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Early gut bacterial colonization may help prevent eczema, research shows

Strains of a bacterium commonly found in skin infections may help to protect against eczema, according to new research in the British Journal of Dermatology.

Atopic eczema is extremely common, affecting around one in five children in the UK. It causes skin to become red, itchy, sore and sometimes infected. This can greatly impact on a child’s quality of life.

The term ‘atopic’ is used to describe a group of conditions which include asthma, eczema and hay-fever. These conditions are linked by an overreaction of the immune system to harmless substances in the environment, such as house dust mites, pet dander, grass and tree pollen.

It is believed that exposure to certain microbes matures the immune system, making it less likely to become overreactive and cause allergies. Not being exposed to these microbes as an infant could potentially make a child more susceptible to reactions to them later in life if they are genetically prone to these sorts of problems. This is known as the ‘hygiene hypothesis’.

Having these microbes in the gastro-intestinal tract in early infancy seems to be especially protective against the development of allergy. Staphylococcus aureus (S. aureus) is one such microbe – it is a bacterium commonly found in the normal skin flora (it lives on our skin) and also commonly colonizes the gut of infants, where it can reach quite high numbers.

Now scientists from Sweden have discovered the strains (genetic variants) of S. aureus that help to protect against the development of atopic eczema.

In the first part of this research, the scientists suggested that, whereas the rate of gut colonisation by S. aureus does not differ between infants who subsequently develop atopic eczema or those who do not, strains of S.aureus from infants without eczema more often carry certain combinations of genes called adhesin and toxin genes, notably ebp, encoding elastin-binding protein, and the superantigen genes selm and seln. Superantigens are toxins produced by S. aureus that are very strongly immune stimulating, and these toxins are commonly known as causing ‘food poisoning’. However, infants colonized by these S. aureus strains have no increased problems with vomiting or diarrhoea, as opposed to adults who consume the toxins, for example in food that has been infected by S. aureus.

The purpose of this latest study was to confirm these earlier findings, in a group of 64 infants. Swabs and fecal samples were taken to measure microbe colonisation in the gut and in the nasal passage at the ages of three days, one, two, four and eight weeks, and at four, six, 12, 18 and 36 months.

12 infants developed atopic eczema and 52 did not, and the strains colonizing these infants were grouped accordingly. Echoing the finding from the first study, S. aureus colonisation in the gut per se was unrelated to subsequent eczema development, however, gut S. aureus strains from the infants who remained eczema-free were more likely to carry the ebp gene and superantigen genes encoded by the egc (selm and seln), as compared to strains from children who developed eczema. Nasal colonization by S. aureus was less clearly related to subsequent eczema development. Notably, the researchers restricted the analysis to strains found in the gut of the infants during the first two months of life, well before the onset of eczema, to exclude that the results were due to a change in gut flora secondary to the atopic disease.

Nina Goad of the British Association of Dermatologists said: “Part of the reason this study is so interesting is that, up until now, S. aureus has been seen as the villain of the eczema story, as this bacterium tends to be found in infected eczema patches and is thought to aggravate the disease. This study shows that actually, it has a positive effect too, as early gut exposure to S. aureus can actually help prevent eczema developing.

“A complex interplay of factors contribute to eczema – there is no one set trigger, but rather a host of biological processes that, in combination, cause the disease. Research like this is incredibly helpful in providing a clearer picture of these factors, as we still do not fully understand this common, sometimes debilitating disease.”

Dr Forough Nowrouzian from the University of Gothenburg in Sweden and lead author of the study said: “The two groups of children used in the two studies were sampled five to seven years apart and from different geographical areas: the first in the city of Gothenburg and the second in a rural part of southwestern Sweden. The almost identical findings for the two cohorts lend credibility to the hypothesis that early mucosal colonisation by certain types of S. aureus beneficially affects stimulation of the infant’s immune system in a manner that reduces the risk of eczema development.”

20 percent of young children now suffer from eczema, which is thought to be four times as many as fifty years ago. Figures for 12 to 14 year olds suffering from eczema in Britain are thought to be among the highest in the world. Incidence of atopic eczema has been increasing greatly in recent decades in industrialised countries for reasons that are largely unclear. For example, studies of eczema among immigrant populations coming to the UK from countries where eczema is less of a problem, show that their children are suffering to same degree as white, non-immigrant children. Therefore, as well as genetic factors, there is a strong environmental influence which appears to be important in young people.

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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.

Study details:
British Journal of Dermatology. Neonatal gut colonisation by Staphylococcus aureus strains with certain adhesins and superantigens is negatively associated with subsequent development of atopic eczema. F.L. Nowrouzian1, A. Ljung1, S. Nilsson1, B. Hesselmar1,2, I. Adlerberth1, and A.E. Wold1
1Institution for Biomedicine, Department of Infectious Disease, University of Gothenburg, Gothenburg, Sweden
2Department of Paediatrics, Institution of Clinical Science, University of Gothenburg, Gothenburg, Sweden.
https://onlinelibrary.wiley.com/doi/10.1111/bjd.17451


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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Rates of skin cancer far higher than previously thought, according to new national database

Data from the newly established UK skin cancer database, the largest database of its kind in the world, has revealed that there are over 45,000 cutaneous squamous cell carcinomas (cSCC) every year in England, 350 per cent1more than previous estimates suggested. Squamous cell carcinoma is the second most common form of skin cancer.

These data are important as they enable researchers and policy makers to evaluate the effectiveness of prevention initiatives, screening, staging2, and treatments for what is a very common cancer. 

Developed by experts at Public Health England (PHE) and Queen Mary University of London, and funded by the British Association of Dermatologists, the database fills in enormous gaps in the recording of skin cancer, ensuring that accurate numbers for the three most common types of skin cancer: melanoma, basal cell carcinoma (BCC), and cSCC, are available for the whole of the UK. The study has been published in JAMA Dermatology.

Along with BCCs, cSCCs make up what are collectively called keratinocyte cancers, also known as non-melanoma skin cancers, which are the most common cancers in the UK.

Previously, the data on keratinocyte cancers has been very poor. They were rarely registered by cancer registries due to the sheer number of cases and the complexity of accurately registering multiple tumours per patient3.

Changes in cancer registration processes in England in 2013, including the introduction of nationalised and automated cSCC registration, has enabled the creation of this population-based nationwide dataset.

A higher risk of cSCC was associated with being older, male, white, and of lower socioeconomic deprivation. This tallies with the consensus that the increase in SCCs in the UK is as a result of the ageing population, tanning trends, and easier access to foreign holidays, which results in greater cumulative UV exposure.

The researchers were also able to use the data to ascertain the number of cases of metastatic cSCC (i.e. it has spread to other parts of the body) in England. Between 2013 and 2015 there were 1,566 patients diagnosed with metastatic SCC for the first time. 85 per cent of these patients had their diagnosis of metastatic SCC within two years of their initial SCC diagnosis.

Until the end of 2016, 13,453 deaths from all causes were observed among the 76,977 patients diagnosed with their first cSCC in 2013 to 2015. The 3-year survival was 65 per cent among men and 68 per cent among women4. In the 836 of these patients who subsequently developed a metastatic SCC, the 3-year survival was 46 per cent in men and 29 per cent in women.

Professor Irene Leigh of Queen Mary University of London, lead author of the study, said:

“Due to their frequency, the healthcare burden of squamous cell carcinoma is substantial, with high risk patients requiring at least two to five years clinical follow-up after treatment and patients often developing multiple tumours. With poor three-year survival once cSCC has metastasised, earlier identification of these high-risk patients and improved treatment options are vital.”

Nina Goad of the British Association of Dermatologists, said:

“This database is an important national milestone in the treatment of skin cancer, the UK’s most common cancer. Previously, researchers and policy makers have been working on a puzzle without all the pieces. Now they know how many cases are being treated every year, better decisions can be made about treatment, prevention, and screening. This is a real step forward.”

This dataset on the number of cSCC cases in England is the first released from the UK skin cancer database, with more to be published shortly.

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Notes to editors:

1https://patient.info/doctor/Squamous-Cell-Carcinoma-of-Skin

2Staging is the process by which a cancer is graded in terms of size, depth and whether it has spread to other parts of the body.

3Unlike most cancers, it is not uncommon for patients to have multiple keratinocyte cancers at any one time which would have to be registered, and cancer registry systems were previously not designed for this.

4Comparatively, expected three-year survival of an 80 year old in England between 2013-2015 would be 76 per cent in men and 82 per cent in women.

Nationwide Incidence of Metastatic Cutaneous Squamous Cell Carcinoma in England

Zoë C. Venables, MBChB; Philippe Autier, PhD; Tamar Nijsten, PhD; Kwok F.Wong, PhD; Sinéad M. Langan, PhD;

Brian Rous, MD; John Broggio, BsC; Catherine Harwood, PhD; Katherine Henson, PhD; Charlotte M. Proby, FRCP;

Jem Rashbass, MBBS; Irene M. Leigh, CBE. JAMA Dermatology. DOI 10.1001/jamadermatol.2018.4219

Paper available here after the embargo lifts: http://dx.doi.org/10.1001/jamadermatol.2018.4219

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

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Plant extract found to rival leading anti-ageing skincare ingredient, research shows

A botanical ingredient found in the seeds of an Indian plant is an effective treatment for skin ageing, according to new research published in the British Journal of Dermatology.

Bakuchiol (pronounced “back-ooh-chee-all”) is found mainly in the seeds of the Indian plant Psoralea corylifolia (babchi) and has recently been shown to have a number of antioxidant and anti-inflammatory properties.

The goal of this study, by researchers from universities in California, Michigan, Florida and Pennsylvania, was to compare the efficacy and side effects of bakuchiol with the commonly-used anti-ageing ingredient retinol.

44 volunteers were asked to apply either bakuchiol 0.5% cream twice daily, or retinol 0.5% cream daily, to facial skin for 12 weeks.

Retinol 0.5% has previously been shown to be effective at preventing and addressing signs of skin ageing but can have side effects including stinging, scaling and redness. As the market for over-the-counter anti-ageing products expands, the desire for retinoid-like products, but with limited side-effects, is therefore growing.

A facial photograph and analytical system was used to take and analyse high-resolution photographs of patients at 0, 4, 8 and 12 weeks of the study. Patients also answered questions about side-effects. During study visits, a dermatologist graded pigmentation (skin colouring) and redness. To avoid bias, this dermatologist was not made aware of which treatment each participant was using.

As the skin ages, and following sun exposure over many years, the skin becomes thinner, loses elasticity and develops wrinkles. Additionally, pigmentation (colour) and texture can become uneven, with darker ‘age spots’ (hyperpigmentation) and dry patches appearing.

The study found that bakuchiol and retinol both significantly decreased wrinkle surface area and hyperpigmentation, with no statistical difference between the two compounds. However, the retinol users reported more skin scaling and stinging.

The results were most marked after the full 12 weeks, with a 20 percent reduction in wrinkle severity.
59 percent of the participants in the bakuchiol group showed improvement in their hyperpigmentation at week 12, compared to 44 percent of those in the retinol group. The improvements related both to the intensity of the colour and to the size of the area affected.

Dr Raja Sivamani, an Adjunct Associate Clinical Professor at the University of California, Davis and the lead study investigator, said: “For consumers who value natural products, bakuchiol provides appeal due to its origin in several plant species. Although retinol may also be derived from various natural sources, it can cause unwanted side-effects that make it less comfortable to use.”

Nina Goad of the British Association of Dermatologists said: “The findings of this study are promising for bakuchiol as an effective anti-ageing treatment with minimal side effects, however we would need to see these results confirmed in larger studies. It is also worth noting that we are talking about subtle changes to the skin – sadly no cream can significantly turn back the clock when it comes to skin ageing. For this reason, prevention is always better than a cure, and as UV from the sun is a major cause of skin ageing, sun protection can help keep us looking youthful for longer.”

For centuries, botanicals were the fundamental basis of treatment for various ailments. Even now, many well-known medications are derived from plants. Patients are still turning to botanicals and natural compounds as alternative treatment options, providing an impetus to advance and progress the scientific knowledge regarding botanically derived phytochemicals (compounds that occur naturally in plants). One sector of growing interest and research has been in cosmeceuticals, where natural products are being evaluated for their use as cosmetic agents.

Bakuchiol is present in other plant sources in addition to babchi, including Psoralea glandulosa, Pimelea drupaceae (cherry riceflower), Ulmus davidiana (Father David elm), Otholobium pubescens and Piper longum (long pepper).

-Ends-

Notes to editors:

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

Study details:
Prospective, randomized, double-blind assessment of topical bakuchiol and retinol for facial photoageing.
S. Dhaliwal,1 I. Rybak,1 S.R. Ellis,1 M. Notay,1 M. Trivedi,2 W. Burney,1 A.R. Vaughn iD,3 M. Nguyen,4 P. Reiter,5 S. Bosanac,4 H. Yan,1 N. Foolad4 and R.K. Sivamani1,6
1Department of Dermatology, University of California – Davis, Sacramento, CA, U.S.A.
2School of Medicine, University of Michigan, Ann Arbor, MI, U.S.A.
3Drexel University College of Medicine, Philadelphia, PA, U.S.A.
4School of Medicine, University of California – Davis, Sacramento, CA, U.S.A.
5Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, FL, U.S.A.
6Department of Biological Sciences, California State University, Sacramento, CA, U.S.A.

Citation: Dhaliwal, S., Rybak, I., Ellis, S., Notay, M., Trivedi, M., Burney, W., Vaughn, A., Nguyen, M., Reiter, P., Bosanac, S., Yan, H., Foolad, N. and Sivamani, R. (2018), Prospective, randomized, double-blind assessment of topical bakuchiol and retinol for facial photoageing. Br J Dermatol. doi:10.1111/bjd.16918
Link to full study: https://onlinelibrary.wiley.com/doi/abs/10.1111/bjd.16918

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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The letters of Vladimir Nabokov highlight the psychological impact of psoriasis

A new research letter published in the British Journal of Dermatology has hypothesised that Vladimir Nabokov, the famous 20th century author best known for his novel ‘Lolita’, suffered from severe psychological distress due to his chronic psoriasis.

The condition, while never referenced in his fiction, is a recurring theme in his letters to his wife Vera between 1923 to 1977. At the time when Nabokov was writing and long after his death, psychodermatology, the management of psychosocial impact of skin conditions, did not even exist as a discipline.

Psoriasis is a long-term condition that affects one in 50 people and may come and go throughout a person’s lifetime. The condition presents itself as well-defined pink or red (depending on skin colour) areas with silvery scales. These areas can be very flaky and crusty and may be sore and exceedingly itchy. Although psoriasis appears normally in smaller patches, known as ‘plaques’, these plaques can cover large parts of the body in cases of moderate to severe psoriasis.

The link between psoriasis and psychological distress has been researched before, with the rate of psychiatric distress and depression from psoriasis being around 10 per cent to 58 per cent and suicidal thoughts in psoriasis patients ranging from 2.5 per cent to 7.2 per cent.

Nabokov himself struggled with suicidal thoughts, writing in 1937:

“I’m so tortured by my Greek”*… “now I can tell you straight that […], I’d reached the border of suicide”.

Nabokov’s psoriasis made him extremely itchy, causing insomnia, and worsening his mood, something that is not uncommon amongst people with psoriasis.

“I don’t sleep at night because of its furious itchy – and this greatly affects my mood”.

Also:

“Sometimes I simply thought I was losing my mind”.

Embarrassment of his condition also seemed to burden him, he wrote of “…constant thoughts about my bloody underwear, blotchy mug** and the scales pouring down on the carpet”.

The researchers also hypothesised that a particularly severe flare of psoriasis that occurred during his time in France may have been linked to the stress of being unfaithful to his wife. Adultery is a theme addressed in Nabokov’s work, notably in novels such as ‘Lolita’ and ‘Pnin’.

The psychological effect of psoriasis on this prolific 20th century writer serves to highlight the usefulness of psychodermatology in the treatment of patients of skin conditions, especially in severe cases such as with Nabokov.

Dr Laurie Rousset, one of the researchers from the Dermatology Unit at the Hôpitaux de Paris, France, said:

“Nabokov’s psoriasis is known about, but the psychological impact of his condition is not discussed enough. His letters paint a vivid picture of a man who was often tormented by the symptoms, social anxiety, and who struggled with shame. Nabokov’s experiences highlight how important it is that patients feel in control of their condition and are happy with their treatments.”

Daragh Rogerson of the British Association of Dermatologists said:

“Treatments for psoriasis have come a long way since Nabokov’s time, as has the availability of psychological support. The itching, the insomnia, and the emotional toil of the condition are still common themes raised by patients. This is one of the reasons why we launched our support website, Skin Support. I hope this powerful testimony will highlight to both doctors and patients the importance of managing the mental aspects of this condition, as well as the physical.”

The British Association of Dermatologists’ Skin Support website is available at www.skinsupport.org.uk. The website brings together, and links to, patient information leaflets, support groups, self-help materials and help-lines.

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Notes to editors:

Psychological Impact of Psoriasis on Vladimir Nabokov
L. Rousset 1, B. Halioua 2

1 - Dermatology Unit, Assistance Publique - Hôpitaux de Paris (AP-HP), Ile de France, France
2 - Dermatology Unit, Paris, France

*Nabokov liked to play on words and bilingual neologisms. This is how he gave the name “My Greek” to his psoriasis.

**”Blotchy mug” refers to his facial psoriasis lesions, which affected him greatly.

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.
https://onlinelibrary.wiley.com/doi/abs/10.1111/bjd.17331
 

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