmental Health in Manchester and the Hillingdon Hospital in Uxbridge, looked at cases of occupational allergic contact dermatitis (a type of allergic eczema caused in the workplace) suffered by beauticians during a 15-year period from 1996 to 2011.

Acrylate chemicals, used in acrylic nails and eyelash extension glue, was the cause of the disease in 64 per cent of cases over the entire period, which is significantly higher than the second most common allergen, fragrances, at 24 per cent.

The study revealed a steady increase in reactions from 1996 onwards, with a four-fold increase between 1997 and 2010 (no cases in 1996, three in 1997, nine in 2009, 12 in 2010 and eight in 2011). This increase coincides with the rise in popularity of acrylic nails and eyelash extensions, as beauticians experience increased exposure to these chemicals.

This study specifically examined reactions experienced by beauticians, however the same allergies could be experienced by customers receiving these treatments on a regular basis. Acrylic nails are artificial nail enhancements that can add length to the tips and give the nails a harder finish.

The first large-scale study of the psychological impact of hand eczema, carried out by researchers at Barts and the London NHS Trust in London, is also being presented at the same conference and gives a worrying insight into the wider effects of the disease.

Of the 1023 study participants suffering from hand eczema, 89 per cent percent said that they were self-conscious and embarrassed about their hand eczema. Hand eczema also had a major impact on daily activities, with 76 per cent of respondents stating that their eczema affected their social and leisure activities, and 74 per cent their ability to work or study. Interpersonal relationships were also affected: 79 per cent of respondents stated that hand eczema had a negative impact on their mood and 27 per cent that it affected their physical relationship with their partner.

Dr Chung Kwok of Chapel Allerton Hospital, Leeds, and one of the authors of the beautician study said: “This kind of research is important in keeping doctors up to date with potential new allergens and trends in allergy caused by new products. Hand dermatitis (eczema on the hands) is common in beauty professionals because they are exposed to a great variety of chemicals.”

Author of the psychological impact study, Dr Tony Bewley of Barts and the London NHS Trust said: “The impact of hand eczema is greatly underestimated by healthcare professionals and we need to address this. It stops people working, affects their relationships and their social life – it is so much more than a minor irritation.”

Nina Goad of the British Association of Dermatologists said: “If you are either a beautician working with acrylates or a customer regularly using these products and you find you develop an eczema reaction, you will need to see your GP who will refer you to a Dermatologist for patch testing. Hand eczema is debilitating for many people, and for beauticians it can mean an inability to carry out their work, which is of course a significant problem.”

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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 ACC Liverpool from July 9th to 11th 2013, and is attended by approximately 1,300 UK and worldwide dermatologists and dermatology nurses.

For more information please contact: Nina Goad, Head of Communications, 0207 391 6094 (or mobile 07825567717 during conference week only) or Deborah Mason, Communications Manager, Phone: 0207 391 6355, Email: comms@bad.org.uk, Website: www.bad.org.uk

Study details: 
1. CD03: Occupational disease in beauticians reported to the health and occupation research network from 1996 to 2011; C. Kwok,1 A. Money,2 M. Carder,2 S. Turner,2 R. Agius,2 D. Orton3 and S.M. Wilkinson1
1Dermatology Department, Chapel Allerton Hospital, Leeds, U.K., 2Centre for Occupational and Environmental Health, Manchester, U.K. and 3Dermatology Department, The Hillingdon Hospitals, Uxbridge, U.K.

2. CD05: An ethnographic insight into the psychological impact of hand eczema
A.P. Bewley,1 N. Mason,2 J. Rawlins3 and S. Walker3
1Barts and the London NHS Trust, London, U.K., 2Stiefel, GlaxoSmithKline, Uxbridge, U.K. and 3Basilea Pharmaceuticals, Guildford, U.K.

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. 

Some traditional antiseptics may be ineffective at killing bacteria

Some traditional antiseptics, used in hospitals and clinics, are actually ineffective at killing bacteria, according to research due to be presented at the British Association of Dermatologists’ Annual Conference in Liverpool this week (July 8th-11th).

The study, conducted by researchers from the Department of Dermatology at the Royal Infirmary of Edinburgh and the University of Edinburgh's Centre for Inflammation Research, sought to test the largely anecdotal evidence supporting various antiseptics’ efficacy.

The researchers tested the bactericidal activity against Staphylococcus aureus, a bacterium commonly found on the skin, of four frequently used topical antiseptics. To do this they used a modified version of the European Standard EN 1276 for evaluation of bacteria killing activity. To meet this standard there has to be a very significant reduction in microbial count within five minutes of exposure to the antiseptic.

Two of the four antiseptics chosen met the standard: 0.1% benzalkonium chloride and 6% hydrogen peroxide, but two did not: 2% aqueous eosin and 1 : 10 000 potassium permanganate.

Dr Claire Leitch, one of the study’s authors from the Royal Infirmary of Edinburgh, said: “Although these antiseptics are commonly used in the treatment of skin complaints, there has been a dearth of scientific evidence to support their bactericidal effectiveness. Whilst some of these antiseptics may have desirable astringent properties, these results suggest they lack effective antiseptic activity.

“This is preliminary research, relating specifically to Staphylococcus aureus, and so it is too early to draw wider conclusions. However, this study is an important step for future research to build on”.

Both aqueous eosin and potassium permanganate are used in primary and secondary care, primarily for the treatment of superficial skin infections, atopic dermatitis and chronic leg ulcers. However, their use in atopic dermatitis and chronic leg ulcers is not just for an antiseptic effect but also for their astringent properties.
Hydrogen peroxide and benzalkonium chloride are components of many commercially manufactured antiseptic creams, lotions and washes.

-Ends-
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 ACC Liverpool from July 9th to 11th 2013, and is attended by approximately 1,300 UK and worldwide dermatologists and dermatology nurses.

For more information please contact: Nina Goad, Head of Communications, 0207 391 6094 (or mobile 07825567717 during conference week only) or Deborah Mason, Communications Manager, Phone: 0207 391 6355, Email: comms@bad.org.uk, Website: www.bad.org.uk

Study details: “Traditional antiseptics show ineffective antistaphylococcal bactericidal activity”; C.S. Leitch, A. Leitch and M.J. Tidman/Department of Dermatology, Royal Infirmary of Edinburgh, Edinburgh, U.K. and Centre for Inflammation Research, Queen’s Medical Research Institute.

Abstract: Topical antiseptics are frequently used in dermatological management, yet evidence for the efficacy of traditional generic formulations is often largely anecdotal. We tested the in vitro bactericidal activity against Staphylococcus aureus of four commonly used topical antiseptics using a modified version of the European Standard, EN 1276, a quantitative suspension test for the evaluation of bactericidal activity of chemical disinfectants and antiseptics. To meet the standard for antiseptic effectiveness of EN 1276, at least a 105-fold reduction in bacteria counts within 5 min of exposure is required. While 0 1% benzalkonium chloride and 6% hydrogen peroxide both achieved this 105-fold reduction in S. aureus counts, neither 2% aqueous eosin nor 1 : 10 000 potassium permanganate showed significant bactericidal activity, when compared with controls, at exposure periods of up to 1 hour. Aqueous eosin and potassium permanganate may have desirable astringent properties, but these results suggest they lack effective antiseptic activity, at least against S. aureus.

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.  

Dermatologists raise the alarm on a contact allergy epidemic

At a special session of the British Society of Cutaneous Allergy to be held at the British Association of Dermatologists’ Annual Conference in Liverpool next week (July 8th to 11th), leading dermatologists will present research highlighting their fears of a new epidemic of contact allergy (causing eczema) to two chemical preservatives.

The ingredients in question are Methylisothiazolinone (MI) Methylchloroisothiazolinone/Methylisothiazolinone (MCI/MI). It is their presence in personal care products that are causing most concern, for example moist tissue wipes, cleansers, shower gels, deodorants, shaving foam. They can also be found in household products such as washing up liquid.

The preservatives are often used together, and past concerns about MCI/MI in Europe led to reductions in the concentrations allowed in cosmetic products.

Despite this a team at the Leeds Centre for Dermatology show in their research (1) that there was a sharp rise (up to 6.2 per cent sensitivity) in contact allergy to MCI/MI and MI over the past three years.

This was also reported by a team of researchers at St John’s Institute for Dermatology at St Thomas’ Hospital in London (2) who had seen a rapid rise in contact allergy to MI in the last two years going from one case in 2010 to 33 cases in 2012 – they also note that reports of high levels of MI allergy are emerging from several European countries. Across the UK other dermatology centres are also noticing rapid rises in numbers of acute allergic contact dermatitis related to MI exposure.

It is suspected that the recent use of MI as a single agent preservative in quantities up to 100 ppm in personal care products may be a major contributor to this outbreak of MI allergy.

David Orton, President of the British Society of Cutaneous Allergy said:

“Across the large patch test centres in the UK, data suggest that rates of allergy to these two preservatives are now nearing 10 per cent – and in some cases higher – this is clearly far too high and is an unacceptable situation.

“The last time a preservative had this type of effect it was banned by the EU. Although the relevant bodies in Europe have set up a review this all takes time – in the meantime the number of people coming to see us with this allergy is only likely to rise.

“We would welcome the opportunity to meet and discuss this issue with representatives of the UK cosmetics industry so as to take immediate steps to protect UK consumers”.

Dr John McFadden, Consultant Dermatologist at St John’s Institute of Dermatology said:
“The time for action is now. We are in the midst of an outbreak of allergy to a preservative (MI) which we have not seen before in terms of scale in our lifetime. Many of our patients have suffered acute dermatitis with redness and swelling of the face. I would ask the cosmetics industry not to wait for legislation but to get on and address the problem of MI allergy before the situation gets worse. If they are already taking action we would urge them to be open and transparent about what steps they are taking”

 

-Ends-
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 ACC Liverpool from July 9th to 11th 2013, and is attended by approximately 1,300 UK and worldwide dermatologists and dermatology nurses.

For more information please contact: Nina Goad, Head of Communications, 0207 391 6094 (or mobile 07825567717 during conference week only) or Deborah Mason, Communications Manager, Phone: 0207 391 6355, Email: comms@bad.org.uk, Website: www.bad.org.uk

1) Methylchoroisothiazolinone and methylisotiazolinone contact allergy: a new epidemic, R. Urwin and S.M Wilkinson, The Leeds Centre for Dermatology, Leeds. UK
2) Outbreak of contact allergy to cosmetic preservative: history repeats itself (again), J.Mann, I.White, J.White, P.Bannerjee and J. McFadden, St John’s Institute of Dermatology, St Thomas’ Hospital, London, UK

1) Abstract CD01 Methylchloroisothiazolinone and methylisothiazolinone contact allergy: a new epidemic
R. Urwin and S.M. Wilkinson
The Leeds Centre for Dermatology, Leeds, U.K.

Methylchloroisothiazolinone (MCI) and methylisothiazolinone (MI) are commonly used preservatives (biocides) in industrial and household products including cosmetics. Despite a reduction of maximum permissible concentrations of MCI/MI in leave-on and rinse-off products (7_5 p.p.m. and 15 p.p.m., respectively) in 1992 (Cosmetic Ingredient Review Expert Panel of The Cosmetics Toiletry and Fragrance Association. Final report on the Safety Assessment of methylchloroisothiazolinone and methylisothiazolinone. J Am Coll Toxicol 1992; 11: 75–128) due to a European epidemic of MCI/MI contact dermatitis, the incidence of contact allergy remains high at approximately 2% (Lundov MD, Krongaard T, Menn_e TL, Johansen JD. Methylisothiazolinone contact allergy: a review. Br J Dermatol 2011; 165: 1178–82). MI alone was introduced in industrial products in the early 2000s. Case reports of occupational contact allergy from exposure in paints followed. In 2005, MI alone was permitted in cosmetic products (maximum concentration 100 p.p.m.). Concentrations of MI in patch testing have varied, but an approximate prevalence of 1_5% has been estimated, with 0_2% aq. (2000 p.p.m.) considered the optimal test concentration. Over the past 4 years there has been suggestion of an increasing trend for sensitization. A retrospective cohort study was conducted from a database of subjects undergoing standard patch testing to the British Society of Cutaneous
Allergy (BSCA) baseline series from 2008 to June 2012. MCI/MI was tested at concentrations of 0_01% aq. (100
p.p.m.) up to 2008 and at 0_02% aq. from 2008. MI was tested at 0_02% aq. from 2009 onwards and additionally at 0_2% aq. from 2011. An increased prevalence of MCI/MI contact allergy over time was demonstrated in 4_9% of those patch tested, with a measurable increase of MI sensitivity over 3 years to 4_6%. Between January 2011 and June 2012, 6_2% of patch-tested patients had allergy to MCI/MI and/or MI at any concentration. This trend is most likely due to increased use in products, and reassessment of current usage and regulation of MCI/MI should be considered. Increased use of MCI/MI and MI could also be explained by the need for an alternative preservative to methyldibromoglutaronitrile following its prohibition from all cosmetic products in Europe since 2008. Testing MI 0_2% aq. compared with 0_02% aq. resulted in a near doubling of the detection of MI sensitivity, suggesting that future testing should involve 0_2% aq. concentrations.

2) Abstract CD02 Outbreak of contact allergy to cosmetic preservative: history repeats itself (again)
J. Mann, I. White, J. White, P. Banerjee and J. McFadden
St John’s Institute of Dermatology, St Thomas’ Hospital, London, U.K.

Methylisothiazolinone has been used in combination of 1 : 3 with methylchloroisothiazolinone as a preservative in toiletries and household products since the 1980s and is currently regulated in this combination to a level of 3_75 p.p.m. It has also been used in wall paints and in industry. This combination has represented a common cause of preservative allergy since then but usually at a reported prevalence rate of < 1_5% from patch test clinics. On the basis of in vivo reports suggesting that methylisothiazolinone is only a moderate sensitizer, it has been allowed in toiletries and household products up to a reported safe limit of 100 p.p.m. Since July 2010, methylisothiazolinone has been included in our cosmetic series. Over the last 2 years there has been a rapid rise in contact allergy to methylisothiazolinone. There were 33 cases (5_7%) in 2012, up from 18 (3_5%) in 2011 and 1 (0_5%) in 2010 (2010 vs. 2011, P < 0_05; 2010 vs. 2012, P = 0_0015). The majority of cases were women over 40 years of age: 17 (8_8%) in 2012 and 15 (7_4%) in 2011, there having been no cases in 2010 in this group. In most cases contact allergy was relevant to the presenting dermatitis (definite relevance 69%; possible relevance 31%) with onset/exacerbation of rash within the previous 2 years (71%). Sources of exposure were diverse, including moist
tissue wipes, cleansers, toners, shower gel, shave foam, mascara, hair products and washing-up liquid. Reports of high levels of methylisothiazolinone allergy are emerging from several European countries. Outbreaks of preservative allergy have been regularly observed in Europe every 5–10 years, perhaps from too high a concentration of preservative being permitted after toxicological data, which, in retrospect, did not reveal the potential hazard. That human and animal data were available for the analysis of the sensitizing potential of
methylisothiazolinone and the failure to identify the risk of sensitization when used in cosmetics at 100 p.p.m. is of considerable concern. In future, animal and human data will not be available for risk assessment when new preservatives are brought into use in Europe. This outbreak also highlights the lack of a formal reporting system at present, although cosmetovigilance is being introduced.

A dermatology smear campaign

Certain drugs used to treat severe psoriasis in women may be associated with an increased risk of cervical cancer and patients and doctors need more awareness of this, suggests research from Glan Clwyd Hospital in Rhyl.

The research, due to be released at the British Association of Dermatologists’ Annual Conference in Liverpool next week (July 8th to 11th), retrospectively audited case notes for cervical smear documentation in female patients who had started taking the drug Ciclosporin as a treatment for psoriasis.

Ciclosporin is an immunosuppressant drug which is commonly used in the treatment of severe psoriasis (and a number of other conditions). Because it functions by suppressing the patient’s immune system it can also increase the risk of cervical abnormalities, of the type caused by the HPV virus, which are usually picked up by routine cervical screening (smear tests).

Because of the known link between immunosuppression and cervical abnormalities there is guidance in the British National Formulary that advises that when Ciclosporin is prescribed ‘exclusion of malignancies, including those of the skin and cervix’ should be undertaken prior to the medicine being given. The audit of medical notes undertaken by the researchers revealed that only 21 per cent of them had any documentation relating to this, and that only 26 per cent of patients had gynaecological records that were relevant.

Although cervical cancer is the second most common cancer in women under 35 years, the cervical screening programme, which aims to detect changes early – often when there are no symptoms – means that death rates are low compared to other cancer types, with about 1,000 women dying from the disease each year.

Many of the patients in this study would have been either too young or too old to be included in the regular cervical screening programme, which may explain the low numbers in the audit; however the authors suggest that in the immunosuppressed population, an increased frequency of cervical screening should be considered, perhaps every six months or every year.

Alison Devine, one of the research team says: “Our audit suggests that more rigorous documentation of cervical smears and history is needed when women are prescribed immunosuppressive agents such as Ciclosporin and that more information should be available to both doctors and patients about this risk. This is particularly the case as a number of patients will either be too young, or too old, to be part of the national cervical screening programme.”

Psoriasis is a common skin problem affecting about two per cent of the population. It occurs equally in men and women. The outer layer of skin (the epidermis) contains cells which are formed at the bottom and then move up towards the surface, gradually changing as they go, finally dying before they are shed from the surface. This process normally takes between three and four weeks. In psoriasis, the rate of turnover is dramatically increased within the affected skin, so that cells are formed and shed in as little as 3 or 4 days. There is also inflammation and blood vessel proliferation on the affected skin; the reasons for these are still not fully understood. Lesions of psoriasis (often known as plaques) are pink or red, and covered with silvery-white scales. They can form a variety of shapes and sizes, and have well-defined boundaries with the surrounding skin.

-Ends-

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 ACC Liverpool from July 9th to 11th 2013, and is attended by approximately 1,300 UK and worldwide dermatologists and dermatology nurses.

For more information please contact: Nina Goad, Head of Communications, 0207 391 6094 (or mobile 07825567717 during conference week only) or Deborah Mason, Communications Manager, Phone: 0207 391 6355, Email: comms@bad.org.uk, Website: www.bad.org.uk

Study details: “A dermatology smear campaign” A. Devine, P.D. Yesudian and K.S. Chen Glan Clwyd Hospital, Bodelwyddan, Rhyl, U.K.

Abstract:
In the U.K., cervical cancer is the second most common malignancy in women aged under 35 years. In its early stages it may be completely asymptomatic. Screening is therefore vital and has led to a reduction in deaths from cervical cancer, although about 1000 women still die each year in the U.K. from the disease. The British National Formulary advises ‘exclusion of malignancies, including those of the skin and cervix’ prior to commencement of ciclosporin for psoriasis (British National Formulary, December 2012, 13 5 3). We retrospectively audited case notes for cervical smear documentation in female patients commenced on ciclosporin in the last 3 years in the dermatology department of our district general hospital. Cases were identified by a computer search for ciclosporin
by the hospital pharmacy. We identified 62 patients and 42 sets of notes were available for audit. Patients were
aged 15–74 years, with 17 between 16 and 40 years old (40%). Conditions treated included psoriasis (22, 52%), eczema (12, 29%), and others including urticaria, lichen planus and nodular prurigo (eight, 19%). Previous systemic immunosuppression had been taken by 26 (62%). Only nine patients (21%) had any documentation of smear history in their clinical notes prior to the commencement of ciclosporin therapy. Of note, 11 patients (26%) had gynaecological records relevant to this audit, including one patient with a history of previous severe cervical dyskaryosis requiring electrosurgical excision under general anaesthetic. We also examined whether patients had received the British Association of Dermatologists (BAD) patient information leaflet (PIL) on ciclosporin. There was documentary evidence in the notes of 14 (33%) patients that they were given this information, whereas those of 28 (66%) did not show this. Interestingly, this PIL does not mention the importance of a previous abnormal smear history. Literature review confirms an increased risk of cervical cytological abnormalities in the immunocompromised (Sasadeusz J, Kelly H, Szer J et al. Abnormal cervical cytology in bone marrow transplant recipients. Bone Marrow Transplant 2001; 28: 393–7; Ozsaran AA, Ates T, Dikmen Y et al. Evaluation of the risk of cervical intraepithelial neoplasia and human papilloma virus infection in renal transplant patients receiving immunosuppressive therapy. Eur J Gynaecol Oncol 1999; 20: 127–30). In the immunosuppressed, an increased frequency of cervical screening has been suggested, perhaps every 6 months or every year. This audit highlights the need for more rigorous documentation of cervical smears in women prescribed immunosuppressive agents. The BAD PIL for ciclosporin could perhaps be amended to mention the importance of abnormal cervical smears, highlighting this to both female patients and clinicians.

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.

Was ‘Sex and the City’ the beginning of the end for pubic lice?

It is estimated that 10,000 species go extinct every year, however, the loss of some are mourned more than others. One species unlikely to be greatly missed is Pthirus pubis, otherwise known as the pubic louse. Much like the panda, pubic lice are being threatened with extinction due to the disappearance of their natural habitat. However this is due to deforestation of another kind - the increased popularity of ‘Brazilian waxing’.

In a presentation due to be given at the British Association of Dermatologists’ Annual Conference in Liverpool next week (8-11 July), researchers will hypothesise that the impetus behind this comprehensive approach to hair removal stems from an episode of the hit US TV show ‘Sex and the City’, first aired in 2000, which introduced an international audience to the practice.

The pubic louse has infested humans for thousands of years, with archaeologists discovering specimens in the UK as far back as the 1st century AD. The pubic louse evolved from its ancestor, the gorilla louse, about 3.3 million years ago and adapted to live in areas on the human body with a similar density of hair to that of the gorilla. Unfortunately this was a costly mistake, as a mere 3.3 million years later the international success of ‘Sex and the City’ has led to an unprecedented removal of this very hair.

A UK study showed a fourfold increase in its incidence, from 0.8% in 1954 to 3.2% in 1964, which may have been due to increased sexual freedom. However, from 1997 to 2003 a further UK study revealed a steep reduction in prevalence from about 0.41% to 0.17%. Similar observations have also been reported from sexual health specialists in Australia. A decrease in sexual activity could not have accounted for this, as the prevalence of other sexually transmitted diseases has increased.

Dr Kun Sen Chen, one of the authors of the presentation, said: ”Pubic hair removal has been practised by humans for thousands of years, by cultures from all over the world, including the Ancient Egyptians. However, until recently, with the rise of truly global mass media, pubic lice have been able to weather changing cultural attitudes to body hair.

“What we have seen at work is the law of unintended consequences, in popularising hair removal Carrie Bradshaw and co. have contributed to ridding humanity of pest that had plagued humans for millions of years. Sadly there isn’t an Emmy for that”.

Before giving all the plaudits to the writers of ‘Sex in the City’ it’s worth considering that other factors for the decline in pubic lice numbers could include the reluctance of patients to seek medical attention leading to self-treatment with over-the-counter insecticidal treatments, therefore causing a decline in recorded numbers.

The research is due to be released at the British Association of Dermatologists’ Annual Conference in Liverpool this week (July 8th - 11th).

-Ends-
Notes to editors:

If using this presentation, please ensure you mention that it was given at the British Association of Dermatologists’ Annual Conference.
The conference will be held at ACC Liverpool from July 9th to 11th 2013, and is attended by approximately 1,300 UK and worldwide dermatologists and dermatology nurses.

For more information please contact: Nina Goad, Head of Communications, 0207 391 6094 (or mobile 07825567717 during conference week only) or Deborah Mason, Communications Manager, Phone: 0207 391 6355, Email: comms@bad.org.uk, Website: www.bad.org.uk

Study details: “Why Pthirus pubis don’t watch Sex and the City”; K.S. Chen and P.D. Yesudian, Glan Clwyd Hospital, Bodelwyddan, U.K.

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.

Dermatologists urge hospitals not to cut on-call services

Research due to be presented at the British Association of Dermatologists’ Annual Conference in Liverpool next week (July 8th - 11th) will highlight the importance of on-call dermatology services and the need to protect these services from NHS cuts.

On-call dermatology services are regularly used by other hospital specialists and GPs and are highly valued, not least because non-dermatology specialists and generalists have little confidence in correctly identifying and managing dermatological emergencies.

Three studies will highlight the importance of out-of-hours and emergency dermatology provision in hospitals and the risks to patients inherent in cutting these services.

One study, by researchers at St George’s Hospital in London, showed a worrying lack of knowledge and confidence in the management of acute dermatological emergencies by non-dermatology professionals.

The researchers asked a group made up of GPs, non dermatology specialists and trainees to identify a dermatological condition from a case vignette and image. 23 per cent of hospital respondents (non-dermatology) correctly identified the dermatology emergency compared with 85 per cent of dermatology trainees and 43 per cent of GPs. These results by specialty were: paediatrics 52 per cent, general medicine 22 per cent, emergency medicine 22 per cent, intensive care 15 per cent and obstetrics and gynaecology five per cent.

Respondents were asked to rate their confidence in managing each condition. Overall, only one per cent of non-dermatology hospital specialists strongly agreed with the statement “I would feel confident initiating treatment, instructing nursing staff and managing” patients with acute skin conditions, and 44 per cent strongly disagreed with this statement. In contrast 39 per cent of dermatology trainees strongly agreed with the statement and two per cent strongly disagreed.

Regarding support for out-of-hours dermatology provision, 82 per cent of GPs and hospital specialists valued the service. The remaining eight per cent thought this was service was “possibly helpful” and no respondents chose the option “cannot see the need”.

Dr Vanessa Pinder, one of the St George’s study’s authors, said: “Our study shows that general medicine is not well equipped to manage dermatology emergencies. There was poor recognition of emergency dermatological presentations, with a lack of confidence in managing potentially life-threatening conditions. Despite this, on-call dermatology is under threat, with an increasing number of hospitals no longer providing emergency cover. These changes have been made with scant regard for how dermatological emergencies will be managed. With the increasing financial pressure on the National Health Service this trend is likely to continue, and dermatology is particularly vulnerable as the potential for skin disease to cause life-threatening and serious illness is not well recognized.”

Two further studies involved audits of all urgent, on-call referrals to Dermatologists and found that, despite pressure to cut on-call care, it offers a crucial service for patients, as well as invaluable training experience for junior doctors.

The first study was carried out at Northampton General Hospital over a four-month period (September to December 2012). Referrals here are made to a dermatology registrar in a district general hospital, with no out-of-hours, on-call service.

The total number of referrals was 63, with the vast majority from other hospital specialties requesting an inpatient review (medical specialties 59%, surgical specialties 21%, paediatrics 5% and intensive treatment unit 3%), followed by the emergency department (9%) and other specialty clinics (rheumatology and haematology: 3%).

68% of patients were seen on the same day, 24% within 24 hours and 6% within 72 hours, the remaining 2% were seen within one week of referral. In 63% of cases the referral asked for identification of a rash, 10% queried diagnosis of a lesion, 10% requested a review of an existing dermatological condition and 16% requested support with the diagnosis and management of leg ulcers.

The second study looked at 90 on-call referrals over a 10-week period (September 2012 to November 2012) at Portsmouth Hospitals NHS Trust. They found an even distribution between referrals from secondary care (53%) and primary care (47%). Of the inpatient referrals received, the majority were from medical departments (77%), followed by paediatrics (7%), intensive care (7%), surgical departments (3%), emergency department (3%) and obstetrics and gynaecology (3%). Of all the referrals received, 49% required an urgent outpatient appointment, 33% required inpatient review and 18% telephone advice.

Nina Goad of the British Association of Dermatologists said: “Hopefully these audits will help to demonstrate to commissioners and managers that on-call dermatology services are greatly valued, by clinicians and patients alike. They are also a vital training tool for registrars. There is a misapprehension that dermatology does not warrant emergency or out-of-hours provision, but this fails to recognise the severity of many skin issues, such as drug reactions. To limit on-call services would be to the detriment of other hospital departments and most importantly to patient care.”

-Ends-
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 ACC Liverpool from July 9th to 11th 2013, and is attended by approximately 1,300 UK and worldwide dermatologists and dermatology nurses.

For more information please contact: Nina Goad, Head of Communications, 0207 391 6094 (or mobile 07825567717 during conference week only) or Deborah Mason, Communications Manager, Phone: 0207 391 6355, Email: comms@bad.org.uk, Website: www.bad.org.uk

Study details:
P33: An audit of acute dermatology referrals at a district general hospital, B. Shaheen and C. Soon, Northampton General Hospital, Northampton, U.K.
P34: Dermatology on-call service: is it really necessary? N. Anjum, L.H. Lee, A. Haworth and B. Hughes, Portsmouth Hospitals NHS Trust, Portsmouth, U.K.
P37: An audit to support the need for emergency dermatology training, V. Pinder, F. Worsnop, J. Wee and L. Ostlere, St George’s Hospital, Tooting, U.K.

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.  

Antibiotics may increase eczema risk in children, study reveals

Use of antibiotics in early life may increase the risk of developing eczema by up to 40 per cent, according to a new study in the British Journal of Dermatology.

The research also found that each additional course of antibiotics further raised the risk of eczema by seven per cent.

The researchers, from Guy’s and St Thomas’ NHS Foundation Trust, King’s College London, the University of Nottingham and the Aberdeen Royal Infirmary, reviewed existing data from 20 separate studies that explored the link between antibiotic exposure prenatally and in the first year of life, and the subsequent development of eczema. They also examined whether the number of antibiotic courses affected the chances of developing the disease.

They found that children with eczema are more likely to have been treated with antibiotics in the first year of life, but not prenatally.

“One potential explanation is that broad-spectrum antibiotics alter the gut microflora and that this in turn affects the maturing immune system in a way that promotes allergic disease development”, said one of the study authors Dr Teresa Tsakok of Guy’s and St Thomas’.

The paper’s senior author Dr Carsten Flohr, King’s College London and Guy’s and St Thomas’, added: “A better understanding of the complex relationship between antibiotic use and allergic disease is a priority for clinicians and health policymakers alike, as determination of a true link between antibiotic use and eczema would have far-reaching clinical and public health implications.”

Nina Goad of the British Association of Dermatologists said: “Eczema is our most common skin disease, affecting one in every five children in the UK at some stage and causing a significant burden to the patient and the health service. Allergic diseases including eczema have increased over past decades, particularly for children in high income countries, but the causes for this are not fully understood. The evidence is not conclusive and the researchers are not suggesting that parents should withhold antibiotics from children when doctors feel such treatment is necessary, but studies like this give an insight into possible avoidable causes and may help to guide medical practice.”

The researchers added a note of caution to their findings, explaining that use of antibiotics may in fact be a consequence of an increased occurrence of infections in children with eczema. Further research is needed that carefully examines the sequence of events between the age antibiotics are prescribed and the onset of eczema development.

Notes to editors:

1. For more information, please contact: Nina Goad or Deborah Mason, British Association of Dermatologists, Phone: 0207 391 6094 / 6355, Email: comms@bad.org.uk, Website: www.bad.org.uk
2. To speak to Dr Carsten Flohr, please call the British Association of Dermatologists on 0207 391 6355 / 6094 or Guy’s and St Thomas’ press office on 020 7188 5577. To speak to Dr Teresa Tsakok, please call the British Association of Dermatologists.
Embargo to 00.01hrs, Thursday June 20th 2013.
3. If using this information, please ensure you mention that the study is being released in the British Journal of Dermatology, the official publication of the British Association of Dermatologists. Study details: Does early life exposure to antibiotics increase the risk of eczema? A systematic review
T. Tsakok1; T.M. McKeever2, L. Yeo3, C. Flohr4
1 Academic Clinical Fellow, Guy’s and St Thomas’ Hospital NHS Foundation Trust, London, UK
2 Division of Epidemiology and Public Health, University of Nottingham, City Hospital, Nottingham, UK
3 Department of Dermatology, Aberdeen Royal Infirmary, Aberdeen, UK
4 Department of Paediatric Dermatology, St John’s Institute of Dermatology, Guy’s & St Thomas’ Hospital NHS Foundation Trust and King’s College London, London, UK
Print publication date TBC; Draft, unedited version due to appear in Accepted Articles section online on 24.06.2013. DOI: available on request on publication. Articles in the BJD can be viewed online: www.brjdermatol.org

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 . Wiley-Blackwell, created in February 2007 by merging Blackwell Publishing with Wiley's Global Scientific, Technical, and Medical business, is now one of the world's foremost academic and professional publishers and the largest society publisher. With a combined list of more than 1,400 scholarly peer-reviewed journals and an extensive collection of books with global appeal, this new business sets the standard for publishing in the life and physical sciences, medicine and allied health, engineering, humanities and social sciences. For more information visit www.wiley.com

Sunbeds blamed for high skin cancer rates in young women in North West, study reveals

Rates of the deadliest form of skin cancer are unusually high in young women in the North West of England, with sunbeds and cheap holidays to blame, according to research published today in the British Journal of Dermatology.

Historically, incidence of melanoma has always been higher in the more southerly latitudes of England, where the hours of sunshine are longer than in northern regions, especially during the summer season.

However, this latest study has found an alarming reversal in this trend in young women aged 10-29, with the disease for this age group most prevalent in the North West.

A further interesting finding of the study, carried out by researchers at the University of Manchester, relates to the socioeconomic status of melanoma patients. Previous data has long established that the disease is most prevalent in more affluent people, which is largely thought to be due to opportunities for foreign travel to sunnier climates, and other lifestyle factors.

However, among young women in the North, the disease was found to be high among the second most deprived socioeconomic group, as well as the second most affluent groups.

Nina Goad of the British Association of Dermatologists said: “This study is interesting as it changes our views on two important risk factors for skin cancer – where we live and how rich we are. Latitudinal position in England has long been associated with risk levels for skin cancer, with southern regions always having the highest rates of the disease. But for young women, the disease is now highest in the North West.

“Previously the disease has consistently been found to be more common amongst the most affluent in society, but in this same group of young women in Northern England, the disease is now also high amongst the most deprived. We know that across England, use of tanning beds is highest among young women in the north and is also high among lower socioeconomic status groups, so this may well be a strong contributing factor to both these findings.”

Sarah Wallingford, from the University of Manchester’s Institute for Inflammation and Repair who led the research working with colleagues at the University of Manchester and the Queensland Institute of Medical Research, Brisbane, Australia, concludes: “The affordability of sun holidays and high prevalence of sunbed use among young adults, especially young women living in the north of England, may explain these trends. Recent banning of sunbed use in those under 18 years of age in the UK should eventually bring a reduction in harmful exposure to artificial UV in the future, however, this regulation will not completely resolve the issue as it applies only to commercial outlets so private use remains unregulated and its effects may continue to be seen. It is important to monitor both UV exposure patterns and melanoma incidence closely in the wake of these trends and the recently implemented legislation.”
The study examined diagnoses of melanoma over eleven years (1996 to 2006 inclusive). Melanoma is the least common but most deadly type of skin cancer and the primary cause is exposure to ultraviolet light through sunlight or tanning beds.

Earlier this year, another study in the British Journal of Dermatology revealed that nine out of 10 tanning beds in England are breaking safety rules and giving off radiation levels that are up to six times higher than Mediterranean sunlight.

Skin cancer is the UK’s most common cancer, with over 100,000 new cases diagnoses annually. Melanoma, the least common but most dangerous form of the disease, accounts for 12,800 of these new cases every year, and 2,700 deaths. In Britain, melanoma incidence rates have more than quadrupled over the last 30 years, and the numbers continue to rise.

Notes to editors:
1. For more information and interview requests, please contact: Nina Goad or Deborah Mason, British Association of Dermatologists, Phone: 0207 391 6355, Email: comms@bad.org.uk, Website: www.bad.org.uk

2. If using this information, please ensure you mention that the study is being released in the British Journal of Dermatology, the official publication of the British Association of Dermatologists.

3. Study details: Regional melanoma incidence in England, 1996-2006: reversal of north-south latitude trends among young females
S.C. Wallingford1, 2, R.D. Alston2, J.M. Birch2, A.C. Green1,3
1 Institute of Inflammation & Repair, University of Manchester, Manchester Academic Health
Science Centre, UK
2 Cancer Research UK Paediatric & Familial Cancer Research Group, Institute of Cancer
Sciences, University of Manchester, Manchester Academic Health Science Centre, UK
3 Cancer & Population Studies Group, Queensland Institute of Medical Research, Brisbane,
Australia
Print publication date TBC; Draft, unedited version due to appear in Accepted Articles section online. DOI: 10.1111/bjd.12460. Articles in the BJD can be viewed online: www.brjdermatol.org

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 . Wiley-Blackwell, created in February 2007 by merging Blackwell Publishing with Wiley's Global Scientific, Technical, and Medical business, is now one of the world's foremost academic and professional publishers and the largest society publisher. With a combined list of more than 1,400 scholarly peer-reviewed journals and an extensive collection of books with global appeal, this new business sets the standard for publishing in the life and physical sciences, medicine and allied health, engineering, humanities and social sciences. For more information visit www.wiley.com

South East coast has England's highest rates of most common cancer, study reveals

The South East coast has England’s highest rates of the most common cancer, according to research due to be published in the British Journal of Dermatology.

The study, carried out by researchers at the University of Nottingham and the British Geological Survey’s Environmental Science Centre in Nottingham, looked at diagnoses of basal cell carcinoma (BCC) across the UK over a six-year period (2004 to 2010). BCC is a type of non-melanoma skin cancer and the primary cause is exposure to ultraviolet light through sunlight or tanning beds.

In England, the South East coast was found to have the highest level of the disease, followed by South Central and South West regions.

The study also found that, despite it being the UK’s most common cancer, BCC is still on the rise, with an increase of 2.6 per cent every year. While an ageing population may contribute to the overall rise, worryingly, the largest average increase was found in the 30 to 39 year age group, followed by those aged 40 to 49.

The researchers further discovered that people living in the least deprived areas were 50 per cent more likely to have a BCC than those with the highest levels of deprivation.

Fiona Bath-Hextall of the University of Nottingham’s Centre of Evidence Based Dermatology and one of the study’s authors said: “Our results indicate that the incidence rate of BCC is increasing, in particular amongst those aged 30 to 49 years. We found that southern regions of the UK have the highest recorded rates of BCC.

“This may be linked to several environmental factors. The most prominent is the latitudinal position - in the UK, the hours of sunshine are normally longer in the south than the northern regions, especially during the summer season. The southern parts of England and Wales usually receive the greatest hours of annual sunshine.”

For socioeconomic deprivation, incidence of BCC was consistently higher in the most affluent groups. This may be linked to higher levels of income for frequent holidays overseas to sunnier places, thereby exposing the skin to sunlight, or having available funds for pursuing other lifestyle habits which are risk factors for BCC.

Nina Goad of the British Association of Dermatologists said: “While basal cell carcinoma is very common, fortunately it is also very treatable.
“These cancers can occur on any part of the body, but are most common on areas of skin that are most often exposed to the sun such as your head and neck, including lips and ears, and the backs of your hands.

“They tend to appear gradually on the skin and slowly get bigger over time. They can vary greatly in their appearance, but people often first become aware of them as a scab that bleeds occasionally and does not heal completely. Some are very superficial and look like a scaly red flat mark, others have a pearl-like rim surrounding a central crater. Others are quite lumpy, with one or more shiny nodules crossed by small but easily seen blood vessels. Most are painless, although sometimes they can be itchy or bleed if caught on clothes or picked up.

“If your doctor thinks you have a skin cancer or is not sure, they can refer you for free through the NHS to see a skin cancer specialist, usually a Consultant Dermatologist, who is an expert in diagnosing and treating skin cancer.”

Basal cell carcinoma (BCC) is the most common cancer found in humans. The incidence of BCC in the UK is not accurately known because recording of the disease is incomplete. However a recent study estimated that approximately 760,000 cases of non-melanoma skin cancer are diagnosed annually in the UK population. BCC is likely to account for approximately 75 per cent of these.

Notes to editors:


1. For more information and interview requests, please contact: Nina Goad or Deborah Mason, British Association of Dermatologists, Phone: 0207 391 6355, Email: comms@bad.org.uk, Website: www.bad.org.uk

2. If using this information, please ensure you mention that the study is being released in the British Journal of Dermatology, the official publication of the British Association of Dermatologists.

3. Study details: British Journal of Dermatology: Regional variations of Basal cell carcinoma incidence in the
UK using THIN database (2004-2010). A. Musah1, J.E. Gibson1, J. Leonardi-Bee1, M.R. Cave2, E.L. Ander2, F. Bath-Hextall3
1Division of Epidemiology and Public Health, Clinical Sciences Building (Phase 2),
University of Nottingham, Nottingham NG5 1PB, UK
2British Geological Survey, Environmental Science Centre, Nottingham NG12 5GG, UK
3Centre of Evidence Based Dermatology, King’s Meadow Campus, University of Nottingham, Nottingham NG7 2NR, UK

Print publication date TBC; Draft, unedited version due to appear in Accepted Articles section online 24.05.13.
DOI 10.1111/bjd.12446. The article in the BJD can be viewed online: http://onlinelibrary.wiley.com/doi/10.1111/bjd.12446/abstract

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 . Wiley-Blackwell, created in February 2007 by merging Blackwell Publishing with Wiley's Global Scientific, Technical, and Medical business, is now one of the world's foremost academic and professional publishers and the largest society publisher. With a combined list of more than 1,400 scholarly peer-reviewed journals and an extensive collection of books with global appeal, this new business sets the standard for publishing in the life and physical sciences, medicine and allied health, engineering, humanities and social sciences. For more information visit www.wiley.com 

Wales is UK nation with the highest rates of most common cancer, study reveals

Wales has the highest rates of the UK’s most common cancer, according to research due to be published in the British Journal of Dermatology.

The study, carried out by researchers at the University of Nottingham and the British Geological Survey’s Environmental Science Centre in Nottingham, looked at diagnoses of basal cell carcinoma (BCC) across the UK over a six-year period (2004 to 2010). BCC is a type of non-melanoma skin cancer and the primary cause is exposure to ultraviolet light through sunlight or tanning beds.

Wales was found to have the highest level of the disease in the UK, followed by England. Scotland and Northern Ireland had lower, and similar, rates.

The study also found that, despite it being the UK’s most common cancer, BCC is still on the rise, with an increase of 2.6 per cent every year. While an ageing population may contribute to the overall rise, worryingly, the largest average increase was found in the 30 to 39 year age group, followed by those aged 40 to 49.

The researchers further discovered that people living in the least deprived areas were 50 per cent more likely to have a BCC than those with the highest levels of deprivation.

Fiona Bath-Hextall of the University of Nottingham’s Centre of Evidence Based Dermatology and one of the study’s authors said: “Our results indicate that the incidence rate of BCC is increasing, in particular amongst those aged 30 to 49 years. The study shows that Wales has the highest recorded rates of BCC.

“This may be linked to several environmental factors. The most prominent is the latitudinal position - in the UK, the hours of sunshine are normally longer in the south than the northern regions, especially during the summer season. The southern parts of England and Wales usually receive the greatest hours of annual sunshine.”

For socioeconomic deprivation, incidence of BCC was consistently higher in the most affluent groups. This may be linked to higher levels of income for frequent holidays overseas to sunnier places, thereby exposing the skin to sunlight, or having available funds for pursuing other lifestyle habits which are risk factors for BCC.

Nina Goad of the British Association of Dermatologists said: “While basal cell carcinoma is very common, fortunately it is also very treatable. 
“These cancers can occur on any part of the body, but are most common on areas of skin that are most often exposed to the sun such as your head and neck, including lips and ears, and the backs of your hands.

“They tend to appear gradually on the skin and slowly get bigger over time. They can vary greatly in their appearance, but people often first become aware of them as a scab that bleeds occasionally and does not heal completely. Some are very superficial and look like a scaly red flat mark, others have a pearl-like rim surrounding a central crater. Others are quite lumpy, with one or more shiny nodules crossed by small but easily seen blood vessels. Most are painless, although sometimes they can be itchy or bleed if caught on clothes or picked up.

“If your doctor thinks you have a skin cancer or is not sure, they can refer you for free through the NHS to see a skin cancer specialist, usually a Consultant Dermatologist, who is an expert in diagnosing and treating skin cancer.”

Basal cell carcinoma (BCC) is the most common cancer found in humans. The incidence of BCC in the UK is not accurately known because recording of the disease is incomplete. However, a recent study estimated that approximately 760,000 cases of non-melanoma skin cancer are diagnosed annually in the UK population. BCC is likely to account for approximately 75 per cent of these.

Notes to editors:
 

1. For more information and interview requests, please contact: Nina Goad or Deborah Mason, British Association of Dermatologists, Phone: 0207 391 6355, Email: comms@bad.org.uk, Website: www.bad.org.uk

2. If using this information, please ensure you mention that the study is being released in the British Journal of Dermatology, the official publication of the British Association of Dermatologists.

3. Study details: British Journal of Dermatology: Regional variations of Basal cell carcinoma incidence in the
UK using THIN database (2004-2010). A. Musah1, J.E. Gibson1, J. Leonardi-Bee1, M.R. Cave2, E.L. Ander2, F. Bath-Hextall3
1Division of Epidemiology and Public Health, Clinical Sciences Building (Phase 2),
University of Nottingham, Nottingham NG5 1PB, UK
2British Geological Survey, Environmental Science Centre, Nottingham NG12 5GG, UK
3Centre of Evidence Based Dermatology, King’s Meadow Campus, University of Nottingham, Nottingham NG7 2NR, UK

Print publication date TBC; Draft, unedited version due to appear in Accepted Articles section online 24.05.13. 
DOI 10.1111/bjd.12446. The article in the BJD can be viewed online: http://onlinelibrary.wiley.com/doi/10.1111/bjd.12446/abstract

Response to University of Edinburgh study on UV and blood pressure

Nina Goad of the British Association of Dermatologists: “While this is interesting, these preliminary data on just 24 healthy volunteers with one hour's observation could be explained by many factors and variables not related to the sun. The findings do not confirm sustained blood pressure reduction in the general population. Research in this area is still very much in its infancy. Emerging evidence about possible health benefits of sunlight do not invalidate the indisputable weight of evidence showing the link between excess UV exposure and skin cancer, which is the UK's most common form of cancer. It's also worth noting that there are many other ways of achieving sustained reductions in blood pressure with evidence-based interventions that do not involve the risks associated with getting too much sun."

New therapy for hair loss – British Journal of Dermatology

Injections using a person’s own blood could hold the key to treatment of a common form of hair loss, according to research published in the British Journal of Dermatology today.

The researchers, based at the International Hair Research Foundation and University of Brescia in Italy and the Hebrew University Medical Center in Israel, examined the role of platelet-rich plasma (PRP) in the treatment of alopecia areata, a common disorder causing hair loss.

PRP was compared to a placebo and to an existing steroid treatment for alopecia called triamcinolone acetonide (TrA).

45 patients received injections of either PRP, TrA or a placebo directly to bald patches on just one half of their head. Patches on the other side were injected with distilled water, to act as a control. A total of three treatments were given to each patient, once a month. Hair growth was assessed by measuring the area where new hairs grew on the bald scalp. Additionally, the researchers looked for specific defective hairs which are characteristic features of alopecia areata. Since alopecia patches are often accompanied by burning or itching, these symptoms were also examined.

Use of TrA and PRP led to a significant hair regrowth in bald patches compared to placebo, as assessed by three different independent dermatologists.

The findings could also hold hope for sufferers of alopecia resulting from chemotherapy. Researcher Dr Fabio Rinaldi said: “PRP has been shown to be a potent anti-inflammatory agent, and therefore could potentially have positive therapeutic effects on chemotherapy-induced alopecia.

“Our aim was to compare PRP to the most common therapy for alopecia areata, and indeed we could show that in several parameters, PRP was better than triamcinolone acetonide in treating alopecia areata.”

Alopecia areata is a common cause of hair loss that usually causes small, coin-sized, round patches of baldness on the scalp, although hair elsewhere such as the beard, eyebrows, eyelashes, body and limbs can be affected. It affects about two per cent of the population. It is not possible to predict how much hair will be lost. It happens when the hair is rejected by the affected person’s immune system, which does not recognise the hair roots (follicles) as the body’s own, but regards them as "foreign" (autoimmunity). Regrowth of hair in typical alopecia areata is usual over a period of months or sometimes years, but cannot be guaranteed. There is no known cure.

Nina Goad of the British Association of Dermatologists said: “Alopecia is known to lead to overwhelming effects on the patient's quality of life and self esteem. This could offer hope to thousands of patients who struggle with their hair loss.”

Platelet rich plasma (PRP) is made using the person’s own blood, by separating the blood’s plasma from the rest of the blood and adding a high concentration of platelets (in this case 3.5 times higher than normal blood).

Ends

Notes to editors:

1. For more information and interview requests, please contact: Nina Goad or Deborah Mason, British Association of Dermatologists, Phone: 0207 391 6355, Email: comms@bad.org.uk, Website: www.bad.org.uk

2. If using this information, please ensure you mention that the study is being released in the British Journal of Dermatology, the official publication of the British Association of Dermatologists.

3. Study details: British Journal of Dermatology: A randomized, double-blind, placebo and active-controlled, half-head study to evaluate the effects of platelet rich plasma on alopecia areata
A. Trink1, E. Sorbellini1, P. Bezzola1, L. Rodella2, R. Rezzani2, Y. Ramot3 F. Rinaldi1
1International Hair Research Foundation (IHRF), Milan, Italy
2University of Brescia, Brescia, Italy
3Department of Dermatology, Hadassah – Hebrew University Medical Center, Jerusalem, Israel
DOI: 10.1111/bjd.12397
Articles in the BJD can be viewed online: www.brjdermatol.org
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

Wiley-Blackwell, created in February 2007 by merging Blackwell Publishing with Wiley's Global Scientific, Technical, and Medical business, is now one of the world's foremost academic and professional publishers and the largest society publisher. With a combined list of more than 1,400 scholarly peer-reviewed journals and an extensive collection of books with global appeal, this new business sets the standard for publishing in the life and physical sciences, medicine and allied health, engineering, humanities and social sciences. For more information visit www.wiley.com

Sun Awareness Week survey results revealed

Half of Britons think that their skin is darker than it actually is, putting them at risk of developing skin cancer, according to new research by the British Association of Dermatologists.

The statistics are being released to mark the start of Sun Awareness Week on Monday May 6th, and to launch the 2013 Be Sun Aware Mole and Sun Advice Roadshow supported by sun protection and skincare brand, La Roche-Posay.

1,350 people attending the organisation’s 2012 Mole and Sun Advice Roadshow were asked about skin cancer and sun safety.

Only 50 per cent of people correctly identified their own skin colour, which was then assessed by a Dermatologist, from a list of options, with 48 per cent thinking their skin was darker.

The survey also found that the desire for tanned skin is increasing, despite public health warnings against sunbathing. 62 per cent said that they found tanned skin more attractive than paler skin, compared to 56 per cent of people responding to a similar survey by the association five years ago.

The results revealed that younger people are less knowledgeable about some aspects of skin cancer than older generations, despite increased education on the disease in recent decades, which was not available to older generations, and on-going campaigns targeted at younger age groups. A third (32%) of people in their twenties perceived a tan to be a sign of good health compared with 21 per cent across all age groups.

Three times more men than women incorrectly believed that a base tan will protect against sun burn and sun damage (65 per cent of men compared to just 22 per cent of women). In fact, a base tan only provides very minimal protection and is actually a sign of ultraviolet (UV) damage.

80 per cent of people infrequently or never check their skin for signs of skin cancer, despite this being the UK’s most common cancer type. Furthermore, 69 per cent admitted they have no idea what to look for even if they were to check their skin.

However, not knowing the signs of skin cancer is not the only obstacle to early diagnosis. Only half of respondents (50%) are happy to show a skin issue to their doctor, with the remaining half citing embarrassment, lack of time, fear of wasting the doctor’s time, not liking going to the doctor and fear of skin cancer as possible barriers.

Twice as many women than men said they are afraid to waste the doctor’s time, and three times as many women are embarrassed to go to the doctor with a skin issue.
Despite persistent health warnings, sunbathing is still the most popular bronzing option with 54 per cent sunbathing abroad and 35 per cent sunbathing in the UK.

There was also a high level of confusion about what to look for in a sunscreen and the difference between a product’s UVA rating and Sun Protection Factor (SPF). Only 38 per cent of respondents knew that the SPF is what predominantly protects against sunburn, and only 39 per cent realised that it is a product’s UVA protection, rather than SPF, that prevents against skin ageing. A recent rise in moisturisers featuring SPF is believed to have led to this misconception, as people assume the added SPF properties will prevent wrinkling, when in fact it is UVA protection - often not included in these moisturisers - that performs this function.

Dr Bav Shergill of the British Association of Dermatologists said: “It is a concern that so many people think their skin is darker and tans more easily than is actually the case, as these people are likely to be spending longer in the sun than they should. I think this could be contributing to the increasing numbers of skin cancer cases I see in my clinics. We also need to address the misconception that a base tan is a good way of protecting against sunburn as this view is still very prevalent among men in particular.”

Managing Director of La Roche-Posay, Yannick Raynaud, said: “La Roche-Posay is delighted to be supporting the British Association of Dermatologists with their 2013 Be Sun Aware Mole & Sun Advice Roadshow. These statistics show that there is still a huge need to raise awareness about the need for sun protection and to educate the public about what to look for in a sunscreen and the difference between a products UVA rating and SPF. Our objective is to help raise awareness of the need for protection and decrease the risks associated with exposure. ”

181 of the 1,350 people attending the 2012 roadshow were advised to seek further advice from their doctor.

For more information, case studies and interview requests, please contact Kimberley Carter or Nina Goad, British Association of Dermatologists, Phone: 0207 391 6084 / 0207 391 6094, Email: comms@bad.org.uk, Website: www.bad.org.uk/sunawareness

Notes to editors:

1. Sun Awareness Week takes place from the 06th to 12th May. It is trademarked to the British Association of Dermatologists.

2. Survey data was collected during the 2012 British Association of Dermatologist Mole & Sun Advice Roadshow supported by La Roche-Posay between May and September 2012. 1,350 people completed surveys as part of the free mole-check demonstration they received from a BAD volunteer dermatologist.

3. The 2013 Be Sun Aware Mole & Sun Advice Roadshow (www.besunaware.com) aims to encourage people to pay more attention to their skin and learn what warning signs to look out for which might indicate a cancerous change, and how best to protect their skin in the sun. Visitors will be offered a free face-to-face practical demonstration by a dermatologist on how to check their skin.

The nationwide roadshow will kick off on 2nd May at Potters Field Park directly outside London’s City Hall, and then visit London’s famous Carnaby Street on the 3rd May, and a further three high profile festival events across the UK. Thousands of members of the public will be provided with free mole and sun-care advice from expert dermatologists and nurses, and complimentary sunscreen, in a bid to make people aware of skin cancer risks and how to enjoy the sun safely. The roadshow will be at the following locations:

1. The Big London Launch - 2nd May (Potters Fields Park) and 3rd May (Carnaby Street)
2. Isle of Wight Festival, Hampshire – 13th to 16th June 
3. Latitude Festival, Suffolk – 18th to 21st July
4. Boardmasters Festival of Music and Surfing, Cornwall – 7th to 11th August 

Patients with skin disease deserve to be seen by properly trained and accredited doctors

The challenge when commissioning Dermatology services is that no matter which organisation provides the service, whether private or NHS, it may struggle to find suitably qualified medical professionals to deliver the service at primary, community and specialist levels.


In her article in BMJ Careers (21 March 2013), Julia Schofield makes the point that effective accreditation for GPwSIs (in all disciplines) needs to be addressed urgently given the imminent disappearance of PCTs. She also references an audit of Dermatology GPwSIs from 2005 that showed that nearly half had not completed the accreditation process. More GPwSIs in Dermatology would be a good thing – skin related problems are the most common reason people visit their GP - but those GPwSIs need to be properly trained and accredited; currently many are not. Dermatology is poorly taught at most Medical Schools, if at all, and Dermatology is not a mandatory component of GP training.

There are 170 Consultant Dermatologist posts vacant in the UK at present and this has led to a situation where in many cases a locum ‘Consultant’ fills the post, without necessarily holding a Certificate of Completion of Training. Such ‘Consultants’ therefore cannot be offered the post substantively. It is expedient for employers to perpetuate the situation and it is compounded by patient demand: without these under qualified and/or unaccredited ‘specialists’ the waiting lists for dermatology would be even longer than they are currently. Patient care, though, is being compromised by people working beyond the scope of their expertise and training.

There are examples of non-NHS providers tendering for services, being awarded contracts for Community Dermatology services based around GPwSIs and then finding that they cannot recruit accredited GPwSIs and so, instead, recruiting GPs who are given a quick training course.

Chris Bunker, President of the British Association of Dermatologists said recently, at the All Party Parliamentary Group for Skin at Westminster, “There are no alternative providers for Dermatology services, only alternative employers.” All employees taken on to provide a particular service should be trained and qualified/accredited for that role.

The provision of Dermatology services is threatened by these workforce issues as well as by increasing demand due to the explosive increase in skin cancer, people living longer and people developing several diseases (co morbidities). Integrated, appropriate Dermatology services are also increasingly challenged by new commissioning arrangements. Many examples of bad process and poor outcomes already exist. Patient care and interests would be better served if the voices of Dermatologists and patients with skin diseases were heard more clearly both in the commissioning process ie the National Commissioning Board (NCB) and by the Department of Health. There is no National Clinical Director for skin disease in Domain 2 of the NCB and there is no single person or unit within the Department of Health with responsibility for Dermatology despite the fact skin disease is behind 13 million consultations in primary care and over a million referrals to secondary care each year. 

85% of skin patients could benefit from pioneering government-funded website. Tailored online psychological support for people with skin conditions – project funding announced

The British Association of Dermatologists (BAD) has been awarded government funding for a groundbreaking project that will bring together two major areas of healthcare, to benefit the lives of millions of people.

The Department of Health Innovation, Excellence & Strategic Development Fund grant, of £97,000 over three years, will enable the BAD to develop a website that will act as a hub for psychological support specifically targeted at skin disease patients.

The project, which was highlighted in a speech by Jeremy Hunt on Wednesday*, will be the first of its kind to unite the specialties of dermatology and mental health, which have a significant overlap. The causal link between mental health issues and skin disease is twofold – skin disorders cause psychological traumas, and conversely, psychological factors like stress can trigger or worsen certain skin diseases. However, Psycho-dermatology services (which provide emotional support specifically for skin disease patients) are extremely limited in the UK and very few dermatology departments even have direct access to general psychiatrists.

The website will bring together, and link to, existing disease specific resources, support groups, forums and help-lines. The BAD aims to work in partnership with a mental health charity to assist skin disease patients in need of immediate psychological help to find it more easily.

Currently, support materials and services directed specifically at skin disease patients are sporadic and disparate, and those that do exist are not always easy to find or access. While there are both patient support groups, centred on individual skin diseases, and also mental health charities, there is no centralised hub that provides coordinated resources, appropriate to people with problems that transcend dermatology and are psychological or psychiatric.

Skin conditions are the most frequent reason for people to consult their GP. It is not just the physical symptoms that affect sufferers’ lives – diseases that are visible, disfiguring or long-term can carry a multitude of psychological and social effects, including isolation and depression. In the UK, psoriasis alone is linked to 300 suicide attempts annually. A British Association of Dermatologists’ survey in 2011 revealed that 85 per cent of patients indicated to their dermatologist that the psycho-social aspects of their skin disease were a major component of their illness.

Stress, as well as being a frequent by-product of skin conditions, is also known to cause and exacerbate skin disease; psychological and self-help interventions can be crucial not only for easing mental distress but also for improving many of the physical symptoms of the skin disorder. It may be difficult for a variety of reasons for skin disease patients to access mental health services directly, one being that they may not identify themselves as having a mental health issue, but they may still understand that the skin disease or disorder is having an adverse effect on their mental wellbeing.

The BAD believes that for patients to have access to self-help materials specifically tailored to their skin disease, as well as being signposted to appropriate support services, will have a huge impact on many people’s lives. Through use of these tools it is hoped that the vicious cycle of stress, that is exacerbating an existing skin condition and subsequently increasing stress levels, will be broken.

President of the British Association of Dermatologists Professor Chris Bunker, said: “We think that this project will be an innovative approach to a largely unmet health burden. We know that there is under provision of specialist Pyscho-dermatology services and, whilst a website cannot replace this kind of specialist care, it may help to raise awareness of the services that are available and of resources for both patients and medical professionals that are specific to skin disease.
“By being able to see easily the range of options available, skin patients will be able to make better informed choices about their health and care and understand how to access the help that they need.
“Our proposal to create an interactive, mobile-phone accessible website for sufferers of skin conditions seeking psychological support, will help people by providing guided, personalised access to self-help tools, information on support groups and networks, and advice on types of guided therapies and other psychological interventions that may be of benefit to them.”

Dr Linda Papadopoulos is one of the most well-known psychologists in the UK and has been working in the field of Psychodermatology for 15 years. She said: “Illnesses do not occur in a vacuum, their ramifications have the potential to affect us not only physically but socially and emotionally too. The social significance of our skin in relation to our body image and the mythology that skin disease is contagious can take a significant emotional toll on people, which is why this project is hugely welcome and, indeed, imperative to give people the right type of well rounded care.”

To create the online hub the BAD will set up a multi-disciplinary advisory group and consult widely to create the best possible resource for people with skin disorders.

Key statistics and notes:

A national survey undertaken by the BAD in 2011 to assess the availability of psycho-dermatology services, revealed poor provision, despite dermatologists reporting:

• 17% of dermatology patients need psychological support to help with psychological distress secondary to a skin condition.
• 14% of dermatology patients have a psychological condition exacerbating their skin disease.
• 8% of dermatology patients present with worsening psychiatric problems due to concomitant skin disorders.
• 3% of dermatology patients have a primary psychiatric disorder.
• 85% of patients have indicated that the psycho-social aspects of their skin disease are a major component of their illness.

*Jeremy Hunt’s speech on innovation in healthcare: http://mediacentre.dh.gov.uk/2013/03/13/13-march-2013-jeremy-hunt-innovation/

The “Working Party Report on Minimum Standards for Pscyho-Dermatology Services 2012” published in December 2012 highlighted the following: Dedicated psycho-dermatology service provision (both psychology and psychiatry) in the UK is scarce despite a need for such services. There is currently only one service in which a psychiatrist and dermatologist see patients concurrently, and there are very few dedicated psychologists working jointly in dermatology clinics.

Long-term skin conditions can cause considerable isolation for many people. According to a study of 2,579 skin disorder patients, at least one in four also suffer from a significant psychological disorder [Picardi, A. et al, BJD, 2000]

Multiple international studies have identified an even higher level of psychological disorders in dermatology patients, generally ranging from 40% to 60% [Hughes JE et al, Br J Psychiatry, 1983; Wessely SC et al, Br J Psychiatry,1989; Attah Johnson FY & Mostaghimi H, Int J Dermatol,1995; Aktan S et al, Dermatology,1998; Carney O et al, Genitourin Med,1994]. Studies attribute much of the psychological distress to disfigurement, perceived social stigma or undesirable changes in life-style resulting from skin disease [Picardi, A. et al, BJD, 2000].

Acute diseases, including skin disorders, are also associated with depression and in some cases suicide [Depression with a chronic physical health problem: NICE guideline CG91].

Dermatologists manage over 2,000 diseases of the skin, hair and nails in adults and children.

Each year 54% of the population are affected by skin disease, and 23 to 33% at any one time have disease that would benefit from medical care.

Ends

For more information, please contact the British Association of Dermatologists Press Office:
email comms@bad.org.uk or call 0207 391 6355 / 6094

References:

“Skin Conditions in the UK: A Health Care Needs Assessment”
Schofield J, Grindlay D, Williams H. Skin Conditions in the UK: a Health Care Needs Assessment. Centre of Evidence-Based Dermatology, University of Nottingham 2009, 1-158.
Published in September 2009, Skin Conditions in the UK: a Health Care Needs Assessment is the first official publication of the Centre of Evidence Based Dermatology. It is a much expanded update of the original 1997 Dermatology Health Care Needs Assessment by Professor Hywel Williams

“Skin Conditions are the commonest new reason people present to general practitioners in England and Wales”
Br J Dermatol. 2011 Nov;165(5):1044-50. doi: 10.1111/j.1365-2133.2011.10464.x. Epub 2011 Sep 22.
Schofield JK, Fleming D, Grindlay D, Williams H.
Source Centre of Evidence Based Dermatology, University of Nottingham, King's Meadow Campus, Nottingham NG7 2NR, UK. j.k.schofield@herts.ac.uk 

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Section 75 Revisions may not be enough to save our skins

The British Association of Dermatologists welcomes any revisions to the Regulations that make clearer that patient care, integration and co-operation are of greater importance than competition but still have concerns regarding the way in which specialist services will be commissioned and the exact nature of clinical input.

The report ‘United Kingdom Performance on Health: Implications from the Global Burden of Disease Study 2010’ published in the Lancet last week was particularly timely. The information it provided on chronic disability in the UK shows that Skin Diseases in the whole population directly cause a high level of disability greater, for instance, than other important illnesses such as diabetes, breast cancer or sensory impairment (eye disease and hearing loss) and unlike many other causes of disability has shown little improvement since 1990. This is can be put down to under provision and underfunding as well as lack of training in primary care.

With Dermatologists being prevented from providing input into the Commissioning Process it is unlikely that this burden of disability will change.  

stuff about todays news

Nine out of 10 sunbeds defy safety rules, study reveals

Nine out of 10 tanning beds in England are breaking safety rules and giving off radiation levels that are up to six times higher than Mediterranean sunlight, according to a groundbreaking study.

Writing in the British Journal of Dermatology, researchers from the University of Dundee reveal that levels of ultraviolet (UV) - the radiation that causes skin cancer - exceed safe limits in 89 percent of sunbeds, and emissions are increasing due to new high power sunlamps.

The study, funded by Cancer Research UK, looked at 402 sunbeds across England and compared their UV levels with natural sunlight. The researchers also measured the sunbeds’ compliance with the British and European Standard*, which stipulates that the total UV irradiance for cosmetic tanning beds should not exceed 0.3 Wm-2 (watts per square metre).
The mean UV level was found to be almost double this (0.56 Wm-2), with only 11 percent falling within the set safety limit.

When compared with natural sunlight, scientists discovered that the average sunbed has a carcinogenic risk (risk of causing cancer) that is 2.3 times greater than midday Mediterranean sun. One in 10 sunbeds were found to emit levels at least 3.6 times higher than the Mediterranean sun, with levels of up to six times greater recorded.

Professor Harry Moseley, Consultant Clinical Scientist and one of the study’s authors, said: “The vast majority of tanning units we surveyed throughout England give off levels of UV radiation that exceed the maximum levels set out by the European standard. The skin cancer risk was up to six times higher than Mediterranean sunlight. The standard has been in place for almost 10 years and clearly self-regulation isn’t working. This situation is unacceptable and stricter control measures must be put in place.”

Technological developments leading to new, high power units, both in stand-up booths and lie-down sunbeds, have been blamed for this latest sunbed scandal.

Nina Goad of the British Association of Dermatologists explained: “High power sunlamps are a relatively new and worrying phenomenon. 15 years ago, sunbeds were generally thought only to emit UV levels that were comparable to UK sunshine. ‘Fast tan’ units are becoming increasingly popular, and England’s lack of regulation is failing to keep up with this trend. Product safety standards are there to protect the public and the government needs to step up its regulation of the industry. England is sadly trailing behind the rest of the UK in this matter. We need proper regulation, covering issues like safety of equipment and health warnings for clients, and this must be enforceable through inspections of premises.”

A recent study concluded that use of sunbeds before the age of 35 years almost doubles a person’s melanoma risk.1 Sunbeds are classified by the International Agency for Research on Cancer (IARC) as ‘carcinogenic to humans’ and fall within their highest cancer risk category.

Skin cancer is the UK’s most common cancer, with over 100,000 new cases diagnoses annually. Melanoma, the least common but most dangerous form of the disease, accounts for 12,800 of these new cases every year, and 2,700 deaths. In Britain, melanoma incidence rates have more than quadrupled over the last 30 years, and the numbers continue to rise.

Yinka Ebo, senior health information officer at Cancer Research UK, who funded the study, said: “Research has already shown that using sunbeds for the first time before the age of 35 increases the risk of malignant melanoma, the most dangerous form of skin cancer, by 87 per cent. They’re not going to do you any good – the best case scenario is that they’ll age and damage your skin; the worst case scenario is a cancer diagnosis and potentially death.”

The majority (60%) of sunbeds examined were located in tanning centres or beauty salons, although significant numbers were also located in hairdressers (17%) and fitness centres (15%).
Sunbed measurements were conducted in the North, Midlands, South West and London.

Ends

Notes to editors:

1. For more information and interview requests, please contact: Nina Goad or Deborah Mason, British Association of Dermatologists, Phone: 0207 391 6355, Email: comms@bad.org.uk, Website: www.bad.org.uk

2. If using this information, please ensure you mention that the study is being released in the British Journal of Dermatology, the official publication of the British Association of Dermatologists

3. British Journal of Dermatology: Cutaneous melanoma attributable to sunbed use: systematic review and meta-analysis; P Tierney, J Ferguson, S Ibbotson, R Dawe, E Eadie, H Moseley; The Photobiology Unit, Ninewells Hospital & Medical School, University of Dundee, DD1 9SY, U.K.
DOI: 10.1111/bjd.12181
Articles in the BJD can be viewed online: www.brjdermatol.org

References:

* BS EN 60335-2-27:2003 British Standard Institution BSI Household and Similar Electrical Appliances – Safety – Part 2-27: Particular requirements for appliances for skin exposure to ultraviolet and infrared radiation. The standard was endorsed by the European Union Scientific Committee on Consumer Products (SCCP): Opinion on Biological effects of ultraviolet radiation relevant to health with particular reference to sun beds for cosmetic purposes. 2006: SCCP/0949/05. All EU member states, including the UK government agreed to introduce this level, from 1 April 2009, for all new and traded tanning devices.

1Cutaneous melanoma attributable to sunbed use: systematic review and meta-analysis, BMJ 2012;345:e4757

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

Cancer Research UK is the world’s leading cancer charity dedicated to saving lives through research. For further information about Cancer Research UK's work or to find out how to support the charity, please call 0300 123 1022 or visit www.cancerresearchuk.org

Wiley-Blackwell, created in February 2007 by merging Blackwell Publishing with Wiley's Global Scientific, Technical, and Medical business, is now one of the world's foremost academic and professional publishers and the largest society publisher. With a combined list of more than 1,400 scholarly peer-reviewed journals and an extensive collection of books with global appeal, this new business sets the standard for publishing in the life and physical sciences, medicine and allied health, engineering, humanities and social sciences. For more information visit www.wiley.com 

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