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Doctors warn of drug which could leave users blind, bald, and covered in painful rashes

Doctors are warning recreational drug users to avoid using a class A drug, called MT-45, after fears that it is responsible for hair loss, loss of sight, and painful rashes have been confirmed. The study, published in the British Journal of Dermatology, outlines three independently similar cases caused by MT-45, thought to be just the tip of the iceberg.

The study outlined the cases of three men, aged between 23 to 34 years old, all from different parts of Sweden, all suffering from very unusual symptoms, including hair depigmentation, hair loss, widespread folliculitis (inflammation of the hair follicles) and dermatitis (inflammation of the skin). During the following year, two of them rapidly developed severe vision loss, requiring cataract surgery in both eyes.

It is not clear whether these reactions are to MT-45 itself, or whether an error was made in the production of this drug, tainting the supply chain.

MT-45 was originally developed as a potential painkiller in the 1970s, but by 2013 it was being used as a so called ‘legal high’, one of a large number of drugs that mimicked the psychoactive effects of illegal drugs but which circumvented UK legislation. MT-45 was eventually designated a class A drug in 2015, and in 2016 the Psychoactive Substances Act came in to force, banning all drugs previously considered ‘legal highs’.

In the UK MT-45 can be bought illegally over the internet, with a 2014 study1 finding 17 internet sites selling the drug. The same study identified one published scientific paper reporting on the acute harms in nine cases of confirmed MT-45 toxicity, one US government report relating to two MT-45-related deaths and 20 user reports on internet discussion forums relating to the use of MT-45.

Matthew Gass of the British Association of Dermatologists said:

“MT-45 is a class A drug, and that in and of itself, should warn potential users to avoid it. However, on top of this we have seen a number of similar, serious, adverse reactions to the drug, some clinically proven and some anecdotal. This suggests that MT-45 is either itself profoundly toxic, or that there is a problem in the MT-45 supply chain that is causing this complex and unusual combination of symptoms.

Either way it is important that patients and healthcare professionals are aware of the potential for MT-45 to leave users blind, bald and covered in painful skin complaints. I would urge anyone currently using this drug to stop immediately and consider getting medical attention.”

One of the authors of the study, Professor Anders Helander of the Karolinska Institutet in Sweden, said:

“The escalating online availability and use of hundreds of unclassified new psychoactive substances has become a growing health problem worldwide. Most new substances have not been tested on humans, increasing the risk for harmful and unexpected adverse events and overdose deaths. Another risk factor is that the substances are typically manufactured in clandestine laboratories with no product control. The number of medical complications and deaths due to these drugs is constantly increasing, and the cases associated with MT-45 are one serious example.”

Users in internet discussion forums, such as BlueLight.org, have also shared experiences of adverse reactions attributed to their use of products sold to them as MT-45.

One user said:

“I do not say this lightly. If I had known what any of things I experienced were going to happen, I'd never have touched [MT-45]…

“Ok, so the first major one I noticed was dry patches of skin. Doesn't sound too bad right? Wrong, that was just the beginning. The rash began to spread over my entire body. By the time I stopped taking the drug it was too late to do anything. The rash is very widespread. The doctors will tell you it is folliculitis, and that it will go away, however, this has not been the case, as the rash continues to worsten [sic] even though I am no longer taking the drug…

“Now, for the second major side effect. This is the one that scared the crap outta [sic] me. You [sic] hair falls out. No lie, no exaggeration, you will just start tearing clump upon clump of hair out of your head.”

Another user said:

“By the time Christmas came and passed, I had already lost all the hair on my head…I had horrible patches of dry skin and rashes, my skin was so dry it was cracking, BAD! My heels were cracked so deep I could barely walk on them. My lips were chapped, I can't even begin to describe the severity of these symptoms.”

-Ends-
Notes to editors:

If using this study, please ensure you mention that the study was published in the British Journal of Dermatology. Although this article has been accepted for publication in the British Journal of Dermatology it is possible that minor changes may be made ahead of publication in the hard copy of the journal.

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

1Siddiqi, S., Verney, C., Dargan, P. and Wood, D. (2014). Understanding the availability, prevalence of use, desired effects, acute toxicity and dependence potential of the novel opioid MT-45. Clinical Toxicology, 53(1), pp.54-59. http://www.tandfonline.com/doi/full/10.3109/15563650.2014.983239

Study details: Acute skin and hair symptoms followed by severe, delayed eye complications in subjects using the synthetic opioid MT-45
Anders Helander,1 Maria Bradley,2 Anja Hasselblad,2 Lars Norlén,2 Ismini Vassilaki,3 Matilda Bäckberg4 and Jan Lapins2

1 Karolinska Institutet, Department of Laboratory Medicine, and Karolinska University Laboratory, Departments of Clinical Chemistry and Clinical Pharmacology, Stockholm, Sweden
2 Karolinska Institutet, Department of Medicine Solna, Dermatology Unit, and Karolinska University Hospital, Department of Dermatology, Stockholm, Sweden
3 Dermatopathology Service, Dermipath AB, Stockholm, Sweden
4 Swedish Poisons Information Centre, Stockholm, Sweden

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

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Doctors forecast a steep rise in skin cancer cases

Cases of the UK’s most common cancers are set to rise by a staggering 78.2% from 20101 to 2025 according to figures released in the British Journal of Dermatology.

The study looked at the two main types of non-melanoma skin cancer (NMSC): Basal Cell Carcinoma (BCC) and Squamous Cell Carcinoma (SCC). Treating this epidemic will cost over £338 million a year by 2025, the study found.

The study did not include the deadliest type of skin cancer, called melanoma, which will further add to this burden.

By analysing rates of non-melanoma skin cancer in the East of England since 2003, the doctors, from Norfolk and Norwich University Hospital and the National Cancer Registration and Analysis Service, were able to estimate the number of cases for the years 2020 and 2025 for the region. By analysing census data and data from the Office of National Statistics the team were then able to extrapolate out the predicted number of cases nationwide for these years.

The predicted cost of diagnosing and treating these cases of skin cancer is estimated to be £289 to £399 million a year in 2020, rising to £338 to £465 million in 2025.

Year: 2010 BCC: 180,725 SCC per year nationwide: 32,492 Total NMSC per year nationwide: 213,217 Cost to NHS per year: £189 to £261 million
Year: 2020 BCC: 258,946 SCC per year nationwide: 66,671 Total NMSC per year nationwide: 325,617 Cost to NHS per year: £289 to £399 million
Year: 2025 BCC: 298,308 SCC per year nationwide: 81,694 Total NMSC per year nationwide: 380,002 Cost to NHS per year: £338 to £465 million

Matthew Gass of the British Association of Dermatologists said:

“The UK has been fighting to combat the rising tide of skin cancer over the last few decades, and this research shows that things are going to get worse. As it stands many dermatology departments are struggling to manage the increasing rates of skin cancer, at a cost to people with other skin diseases. This situation will be made even worse by rising staff shortages - we are not being allowed to train an adequate number of doctors to cope with the current workload in dermatology resulting in almost a quarter of Consultant Dermatologist posts in the UK being unfilled. This workforce shortage will only get worse in the future.

“This research is invaluable in that it gives us a snapshot of what the future holds, giving the NHS and the Government the opportunity to plan ahead and prepare, we can only hope that the warning is heeded.”

Dr Peter Goon, one of the researchers, said:

“Our data and analyses show the predicted numbers of cases of both SCCs and BCCs for the UK in 2020 and 2025. These NMSCs are set to increase by 78.2% from 2010 to 2025 if current trends continue in the same manner. The NHS will need to budget wisely to cope with these predicted increases, and invest in personnel and resources, in order to give the country the healthcare it needs.”

Dr Nick Levell, one of the researchers and President of the British Association of Dermatologists said:

“Our study shows that non-melanoma skin cancer, the commonest cancer in the UK, is increasing rapidly. Within ten years we will see over a third of a million cancers per year. Skin cancer can affect all ages of adults and it becomes commoner in the elderly. We need more money spending on public health campaigns, more staff to treat the cancers and more operating theatres in which to do the work, if the public wishes these cancers to be treated promptly by the NHS in the future.”

Non-melanoma skin cancer

Non-melanoma skin cancers can occur on any part of the body, but are most common on areas of skin that most often exposed to the sun such as your head and neck (including lips and ears) and the backs of your hands. They can also appear where the skin has been damaged by X-rays, and on old scars, ulcers, burns and persistent wounds.

Non-melanoma skin cancers vary greatly in what they look like. They tend to appear gradually on the skin, and slowly get bigger over time. They will not go away on their own without treatment. Some possible signs include:

- A scab or sore that won’t heal. It may also bleed occasionally
- A scaly or crusty patch of skin that looks red or inflamed
- A flesh coloured, pearly lump that won’t go away and appears to be growing in size
- A lump on the skin which is getting bigger and that may be scabby
- A growth with a pearly rim surrounding a central crater, a bit like an upturned volcano

-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 the media team: comms@bad.org.uk, 0207 391 6084. Website: www.bad.org.uk.

1Data for 2010 compiled by the same authors, using comparable methods.

2These estimates are based on the following study, and do not take into account inflation: Vallejo-Torres L, Morris S, Kinge JM, et al. Measuring current and future cost of skin cancer in England. J Public Health (Oxf). 2014 Mar;36(1):140-8.

Study details: Predicted cases of UK skin SCC and BCC in 2020 and 2025: Horizon planning for NHS Dermatology and Dermatopathology
P.K.C. Goon1, D.C Greenberg2, L. Igali3 and N.J. Levell1
1 Dept of Dermatology, Norfolk and Norwich University Hospital, Norwich
2 National Cancer Registration and Analysis Service, Public Health England, Unit C, Cambridge
3 Dept of Pathology, Norfolk and Norwich University Hospital, Norwich
http://onlinelibrary.wiley.com/doi/10.1111/bjd.15110/full

Potential skin cancer referrals constitute a dominant and disproportionate number of dermatology referrals from primary care in the UK. The majority of dermatology and pathology departments in the UK are struggling to cope with rising demand for diagnostic and treatment services and recent austerity measures, with cutbacks in all public service budgets have also affected the NHS.

In this study, we have analysed data from the East of England, specifically East Norfolk and Waveney, and estimated the number of cases for SCCs and BCCs of skin for 2020 and 2025. It is hoped that the data will assist in the planning of NHS resource allocation in the short- and medium-term, both for this region and nationally.

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

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Tomatoes found to protect against sun damage at a molecular level

Researchers have discovered that tomatoes could offer another line of defence in our efforts to protect our skin from the sun, according to a study published in the British Journal of Dermatology.

The study, conducted by researchers from Germany, found that a lycopene-rich tomato nutrient complex and a lutein-containing nutritional supplement both helped to protect the skin from sunburn and photo-ageing (skin ageing in response to sunlight). Lycopene and lutein are two pigments that are produced by vegetables, lycopene is found in high concentration in tomatoes, whereas lutein is commonly found in kale and spinach.

The researchers compared the skin of 65 people who were divided into two treatment groups, one for lycopene and one for lutein. Within these treatment groups the subjects were again divided between the actual treatment and a placebo. Two weeks before the first 12-week treatment phase began, the different groups were subject to a “wash-out” phase, where no treatment occurred to allow the researchers to get an accurate base-line to compare their future results against. After the first treatment phase the different treatment arms underwent another wash-out phase before transitioning from the lycopene or lutein to the placebo, or vice-versa.

At the beginning and at the end of each treatment phase, skin was exposed to two types of ultraviolet (UV) light, UVA1 and UVA/B, in a process known as irradiation. 24 hours later biopsies were taken to see if biomarkers for certain “indicator genes” were present. These genes are suggestive of photo-ageing and inflammation, two common side effects of sun damage.

When the skin of volunteers who were either untreated (received no lycopene or lutein), or who had been treated with a placebo, was analysed it was revealed that UVB/A as well as UVA1 radiation increased expression of indicator genes, including heme oxygenase-1 (HO-1), intercellular adhesion molecule-1 (ICAM-1) and matrix metalloproteinase-1 (MMP-1), all of which are thought to be a sign of UV damage.

In contrast, lycopene as well as lutein treatment significantly reduced the expression of these genes.

Matthew Gass of the British Association of Dermatologists said:

“Eating tomatoes and kale isn’t a substitute for sunscreen or other forms of sun protection such as protective clothing and shade. However, this study shows that these lycopene and lutein supplements could be an extra tool to protect against sun damage.”

Professor Jean Krutmann, one of the researchers from the Leibniz Research Institute for Environmental Medicine, said:

“Our study further supports the concept that dietary strategies are beneficial for human skin in general and that nutritional supplements of the exact kind used in this study are very effective in providing protection against UVA radiation-induced skin damage in particular.  It also demonstrates that assessment of molecular markers is a very powerful approach to study efficacy of oral photo-protective strategies and that measurement of erythema responses only poses the risk of underestimating these benefits.”

Previous studies into lycopene have generally assessed its ability to reduce UV-induced erythema, which is the skin reddening that is a sign of sun damage. One such study found that people taking a lycopene mixture had 33 per cent more protection against sunburn, equivalent to a sunscreen with a sun protection factor (SPF) of 1.3. This latest study looks at gene expression as a method of demonstrating sun damage to human skin.

-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 the media team: comms@bad.org.uk, 0207 391 6084. Website: www.bad.org.uk.

Study details: Molecular evidence that oral supplementation with lycopene or lutein protects human skin against ultraviolet radiation: Results from a double-blinded, placebo-controlled, cross-over study

Grether-Beck, S.1, Marini, A.1, Jaenicke, T.1, Stahl, W.2 and Krutmann, J.1 (2016).

1IUF – Leibniz Research Institute for Environmental Medicine, Dusseldorf, Germany;

2Institute of Biochemistry and Molecular Biology I, Faculty of Medicine, Heinrich Heine University, Dusseldorf, Germany

DOI: 10.1111/bjd.15080

http://onlinelibrary.wiley.com/doi/10.1111/bjd.15080/epdf

Background: Increasing evidence suggests photo-protection by oral supplementation with ß-carotene and lycopene.

Objectives: We examined the capacity of lycopene rich tomato nutrient complex (TNC) and lutein, to protect against UVA/B- and UVA1 radiation at a molecular level.

Methods: In a placebo-controlled, double blinded, randomized cross over study two actives containing either TNC or lutein were assessed for their capacity to decrease the expression of UVA1 radiation-inducible genes including heme oxygenase-1 (HO-1), intercellular adhesion molecule-1 (ICAM-1) and matrix metalloproteinase-1 (MMP-1). 65 healthy volunteers were allocated to 4 treatment groups and subjected to a 2-weeks wash-out phase, followed by two 12-weeks treatment phases separated by another 2-weeks wash-out. Volunteers started either with active and switched then to placebo or vice versa. At the beginning and at the end of each treatment phase skin was irradiated and 24 hours later biopsies were taken from untreated, UVB/A- and UVA1 irradiated skin for subsequent RT-PCR analysis of gene expression. Moreover, blood samples were taken after the wash out and the treatment phases for assessment of carotenoids.

Results: TNC completely inhibited UVA1 as well as UVA/B induced upregulation of HO-1, ICAM-1 and MMP1 mRNA no matter of sequence (ANOVA, p<0.05). In contrast, lutein provided complete protection if it was taken in the first period, but showed significantly smaller effects in the second sequence compared to TNC.

Conclusion: Assuming the role of these genes as indicators of oxidative stress, photo-dermatoses and photo-aging these results might indicate that TNC and lutein could protect against solar radiation-induced health damage.

About us:

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

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The need for psychological support amongst dermatology patients is not being met

Experts from an award winning multidisciplinary team, the Severe Eczema and Psoriasis Team at St. John's Institute of Dermatology, St Guys’ and St Thomas’ NHS Foundation Trust, today warned that the true need for psychological support amongst dermatology patients is not being met.

The team recently won the first ever “BMJ Dermatology Team of the Year”, up against excellent competition, for their commitment to holistic care - care which accounts for, and treats, the range of issues that come with having a skin disease, particularly the psychological impact.

Recognising that their standard approach to patients wasn’t efficient enough at recognising patients in need of psychological support, the St. John’s team rewrote the rulebook using a tripartite approach first developed by the IMPARTS* team led by Professor Matthew Hotopf. They developed a system whereby iPads are used to survey patients with pre-selected and validated questionnaires relevant to their condition, whilst waiting for their appointment. This information is then automatically uploaded to their electronic patient record.

The questionnaire results are then used to alert doctors to any potential emotional wellbeing issues and automatically suggest treatments or referral pathways that may be appropriate for them. In some cases there may be no need for psychological support. Those who do require help may be provided with self-help materials – such as the IMPARTS materials or the British Association of Dermatologists’ Skin Support** website – or be offered a referral to a team psychologist or liaison psychiatry.

The team found that 71 per cent of their patients, who were subsequently diagnosed with major depressive illness using the new system, and 88.6 per cent with anxiety, were previously unrecognised as having mental health problems.

Professor Catherine Smith, consultant dermatologist within the Severe Eczema and Psoriasis Team, said:

“This rigorous and systematic approach to providing holistic care within our team has reaped huge benefits for our patients, who previously might have had unrecognized morbidity. Prior to evaluating our service and introducing this new approach, we considered that we were already providing holistic care.

“Identifying the high needs of our patient population motivated us to fully integrate psychological support with treatment of the physical symptoms of skin disease throughout the visit to our service. We improved training for all staff, from our receptionists to our consultant dermatologists, and implemented internal care pathways that ensure the mental wellbeing of the patient is monitored and treated according to their needs. By taking this methodical approach we were also able to quantify and justify the need for a full time clinical health psychologist on staff.”

Dr Nick Levell, President of the British Association of Dermatologists, said:

“We are enormously proud of all the teams that were in the running for dermatology team of the year, and I am particularly pleased to see the incredible work that this winning team has put into achieving a parity of esteem between physical and mental health, something the BAD recognises as being hugely important for patient wellbeing. I hope that this will encourage other departments to reflect on their own work, and investigate ways in which they can improve.”

The multidisciplinary team of specialists included consultant dermatologists, receptionists, clinical research and specialist nurses, a consultant rheumatologist, a specialist pharmacist, and a clinical health psychologist in collaboration with the King’s Health Partners IMPARTS team.

-Ends-
Notes to editors:

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

The BAD Annual Conference will be held at the Birmingham ICC from July 5th to 7th and is attended by approximately 1,300 UK and worldwide dermatologists.

*IMPARTS stands for Integrating Mental & Physical healthcare: Research, Training & Services (IMPARTS) and is an initiative funded by King's Health Partners to integrate mental and physical healthcare in research, training and clinical services at Guy’s, St Thomas’s and King’s College Hospitals, as well as South London and Maudsley NHS Foundation Trust (http://www.kcl.ac.uk/ioppn/depts/pm/research/imparts/index.aspx).

**Skin Support is a psychological support website for people in distress due to skin conditions (www.skinsupport.org.uk). It is owned and managed by the British Association of Dermatologists.

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.

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

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Male genital piercing – a sensitive subject

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

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

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

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

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

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

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The ‘Prince Albert’

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

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

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

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

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

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

-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 the Birmingham ICC from July 5th to 7th and is attended by approximately 1,200 UK and worldwide dermatologists.

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

Study Information:

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

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

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

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Acne patients in the UK are being over-exposed to oral antibiotics, despite antibiotic resistance concerns

Doctors at the British Association of Dermatologists’ Annual Conference have warned that oral antibiotics, which are routinely prescribed for acne, are being used for durations that exceed recommendations, despite concerns about antibiotic resistance.

Dr Alison Layton and the dermatology team at Harrogate and District NHS Foundation Trust, say that reliance on oral antibiotics beyond the recommended duration is harmful for two key reasons. The practice could cause the emergence of antibiotic-resistant Propionibacterium acnes, the bacterium implicated in acne, making acne harder to treat in some cases. Worryingly, the use of oral antibiotics is also likely to drive resistance in other bacteria, unrelated to acne*

Their recent study shows that patients are facing delays in starting treatment options which could be used effectively in place, or alongside, antibiotics resulting in more rapid and better outcomes. This is important, as delay in implementing effective treatments is known to increase the risk of acne scarring**.

A retrospective review of oral antibiotic duration for 928 patients with acne found the mean duration of oral antibiotic use prior to referral to dermatology services was six and a half months (195 days). The longest exposure to a single antibiotic was 84 months (2520 days) – a little short of seven years. Guidance from the National Institute for Health and Care Excellence (NICE) recommends that, unless an improvement in the patient’s acne is seen, GPs should only continue to prescribe antibiotics for up to three months (90 days) before considering referral to a dermatologist. In cases where patients are responding to the antibiotics, then treatment should continue for four to six months, 120 to 180 days, alongside appropriate topical (applied to the skin) treatment.

A second study being presented at the conference by the same authors, in which 4518 patients and 1227 healthcare professionals were surveyed, offers an insight into why efforts by advisory bodies are falling short. The survey found that only small numbers of healthcare providers say that they ‘often’ consult evidence-based guidance (dermatologists 15%, GPs with a Special Interest 13%, and GPs 3%), questioning the impact of guidelines on prescribing habits.

Despite this, over 50 per cent of HCPs agreed that ‘antibiotic resistance is a big problem in managing acne’, but only 25 per cent said it was a concern for their patients. This contrasts with 74 per cent of patients worrying about antibiotic-resistant infections later in life.

Dr Heather Whitehouse, one of the authors, said: “Antibiotics remain an important part of acne management, but given concerns about antibiotic resistance we should be using antibiotics judiciously as part of a treatment regime, limited to the shortest possible time period

“Oral antibiotics are frequently being prescribed on their own for patients with acne, this is not something that guidelines advocate as individually they are not effective at treating all aspects of the condition. Not to mention the fact that this sort of monotherapy is implicated in driving antimicrobial resistance

“From the patient perspective the study has shown that the duration of oral antibiotic use is longer than we would wish to ensure patients are receiving optimum therapy.”

Matthew Gass of the British Association of Dermatologists said: “As the NHS and advisory bodies get increasingly serious about the responsible use of antibiotics, it is important for doctors to reflect on how they prescribe for such a common condition which relies so heavily on antibiotic usage. This study provides an important warning, and will hopefully help healthcare professionals and patients alike.”

Facts about acne and acne treatments

What is acne?

Acne is a very common skin condition characterised by blackheads and whiteheads and pus-filled spots. It usually starts at puberty and varies in severity from a few spots on the face, neck, back and chest, which most adolescents will have at some time, to a more significant problem that may cause scarring and impact on self-confidence. For the majority it tends to resolve by the late teens or early twenties, but it can persist for longer in some people.

According to a 2013 study** a degree of acne affects nearly all people between the ages of 15 and 17, and in 15 to 20 per cent of young people, acne is moderate to severe.

What causes acne?

The sebaceous (oil-producing) glands of people who get acne are particularly sensitive to normal blood levels of certain hormones, which are present in both men and women. These cause the glands to produce an excess of oil. At the same time, the dead skin cells lining the pores are not shed properly and clog up the follicles. These two effects result in a build-up of oil, producing blackheads and whiteheads.

Propionibacterium acnes lives on everyone’s skin, usually causing no problems, but in those prone to acne, the build-up of oil creates an ideal environment in which these bacteria can multiply. This triggers inflammation and the formation of spots.


NICE Clinical Knowledge Summary recommendations:

• To minimize the risk of P. acnes developing resistance, antibiotics should be limited to the shortest possible period, and discontinued when further improvement of acne is unlikely
• Oral antibiotics should always be combined with a topical treatment (retinoid and/or benzoyl peroxide). Topical antibiotics and oral antibiotics should not be combined together, as this combination is unlikely to confer additional benefit and may encourage the development of bacterial resistance
• Response to oral antibiotics should be reviewed at six to eight weeks. If the person has responded to treatment:
o Continue for an additional 4–6 months
o Continue topical treatment after stopping
o If the person has not responded adequately, continue for 3 months before assuming treatment is ineffective. At this stage, consider seeking specialist advice or referring to a dermatologist.

-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 the Birmingham ICC from July 5th to 7th and is attended by approximately 1,300 UK and worldwide dermatologists.

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

Oral antibiotics for acne: are we adopting premium use?
H.J. Whitehouse, E. Fryatt, I. El-Mansori and A.M. Layton
Department of Dermatology, Harrogate and District NHS Foundation Trust, Harrogate, North Yorkshire, U.K.
Oral antibiotics are used globally for the treatment of moderate-to-severe acne vulgaris due to their antimicrobial affects against Propionibacterium acnes. While they are still a mainstay of management, the use of antibiotics has come under increasing scrutiny from advisory bodies including the Global Alliance to Improve Acne Outcomes and the European Evidence-Based (S3) Guidelines for the Treatment of Acne. The prolonged use of antibiotics in acne is a concern due to the potential to drive antibiotic resistance in commensal bacteria, as well as antibiotic-resistant P. acnes, which may translate to reduced or lack of efficacy. The incorporation of antibiotic stewardship into commissioning programmes has therefore become a key focus for the National Health Service in England, manifest as the National Antibiotic Premium 2015–2016. Given the emphasis on antibiotic stewardship, surprisingly few studies have focused on antibiotic duration in this chronic disease. A recent study in the U.S.A. found that the average duration of antibiotic use in acne prior to commencing isotretinoin far exceeded current recommendations. To our knowledge, there are no comparable studies for antibiotic duration in the U.K. An initial pilot study has been retrospectively conducted on 100 patients with moderate-to-severe acne treated with oral antibiotics prior to referral into the secondary-care acne clinic. We now aim to determine the duration of oral antibiotic use in patients with inflammatory acne prior to referral to a secondary-care clinic for consideration of isotretinoin, by conducting a further retrospective review of data held on an ethically approved secure acne database of 1178 patients. The pilot data demonstrate that the mean age of onset of acne was 13.7 years. Lymecycline (75%) was most frequently prescribed, followed by oxytetracycline (52%), erythromycin (44%), trimethoprim (19%), doxycycline (12%), minocycline (10%) and other (4%). A mean number of 2.2 different antibiotics were prescribed per patient (range 1–5). The mean duration of antibiotic use was 305.3 days (range 7–3240). The longest duration for a single antibiotic was 1230 days. This demonstrates that patients with acne in the U.K. have exposure to antibiotics beyond current recommendations, and delays in securing adequate treatment. Delay in initiating effective therapy is known to increase the risk of acne scarring (Layton AM, Henderson CA, Cunliffe WJ. A clinical evaluation of acne scarring and its incidence. Clin Exp Dermatol 1994; 19: 303–8). Results from this study could help to drive a change in prescribing habits in line with the national antibiotic quality premium.


Prescribing for acne in the U.K.: patterns and influencers
H.J. Whitehouse, E.A. Eady, C.J. Ward and A.M. Layton
Department of Dermatology, Harrogate and District NHS Foundation Trust, Harrogate, North Yorkshire, U.K.
We sought to examine beliefs among U.K. healthcare practitioners (HCPs) and patients about acne management to identify influences on practice, including consideration of antibiotic resistance. In the U.K., acquired resistance in Propionibacterium acnes, the target of antibiotic therapy in acne, is among the highest globally. Although U.K. prescribing data are not publicly available, data on file show heavy reliance on antibiotics. Structured questionnaires developed by multidisciplinary teams were launched on 1 March 2015. To date, 4518 patient and 1227 professional responses have been secured. The professionals included 372 general practitioners (GPs), 101 GPs with a special interest (GPwSIs), 277 dermatologists, 47 nurse prescribers and 430 others/not disclosed. The results suggest that professionals consult a wide range of information concerning acne treatments. The British National Formulary (BNF) is used most widely (86%), followed by National Institute for Health and Care Excellence Clinical Knowledge Summaries (70%). Overall 89% of GPs may seek advice from consultant colleagues, GPwSIs are more likely to obtain information from training courses (33%), and dermatologists are most likely to consult specialist journals (55.6%). Multiple clinical features are considered when prescribing; acne severity and presence of scarring are the most frequent (‘always’ or ‘often’ by 98% and 91%, respectively), followed by psychological impact (88%), type of lesion (87%) and treatment history (85%). In total 33% most commonly prescribe regimens that include an oral tetracycline, whereas 24% include a topical antibiotic. Lymecycline was the most frequently prescribed oral antibiotic (90%) for moderate-to-severe acne. However, 28% of respondents used tetracyclines ‘always’ or ‘most of the time’ for comedonal acne, and 19% for mild acne. Around half (45%) of all professionals have not changed prescribing habits in the last 3 years. Over 50% agreed that ‘antibiotic resistance is a big problem in managing acne’, but only 25% said it was a concern for their patients, contrasting with 74% of patients worrying about antibiotic-resistant infections later in life. Changes in local and (inter)national guidance plus regulatory warnings were stated as factors that would alter practice. However, only small numbers suggest that they ‘often’ consult evidence-based guidance (dermatologists 15%, GPwSIs 13% and GPs 3%), questioning the impact of guidelines on prescribing habits. These initial results suggest that a significant number of HCPs are aware that antibiotic resistance should influence prescribing behaviour. However, there are some potential differences between prescribers, and possible educational requirements, including the need to appreciate patients’ concerns about antimicrobial resistance. Advice contained within the BNF and a Medicines and Healthcare Products Regulatory Agency warning might be the best ways of drawing attention to the need to reduce reliance on antibiotics for managing acne.

* This occurs because the use of anti-biotics results in selective pressure in bacteria beyond the skin, meaning that only those that are resistant to anti-biotics survive, in a form of natural selection.

** Layton AM, Henderson CA, Cunliffe WJ (1994). A clinical evaluation of acne scarring and its incidence. Clin Exp Dermatol, 19: 303–8 DOI: 10.1111/j.1365-2230.1994.tb01200.x

***Bhate, K. and Williams, H.C. (2013), Epidemiology of acne vulgaris. British Journal of Dermatology, 168: 474–485. DOI: 10.1111/bjd.12149
For more information on acne please visit our website: http://www.bad.org.uk/for-the-public/patient-information-leaflets/acne

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

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Brits’ slapdash approach to sunscreen putting lives at risk
 
 
Eight out of ten people are failing to adequately apply sunscreen before going out in the sun, according to a survey carried out by the British Association of Dermatologists to mark Sun Awareness Week (9th-15th May).
 
The poll found that 80 per cent of us don’t apply sunscreen before going out in the sun and then shortly afterwards. This is the approach recommended for three key reasons of which the public should be aware: to make sure that the product is fully absorbed before skin is exposed to sun, to help reduce the chances of areas of skin being missed, and to ensure a thick enough layer is applied.
 
The survey also found that 70 per cent of people fail to reapply sunscreen every two hours as recommended.
 
This confusion over how, or when, to apply sunscreen goes some way to explaining the fact that in a previous survey by the British Association of Dermatologists, 72 per cent of people admitted that they had been sunburned in the previous year.*
 
Other potentially bad habits also came to light as 35 per cent of people surveyed would only seek shade if they were hot, rather than to avoid burning.
 
Of all forms of protective clothing, sunglasses were by far the most popular, worn by 81 per cent of people, suggesting that people are more concerned with protecting their eyes than their skin, or wear them for reasons of fashion.
 
All of this is of concern given that the risk of developing melanoma – the deadliest form of skin cancer - more than doubles in people with a history of sunburn compared with people who have never been sunburned.
 
Skin cancer is the most common cancer in the UK and rates have been climbing since the 1960s. Every year over 250,000 new cases of non-melanoma skin cancer – the most common type – are diagnosed, in addition to over 13,000 new cases of melanoma, resulting in around 2,148 deaths annually.
 
Johnathon Major of the British Association of Dermatologists said: “Sunscreens are an important part of good sun safety practices, though they must be applied properly for them to be effective. Applying liberally half an hour before going out into the sun, and then again shortly after going outside, is vital to ensure that you are fully covered and that the sunscreen has had time to be absorbed into the skin. It should then be reapplied at least every two hours, as the protective filters can break down over time. It should also be reapplied after any activity where it might be accidentally removed, such as swimming. Water-resistant sunscreens are not friction-resistant, and therefore they can be accidentally removed if you towel dry after swimming or sweating.
 
“These results show just how widely sunscreens are not being used properly by the British public, and highlight an important area for sun awareness campaigns to target. While we have succeeded in making people aware of the link between sunburn and skin cancer, we have more work to do in teaching people how to use sunscreen properly. Education is key if we are going improve sun safety habits and prevent the public from putting themselves at risk.”
 
Stevie Cameron of La Roche-Posay said: “It’s really important that the British public are using the right sunscreen. When choosing a sunscreen, it is important to look for a high SPF value, such as 30 or 50+ that protects against UVB rays. In addition, it is very important to look for a circled UVA logo. This means the sunscreen meets EU requirements for UVA protection, rays that are present all year-round. Today the best sunscreens provide protection against UVB and UVA rays. As for those who do not ‘get on’ with the texture of normal sunscreens – there are textures on the market that are specifically formulated for sensitive, dry or oily and blemish prone skin.”
 
Sun protection tips:
 
1. Spend time in the shade during the sunniest part of the day when the sun is at its strongest, which is usually between 11am and 3pm in the summer months.
2. Avoid direct sun exposure for babies and very young children.
3. When it is not possible to stay out of the sun, keeping yourself well covered, with a hat, T-shirt, and sunglasses can give you additional protection.
4. Apply sunscreen liberally to exposed areas of skin. Re-apply every two hours and straight after swimming or towelling in order to maintain protection.
 
Checking for skin cancer:
 
There are two main types of skin cancer: non-melanoma, the most common, and melanoma, which is less common but more dangerous. The following ABCD-Easy rules show you a few changes that might indicate a 'melanoma', which is the deadliest form of skin cancer. As skin cancers vary, you should tell your doctor about any changes to your skin, even if they are not similar to those mentioned here. If your GP is concerned about your skin, make sure you see a Consultant Dermatologist, the most expert person to diagnose a skin cancer. Your GP can refer you via the NHS.
 
Asymmetry - the two halves of the area may differ in shape
Border - the edges of the area may be irregular or blurred, and sometimes show notches
Colour - this may be uneven. Different shades of black, brown and pink may be seen
Diameter - most melanomas are at least 6mm in diameter. Report any change in size, shape or diameter to your doctor
Expert - if in doubt, check it out! If your GP is concerned about your skin, make sure you see a Consultant Dermatologist, the most expert person to diagnose a skin cancer. Your GP can refer you via the NHS
 
Non-melanoma skin cancer
 
Non-melanoma skin cancers can occur on any part of the body, but are most common on areas of skin that most often exposed to the sun such as your head and neck (including lips and ears) and the backs of your hands. They can also appear where the skin has been damaged by X-rays, and on old scars, ulcers, burns and persistent wounds.
 
Non-melanoma skin cancers vary greatly in what they look like. They tend to appear gradually on the skin, and slowly get bigger over time. They will not go away on their own without treatment. Some possible signs include:
 
- A scab or sore that won’t heal. It may also bleed occasionally
- A scaly or crusty patch of skin that looks red or inflamed
- A flesh coloured, pearly lump that won’t go away and appears to be growing in size
- A lump on the skin which is getting bigger and that may be scabby
- A growth with a pearly rim surrounding a central crater, a bit like an upturned volcano
 
-Ends-
 
Notes to editors:
*Sunburn statistic from the Sun Awareness Week survey by the British Association of Dermatologists 2015
 
Sun Awareness Week takes place from May 9th to 15th 2016 and is owned by and trademarked to the British Association of Dermatologists. La Roche-Posay is the sole sun protection brand partner of the 2016 campaign and has been a sponsor of the British Association of Dermatologists’ Sun Awareness Campaigns since 2011.
 
This survey of 215 people was conducted online by the British Association of Dermatologists.
 
The hashtag for Sun Awareness Week 2016 is #SunAwarenessWeek.
 
For more information please contact the media team: comms@bad.org.uk, 0207 391 6084 (Mon-Fri). Website:http://www.bad.org.uk/for-the-public
 
About us:
The British Association of Dermatologists is the central association of practising UK dermatologists. Our aim is to continually improve the treatment and understanding of skin disease. For further information about the charity, visit www.bad.org.uk 
 
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Healthcare profession takes strides in protecting non-surgical cosmetic intervention patients

Five prominent healthcare groups have come together to improve safety for patients undergoing non-surgical cosmetic interventions. The groups have joined forces to form the Cosmetic Practice Standards Authority (CPSA) and the Joint Council for Cosmetic Practitioners (JCCP) with support from the Department of Health (DoH).

The two groups will work collaboratively to ensure patient safety in the specific area of non-surgical interventions, which includes dermal fillers, Botox injections and cosmetic laser therapies. This area is largely unregulated and although many of these treatments are carried out by doctors, nurses and dentists who are covered by their own professional codes of conduct, there are also a large number of treatments carried out by non-regulated practitioners.

The associations currently involved are:

·         The British Association of Aesthetic Plastic Surgeons (BAAPS)

·         The British Association of Cosmetic Nurses (BACN)

·         The British Association of Dermatologists (BAD)

·         The British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS)

·         The British College of Aesthetic Medicine (BCAM)

These bodies will work together to protect patients by improving and enforcing clinical standards and training, and by maintaining a register of practitioners.

The CPSA and the JCCP have already started on these key tasks with the objective of fully launching in April 2017. Professor David Sines, CBE, has been appointed as the Interim Chair of the JCCP and his first task has been to bring together the key professional medical associations involved in delivering non-surgical services followed by other professional associations and stakeholders.

This news comes hot on the heels of the recent publication of the ‘Guidance for Doctors who offer cosmetic interventions’ by the General Medical Council (GMC), which both the CPSA and the JCCP welcomed.

Professor David Sines, Interim Chair of the JCCP, said: “In 2013 the Keogh ‘Review of the Regulation of Cosmetic Interventions’ found that the regulatory framework had not managed to keep up with the growing cosmetic intervention industry. Sections of the non-surgical cosmetic interventions industry remain largely unregulated, however healthcare professionals have made important strides in improving patient safety. The formation of the CSA and the JCCP is an important step forward.”

The need for improved training and oversight to be addressed by the groups is highlighted by an audit of dermatologists and plastic surgeons*, which showed:

• 58 per cent of the dermatologists answering the survey had seen patients with complications from non-surgical cosmetic procedures.

• 54 per cent of these complications were due to dermal filler injections. Of these, 33 per cent had granuloma formation and 10 per cent had allergic reactions. Granuloma formation is a chronic, debilitating foreign body reaction, where chronic nodules develop which may require treatment with systemic immunosuppressive agents and recurrent surgical removal.

• 63 per cent of respondents stated the complications were irreversible or chronic.

• 59 per cent of respondents stated the complications had a highly negative impact on the patient's quality of life.

• 49 per cent of respondents felt there was either a missed diagnosis of skin disease, or inappropriate treatment of skin disease associated with the non-surgical cosmetic procedure (including skin cancer).

• The two main areas where complications arose were laser/light treatments (67 per cent) and dermal fillers (54 per cent).

 

ENDS

Notes to editors:

Below is a summary of the current makeup and remit of the two groups, who are committed to interdisciplinary and collaborative working:

The Cosmetic Practice Standards Authority (CPSA):

The CPSA is currently made up ofthe British Association of Dermatologists (BAD), the British Association of Aesthetic Plastic Surgeons (BAAPS) and the British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS). Its role is to:

  • Set standards and a code of conduct that all practitioners must adhere to;
  • Lead evidence-based research;
  • Scan the horizon for new therapies to mitigate risk;
  • Collect data on activity and adverse events;
  • Collaborate with stakeholders such as JCCP and advise regulatory bodies such as Department of Health (DoH), The Medicines and Healthcare Products Regulatory Agency (MHRA), the General Medical Council (GMC) and others.

The Joint Council for Cosmetic Practitioners (JCCP):

The JCCP is currently made up of the British Association of Cosmetic Nurses (BACN) and the British College of Aesthetic Medicine (BCAM). Its role is to:

•        Oversee compliance with clinical standards established by the new Cosmetic Practice Standards Authority

•        Develop an educational and training framework linked to the standards and processes of accreditation;

•        Maintain a register(s) of members who meet the entry requirements of the JCCP and abide by its Code of Practice;

•        Collaborate with stakeholders such as JCCP and advise regulatory bodies such as Department of Health (DoH), The Medicines and Healthcare Products Regulatory Agency (MHRA), the General Medical Council (GMC) and others (within the context of its defined remit).

While the current membership of both Groups is as stated, this is open to expansion and development; multidisciplinary collaboration will underpin both groups in order to provide public protection and assurance.

*Audit of members of BAD, BAAPS and BAPRAS, 2012

Contact:

For more information about the role of CPSA, please contact the BAD press team: comms@bad.org.uk/ 0207 391 6084 or the BAPRAS PR team:  bapras@portland-communications.com

For more information about the JCCP, please email:

British Association of Cosmetic Nurses Chief Executive Officer: pburgess@bacn.org.uk– 07971476312 or the British College of Aesthetic Medicine Press Office: Kim Greer - 01474 823900 or 07545371100

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BAD response to NICE guideline on Sunlight Exposure: Benefits and Risks

The BAD agrees with the report’s statement that there is no such thing as a safe tan, as a tan is a sign of sun damage. Contrary to the report, we recommend using a sunscreen with an SPF of at least 30, rather than 15, as most people don't apply sunscreen thickly enough and using a higher SPF may help to increase your protection. However, protective clothing and seeking shade during the hottest parts of the day are still the first line of defence. In terms of acquiring vitamin D from the sun, we are of the position that for light skinned people who are at the highest risk of sunburn and skin cancer, the evidence of risks of sun exposure outweigh the evidence of benefits. There are other ways to get vitamin D that don't put you at risk of potentially deadly skin cancer, such as through diet and the use of supplements, and you don't need to sunbathe or sunburn for your health. We are certainly not telling people to stay out of the sun, but be sensible: know your skin type, take precautions to protect your skin when it's sunny, and don't let your skin burn.

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BAD response to 'rash' comments by Jeremy Hunt

Dr Nick Levell, President-elect: "Rashes in children can be the first sign of a serious illness. There are more than 2000 different skin diseases, so it is not reasonable to expect parents, under pressure with a sick child, to be able to distinguish between serious and non-serious problems by browsing images on the internet. We encourage people to read about the best way to manage and treat illnesses, using reputable internet sites such as that provided by the British Association of Dermatologists. It is important though to get the diagnosis right first, by seeking advice from a health professional."

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The Cosmetic Practice Standards Authority welcomes the introduction of a curriculum for non-surgical cosmetic procedures

The Cosmetic Practice Standards Authority (CPSA), a tripartite group consisting of 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), welcomes the introduction today of a curriculum for non-surgical cosmetic procedures.

The new Health Education England (HEE) curriculum was developed in conjunction with members of the Cosmetic Practice Standards Authority as a response to the Keogh Review into the regulation of cosmetic interventions*. 

The new curriculum is a training standard for all practitioners of non-surgical cosmetic interventions, including both clinicians and non-clinicians, in order to ensure a minimum standard of training across the board. 

The CPSA believes that patient safety is paramount, and the need for improved training is highlighted by the most recent audit of CPSA members, which showed:

• 58 per cent of the dermatologists answering the survey had seen patients with complications from non-surgical cosmetic procedures.
• 54 per cent of these complications were due to dermal filler injections. Of these, 33 per cent had granuloma formation and 10 per cent had allergic reactions. Granuloma formation is a chronic, debilitating foreign body reaction, where chronic nodules develop which may require treatment with systemic immunosuppressive agents and recurrent surgical removal.
• 63 per cent of respondents stated the complications were irreversible or chronic.
• 59 per cent of respondents stated the complications had a highly negative impact on the patient's quality of life.
• 49 per cent of respondents felt there was either a missed diagnosis of skin disease, or inappropriate treatment of skin disease associated with the non-surgical cosmetic procedure (including skin cancer).
• The two main areas where complications arose were laser/light treatments (67 per cent) and dermal fillers (54 per cent).

Dr Tamara Griffiths of the British Association of Dermatologists said: 

“We welcome the development of these training standards which, crucially, cover both clinicians and non-clinicians. When developing standards for non-surgical cosmetic interventions, common sense dictates that they apply to everyone practising these procedures, not just doctors and nurses.

“With the curriculum in place, it is also paramount that all relevant professional groups work together to develop an agreed model both for setting standards and for oversight of the sector. This process is still in its infancy and openness, transparency and full collaboration is required.”

ENDS

Notes to Editors:

The Cosmetic Practice Standards Authority (CPSA) is a tripartite group consisting of 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). 

*Keogh, B. (2013). Review of the Regulation of Cosmetic Interventions. Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/192028/Review_of_the_Regulation_of_Cosmetic_Interventions.pdf
 

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