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BAD response to ‘Association of Psoriasis With the Risk of Developing or Dying of Cancer’

Below is the BAD response to ‘Association of Psoriasis With the Risk of Developing or Dying of Cancer' published in JAMA Dermatology on October 16, 2019.

Professor Brian Kirby, British Association of Dermatologists (consultant dermatologist), said:

“This study reports that the risk of certain cancers and of dying from cancer are increased in psoriasis patients compared to controls. Patients with more severe disease are at a higher risk. It is important to recognize that this study shows that psoriasis is associated with certain cancers and that studies such as this do not suggest that psoriasis causes cancer. This would require significantly larger and differently designed studies to assess causation.

“As stated by the authors, certain factors associated with psoriasis and in particular more severe psoriasis such as obesity, cigarette smoking and excessive alcoholic intake are all strongly associated with certain cancers. The findings of this study therefore probably reflect an excess of risk factors in the psoriasis population rather than the disease itself. If these factors were controlled, then the risk from psoriasis alone would be probably very small. Patients with psoriasis along with everybody else should follow general health advice regarding cancer prevention.”

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Parents warned to prepare for the start of head lice season

Experts provide tips on how to hunt ‘super lice’


Not Peer Reviewed | People

Dermatologists are warning that with the start of the new school year many parents will find their children bringing home more than just homework. The start of classes tends to also mark the start of head lice season, as lice previously contained to small networks over the summer spread from child to child.

Research from 2017 found that 45 per cent of children had head lice in the past five years, most commonly affecting those between the ages of six and nine1. But the more prepared you are the quicker the problem can be resolved, and the less likely it is that the lice will get the chance to spread to other family members.

With the rise of what have been dubbed by some as ‘super head lice’, strains of the parasite which are resistant to traditional chemical insecticides, it can be a bit confusing about how best to manage a head lice outbreak.

To this end, the British Association of Dermatologists has provided some simple steps for preparing for and managing an outbreak:

1. Make sure that you have the essentials at home already:
a. A large bottle of conditioner
b. A nit comb
2. Check for nits pre-emptively at home using a nit comb to identify infestation early, prompt treatment helps prevent further spread
3. If you do find evidence of nits, get to work with the nit comb. Lubricating the hair with a generous amount of conditioner to wet hair will make the procedure easier, particularly for curly hair. You should then comb through all the hair from the roots to the ends. Depending on the hair type and length, the wet combing process can take up to 45 minutes
4. The comb must be immediately cleaned after each pass to remove lice and eggs. This is best done by wiping on clean white paper or cloth
5. Check family members for head lice – they may have spread
6. To ensure all head lice are removed, you should repeat this wet combing process two or three times within the first two weeks following infestation
7. Continue to check for head lice every week for a month to ensure that they have not returned

Holly Barber of the British Association of Dermatologists said:

“Although it’s important for parents to be prepared for the increased risk of head lice infestation in their children ahead of the new school year, chemical treatments shouldn’t be used as a preventative measure. This can encourage the resistant head lice to develop, making them even harder to get rid of.

“Instead, the British Association of Dermatologists recommends regular examinations with a nit comb in order to detect an infestation early, as starting treatment sooner rather than later will help prevent further spread.

“Parents should also keep in mind that head lice can spread to anybody, no matter how clean their hair or home is. It is unnecessary to keep children home from school if they have head lice, however, treatment should be started immediately.”

More information can be found in the BAD’s patient information leaflet on head lice.

-Ends-

1Hitchen, N., McPherson, T. and Warnapala, D. (2017). How common are head lice? Are smartphone/tablet devices to blame?

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

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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Professor Chris Bunker wins Sir Archibald Gray Medal

The British Association of Dermatologists (BAD) is pleased to announce that Professor Chris Bunker, past-president of the BAD (2012-2014), is the winner of the 2019 Sir Archibald Gray Medal.

Named after the founder of the BAD, the Sir Archibald Gray Medal is awarded as the BAD's ultimate accolade for outstanding services to dermatology.

Professor Bunker is a Consultant at the University College London Hospital. 

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36 per cent of top YouTube videos on eczema are potentially harmful

Thirty-six per cent of the most-viewed eczema YouTube videos are potentially harmful, according to a study presented at the British Association of Dermatologists’ Annual Meeting in Liverpool (2nd-4th July 2019).

Eczema, also known as atopic dermatitis, affects approximately 20 per cent of children and two per cent of adults worldwide making it one of the most common skin conditions. YouTube, the internet’s second most visited website*, hosts thousands of videos on the topic.

This study analysed the quality of information provided in the 100 most-viewed eczema-related videos on YouTube. These have a combined total of 8,527,624 views and a duration of seven hours and 52 minutes.

The quality of the videos was assessed using the Global Quality Scale (GQS) and the DISCERN instrument* and the videos were classified into ‘useful’, ‘misleading’ and ‘potentially harmful’. The number of viewers’ ratings (‘likes’) was correlated with the scores of the GQS and DISCERN.

The authors found that 46 per cent of the YouTube videos were misleading, and 36 per cent were found to disseminate content potentially dangerous to eczema patients.

For example, patients with eczema were not only encouraged to pursue unnecessary diets such as avoidance of dairy or gluten, but also to use harmful topical treatments and home-based phototherapies without any detailed information about the duration of the application and potential risks. Furthermore, conventional medicine and physician’s advice were discredited in various ways, while promising a “fast and easy cure”.

The two assessment tools, GQS and DISCERN, revealed that around two thirds of the videos were of poor or very poor scientific quality. The viewers’ ratings did not correlate with the results of the GQS and DISCERN analysis indicating that the viewers were not able to recognise good and poor quality of the videos.

Healthcare institutions and universities accounted for just 21 per cent and eight per cent of the videos, respectively, with private individuals and promotors of complementary and alternative treatments having posted 50 per cent of the videos analysed.

Dr Simon Mueller of University Hospital Basel, Switzerland, and lead author of the study, said:

“Social media is a continually growing source of medical information for patients, particularly for young people. This information often doesn’t undergo review for scientific accuracy or quality and as our research shows, it has the potential to be heavily biased or even harmful.

“We hope that our research will make people think twice about the medical information they get from social media. The internet is a powerful and often helpful research tool, but where you source your information from is important. We do not advise against this kind of lay research, but we clearly advise against decision making based on YouTube videos only. We rather encourage to discuss the content of the videos with a doctor of trust to avoid adverse outcomes.”

Holly Barber of the British Association of Dermatologists, said:

“With so much information about eczema available online, it can be hard to know who and what to trust. This study highlights that the number of views and likes a video has does not necessarily match up with the quality and accuracy of information presented.

“It’s really important that individuals and organisations are responsible about the information they share on social media. For members of the public looking for information, be sceptical of extraordinary claims made without evidence, and make use of reputable bodies such as the National Eczema Society, the NHS, or the British Association of Dermatologists.”

-Ends-

Notes to Editors:

* Alexa Internet, January 2019

** Two repeatedly used quality assessment tools known as the DISCERN instrument and the Global Quality Score (GQS) were applied to evaluate the medical quality of the posted videos. The DISCERN instrument measures a video’s quality of information about treatment choices. Composed of 16 questions, reliability (questions 1-8), quality of health information (questions 9-15) and overall quality of a publication (question 16) can be evaluated by assigning 1-5 points to each question. The GQS is based on a 5-point scale measuring the quality of the video, its flow and value as a source of information for medical lay people. For both tools, the higher the accomplished value, the higher the quality of the video clip.

Study details

If writing about 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 2nd to 4th 2019 and is attended by approximately 1,300 UK and international dermatologists.

YouTube on atopic dermatitis: fiction, falsehoods and few facts

S.M. Mueller,1 V.N. Hongler,1 P. Jungo,1 L. Cajacob,1 S. Schwegler,1 E. Steveling,1 S. Hogg,2 A. Navarini,1 O. Brandt1 and K.S. Hofmeier1

1University Hospital Basel, Basel, Switzerland

2The Manchester Academic Health Science Centre, Manchester, U.K.

Atopic dermatitis (AD) is a chronic relapsing inflammatory skin condition affecting approximately 20% of children and 2% of adults worldwide. In recent years, the role of social media in patient education has grown considerably. In particular, YouTube, the second most visited website in existence, has become a recognized source of medical information for healthcare consumers, including dermatology patients. In addition to the advantages that YouTube offers in this context, there are also potential dangers as videos may contain unscientific, misleading or even harmful information. As little is known about YouTube as a source of information on AD, we aimed to investigate the quality of AD-related videos and how these videos are perceived. The quality of the 100 mostviewed AD-related videos, with a total of 8 527 624 views and 7:52 h of duration, was assessed using the Global Quality Scale (GQS) and the DISCERN instrument. Videos were classified into ‘useful’, ‘misleading’ and ‘potentially harmful’ and the viewers’ ratings (‘likes’) were correlated with the scores of the GQS and DISCERN. According to the GQS and DISCERN, 68% and 62% of the videos were of poor or very poor scientific quality, respectively. Overall, 46% of the videos were classified as misleading and 36% as potentially dangerous. The major topics addressed in the videos were topical treatments, (non)pharmaceutical advertisements, patient education, nutrition and complementary and alternative treatments (CAM). The viewers’ ratings did not correlate with the scores of the GQS and DISCERN (Spearman’s correlation rho = 0.17, P = 0.08 and rho = 0.12, P = 0.25 respectively). In total, 50% of the videos were posted by private individuals and promotors of CAM, whereas videos by healthcare institutions accounted for 21% and universities for 8% only. Our in-depth study demonstrates that two-thirds of the AD-related videos we analysed were of (very) poor scientific quality, and many were found to be disseminating misleading or even dangerous content. Subjective anecdotal and unscientific content is overrepresented and viewers do not appear to recognize the quality of the videos. As stated elsewhere, strategies by professional dermatological organizations are urgently needed to improve their presence and visibility on YouTube.

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

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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Pet products a hidden health risk for owners and their animals

Pet products are a hidden source of potential allergens, according to research being presented at the British Association of Dermatologists’ Annual Meeting in Liverpool (2nd-4th July 2019).

The lack of regulation around animal care products, such as shampoos and deodorising sprays, is exposing pets and their owners to ingredients which would be banned in equivalent products for people. This has led to concerns that these products have the potential to cause new allergies or trigger pre-existing ones. 

The researchers from the Royal United Hospital, Bath, surveyed 62 cosmetic products intended for use on dogs. Twenty-seven of these products were classified as ‘leave-on’, meaning that they are not washed off after use, and 35 were classified as ‘rinse-off’, meaning that they are washed off after use.

Twenty-six per cent of leave-on products and 51 per cent of rinse-off products contained the preservatives methylisothiazolinone (MI) and/or methylchloroisothiazolinone (MCI). EU regulations ban these ingredients from use in leave-on products and limit their use in rinse-off, as they are well known allergens, but this ban does not extend to cosmetics aimed at animals.

Fragrance allergy is very common, yet 56 per cent of leave-on products and 83 per cent of rinse-off products contained known fragrance allergens.

The EU also requires ingredients to be labelled in cosmetics, but again, this does not apply to pet products. Six of the 62 products had vague or no ingredient listings.

Dr Lucy Howard of the Royal United Hospital, Bath, said:

“Our study has highlighted a number of well-known allergens contained in pet cleaning products. Sometimes their presence is concealed by labelling with a different name, and it may be concealed by no labelling at all. These chemicals have the potential to cause allergic skin reactions in pet owners caring for their animals.

“There is no specific legislation regulating these ingredients in the same way that there is for human cosmetics. Clinicians should consider this when patients present with hand dermatitis, and pet owners should be able to expect the same standards for their pets as they do for themselves.”

Matthew Gass of the British Association of Dermatologists, said:

“We hope that this research will highlight the lack of specific legislation for the regulation of animal cosmetics, despite the risk to pet owners and their animals. After all, it is not as if dogs apply their own shampoo.

“If you are a pet owner and you are suffering from hand eczema, then it is possible that your pet products are the source of this issue. If you go for tests, then it is something worth mentioning to your doctor.”

Since 2013, the British Association of Dermatologists has issued several warnings about the rate of MI/MCI allergies. In 2016, the EU banned MI from leave-on cosmetics, following rules in 2015 that only allowed the mixture of MCI and MI as a preservative in rinse-off cosmetic products at a maximum concentration of 0.0015% (15ppm) in a ratio 3:1 of the two substances.

-Ends-

Notes to editors:

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

The conference will be held at the ACC, Liverpool from July 2nd – 4th 2019, and is attended by approximately 1,300 UK and international dermatologists.

Dogs: a hidden source of exposure to common allergens

L. Howard, N. Mansoor and D.A. Buckley

Royal United Hospital, Bath, U.K.

Consumers are protected from direct cutaneous exposure to common allergens such as preservatives and fragrances by European Union (EU) legislation, which bans certain allergens from leave-on products, limits the concentration of others and mandates statutory product labelling using International Nomenclature of Cosmetic Ingredients (INCI) names. No such legislation applies to products intended for direct application to animals. However, animal lovers may become sensitized to these preparations, or such products may unknowingly act as elicitants in previously sensitized patients. We undertook a survey of cosmetic products intended for use on dogs. All items were on the shelves of U.K. pet stores and garden centres in December 2018, or available for online purchase. In total, 62 products were surveyed: 27 leave-on (detangling and deodorizing sprays and leave-on shampoos) and 35 rinse-off (shampoos and conditioners). Of the 27 leave-on products, 19 (70%) were manufactured in the U.K., seven in the U.S.A. or China, and one did not state the country of manufacture. Seven (26%) contained methylisothiazolinone (MI) and/or methylchloroisothiazolinone (MCI), which in three cases was labelled only as Kathon CG. Fifteen (56%) contained fragrance; two of these contained hydroxyisohexyl cyclohexene carboxaldehyde (Lyral). Two of the 27 were labelled only as containing ‘preservative blend’, while one had no ingredient listing and one contained methyldibromoglutaronitrile. Of the 35 rinse-off products, 18 (51%) were manufactured in the U.K., 16 in the U.S.A. or China, and one did not state the country of manufacture. Eighteen (51%) contained MI and/or MCI, which in four cases was labelled only as Kathon CG. Twenty-nine (83%) contained fragrance. Two of the 35 productswere labelled only as containing ‘preservative blend’ and one had no ingredient listing. All seven items labelled as Kathon CG were manufactured in the U.S.A. and all four labelled ‘preservative blend’ were manufactured in the U.K. Four leave-on products containing MI and/or MCI were manufactured in the U.K. The EU Cosmetics Directive 1223/2009 (30.12.2009) states that it relates only to cosmetic products and not to medicinal products, medical devices or biocidal products. Ingredients must be labelled on the packaging, or as an enclosed leaflet. Despite the increasing production of cosmetics for animals, there is no specific legislation for the regulation of such products (safepetcosmetics.eu). Pet owners with hand dermatitis should be questioned specifically about direct skin contact with animal cosmetics, and non-INCI names of any positive allergens should be provided after patch testing. 

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

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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34 per cent of eczema self-management apps contain information which is inconsistent with international guidelines

Peer Reviewed | Systematic Review | Apps

Thirty-four per cent of eczema smartphone applications (apps) contain information which is inconsistent with international guidelines, particularly regarding treatments and the progression of the condition, according to a new study of 98 apps, published in the British Journal of Dermatology.

Eczema is one of the most common skin conditions in the world, and although it can occur at any age it is most common in childhood, affecting around 20 per cent of children in the UK at some point. Eczema cannot be cured, but it can be managed, usually with moisturisers (known as emollients).

This study reviewed English, Chinese, and Spanish eczema self-management smartphone apps aimed at patients and carers. Of the apps 67 were in English, 22 were in Chinese, nine were in Spanish. The researchers evaluated these apps using international eczema guidelines, including NICE guidelines from the UK, to assess eczema educational information, eczema specific tracking functions, and compliance with health information best practice principles.

Of the apps assessed, 84 per cent provided educational information, 39 per cent tracking functions, and 13 per cent both. Among 38 apps with a tracking function, 82 per cent measured specific symptoms, disease severity or current skin condition and 89 per cent helped users to record medication usage including application of topical (applied to the skin) treatments. 34 per cent recorded environmental or dietary allergens.

In addition to the 34 per cent of apps providing information which is inconsistent with international guidelines, only 15 per cent provided information supported by international guidelines on pharmacological therapies and 16 percent on non-pharmacological therapies. None of the included apps complied with all criteria for educational information, tracking functions or health information principles. Eleven per cent of the apps failed to mention mainstay therapies such as the use of emollients and moisturisers.

Associate Professor Josip Car of Nanyang Technological University, senior author, said:

“The assessed eczema self-management apps had shortcomings, however certain apps did provide appropriate functions with accurate information and comprehensive tracking of eczema-related factors. Our research shows that there is a large variance in the quality of eczema apps. Perhaps the most useful way to address this issue would be to publish a list of recommended apps to aid clinicians in suggesting the appropriate options for eczema patients and caregivers.

“With room for further development of quality, the field of mobile health has great potential to better patient care and self-management of eczema and address major unmet needs, provided that appropriate measures are taken to improve the quality standards.”

Matthew Gass of the British Association of Dermatologists, said:

“It is important that researchers continue to test the accuracy and safety of health apps. There has been an enormous boom in the number of dermatology apps available to the public, and with this comes the risk that some will be inaccurate, and even unsafe. Similar concerns have been raised in the past regarding skin cancer apps.

“App developers should clearly label the sources of their information and should make use of existing resources such as published NICE guidelines. There is no doubt that apps will play a big role in the self-management of skin conditions, but we should have high standards for any health apps.”

At the British Association of Dermatologists’ Annual Meeting in 2018 concerns were raised that a lack of thorough testing of skin cancer apps is a risk to public safety.

-Ends-

Study details:

Eczema apps conformance with clinical guidelines: A systematic assessment of functions, tools and content
Louise S van Galen MD PhD 1,2†, Xiaomeng Xu MD 1†, Mark Jean Aan Koh MD 3, Steven Thng MD 4, Josip Car MD PhD FRCP (Edin) 1,5*

1Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University Singapore
2Section of Acute Medicine, Department of Internal Medicine, Amsterdam UMC
3Dermatology Service, KK Women's and Children's Hospital, Singapore
4National Skin Centre, Singapore and Skin Research Institute of Singapore, A*STAR
5Global Digital Health Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London

https://onlinelibrary.wiley.com/doi/10.1111/bjd.18152 DOI: https://doi.org/10.1111/bjd.18152

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

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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Sunscreen application does not prevent vitamin D production in the majority of people

Peer Reviewed |Observational Study/Systemic Review | People

Sunscreens do not prevent vitamin D production according to a new study due to be released in the British Journal of Dermatology (BJD). The results of this study are supported by a systematic review of 75 papers on sunscreen and vitamin D also published recently by the BJD.

Vitamin D, which is vital for bone health, is produced by the skin in response to ultraviolet radiation (UVR) from sunlight. However, as well as being the primary source of vitamin D, UVR is a major cause of a skin cancer, the UK’s most common type of cancer.

In recent years, global concern about vitamin D deficiency has fuelled debates on how best to achieve healthy levels of vitamin D, known as vitamin D sufficiency, while simultaneously limiting the risk of skin cancer. Concerns have been raised that sun protection methods, including sunscreen use, may be contributing to vitamin D deficiency.

Now, three separate studies have concluded that use of sunscreen does not impact on vitamin D status in the majority of people.

In the first study, funded by the EU and conducted by researchers from King’s College London, participants were split into four groups. The participants, apart from those in the control group, then went on a week-long holiday to an area with a very high UV index.

Twenty people received a broad spectrum* sunscreen with a Sun Protection Factor (SPF) of 15, offering UVB protection and high UVA protection. Twenty people received a non-broad spectrum sunscreen, also SPF 15 but with low UVA protection. These two groups were told how to use their sunscreens correctly, so as to achieve the labelled SPF. In contrast, 22 people used their own sunscreen with no instructions on how to apply it, and 17 people formed a control group who remained in Poland.

Blood (serum) samples were taken from participants 24 hours before and 24 to 48 hours after the holiday.

SPF 15 sunscreens applied at sufficient thickness to inhibit sunburn allowed a highly significant improvement of vitamin D levels. Furthermore, the broad spectrum sunscreen enabled higher vitamin D synthesis than a low UVA protective sunscreen, possibly because the former, due to its composition, transmits more a little more UVB than the latter. The people who used their own sunscreens, also had significant vitamin D synthesis, but they all had sunburn. This was almost certainly because they did not use their sunscreens correctly. During the same period, the control group has a slight decline in vitamin D.

In the second study, researchers from the QIMR Berghofer Medical Research Institute in Australia, and the Australian National University, systematically reviewed all published experimental studies, field trials, and observational studies published between 1970 and 2017, totalling 75 studies, for the first time.

The researchers found that while the experimental studies - using artificial light sources in a laboratory setting - support the theoretical risk that sunscreen use may affect vitamin D, the weight of evidence from field trials and observational studies - taking place in real-life situations involving natural sunlight - suggests that the risk is low.

The researchers explain that the conditions in the experimental studies did not reflect those of the real-world so the results cannot be used to inform public health policy.

Observational studies which reported an association between vitamin D levels and sunscreen application most commonly found a positive relationship, supporting the conclusion vitamin D synthesis is maintained whilst wearing sunscreen.

A further review which presents the findings of an international panel of 13 experts in endocrinology, dermatology, photobiology, epidemiology and biological anthropology, who reviewed scientific literature on vitamin D and sun protection prior to an evidence review meeting also concluded that sunscreen use is unlikely to affect vitamin D production and that UVA protection does not affect vitamin D synthesis.

Professor Antony Young of King’s College London and lead author of the first study, said:

“Sunlight is the main source of vitamin D. Sunscreens can prevent sunburn and skin cancer, but there has been a lot of uncertainty about the effects of sunscreens on vitamin D.

“Our study, during a week of perfect weather in Tenerife, showed that sunscreens, even when used optimally to prevent sunburn, allowed excellent vitamin D synthesis.”

Professor Rachel Neale of the QIMR Berghofer Medical Research Institute and lead author of the second study, said:

“A common concern amongst the general public is that sunscreen use may increase the risk of vitamin D deficiency. This has the potential to undermine sun protection messages, which aim to prevent skin cancer. A 2015 survey conducted in the United States found that 20 per cent of people agreed that regularly protecting the skin leads to a risk of not getting enough vitamin D.

“These recent findings should reduce this concern, and encourage people to follow recommended sunscreen application, which could eventually lead to a reduction in the number of new skin cancer cases.”

Holly Barber of the British Association of Dermatologists, said:

“The ability to achieve adequate protection from the sun to avoid sunburn, a risk factor of skin cancer, whilst not impacting vitamin D production is really encouraging. The risk of vitamin D deficiency from sunscreen has been found to be low, and therefore is unlikely to outweigh the benefits of sunscreen for skin cancer prevention.

“Further research is required on SPF 30 and higher sunscreen, as this is what we recommend people use for optimal protection in real-life situations. People with dark skin types are at a higher risk of vitamin D deficiency, and lower risk of skin cancer, so further research is also required to see how these findings translate to people with dark skin types.”

-Ends-

Notes to Editors:

* Sunscreens that provide a balance of UVA and UVB protection are called ‘broad spectrum’, and these are generally recommended by medical experts.

Professors Young and Neale are members of the Environmental Effects Assessment Panel (EEAP) under the auspices of the United Nations Environment Programme (UNEP). The EEAP prepares annual reports for about 200 governments on the impacts of ozone layer depletion on human health.

https://ozone.unep.org/science/assessment/eeap

Study details:

Optimal sunscreen use, during a very high UV index holiday, allows vitamin D synthesis without sunburn
A.R. Young1, J. Narbutt2*, G.I. Harrison1, K.P. Lawrence1, M. Bell3, C. O’Connor3, P. Olson4, K. Grys1, K. Baczynska5, M. Rogowski-Tylman6, H.C. Wulf4, A. Lesiak2 and P.A. Philipsen4

1King’s College London, St John’s Institute of Dermatology, London, SE1 9RT, UK;
2Medical University of Lódz, Department of Dermatology, Pediatric Dermatology and Dermatological Oncology, Lódz, 90-647, Poland;
3Walgreens Boots Alliance Inc., Nottingham NG90 5EF, UK;
4Bispebjerg Hospital, Department of Dermatological Research, Copenhagen 2400, Denmark;
5Public Health England, Centre for Radiation, Chemical and Environmental Hazards, Chilton, Didcot, Oxfordshire OX11 0RQ, UK;
6Dermoklinika Centrum Medyczne, Lódz, 90-436, Poland;
*Equal 1st author

Link to study: https://onlinelibrary.wiley.com/doi/abs/10.1111/bjd.17888

The effect of sunscreen on vitamin D: a review
R.E. Neale1, S.R. Khan1, R.M. Lucas2, M. Waterhouse1, D.C. Whiteman1 and C.M. Olsen1

1Population Health Department, QIMR Berghofer Medical Research Institute
2National Centre for Epidemiology and Population Health, Australian National University

Link to study: https://onlinelibrary.wiley.com/doi/10.1111/bjd.17980

Sunscreen photoprotection and vitamin D status
T. Passeron1, R. Bouillon2, V. Callender3, T. Cestari4, T. Diepgen5, A.C. Green6, J. van der Pols7, B.A. Bernard8, F. Ly9, F. Bernerd10, L. Marrot10, M. Nielsen8, M. Verschoore8, N.G. Jablonski11, and A.R. Young12

1Université Côte d’Azur. Department of Dermatology. CHU Nice & INSERM U1065 team 12, C3M. 150, route de St-Antoine de Ginestière, 06200 Nice, France
2Schoonzichtlaan 22, Herent 3020, Belgium
312200 Annapolis Rd #315, Glenn Dale, MD 20769, USA
4Santo Inacio 500 AP 1002, Porto Alegre, 90570-150, Brazil
5Universität Heidelberg, Klinische Sozialmedizin, Voßstr. 2, 69115, Heidelberg, Germany
6Cancer and Population Studies Group, Locked Bag 2000, Royal Brisbane Hospital QLD
4029, Australia
7Level 4, 88 Musk Avenue, Kelvin Grove, Queensland 4059, Australia
8L'Oréal R&I, Scientific Directorate, 9 rue Pierre Dreyfus, 92110 Clichy, France
9University of Medicine and Pharmacy of Dakar and Cheikh Anta Diop University, Dakar,
Senegal
10L’Oréal R&I, 1 Avenue Eugène Schueller, 93600 Aulnay-sous-bois, France
11State college, 432 West Shadow Lane, PA 16803-1246, USA
12King’s College London, St John’s Institute of Dermatology, London SE1 9RT, UK

Link: https://onlinelibrary.wiley.com/doi/abs/10.1111/bjd.17992

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

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BAD response to sunscreen chemical concerns following JAMA study

Below is the BAD response to 'Effect of Sunscreen Application Under Maximal Use Conditions on Plasma Concentration of Sunscreen Active Ingredients'.

Dr Andrew Birnie, British Association of Dermatologists (consultant dermatologist and skin cancer surgeon), said:

“It’s worth noting that the amounts of sunscreen used in this study are significantly higher than the average person would use in normal circumstances.  Furthermore, sunscreen has been used by a large portion of the population for a number of decades and there has not been any epidemiological data that suggests users come to harm.  We agree with the researchers that people should not make the knee-jerk decision to stop using sunscreen.

“Skin cancer is the UK’s most common cancer, equalling all other cancers combined.  The link between excess sun exposure and skin cancer is well documented and indisputable.  This research on sunscreen is very much at an early stage.  The first line of defence against the sun should be shade and clothing, with sunscreen used for additional protection.”

Prof Brian Diffey of the British Association of Dermatologists (Emeritus Professor of Photobiology, Dermatological Sciences, Newcastle University), said:

“As the authors themselves have said, this was a maximal use study using generous and frequent applications of sunscreen – in practice most people apply a thinner layer of sunscreen over a smaller fraction of the body surface less often during the day, resulting in a daily amount of sunscreen about one tenth of the amount used in this study.

“This would mean that for 3 of the 4 agents studied here, the levels of active ingredients found in the plasma during typical usage would fall below the threshold value.  (The threshold value in toxicology means the value that would approximate the highest plasma level below which the carcinogenic risk of any unknown compound would be less than 1 in 100,000 after a single dose.)

“The authors suggest their findings mean we should do further to determine the clinical significance of these findings.  It is important to note there is no evidence from this study that there is any health risk.  And even at maximal use, any theoretical risk is almost certainly far smaller than the reduced risk of skin cancer that has been shown to be associated with sunscreen use.  Indeed, the authors themselves say that their results do not suggest that people should refrain from using sunscreen.

“It is important to note that each participant in the study applied the equivalent of two standard bottles of sunscreen over four days.  This is considerably greater than typical use where it has been estimated that people who use sunscreen go through about one bottle per year per person.”

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Half of all adults with eczema experience anxiety or depression

Peer Reviewed | Observational Study | People

50 percent of adults with eczema have been diagnosed with anxiety or depression in the last 12 months, or show signs of these mental health problems, according to new research in the British Journal of Dermatology.

The risk of anxiety and depression is dramatically higher in adults with eczema than those without, as this figure falls to 27.3 percent amongst adults without eczema.

The research, carried out by dermatologists and allergists in the US, also found the severity of eczema symptoms to be strongly linked to the risk of anxiety and depression, with these mental health complications often going undiagnosed in adults in the US.

The study looked at a common type of eczema called atopic dermatitis, a common skin condition which causes red, itchy and sore skin. The condition usually begins in childhood, however it often continues into adulthood, affecting one in 12 adults in the UK.

The study included 2893 US adults, 602 of whom had eczema. Participants completed an online survey which was designed to reveal the severity of their eczema if they had the condition and the state of their mental wellbeing.

Eczema severity was defined using three different assessments which considered factors such as sleep disturbance, itchiness and the extent of dry skin. Severity was categorised ranging from mild to very severe based on the assessment scores.

The mental health assessment was completed using the Hospital Anxiety and Depression Scale (HADS), which translated to anxiety and depression scores. Participants were also asked if they had been diagnosed with depression or anxiety by a healthcare professional within the past year.

40 percent of adults with eczema reported having been medically diagnosed with anxiety or depression in the past year, compared to 17.5 percent of people without eczema.

Using the HADS scores, eczema was found to be associated with a significantly higher chance of experiencing symptoms of anxiety and depression. Borderline or abnormal scores for anxiety, depression and for both anxiety and depression were reported in 48.4 percent, 34.5 percent and 26.6 percent of adults with eczema, respectively. This is compared to 29.4 percent, 19.5 percent and 14.1 percent in those without eczema.

In combination, 50 percent of adults with eczema and 27 percent of adults without eczema had abnormal HADS anxiety or depression scores or reported a healthcare diagnosis for either mental health condition.

Anxiety and depression scores increased significantly with each eczema severity category, suggesting that disease severity is a major driver of anxiety and depression in eczema patients. 100 percent of adults with severe eczema, scored across all three measurement criteria, had borderline or abnormal anxiety and depression HADS scores.

Lead study author Dr. Jonathan Silverberg, associate professor of dermatology at Northwestern University Feinberg School of Medicine, said:

“This research confirms previous studies that rates of anxiety and depression are higher among adults with eczema. The mental health burden of eczema is greatly underappreciated, particularly in patients with severe symptoms. We therefore suggest that people with moderate or severe eczema would benefit from routine screening for signs of mental health problems. Eczema patients warrant a multi-disciplinary approach to assessing their eczema and comorbid medical and mental health disorders.”

Holly Barber of the British Association of Dermatologists said:

“There is a strong link between our skin and our mental health. This study confirms the need to ensure mental health services are accessible to patients with skin conditions, and where possible integrate mental and physical care at the earliest opportunity.

“Unfortunately, few dermatology departments currently have the resources to consistently apply this approach, to achieve this will require more investment. Those who feel that the level of mental health support they are getting is inadequate should discuss this with their dermatologist or GP. For those who prefer self-help methods, the British Association of Dermatologists has set up the Skin Support website to provide these types of resources.”

Skin Support (www.skinsupport.org.uk), is a website designed to provide psychological support and self-help resources for people with skin conditions.

Understanding the cause of anxiety and depression in eczema patients, such as the severity of symptoms, may help to improve mental health care for patients with common skin conditions.


-Ends-

Study details:

Symptoms and diagnosis of anxiety and depression in atopic dermatitis in US adults
J.I. Silverberg1, J.M. Gelfand2, D.J. Margolis2, M. Boguniewicz3, L. Fonacier4, M.H. Grayson5, P.Y. Ong6, Z.C. Chiesa Fuxench2, and E.L. Simpson7
1Northwestern University Feinberg School of Medicine, Chicago, IL, 2University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 3National Jewish Health and University of Colorado School of Medicine, Denver, CO, 4NYU Winthrop Hospital, Mineola, NY, 5Nationwide Children’s Hospital–The Ohio State University College of Medicine, Columbus, OH, 6Children’s Hospital Los Angeles, University of Southern California, Keck School of Medicine, Los Angeles, CA, 7Oregon Health & Science University, Portland, OR

J.I. Silverberg, J.M. Gelfand, D.J. Margolis, M. Boguniewicz, L.Fonacier, M.H. Grayson, P.Y. Ong, Z.C. Chiesa Fuxench and E.L. Simpson (2019), Symptoms and diagnosis of anxiety and depression in atopic dermatitis in US adults. Br J Dermatol. DOI

This study was conducted in partnership with the Asthma and Allergy Foundation of America and the National Eczema Association with support from Sanofi Genzyme and Regeneron.

The study will be available online on Wednesday 6th March 2019 at 05.01hrs GMT here: https://onlinelibrary.wiley.com/doi/abs/10.1111/bjd.17683

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

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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Scared of needles or pain? Study finds Virtual Reality could help

Peer Reviewed |Case Report | People

Virtual reality (VR) could replace local anaesthesia to reduce pain and discomfort during simple medical procedures, and could help people with needle phobia, according to research published in the British Journal of Dermatology.

Minor treatments which can be administered at the bedside, such as wart destruction and cleaning of an open wound, are commonplace in medicine. A current solution for the pain associated with these practices is an injection of a local anaesthesia. However, this also causes pain and anxiety in patients as well as being associated with a risk of causing an eczema flare, light-headedness, tinnitus and occasionally systemic toxicity.

Virtual reality is a computer-generated, interactive three-dimensional (3D) environment experienced by wearing a head-mounted device, goggles and noise cancelling headphones connected to a smartphone. The simulated environment is multi-sensory often incorporating auditory, visual and touch settings.

In this study from the US, nine patients, aged between four and 70 years, were provided with VR headsets during minor procedures that would normally be painful and may require local anaesthetic. The researchers found that all participants included in the study experienced minimal pain, with half experiencing no pain at all. All participants, regardless of age, reported finding the technology simple to use.

Seven patients were undergoing wart destruction, one was having a venous leg ulcer cleaned and another having an anaesthetic injection for a skin biopsy.

The patients were cleaned and prepped as standard, and then fitted with a VR system. After a few minutes of use, the procedure was commenced. Upon completion, each patient was asked about their experience and level of pain and the provider of the procedure gave a score based upon the patients’ reactions.

The provider score of patient response to treatment was ranked between zero and four. A score of zero meant that the patient did not retract the treated limb and demonstrated no signs of pain. A score of four was given if the patient retracted the limb, demonstrated severe signs of pain and asked to stop the procedure.

Five out of the nine patients were ranked a provider score of zero, having demonstrated no pain response. The highest provider score from all of the patients studied was just two.

When asked, all patients said they experienced minimal pain, with half describing that they felt no pain at all, accompanied by surprise that the procedure was over.

VR is believed to have this positive effect on pain due to the multi-sensory, immersive nature of the simulated environment. This acts as a distraction in the brain, which interacts with how pain is perceived.

Dr. Hadar Lev-Tov of the University of Miami, one of the authors of the study, said:

“Most people will have undergone some type of minor medical procedure in their life such as wart removal, wound cleaning or injections. Although minor, these treatments are often uncomfortable and for some people, for example those with a phobia of needles, they can cause considerable anxiety.

“Virtual Reality is a relatively recent technology, and as such research into this area is new. However, distraction techniques have long been used by doctors when performing these procedures - Virtual Reality is just particularly effective at taking the patients from the here-and-now and immersing them in another experience. So effective in fact, that during our research some patients were surprised when their treatments were over.

“Especially encouraging is a new generation of VR devices which are now available, affordable and can be easily incorporated into clinical practice. At the same time, we need to expand research into the safety of using VR as it is not known for example how people with seizure disorders or vertigo respond to this immersive environment.”

Holly Barber of the British Association of Dermatologists said:

“There are a huge number of people for whom minor medical procedures, such as getting injections, or having stitches, are incredibly stressful. This leads to people putting them off for as long as possible, potentially endangering their health. This research is at a very early stage, but it suggests that VR could be a way to solve this problem. I suspect that for most people who wish to avoid these sorts of treatments, the idea is worse than the actual process.”

It is hoped that larger randomised control trials focusing on VR in bedside procedures will expand upon and confirm the results of this study.

 

-Ends-

Study details:

The use of Virtual Reality for Bedside Procedures
P.A. Hirt1 and H. Lev-Tov1

1Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine.

Citation: P.A. Hirt and H. Lev-Tov (2019), The use of Virtual Reality for Bedside Procedures. Br J Dermatol. DOI 10.1111/bjd.17682.

Link to full study: https://onlinelibrary.wiley.com/doi/abs/10.1111/bjd.17682?af=R

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

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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New research demonstrates the effectiveness of potential new eczema treatment

Peer Reviewed | Randomised Control Trial | People

A new cream being developed by scientists could greatly improve the treatment of eczema symptoms, according to new research published in the British Journal of Dermatology.

The research, conducted by dermatologists in Korea, has shown that a non-steroid containing cream, called PAC-14028, can be as effective in treating eczema symptoms as current creams on the market but with fewer side-effects.

Eczema is one of the most common skin diseases and is often linked to allergies, asthma and hay fever. One in five children is affected by eczema at some point, and the condition often continues into adulthood. It is characterised by red, itchy and sore skin which can affect the ability to sleep and generally reduce the patient’s quality of life.

Available topical (applied to the skin) treatments can be very effective in treating eczema symptoms. However, they can also cause negative side-effects such as itching and burning, which can result in patients discontinuing their treatment. Existing treatments can also lead to more serious complications in patients who rely on them for long periods, such as thinning of the skin with creams containing steroids.

The research was conducted with 194 adults with mild to moderate eczema. Participants were split into four groups and treated with either a control cream or the new treatment, PAC-14028 cream, at one of three different concentrations (0.1%, 0.3% or 1.0%). Participants applied the cream twice daily for eight weeks.

The results were primarily measured using the Investigator’s Global Assessment (IGA). This is a standardised visual scale for assessing the severity of eczema in a patient based upon typical symptoms. A score of zero represents a patient completely clear of eczema up to a score of five representing very severe eczema. Treatment success was classed as an IGA score of zero or one at the end of the trial.

After eight weeks, 57.5 percent of patients in the group who received the highest concentration PAC-14028 cream, had an IGA score of zero or one. Symptoms of eczema were therefore completely eradicated or reduced to an almost-clear level in a significant number.

IGA success rates at week eight were 15 percent for the control cream, compared to 43 percent for PAC-14028 cream at 0.1%, 38 percent for 0.3% and 57 percent 1.0%.

Those treated with the control cream showed relatively little improvement, with just 4.2 percent of patients having a two-grade IGA score improvement from the start of the trial, compared to 38.3 percent in the 1.0% cream.

Safety of the creams was also monitored as part of this study. The highest concentration PAC-14028 cream, 1.0%, had a favourable safety profile. Between treatment groups, there was no significant difference in the number of negative side-effects noted. Side-effects which were noted were all considered mild to moderate in severity, with no serious complications in any treatment group.

The efficacy of PAC-14028 cream was similar to a commonly used non-steroidal cream called pimecrolimus but with a far lower incidence of unwanted side-effects.

PAC-14028 cream works by inhibiting the impact of TRPV1, a protein which plays a role in the pain, inflammation and itching of eczema.

Holly Barber of the British Association of Dermatologists said: “The symptoms of eczema can have a huge impact on the day-to-day lives of patients. This study is exciting as potential new topical treatments for eczema flares are rare. However, further trials are required to confirm these findings after long periods of application.”

-Ends-

Notes to Editors:

The British Association of Dermatologists’ Patient Information Leaflet on eczema is available here.

Study details:

Efficacy and safety of PAC-14028 cream, a novel, topical, nonsteroidal, selective TRPV1 antagonist in patients with mild to moderate atopic dermatitis: a phase IIb randomized trial
Y.W. Lee,1 C.-H. Won,2 K. Jung,3 H.-J. Nam,3 G. Choi,3 Y.-H. Park,3 M. Park3 and B. Kim4

1Department of Dermatology, Konkuk University School of Medicine, Seoul, Republic of Korea, 2Department of Dermatology, Ulsan University College of Medicine, Asan Medical Center, Seoul, Republic of Korea, 3Vital Beautie Research Institute, AmorePacific Corporation R&D Center, Yongin, Republic of Korea, 4Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Republic of Korea

Citation: Y.W. Lee, C.-H. Won, K. Jung, H.-J. Nam, G. Choi, Y.-H. Park, M. Park and B. Kim (2018), Efficacy and safety of PAC-14028 cream, a novel, topical, nonsteroidal, selective TRPV1 antagonist in patients with mild to moderate atopic dermatitis: a phase IIb randomized trial. Br J Dermatol. DOI 10.1111/bjd.17455.

Link to full study: https://onlinelibrary.wiley.com/doi/full/10.1111/bjd.17455

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

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