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Statement on the use of Borax as a home remedy for lichen sclerosus

Updated 3rd February 2020

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

We understand that some users may find relief from applying  Borax preparations to affected areas. However, unlike licensed medicines, it has not been subject to any testing and there are no safety data for its use. This means that we do not know the short or long term risks of using Borax on the skin. 

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

The British Association of Dermatologists understands the fears, pressures and concerns which can drive people to try cheaper and unusual alternatives.  However, we advise against use of experimental and untried treatments unless this is part of an ethically approved research project, as there may be serious risks. The use of steroid ointments under the supervision of an experienced dermatologist has been shown to have very little risk of any side effects and helps most people.

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84 per cent of dermatologists think that Brits have an unhealthy relationship with tanning

84 per cent of dermatologists think that people in the UK have an unhealthy relationship with tanning, according to a snapshot survey by the British Association of Dermatologists (BAD). Overall, the survey shows that skin specialists are largely pessimistic about attitudes towards tanning and sunbathing.

Previous surveys by the BAD suggest that people in the UK are aware of the risks of excessive sun exposure. However, there is little evidence to suggest that behaviour has changed to reflect this. In fact, skin cancer rates continue to rise, and it is by far the most common cancer in the UK.

There are a number of reasons for the high rates of skin cancers, not least the ageing population in the UK. However, there are also social and cultural issues that play a part, such as more affordable foreign holidays, use of sunbeds, and attitudes towards tanned skin.

This latter issue is one of the most pressing. The fashion for tans has stood the test of time and has become very entrenched within our culture. 63 per cent of UK dermatologists believe that tans won’t go out of fashion within their lifetime. A 2013 study by the Centre for Health Psychology at Staffordshire University* helps explain why this is - the research showed that 80 per cent of female participants felt that a tan looked good and 71 per cent felt that tanned people look healthy – and this phenomenon is not just limited to women.

According to the BAD survey, dermatologists believe that more public health messaging should be focussed on the link between skin ageing and excessive sun exposure, despite the public being better informed on the cancer threat.

Two-thirds of dermatologists (66 per cent) felt that their patients had a better understanding of the link between UV exposure and skin cancer than between UV exposure and skin ageing. However, one-third (34 per cent) felt that people who tan excessively are more likely to change their behaviour in response to warnings about skin ageing than about skin cancer, while only 10 per cent thought that the inverse was true. The remainder felt that both carried equal weight, or neither was influential.

As part of this new public health messaging campaign the BAD is launching The ‘Don’t Bake’ Bake, encouraging people to bake cakes, instead of their skin. The bake has been set up to help educate the public on best sun safety practices and how to spot the warning signs of skin cancer early, with take-home information available at every event venue. It was also set up to help raise funds for the BAD's public facing skin disease prevention initiatives.

More information on The ‘Don’t Bake’ Bake, including how people can get involved, can be found online at: https://www.thedontbakebake.com/

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

“I can understand why many of my colleagues are concerned about attitudes towards excessive sun exposure and tanning. Skin cancer rates continue to rise, and don’t show any sign of abating. However, this means that public health campaigns need to be more creative than ever. We also need leadership from people who have the influence to change minds on the fashion for sun tans.

“We hope that The ‘Don’t Bake’ Bake campaign will play a part in this, as well as providing funds to find new ways to help people understand how to enjoy the summer without damaging their skin. Continuing to put out the same information year on year about skin cancer is not enough, it is not getting through. If some people are more interested in us talking about the impact the sun will have on wrinkles and their appearance, then this is something we need to explore.”

Skin cancer is the most common cancer in the UK and rates have been climbing since the 1960s. Every year over 230,000 new cases of non-melanoma skin cancer (NMSC) – the most common type – are diagnosed in the UK. In addition to NMSC, there are approximately 16,000 new cases of melanoma every year, resulting in around 2,285 UK deaths annually.

In addition to skin cancer, excessive sun exposure is one of the most important factors in skin ageing. Excessive sun exposure in people with white skin has also been linked with an increase in the age which people perceive you to be.

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. 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. Several 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. 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 such as old scars, ulcers, burns, X-ray damage or persistent wounds.

Non-melanoma skin cancers vary greatly in what they look like. They may appear gradually on the skin and will 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 tender or sore
- A growth with a pearly rim surrounding a central crater, a bit like an upturned volcano

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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

Sun Awareness Week takes place from May 14th to 20th 2018 and is owned by and trademarked to the British Association of Dermatologists. The hashtag for Sun Awareness Week 2018 is #SunAwarenessWeek. The hashtag for The ‘Don’t Bake’ Bake is #thedontbakebake

The British Association of Dermatologists (BAD) invites you to tie on your apron and get baking for the UK's first ever 'Don't Bake' Bake. Starting from the BAD's Sun Awareness Week (May 14th-20th 2018), people from across the country will be busy mixing-up a whole range of tasty treats, all in the name of encouraging the British public not to bake themselves in the sun and helping in the fight against skin cancer — the UK's most common form of cancer.

By raising awareness, promoting sun safety, and creating funds for skin cancer prevention initiatives, The 'Don't Bake' Bake is uniting people to push back against skin cancer. There are lots of ways that you can get involved in The 'Don't Bake' Bake 2018, from organising or joining in with a local 'Don't Bake' Bake cake sale, to entering to win one of seven prize cakes, to taking on The 'Don't Bake' Bake mega challenge — there's something for everyone.

www.thedontbakebake.com

The survey of consultant dermatologists was carried out online in April 2018 with 151 responses.

References:

* Williams, A., Grogan, S., Clark-Carter, D. and Buckley, E. (2013). Impact of a facial-ageing intervention versus a health literature intervention on women’s sun protection attitudes and behavioural intentions. Psychology & Health, 28(9), pp.993-1008.

About us:

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

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Expert comment on the BATHE trial - the effectiveness of bath additives for child eczema

Response from BAD member Dr Carsten Flohr:

This is an important and welcome study in terms of improving our understanding of effective treatments for eczema. Previously, guidelines advised the use of bath emollients for the treatment of children. These can now be amended to reflect this new evidence, saving time, effort, and money for patients, their families and for the NHS; resources that can be invested more effectively into other aspects of eczema treatment and research.

However, it is probably too early to say that bath emollients have absolutely no role in the management of eczema. For instance, children under 1 year of age were not included in the study, an age group that has a particularly high burden of eczema. The study also excluded preparations with antiseptic properties, and these might still have a part to play in children with recurrent skin infections. The trial also did not assess the optimal regimen for leave-on treatments, soap substitutes, and frequency of bathing or washing in children with eczema, so there is still room for important further eczema research.

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