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Diet and lifestyle could increase the risk of developing psoriasis by 30 per cent

Research being presented this week at the Psoriasis: From Gene to Clinic International Congress in London suggests that diet and lifestyle factors can contribute up to 30 per cent to the risk of psoriasis onset in people with the genetic predisposition to the condition.

Psoriasis is an inflammatory skin condition, affecting around two per cent of the population. Psoriasis occurs when a type of immune cell, called a T-cell, becomes overactive. They attack melanocytes, specialist skin cells that produce the pigment melanin, this immune response causes a growth of skin cells in the form of psoriatic plaques. However, the reason why this happens has been unclear.

Certain alleles (alternative forms of a gene) are linked with a higher risk of developing psoriasis, and HLA-C*06:02 is the main psoriasis risk gene. HLA-C*06:02 positive people are between 9- and 23-fold more likely to develop psoriasis than someone without an allele associated with the disease.

In a recent study the same authors identified that T-cells attack melanocytes in patients with psoriasis HLA-C*06:02 due to reaction against a certain a peptide (a chain of amino acids, the building blocks of proteins, amongst other things). In the skin, this peptide is only found in melanocytes, however similar peptides are also found in our external environment, including in certain foods

T-cell immune reactions are triggered by amino acid patterns. This means that peptides sharing the same amino acid pattern as the peptide in melanocytes may trigger the same psoriasis-inducing reaction. In this study the researchers used a database to find peptides which have the same amino acid pattern as seen in melanocytes. These environmental candidates were then tested for their ability to trigger the reaction that causes psoriasis.

In this way they identified a variety of peptides in proteins from human skin and gut microbiomes, the chlamydia bacterium, and from foods such as wheat, coffee, apples, and spinach, all of which brought on this reaction.

The identification of potential triggers may help to develop strategies for psoriasis prevention in individual patients, these patients and their triggers would have to be verified in clinical practice.

Dr Jörg Prinz, from the Ludwig-Maximilian-University of Munich, one of the authors of the study, said:

“The aim of our study was to get a better understanding the factors at the molecular level that translate the genetic predisposition for psoriasis into the actual manifestation of the disease. Essentially, why do only some of the people who have a genetic tendency towards psoriasis have it, whilst others don’t? Our results show that lifestyle factors may be important.

“These results provide initial evidence that environmental factors may serve as potential triggers for this specific autoimmune response in psoriasis. It may also have implications in understanding how environmental factors affect the risk of autoimmune diseases in general.”

Matthew Gass of the British Association of Dermatologists said:

“This is very interesting research that has the potential to expand our understanding of the mechanisms that drive the development of psoriasis, but also could have practical benefits for potential patients.”

“What we need now is more research that can build on these findings. In an ideal world we would have ways of identifying triggers in individual patients, to help them avoid them.”

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Notes to editors:

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

The 8th International Congress of Psoriasis from gene to clinic is taking place in London from Thursday 30th November to Saturday 2nd December 2017. For more information, visit: www.psoriasisg2c.com

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 

Environmental antigens may trigger HLA-C*06:02-mediated autoimmunity in psoriasis

Y. Arakawa, A. Arakawa, S. Vural, A. Galinski, S. Vollmer and J. Prinz 

Department of Dermatology, Ludwig-Maximilian-University of Munich, Munich, Germany 

Psoriasis vulgaris is a human leucocyte antigen (HLA)-C*06:02-associated T-cell-mediated autoimmune skin disease that develops upon epidermal infiltration and activation of CD8+ T cells. Environmental and lifestyle factors may trigger disease onset, and account for approximately 30% of disease risk. Using a V?3S1/V?13S1 T cell receptor (TCR) from a pathogenic epidermal psoriatic CD8+ T-cell clone we have recently shown that in psoriasis HLA-C*06:02 mediates an autoimmune response against melanocytes, and we had identified a peptide from ADAMTS-like protein 5 as a melanocytic antigen. In this study, we aim to identify environmental factors at the molecular level that translate the genetic predisposition into disease manifestation. TCRs are polyspecific. They do not recognize specific antigens but react against HLA-presented peptides sharing a particular amino acid pattern specific to this TCR. After defining the amino acid pattern recognized by the V?3S1/V?13S1 TCR in the context of HLA-C*06:02 by peptide library screening we searched environmental proteomes for peptides sharing this particular pattern. Environmental candidate epitopes were tested for their ability to ligate the ADAMTSL5-reactive V?3S1/V?13S1 TCR when presented by HLA-C*06:02. This way we identified a variety of peptides contained in proteins from human skin and gut microbiomes, from infectious pathogens including Chlamydia trachomatis, and from foods (wheat, coffee, apple and spinach) that ligated the V?3S1/V?13S1 TCR. These results provide the first evidence of environmental antigens that may serve as potential triggers of the melanocyte-specific autoimmune response in psoriasis. They suggest that exposure to environmental antigens may drive priming and expansion of potentially self-reactive T cells and thus initiate autoimmune disease responses. Through the unbiased analysis of a pathogenic psoriatic TCR our data furthermore may have important implications in understanding how environmental factors affect the risk for autoimmune diseases in general.
  

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Caffeine can reduce inflammation in patients with eczema and psoriasis

Doctors at the Psoriasis: From Gene to Clinic International Congress in London have today presented their findings on the use of caffeine to reduce inflammation in patients with atopic dermatitis and psoriasis – two of the most common chronic skin conditions worldwide.

Their review has found that caffeine acts in a number of ways to improve symptoms of inflammation, making it an effective therapy to complement primary treatments for eczema or psoriasis, namely topical corticosteroids.

The research has suggested several ways in which caffeine reduces inflammation. Conditions such as atopic dermatitis and psoriasis result in decreased levels of a molecule called cyclic adenosine monophosphate (cAMP) in skin cells*. These cAMP molecules act as messengers within the cells, and low levels have been found to increase inflammatory pathways and suppress anti-inflammatory ones. Caffeine has been shown to inhibit the enzyme that degrades cAMP, phosphodiesterase, and so raise the levels of this molecule back to normal and counter the inflammation.

Caffeine also plays a helpful role in cell death to reduce inflammation. There are two ways in which cells can die: apoptosis is usually the beneficial process by which a cell is programmed to die in response to certain triggers, while necrosis is when the cell dies due to external forces, such as injury or infection – and this can lead to further inflammation in the body. Caffeine encourages damaged cells to promptly trigger apoptosis and has effects which prevent cells from dying prematurely from necrosis when damaged by oxidative stress (the harmful effect of free radicals when not enough antioxidants are present to fight them off). These properties, in addition to further anti-oxidising (free radical fighting) effects of the caffeine’s metabolites, may also reduce inflammation.

The researchers, from Alfaisal University, Riyadh and Mount Sinai Health System, New York, emphasised that although oral intake may have a positive effect, a topical approach is much more likely to produce greater improvement. This would involve adding caffeine to steroid creams and then applying the cream to the skin.

Dr Mais Alashqar, one of the researchers, said:

“This review on the potential for caffeine to reduce inflammation in skin disease patients has been a long time coming. Initial studies in the 1970s first demonstrated this, but 40 years later this knowledge has, in a sense, faded. We still don’t add caffeine to topical steroids that patients use daily. It is a simple step that could significantly benefit the many patients around the world that suffer from inflammatory skin conditions like eczema or psoriasis. We hope that our review will help bring this knowledge back into the consciousness of doctors and patients.”

Matthew Gass of the British Association of Dermatologists said:

“Research such as this review is important. Such is the scale of the scientific literature that is available to modern experts that it is easy for some of it to not to be acted upon, or even forgotten. In the case of using caffeine in steroid creams, it seems that even if it has not been entirely forgotten there is certainly room to research this option in more depth. There are so many patients out there who are struggling to manage inflammatory skin conditions and so research avenues such as this should be thoroughly explored.”

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Notes to editors:

* Keratinocytes and leukocytes specifically

Psoriasis is a common inflammatory skin disease affecting two per cent of the population. It occurs equally in men and women, can appear at any age, and tends to come and go unpredictably. Atopic eczema is a very common skin condition due to skin inflammation. It may start at any age, but the onset is often in childhood. One in every five children in the UK is affected by eczema at some stage. It may also start later in life in people who did not have atopic eczema as a child.

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

The 8th International Congress of Psoriasis from gene to clinic is taking place in London from Thursday 30th November to Saturday 2nd December 2017. For more information, visit: www.psoriasisg2c.com

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

Caffeine in the treatment of atopic dermatitis and psoriasis: a review

M. Alashqar1 and N. Goldstein2 

1Alfaisal University, Riyadh, Saudi Arabia and 2Mount Sinai Health System, New York, NY, U.S.A. 

Atopic dermatitis (AD) and psoriasis are inflammatory skin diseases. AD is characterized by immune dysregulation and barrier impairment, while psoriasis shows immune dysfunction and resultant keratinocyte hyperproliferation. Caffeine has shown efficacy in ameliorating the symptoms of both diseases, but it is not conclusive through which pathways. The aim of this study was to provide a detailed discussion of the available work on this topic, as well as known modes of action of caffeine that are relevant to these two conditions. After an extensive review of the literature, we found that both diseases have decreased intracellular cAMP levels in cutaneous leucocytes, so it is very likely that being a methylxanthine, and hence a phosphodiesterase inhibitor, caffeine raises intracellular cAMP levels, which suppresses inflammatory pathways and potentiates anti-inflammatory ones. Moreover, caffeine is known to be an ATR (ataxia-telangiectasia mutated) kinase inhibitor and an ATM (ATM- and Rad3-related) kinase inhibitor, which promotes prompt apoptosis of damaged cells. It was also found to have antinecrotic effects in cells damaged by reactive oxygen species (ROS). These proapoptotic and antinecrotic properties may also be reducing the inflammation. Finally, caffeine’s metabolites have shown antioxidizing effects against ROS, which certainly would reduce inflammation caused by lipid peroxidation, DNA damage and organelle destruction. We find that caffeine acts in a number of ways to improve symptoms of inflammation and that it is an effective adjunct to therapy in AD and psoriasis.
  

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Poor nutrition in psoriasis patients may be caused by impaired senses

Psoriasis has long been linked with poor nutrition and increased body mass index in patients. Doctors at the Psoriasis: From Gene to Clinic International Congress in London have today presented evidence suggesting that a reduced sense of taste and smell, caused by inflammation, may be part of the explanation.

Psoriasis is a common inflammatory skin disease affecting two per cent of the population. It occurs equally in men and women, can appear at any age, and tends to come and go unpredictably. The link between psoriasis and higher rates of obesity has generally been explained by obesity being a risk factor for psoriasis.

Nutrition is a major issue in patient care for psoriasis. Metabolic disorders, disorders that affect your body’s ability to process food into energy, and increased body mass index are common and may result from the inflammatory characteristics of the disease or unbalanced diet.

It is already known that in chronic inflammatory bowel diseases, patients’ sense of smell and taste can be impaired. This can change the food a patient eats, but diet returns to normal once the disease has been successfully treated. The researchers wanted to test whether the same was true of psoriasis.

In this study, before any treatment, 50 patients with psoriasis were asked to complete a taste test to try to identify sweet, sour, salty, bitter and umami. They were tested with solutions sprayed onto the back of the tongue, as well as by using sniffing sticks. The results were compared with those in a group of healthy volunteers. Whereas sweet taste was detected by all psoriasis patients, bitter could not be tasted by 33 patients and umami by 15 patients. Altogether, a distinct impairment of taste and smell was found in patients with psoriasis.

The implication of this study is that inflammation impairs our sense of smell and taste. This may influence food uptake and adequate nutrition resulting in the discrepancy in average BMI compared to the rest of the population. However, more study is necessary to learn how taste impacts on nutrition, and how this in turn impacts on BMI in psoriasis patients.

Michael Sticherling MD, one of the researchers from the Department of Dermatology at University Hospitals Erlangen in Germany, said:

“Patients with psoriasis commonly have issues with nutrition, which can have an impact on their overall health. We wanted to explore in greater detail the reasons for this. Our results show that psoriasis patients may have greater difficulty identifying tastes than the general population, with the exception of sweet flavours. It’s possible that this is part of the reason for nutrition issues amongst people with the disease. More study is needed before we can say this for sure, but in the meantime there is compelling evidence that inflammation does have an impact on our ability to taste and smell things.”

Matthew Gass of the British Association of Dermatologists said:

“Patients with psoriasis don’t just have to manage the main symptoms of the condition, they also have an increased risk of a whole host of other issues, including obesity. Research that helps us better understand why this happens, will help us come up with better strategies for helping future patients.”


-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 8th International Congress of Psoriasis from gene to clinic is taking place in London from Thursday 30th November to Saturday 2nd December 2017. For more information, visit: www.psoriasisg2c.com

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

Please note that this is the original abstract submitted for the conference, since submission the authors have continued their research on more subjects, hence the discrepancies with the press release.

Impairment of gustatory and olfactory senses in plaque psoriasis

P. Rüter,1 V. Grünthaler,1 Y. Zopf2 and M. Sticherling1 

1Hautklinik Universitätsklinikum Erlangen, Erlangen, Germany and 2Medizinische Klinik 1, Universitätsklinikum Erlangen, Erlangen, Germany 

The various aspects of nutrition are a major issue in patient care for psoriasis. Metabolic disorders and increased body mass index are frequently encountered in this patients group and may result from systemic inflammation characteristic for the disease and/or unbalanced intake of food calories by the patients. Interestingly, in chronic inflammatory bowel diseases relevant gustatory and olfactory changes have been detected. These result in a disturbed food intake and are normalized again upon successful treatment of the disease. Here, patients with psoriasis were tested before any systemic treatment for the gustatory qualities sweet, sour, salty, bitter and umami. They were tested with appropriate solutions sprayed onto the back of the tongue in a standardized procedure, as well as by using sniffing sticks for olfaction. Thirty-three patients were tested: 18 women and 15 men with a mean age of 54.3 years (range 21–85), a mean Psoriasis Area and Severity Index (PASI) of 8 (range 0.7–24) and mean C-reactive protein (CRP) of 5.4 ng mL−1 (range 0.6–24.1). The results were compared with those in a group of healthy volunteers. Whereas sweet taste was detected by all patients, bitter could not be tasted by 21 patients and umami by 11 patients. Two and 23 patients showed hyposmia with results off the 10% and 50% percentiles of normal volunteers, respectively. Altogether, a distinct impairment of gustatory and olfactory senses was found in patients with psoriasis. Considering the low number of patients, the correlation to PASI and CRP was barely significant. In addition, a normalization of sensory capacity in relation to therapeutic responses and improvement of psoriasis has to be monitored.
 

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Smokers twice as likely to develop debilitating skin disease

Tobacco smokers are twice as likely to develop a debilitating skin disease, according to new research published in the British Journal of Dermatology this week.

Hidradenitis suppurativa (HS) is a chronic and recurring inflammatory disease of the hair follicles, which causes a mixture of boil-like lumps, areas leaking pus, and scarring. It is estimated to affect around one per cent of the population, and it is difficult to predict the severity of individual cases and how they will respond to treatment.

The study was a retrospective cohort analysis, meaning that a database of medical records is examined to spot trends in a population’s health. The database that the researchers used has data on the health of over 50 million people in the United States, though for this study only patients with an active status in the database over the last three years who had race, gender, and age information, as well as at least one measurement for BMI with the study period were included. Patients who had already been diagnosed with HS before the start of the study were also excluded, as were patients who started smoking after they were diagnosed with HS.

Using this information the researchers were able to split the cohort into smokers and non-smokers and calculate the incidence of HS among both groups, taking into account other factors that influence HS incidence, such as age, gender, race, and obesity.

Of the 3,924,310 tobacco smokers, there were 7,860 patients diagnosed with HS during the study period, this compares to 8,430 cases of HS among 8,027,790 non-smokers. This equals an overall incidence among smokers of 0.20 per cent compared to 0.11 per cent among non-smokers.

Overall incidence was highest amongst the following smoking sub-groups: those aged 30-39 years (0.35 per cent); women (0.28 per cent); African Americans (0.46 per cent), and those with a BMI greater than, or equal to, 30 (0.33 per cent), qualifying them as obese.

Although the exact mechanisms linking tobacco smoking to HS are not understood, it has been speculated that nicotine has a role in triggering the disease.

Senior author, Dr Amit Garg, said: “This is the first population level evidence that tobacco smoking is a true risk factor for the development of Hidradenitis suppurativa. What is not yet understood is whether cessation of smoking can lead to improvement in disease activity.”

Matthew Gass of the British Association of Dermatologists said: “Hidradenitis suppurativa is a recurrent and painful disease, which can have an enormous physical and psychological impact on people, as such it is very important that medical professionals and patients understand the potential causes of this condition.

“This study also builds on the existing evidence base regarding the impact of smoking on skin health. There is already evidence that it is one of the biggest factors in skin ageing, and that it can increase the chances of acne scarring.”

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Notes to editors:

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

For more information on HS please read our patient information leaflet.

Study details: “Incidence of Hidradenitis Suppurativa among Tobacco Smokers: a population based retrospective analysis in the United States”
Garg, Amit; Papagermanos, Vassiliki; Midura, Margaretta; Strunk, Andrew.
Hofstra Northwell School of Medicine, Dermatology

Manuscript ID BJD-2017-1419.R1

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

The British Association of Dermatologists publishes two world-renowned dermatology journals, both published by Wiley-Blackwell. The British Journal of Dermatology is one of the top dermatology journals in the world, and publishes papers on all aspects of the biology and pathology of the skin.
http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-2133
 

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One in five sunbed users may be ‘addicted’, study finds

Scientists have tested a potential new way of screening for symptoms of indoor tanning addiction in sunbed users, showing that as many as one in five users may be addicted to the practice.

Ultraviolet (UV) radiation has been classified as carcinogenic to humans. One important source of exposure to UV rays are indoor tanning facilities, commonly known as sunbeds. A growing body of research suggests that excessive tanning is a behaviour with addictive potential.

The study, released in the British Journal of Dermatology this week, assessed a method called the Behavioral Addiction Indoor Tanning Screener (BAITS), a brief screening survey including seven questions, on a representative sample of the German population.

BAITS was developed based on the addiction disorder model published by the American Psychiatric Association. It is designed to capture the main features of addictive behaviours, such as experience of diminished control over behaviour and temptations that lead to urges or craving for the behaviour.

The researchers used data of the National Cancer Aid Monitoring on Sunbed Use (NCAM), which includes a cognitive pretest and a Germany-wide representative survey with 3,000 individuals.

Among 330 current users of sunbeds, 19.7% screened positive for symptoms of a potential indoor tanning addiction compared to 1.8% of 553 former users who had not used a tanning bed in the last 12 months.

While BAITS is not a final diagnosis of indoor tanning addiction, which would require a more formal assessment, it does identify symptoms of a potential addiction.

Lead author Dr Katharina Diehl of the Mannheim Institute of Public Health, Social and Preventive Medicine at Heidelberg University in Germany explained: “BAITS can be used as a screening tool in large surveys but it may also help physicians and health care providers to identify individuals in particular need of specific counselling to avoid the continuous use of tanning beds. By this psychological testing of the BAITS, it will be proven how accurate it is in identifying indoor tanning addicted individuals.”

Nina Goad of the British Association of Dermatologists said: “This is an interesting pilot study with two important developments: the first is a new way of measuring symptoms of tanning addiction in a large population group. The second is the finding, on testing this method, that as many as one in five sunbed users may have symptoms of addiction.

“There is strong evidence that use of sunbeds increases the risk of skin cancers, including malignant melanoma which is the most deadly type. For people who start using sunbeds before the age of 35 years the relative risk of malignant melanoma almost doubles. If indoor tanning does indeed have addiction potential, being able to assess the scale of the problem will be imperative. It certainly would help to explain why so many people continue to use sunbeds despite knowing the risks.”

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Notes to editors:

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

The study can be found online at: http://onlinelibrary.wiley.com/doi/10.1111/bjd.15888/full

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

The British Association of Dermatologists publishes two world-renowned dermatology journals, both published by Wiley-Blackwell. The British Journal of Dermatology is one of the top dermatology journals in the world, and publishes papers on all aspects of the biology and pathology of the skin.
http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-2133
 

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Misapplication of sunscreen leaving people vulnerable to skin cancer

When applying sunscreen people miss on average 10 per cent of their face, the most common site for skin cancer, according to a study being presented at the British Association of Dermatologists' Annual Conference in Liverpool. More than 90 per cent of basal cell carcinomas, the most common cancer in the UK, occur on the head or neck, and between five and 10 per cent of all skin cancers occur on the eyelids specifically.

57 participants, male and female, were asked to apply sunscreen to their face with no further information or instructions given by the researchers from the University of Liverpool. Photos were taken of each of the participants with a UV-sensitive camera before and after the application of sunscreen, with areas covered with sunscreen appearing black due to the UV camera. These images were then segmented and analysed by a custom-designed program to judge how successful each person was at covering their whole face.

On average people missed 9.5 per cent of the whole face, with the most commonly missed areas being the eyelids, where on average 13.5 per cent of the eyelid was missed, and the medial canthal region, the area between the inner corner of the eye and the bridge of the nose which was missed by 77 per cent of participants.

The researchers then asked the participants back to repeat the experiment, this time giving extra information about skin cancers of the eyelid region. Armed with this information there was a slight improvement in the level of sunscreen coverage with 7.7% per cent of the face left unprotected.

As applying sunscreen in these areas is not necessarily practical in light of manufacturers’ warnings to keep products out of the eye, it is important to use other forms of protection such as sunglasses.

Matthew Gass of the British Association of Dermatologists said:

“As sunscreen is one of the main protections against UV damage and skin cancer it is vital that people understand how to apply it. Skin cancer is the most common type of cancer in the UK, and numbers continue to rise at a worryingly fast rate.

“We still want people to enjoy themselves outdoors, but to go back to the basics of sun protection, especially those with fair skin that burns easily, and during periods of strong sunshine either in the UK or abroad. These are to thoroughly apply and reapply sunscreen with a minimum of factor 30 and good UVA protection, to wear protective clothing such as a t-shirt or a hat, to wear sunglasses that show the CE mark and British Standard (BSEN1836), and to spend time in the shade when the sun is at its hottest between 11am and 3pm.”

Dr Kevin Hamill of the University of Liverpool, one of the researchers, said:

“It's worrying that people find it so hard to sufficiently apply sunscreen to their face, an area which is particularly at risk of skin cancer due to the amount of sun exposure it receives. Our research shows that simple health messaging can help improve this problem, and we hope that industry groups and public health campaigners can take this onboard.”

“Perhaps the most important thing to take away from this research is the importance of sunglasses. Most people consider the point of sunglasses is to protect the eyes, specifically corneas, from UV damage, and to make it easier to see in bright sunlight. However, they do more than that, they protect the highly cancer prone eyelid skin as well.”

Teenage use of sunbeds on the rise in Ireland

Rates of sunbed use amongst Irish teenagers have risen since 2014 legislation banning sunbed use by under-18s, according to a study being presented at the British Association of Dermatologists' Annual Conference in Liverpool. The researchers, from Sligo University Hospital, suggest that a lack of enforcement may be a reason for this increase.

In the current study 8.8 per cent of respondents aged 14-18 years old had used a sunbed, with the highest rate being in Dublin (13.9 per cent). A similar 2014 survey of teenagers by the same researchers prior to the legislation showed that 7.5% of respondents had used a sunbed, with a higher rate in Dublin (11.2%). Indoor tanning is associated with an increased risk of skin cancer, and the risk is higher in frequent users and in those using sunbeds at a younger age.

Over 50 per cent of those that used sunbeds experienced burning due to sunbed use, most frequently occurring on the face (33%) and chest (22%). The majority (65%) did not use protective eyewear and this resulted in eye problems in 12 per cent. Furthermore, a concerning 2 per cent of Irish teenagers are using Melanotan® to enhance tanning.

Sunburn due to the sun was reported by 90 per cent of teenagers, with 43 per cent experiencing at least five burns. Sunscreen was seldom used at home (34%) compared with when holidaying abroad (85%). The majority of teenagers believe that a tan looks healthy (70%) and makes you look more attractive (73%). Conversely, the majority also acknowledged that tanning is dangerous (77%) and associated with wrinkles (83%).

Dr Dermot McKenna of Sligo University Hospital, one of the researchers, said:

“The failure to effectively enforce sunbed legislation in Ireland is hugely worrying. Skin damage at an early age is particularly concerning. A crucial step forward was taken by bringing in this legislation, however this should not be relied on in isolation. We need to ensure that the legislation is being enforced and that on-going education is provided to ensure its success. It is disappointing that currently it is not proving effective. Of note, the current legislation does not cover home sunbed use allowing teenagers to circumvent the legislation.

“We can also see that although young people seem to be aware of the dangers of tanning this is not necessarily changing their habits, particularly in terms of protecting their skin from the sun when at home (Ireland). More effort needs to be put into changing the cultural perception of a tan as healthy and attractive, as tricky as it may be.”

Matthew Gass of the British Association of Dermatologists said:

“What this study shows is that despite generally good awareness of the dangers of excessive UV exposure Irish teenagers are still getting caught out in the sun, and are particularly lax when they’re in Ireland. An important reason for this is the desire for a tan which is considered both healthy-looking and attractive. Until this changes it’s always going to be a tricky persuading young people to make good long-term health decisions, as for many people body image and attractiveness is very closely linked to self-esteem and sense of self. Clearly this problem isn’t limited to Ireland, where there have been excellent steps taken to educate and protect people on sun awareness.”

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Notes to editors:

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

The conference will be held at the ACC Liverpool from July 4th to 6th and is attended by approximately 1,300 UK and international dermatologists.

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

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

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 limit your time in 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, sweating or towelling 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 ABCDE rules describe 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 like those mentioned here. If your GP is concerned about your skin, make sure that you are referred to a 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 or colour
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
Evolution – if you see progressive changes in size, shape or colour over weeks or a few months, you must seek Expert help.

If in doubt, check it out! If your GP is concerned about your skin, make sure you see a 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 are 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

Study 1: Ultraviolet imaging reveals that areas on the face that are prone to skin cancer are disproportionately missed during sunscreen application

K. Hassanin, H. Pratt, Y. Zheng, G. Czanner, K. Hamill and A. McCormick University of Liverpool, Liverpool, Merseyside, U.K.

Use of sunscreen is an effective means of protecting skin against the harmful actions of ultraviolet (UV) radiation. Despite increasing sun awareness and sun protection usage, > 90% of basal cell carcinomas develop in sun-exposed head and neck and areas 5–10% of all skin cancers (including basal and squamous cell carcinomas and melanomas) occur on the eyelids. We hypothesized that high-risk areas, notably the eyelids and medial canthal regions, may be ineffectively covered and that provision of improved information regarding application would be an effective strategy to improve coverage. A crossover study was undertaken with 57 participant (27 male, 30 female). Participants were provided with minimal instructions and imaged with a UV-sensitive camera before and after sunscreen application. Images were processed autonomously by a custom-designed image analysis program to reduce subjectivity in segmentation. Facial landmarks were detected and images cropped respective to these landmarks so each images analysed was uniform. Images were pre-processed to remove artefacts and segmented through thresholding for regions missed. Analysis revealed a median of 9.5% of the whole face to be missed [interquartile range (range 0 – 22.2%,]; however, the proportion of the eyelid region missed was significantly higher at 13.5%, (p<0.001 Mann-Whitney test). The medial canthal region was missed by 77% of participants. Participants were invited to return for a second visit, when a new set of instructions was given with extra information pertaining to skin cancer of the eyelid region; participants were imaged as previously. Application during the second visit showed a slight overall improvement in whole face area covered (7.7%, 1.8% increase P < 0.05); however, the eyelid regions showed 3.8% increased coverage with the area missed reduced from 13.5% without information to 9.7% with (Range 0-23.5%, P < 0.05). No significant improvement in medial canthal region coverage was observed. Together these data reveal that even those who apply sunscreen are likely to be missing high-risk areas, and in turn suggest that those who believe they are protected and therefore may modify their behaviour are actually still at risk. Moreover, importantly, our data show that a simple public health announcement-type intervention could be effective at reducing risk.

Study 2: A re-evaluation of teenage sunbed use following the introduction of legislation banning use for under 18 year olds

S. Menzies, S. Daly, M. Fitzgerald and D. McKenna Sligo University Hospital, Sligo, Ireland

Indoor tanning is associated with an increased risk of skin cancer. The risk is higher in frequent users and in those using sunbeds at a younger age. In a previous study of Irish teenagers, we showed that 7.5% of respondents had used a sunbed, with a higher rate in Dublin (11.2%) [Fitzgerald M, Daly S, McKenna D et al. Ambient and sunbed ultraviolet radiation exposure: exposure rates, protection habits and attitudes of Irish teenagers aged 14–18 years before introduction of national sunbed legislation. Br J Dermatol 2015; 173 (Suppl. S1): 6]. In 2014, legislation was introduced in Ireland to ban the use of sunbeds in teenagers under the age of 18 years old. The purpose of the present study was to reassess sunbed usage among teenagers aged 14–18 years, 2 years after the introduction of the ban. We assessed (i) sunbed usage rates, (ii) sunburn history, (iii) sun-protection habits and (iv) attitudes towards sun and sunbed exposure. The same secondary schools as before were visited and the teenagers completed an anonymous questionnaire. The numbers completing the questionnaire, age and male-to-female ratio were similar to those in the original study. The results showed that more teenagers are using sunbeds following the ban (8.8%). Teenagers in Dublin continue to have a higher rate of sunbed use (13.9%) compared with other regions. After the ban there was an increase in sunbed usage in tanning shops (before 44%, after 50%) and at home (before 26%, after 41%). More teenagers were consented prior to treatment (before 9%, after 15%). The majority did not wear eye protection (65%), resulting in eye problems in 12%. In the present study, over 50% had experienced burning due to sunbed use, most frequently occurring on the face (33%) and chest (22%). A minority (2%) of teenagers used Melanotan. Sunburn due to ambient exposure was reported by 91% of teenagers, with 43% experiencing at least five burns. Sunscreen was seldom used at home (34%) compared with when holidaying abroad (85%). The majority of teenagers believe that a tan looks healthy (70%) and makes you look more attractive (73%). Conversely, the majority also acknowledged that tanning is dangerous (77%) and associated with wrinkles (83%). Our findings show that there has been no reduction of sunbed use in teenagers following the introduction of legislation banning its use in those aged < 18 years. This may be due to a lack of enforcement of the legislation, in addition to an increasing trend for sunbed use at home. Further education is needed highlighting the dangers of sunbed use and excessive sun exposure.
 

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Children with smartphones more likely to get head lice

British children who have smartphones or tablets are significantly more likely to get head lice than those who don’t, according to a study being presented at the British Association of Dermatologists' Annual Conference in Liverpool. Despite past theories that selfies increase the transmission of lice, no conclusive evidence of this was discovered by the study.

The study, which was primarily researching the incidence of head lice amongst children in the UK, also found that previous estimates of the prevalence of head lice in British children may be conservative, although this could also reflect the longer period covered by the study. Previously it’s been thought that between two and eight per cent of school-aged children have head lice, however, this study found that 45 per cent of children had had headlice in the last five years, with girls with siblings who are aged 6–9 years most commonly affected.

Data was gathered on 202 children which found that 104 (51.5%) owned a smartphone or tablet; 82 (40.5%) were using a device for ‘selfies’. Taking regular selfies did increase risk, compared with not taking selfies, but not enough to draw conclusions. The study did not differentiate between individual and group selfies. Of the 98 children who did not own or use a smartphone or tablet, 29 (29.5%) experienced head lice compared to 65 of the 104 (62.5%) who did own or use a smartphone or tablet.

Matthew Gass of the British Association of Dermatologists said:

“Head lice are a pain to deal with, both for children and their parents. Speaking from experience, they are intractable misery bugs that take far more time and effort to remove than is reasonable. Not to mention the obligatory quarantine period that they necessitate. That’s why a better understanding of how these pests are transmitted is useful. Prevention is always better than a cure, particularly if the cure means wrenching your poor daughter’s hair with a fine-toothed nit comb, or relying on over-the-counter remedies that head lice are increasingly resistant to.

“We’re not saying that smartphones are causing children to get head lice, but that there is a link, so if there’s an outbreak at home or at school, consider how electronic devices might cause children to congregate, allowing head lice to spread.”

Dr Tess McPherson of Oxford University Hospitals NHS Foundation Trust, one of the researchers, said:

“Compared to previous estimates of head lice incidence, our figures were much higher, showing that almost half of children have had them in the last five years, which may not come as a surprise to parents. We also noted that children with smartphones or tablets were more likely to get head lice, which is interesting but we can only guess that this is due to the way that young people gather around them, though there could be other reasons.

“Selfie culture gets its fair share of negative press so it’s worth noting that despite previous speculation it seems that selfies can’t specifically be blamed for helping the spread of head lice at this stage.”

-Ends-
Notes to editors:

For more information on head lice and treatments please see the BAD’s patient information leaflet.

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 ACC Liverpool from July 4th to 6th and is attended by approximately 1,300 UK and international dermatologists.

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

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 

PA14 How common are head lice? Are smartphone/tablet devices to blame?

N. Hitchen, T. McPherson and D. Warnapala Oxford University Hospitals NHS Foundation Trust, Oxford, U.K.

There is limited scientific data on current prevalence of head lice in the U.K., but it has been previously cited at between 2% and 8% in school-aged children. There has been evidence that links lower socioeconomic status, long hair and low frequency of washing to head lice infestation (Moosazadeh M, Afshari M, Keianian H et al. Prevalence of head lice infestation and its associated factors among primary school students in Iran: a systematic review and meta-analysis. Osong Public Health Res Perspect 2015; 6: 346–56; Falagas ME, Matthaious DK, Rafailidis PI et al. Worldwide prevalence of head lice. Emerg Infect Dis 2008; 14: 1493–4). It has been suggested that head lice prevalence is increasing worldwide. Additionally there is a theory that increasing use of portable devices such as smartphones and tablets has led to increased transmission of head lice. This study aims to investigate the current prevalence of head lice and identify possible factors associated with transmission. Questionnaires were given to all parents/guardians attending the paediatric outpatient department at the John Radcliffe Hospital in Oxford, over a 1-month period. Completion required information on all children in the household. Questions included information on sex, hair length, socioeconomic status, and smartphone or tablet ownership. Ninety two questionnaires were completed, which included data on 202 children. Of these, 91 (45%) had experienced head lice within the last 5 years, and girls with siblings aged 6–9 years were most commonly affected. Of the 202 children, 104 (51.5%) owned a smartphone or tablet; 82 (40.5%) were using a device for ‘selfies’, and 45 (54.8%) of those performing selfies experienced head lice. Of the 98 children who did not own or use a smartphone or tablet, 29 (29.5%) experienced head lice. Use of a smartphone significantly increased risk of head lice [risk ratio (RR) = 3.97, v2 = 12.02; P < 0.001]. Taking regular selfies did increase risk (RR = 1.76), compared with not taking selfies, but did not reach significance. The cohort we studied shows that head lice are common in this population and the prevalence is higher than that reported by other U.K. studies, which may reflect the longer time period. Those with a history of head lice were most commonly female and of younger age, although all ages were affected. Notably, over half the children owned a smartphone or tablet and this significantly increased their risk of having had head lice, which raises interesting questions about transmission.
 

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Doctor’s warn of the dangers of so-called “herbal creams”

Doctors at the British Association of Dermatologists’ Annual Conference in Liverpool have issued a warning about the dangers of using unlabelled herbal treatments, after potent steroids were detected in samples of several such products.

Doctors are also urging people not to use herbal preparations for the treatment of skin cancer, following a series of cases in which this has occurred, leaving patients in need of reconstructive surgery.

Herbal remedies are particularly popular for treating skin conditions, with researchers estimating that approximately 33 per cent of all herbal treatments are used to target wounds or skin diseases, this compares with only one to three per cent of Western medicines.

Herbal products with few or no ingredients listed, and often claiming to be ‘miracle creams’, were obtained from 11 patients, and tested by Researchers from the Birmingham Skin Centre, based at City Hospital, using a liquid chromatography–mass spectrometry–(time of flight) analyser, a highly sensitive and specific technology used to detect drugs and other chemicals to a high degree of accuracy. Super-potent topical steroids such as clobetasol propionate were found in seven of the 11 samples, which were largely being used to treat chronic skin conditions, such as eczema or psoriasis particularly in children.

In the UK, all cosmetic products are subject to European Union safety regulations and must comply with detailed compositional and labelling requirements. The failure of the products tested to provide a detailed ingredients list is a breach of these regulations.

Dr Sue Ann Chan, one of the researchers from the Birmingham Skin Centre, which is run by Sandwell and West Birmingham Hospitals NHS Trust, said:

“It is very concerning that unregulated topical herbal remedies continue to be accessible to patients with chronic skin disorders. The people selling these products in the UK are doing so illegally, and are putting peoples’ health in jeopardy. A common reason why people resort to these products is fear of potential long-term side effects of prescribed Western medicines, however, they end up inadvertently using potent drugs that should be used under instruction from a doctor.”

Dr Donna Thompson, Consultant Dermatologist and Head of Department at the Birmingham Skin Centre, who was also one of the researchers, said:

“The results of our tests were quite shocking, a number of these so-called herbal ‘miracle creams’ in fact contained super-potent steroids, which could have significant adverse health implications for users, particularly if they are being used on a regular basis. People have the right to know what ingredients are present in the treatments they are using and public awareness should be raised regarding this matter. If you notice that a cream you are using does not list ingredients, then I would strongly urge you not to use it on yourself or on your children.”

Another study at the BAD Annual Conference involved four cases in which patients had been self-medicating with herbal remedies that they believed were capable of treating skin cancers. All patients delayed seeing a doctor and undergoing surgical intervention due to their faith in the efficacy of their herbal treatments, this delay resulted in larger surgical defects in all cases, according to the doctors from St James’ Hospital, Dublin.

One 51-year-old man with a basal cell carcinoma (BCC, the most common type of skin cancer) on his nose had been diagnosed a year before by a dermatologist but instead of surgical removal decided to apply an alternative treatment* on a daily basis for several months. This delay resulted in a large crater-like tumour, which required two stages of surgery to remove resulting in the complete loss of the tip of his nose and necessitating a reconstructive procedure called a paramedian forehead flap, where skin from the forehead above the eyebrow is used to replace missing tissue from the nose.

In other cases a 70-year-old man presented with a nonhealing lesion over the right cheek, which turned out to be a squamous cell carcinoma (SCC, the second most common type of skin cancer). He had been applying an alternative topical therapy (pawpaw ointment), which was sent to him by his daughter living in Australia. A 46-year-old woman was referred with a BCC on her nose, which she was treating with an alternative treatment and a supplement, convinced that these would result in a nonsurgical cure of the BCC. Finally, a 58-year-old woman who 10 years previously had had a BCC excised from the left temple presented with a recurrence of the cancer, the patient had been using topical zinc chloride paste over the site as a means of treatment.

Dr Rupert Barry, Consultant Dermatologist and Dermatological surgeon, one of the researchers from St. James’s Hospital, Dublin, said:

“We feel that it’s really important to highlight the increasing trend of patients who seek alternative topical therapies for skin cancers, even for high-risk facial tumours. Interestingly, all of these patients were utterly convinced by the online claims made by either the manufacturers or in forums of the efficacy of such therapies, despite a lack of clinical evidence to suggest this.”


Dr Michael Lavery, another researcher from St. James’s Hospital, Dublin, said:

“Surgical removal of skin cancer is a highly effective treatment; the earlier it is done the better. Scarring for small non-melanoma skin cancers can be relatively minor, but if left the cancer has time to grow and scarring can be significant in some cases. It is understandable that people are hesitant about surgery, and want a non-surgical option, but it’s important that people understand that it really is the best option.”

Matthew Gass of the British Association of Dermatologists said:

“We’ve been concerned about the popularity of herbal creams for the treatment of skin disease for a long time. The increasing availability of some bogus treatments online has made them easier than ever to buy. The dangers of these products are two-fold, firstly that it is claimed that they treat a disease which they don’t, leaving it unchecked, and secondly that they are poorly labelled, and often contain ingredients that should only be used on advice from a doctor.

“Big online marketplaces need to make a concerted effort to root out these unprincipled sellers and remove them from their websites. More efforts need to be made to educate people, who are often scared and desperate, on the dangers of these products. It’s also important for people to remember that when you recommend untested herbal treatments to friends, family members, or co-workers with a cancer you are potentially risking their life – please encourage them to see a doctor instead.”

-Ends-
Notes to editors:

* The names of all products can be found in the study abstract provided below please note that in most cases it is members of the public, or third-party sellers making claims about these products’ abilities to treat different conditions, not the manufacturers.

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 ACC Liverpool from July 4th to 6th and is attended by approximately 1,300 UK and international dermatologists.

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

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

P100 Unravelling the mystery of the miracle cream: a retrospective regional review

S.A. Chan and D.A. Thompson Birmingham Skin Centre, Birmingham, U.K.

Approximately one-third of all herbal medicines are used to treat wounds or skin diseases, compared with only 1–3% of Western medicines, with their uses based mainly on historical and anecdotal evidence. Two reports have demonstrated evidence of topical corticosteroids in some herbal preparations. However, dermatologists continue to find patients using these preparations with little or no ingredients labelling. In the U.K., all cosmetic products are subject to wide European Union safety regulations and must comply with detailed compositional and labelling requirements. We conducted a 5-year retrospective review (2011–2015) to examine recent trends in the usage of topical herbal preparations for skin conditions. Samples sent to a regional toxicology unit for analysis were identified from 11 patients, all of Asian ethnicity (Indian, Pakistani and other), with an age range of 2–39 years. All patients had atopic dermatitis and reported obtaining preparations from the following sources: ‘herbalists’ (unclear source) (n = 6), Birmingham herbalists (n = 2), India (n = 2) and Pakistan (n = 1). All samples were inappropriately labelled with little or no ingredients listed. Samples were analysed using a liquid chromatography–mass spectrometry–time of flight analyser, a highly sensitive and specific technology used to detect drugs and other analytes to a high degree of accuracy. Gross appearances of the samples included light orange-pink cream (n = 4; three of the four creams with this appearance were labelled as ‘miracle cream’), clear paraffin consistency (n = 2), light green fragrant paraffin consistency (n = 2), clear fragrant brown oil (n = 1) and perfumed white cream (n = 1, labelled as ‘hydrogel cream’ and found to contain clotrimazole). Superpotent topical steroids/clobetasol propionate were found in seven of the eleven samples, including orange-pink cream (n = 4), light brown oil (n = 1), clear paraffin consistency (n = 1) and another with no clear description. Three other samples were free of drugs/corticosteroids, one of which was labelled ‘95% graphite’ cream. Unregulated topical herbal remedies continue to be accessible to patients with chronic skin disorders, particularly to those of Asian ethnicity, who often resort to these alternative preparations fearing potential long-term side effects of prescribed Western medicines. The majority of the products marketed as herbal preparations may contain potent topical steroids not mentioned on the labels, and dermatologists need to highlight the potential harms of these herbal remedies to their patients.

DS51 ‘Natural’ topical therapies don’t lead to healthy surgical defects

M.J. Lavery, J. Boggs, D. Wall, P. Ormond and R.B.M. Barry St James’ Hospital, Dublin, Ireland

Basal cell carcinomas (BCCs) are the most common cutaneous neoplasm. Treatment is predominantly surgical; however, the use of herbal medicines is becoming more common. We present a case series of four patients who self-medicated with alternative medicine topical therapies. The delayed presentation to a dermatologist resulted in larger, more extensive surgical defects. A 51-year-old man was seen as a tertiary referral for a biopsy-proven infiltrative BCC on the nasal tip. He had been diagnosed 1 year previously by the referring dermatologist but elected to pursue alternative topical treatment (‘Curaderm Bec 5’ on a daily basis for several months). One year later, the tumour was now a large crateriform scar-like BCC that now extended into multiple nasal cosmetic subunits. He underwent Mohs micrographic surgery (MMS) of the tumour, which was cleared after two stages, resulting in a deep large nasal defect (27 9 26 mm) requiring a paramedian forehead flap. A 70-year-old man presented with a nonhealing eroded plaque over the right zygomatic cheek. He had been applying an alternative topical therapy (Lucas’ Pawpaw ointment) acquired from Australia. A diagnostic biopsy showed a moderately differentiated invasive squamous cell carcinoma. This was excised after one stage of MMS and repaired with superficial muscular aponeurotic system plication sutures, which enabled primary closure. A 46-year-old woman was referred with a biopsy-proven BCC on the right nasal sidewall. She had been using topical ‘Curaderm Bec 5’ and a Juiceplus supplement, convinced that these would result in a nonsurgical cure of the BCC. She ultimately underwent MMS and required a full-thickness skin graft to repair a 16 9 14-mm defect. A 58- year-old woman with a past history of a BCC excised from the left temple 10 years previously presented with a recurrence at the inferior margin of the scar. The patient had been using topical zinc chloride paste over the site as a means of treatment. The patient underwent MMS excision and was repaired with a primary layered closure with a W-plasty at the lateral canthus. We highlight the increasing trend of some patients who seek alternative topical therapies for nonmelanoma skin cancers, even for high-risk facial tumours. Interestingly, all of these patients were utterly convinced by the online claims of efficacy of such therapies. In fact, all patients delayed appropriate surgical excision of their facial tumours, leading to larger surgical defects.
 

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The BAD guide to coping during a British heatwave

Comment from Matthew Gass of the British Association of Dermatologists:

“What with the UK’s notoriously hit and miss summers, it’s not surprising that people get excited at the prospect of a heatwave. However, nobody wants to go into work or school the next day sunburnt from head to toe. Quite aside from the potential embarrassment it can be very damaging to your skin. We aren’t advocating that people stay out of the sun altogether, but that they take extra care during the hottest parts of the day. People with pale skin are particularly at risk of sun damage, while naturally darker skin types, such as Asian or African-Caribbean skin types, are at less risk of sunburn in the UK, though it is still possible.”

Top tips:

1. Wear protective clothing: Protective clothing means anything that will help block the sun’s rays. We recommend a t-shirt, hat, and sunglasses. A hat is particularly important if you are bald, or have thinning hair as the scalp can be particularly susceptible to sun damage

2. Seek shade: Studies have shown that even with sunscreen you can get burnt. During the hottest part of the day, between 11am and 3pm it’s best to get plenty of shade.

3. Slather on the sunscreen: You want a sunscreen with a minimum of SPF 30 and good UVA protection – look for at least 4 UVA stars or the UVA circle. Remember to reapply regularly, roughly every two hours, even if you are using an extended wear sunscreen – it’s easy to miss spots or rub sunscreen off.

4. Vitamin D: The British Association of Dermatologists doesn’t recommend sunbathing to top up your vitamin D levels, particularly during heatwaves and particularly for Caucasian skin types. There are other ways to get vitamin D, such as in fortified foods and supplementation. Small amounts of sunlight will help boost vitamin D but at the level where skin starts to redden, vitamin D has long reached its optimum level and instead, skin is receiving damage that can lead to cancer.

5. Carry water with you: Dehydration can be a serious problem, so make sure you drink plenty of fluids (not alcohol or caffeine), particularly on hot days. For information on the symptoms of dehydration visit: http://www.nhs.uk/Conditions/dehydration/Pages/Introduction.aspx
 

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MSPs attend event to raise awareness of Scottish dermatology services

More than 40 Members of the Scottish Parliament and parliamentary staff met yesterday at Holyrood with the British Association of Dermatologists, Skin Conditions Campaign Scotland (SCCS), and leading dermatology support groups, to raise awareness around skin disease and to discuss the current state of Scottish dermatology services.

1.2 million people, a quarter of the population, visit their GP with a skin issue every year in Scotland – these visits account for around one in five of all GP consultations. This results in more than 100,000 patients a year visiting Scottish dermatology departments. Many of these departments are not fully staffed, with around 22 per cent of dermatologist posts in the country unfilled.

Scotland also has an increasing skin cancer problem, with more people developing skin cancer than all other cancers combined, and numbers are on the rise.

Across Scotland, around 50,000 people are referred to hospitals annually for possible skin cancers. The number of people in the UK developing melanoma (the deadliest form of skin cancer) each year has risen from around 1,800 in the mid-1970s to over 15,000 today.

MSPs attending the event were offered a free education session on checking their skin for signs of skin cancer, and were able to speak directly to patients, clinicians and charities about the issues they face and how politicians can help.

Maree Todd MSP, Highlands and Islands, said: "The event provided lots of really good information about skin cancer and other skin lesions. Skin conditions are visible so can be quite disfiguring. As well as suffering the disease, folk suffer stigma and discrimination."

Dr Colin Morton, British Association of Dermatologists representative for Scotland and consultant dermatologist at the Stirling Royal Infirmary said: “I want to thank the MSPs and everyone else who attended the event. It’s important that patients, health care professionals and policy makers come together to discuss these issues with one another. If we work together we can address the problems that Scottish dermatology faces, from the rising tide of skin cancers to insufficient numbers of dermatologists to treat them.”

Graham Simpson, MSP for Central Scotland, said: "I've learnt that there is a shortage of dermatologists that's causing worrying waiting times."

Over 40 MSPs and parliamentary staff attended the event*, which was sponsored by Clare Haughey MSP.


-Ends-


Notes to editors:

MSPs attending the event included:
Graham Simpson MSP, Central Scotland: "I've learnt that there is a shortage of dermatologists that's causing worrying waiting times."
Kenneth Gibson MSP, Cunninghame North: “Quality of life for patients is crucial for many patients with dermatological conditions.”
Annabelle Ewing MSP, Mid Scotland and Fife
Tom Arthur MSP, Renfrewshire South
Anas Sanwar MSP, Glasgow
Clare Adamson MSP, Central Scotland
Maree Todd MSP, Highlands and Islands
Rhoda Grant MSP, Highland and Islands

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

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

Skin Conditions Campaign Scotland represents the needs of patients and grass roots charities working to support people with skin conditions. We work to raise awareness of skin conditions, to increase access to appropriate services for patients and to provide training for health professionals in Scotland. For further information about the charity, visit www.skinconditionscampaignscotland.org
 

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Home and Away – Brits getting sunburnt in the UK and abroad

More than one in three (35%) Brits have been sunburnt in the last year while in the UK, and of those 28 per cent were sunburnt three or more times, according to a survey carried out by the British Association of Dermatologists to mark their Sun Awareness Week (8th-14th May).

Brits are even more likely to be sunburnt abroad, with almost half of people who have been abroad in the last twelve months getting sunburnt whilst away (46 per cent).

This high rate of sunburn is despite the fact that 88 per cent of Brits believe that sun awareness messaging is relevant to their skin type.

When those who have suffered sunburn were asked about factors that might have contributed to previous cases of sunburn, the most common issues cited all could have been avoided by following basic sun protection advice. Top of the list was not realising how strong the sun was (61 per cent), failing to reapply sunscreen after long periods (43 per cent), and not reapplying sunscreen after sweating or swimming (30 per cent).

However, there were also cultural reasons why Brits have been sunburnt, reflecting how we like to spend our time in the sun. Top of these was the desire for a tan (19 per cent), eight per cent felt that their alcohol consumption had contributed to their sunburn, and 13 per cent simply fell asleep in the sun.

Although men and women had similar rates of sunburn while in the UK, 37 per cent and 34 per cent respectively, there was a lot of variation across age groups, with younger people generally being less cautious in the sun. The age group that admitted to being sunburnt in the UK the most were 25-34 year olds (51 per cent), followed by 35-44 year olds and 18-24 year olds (both 46 per cent), 45-55 year olds (35 per cent), and people aged 55 years or more (22 per cent).

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 sunburnt. The British Association of Dermatologists’ Sun Awareness Week™ campaign aims to tackle common misconceptions that can lead to sunburn, as shown by this latest research, such as an underestimation of the UK’s UV levels on hot, sunny days, or the belief that a single application of sunscreen provides lengthy sunburn protection.

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 (NMSC) – the most common type – are diagnosed in the UK. In addition to NMSC, there are over 15,400 new cases of melanoma every year, resulting in around 2,459 UK deaths annually.

Dr Nick Levell, President of the British Association of Dermatologists, said: “British people are increasingly well informed about sun protection and seem to understand the risks of sunburn, largely thanks to campaigns like Sun Awareness Week, however it’s proving to be a long and slow road to actually changing how we, as a culture, look after ourselves in the sun. Too many people are ready to laugh off sunburn as the inevitable price of enjoying the summer, but it shouldn’t be. It’s possible to enjoy the sun, and summer, without suffering sun damage; it just takes a bit of care.

“Particularly shocking is the small, but not insignificant, proportion of the population who seem to be “super burners”. It’s far from ideal for anyone to get sunburnt, but there are people out there who are reporting being burnt seven, eight, nine, ten, or even eleven times a year, both in the UK and abroad*. These people are really putting their lives at risk and need to think about how they can change their behaviour to prevent sunburn.”

This year, Sun Awareness Week takes place from May 8th to 14th and kicks off the association’s broader Sun Awareness campaign, which runs throughout the summer, taking sun safety messages to the UK public and addressing myths and misconceptions.

As part of the Sun Awareness campaign, the British Association of Dermatologists has teamed up with Macmillan Cancer Support to deliver a nationwide sun awareness roadshow. Macmillan’s information and support buses will be visiting events across the country, alongside Consultant Dermatologists and Skin Cancer Nurse Specialists from the British Association of Dermatologists to deliver vital skin cancer prevention and early detection advice.

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 limit your time in 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, sweating or towelling 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 ABCDE rules describe 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 like those mentioned here. If your GP is concerned about your skin, make sure that you are referred to a 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 or colour
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
Evolution – if you see progressive changes in size, shape or colour over weeks or a few months, you must seek Expert help.

If in doubt, check it out! If your GP is concerned about your skin, make sure you see a 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 are 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:

*2.6 per cent of people admitted to getting burnt more than seven times in the UK in the last 12 months, and 2.2 per cent of people admitted to getting burnt more than seven times abroad in the last 12 months.

Sun Awareness Week takes place from May 8th to 14th 2017 and is owned by and trademarked to the British Association of Dermatologists.

All figures, unless otherwise stated, are from YouGov Plc. Total initial sample size was 2145 adults. Fieldwork was undertaken between 12th - 13th April 2017. The survey was carried out online. The figures have been weighted and are representative of all GB adults (aged 18+) and have been filtered to all who selected an answer from the Fitzpatrick Skin Type Scale (making a total sample size of 2,110).

The hashtag for Sun Awareness Week 2017 is #SunAwarenessWeek.

Experts from the British Association of Dermatologists are available to interview, interviews will need to take place Monday-Friday.

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

About Macmillan Cancer Support:
Macmillan’s mobile information and support team travel around the UK visiting local communities, providing cancer information and support. In 2016, they reached 115,800 people affected by cancer.
 

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