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Audit highlights the impact of PPE and hand disinfection on the skin health of healthcare professionals during the COVID-19 pandemic

Fifty nine per cent of healthcare workers seen in occupational skin disease clinics set up during the COVID-19 pandemic were found to be affected by irritant contact dermatitis, a type of eczema, according to research being presented at the Virtual Annual Meeting of the British Association of Dermatologists (September 2020).

Increased use of personal protective equipment (PPE) and frequent hand cleansing has led to a spike of skin irritation amongst healthcare workers around the world*, particularly those on the frontline of the pandemic. Members of the British Society of Cutaneous Allergy conducted an audit of 200 hospital-based healthcare workers attending clinics for those with occupational skin disease in the UK and Ireland to describe the features of occupational skin disease during the COVID-19 pandemic.

Repeated and frequent exposure to water, soap, and alcohol hand gel, and prolonged contact with PPE can cause dry skin, and what is known as irritant contact dermatitis. The skin may start to itch, become sore and red, and develop small blisters, painful cracks (fissures) and erosions (broken skin).

On average, the healthcare workers washed their hands with soap 22.8 times per day and used alcohol hand gel 22.7 times per day. Eighteen per cent of the healthcare workers required time off work as a result of occupational skin problems, representing a significant burden on the health service during an extremely difficult time.

The duration for which PPE is worn, frequency of handwashing and use of alcohol hand gel were found to have an impact on the time off work required. Longer duration of PPE wear during a shift, and more frequent handwashing tended to increase the amount of time off and using alcohol gel did not.

Almost all the skin problems affected the face and hands. The second most common diagnosis seen in the audit was acne, caused by the occlusive effects of prolonged mask wear and seen in 15 per cent of healthcare workers. Pressure injuries related to mask wear were seen in five per cent of subjects.

Dr Isha Narang, lead researcher of the study and registrar at University Hospitals of Derby and Burton NHS Foundation, said:

“Wearing PPE for long periods can cause pressure and irritant effects on the skin and frequent handwashing with soap is drying; sometimes the effects can be bad enough to require time off work. As PPE and handwashing are essential methods of reducing the spread of COVID-19, it is important to provide healthcare workers with advice and support in managing their skin.”

Dr Harriet O’Neill, another lead researcher of the study and registrar at University Hospitals of Derby and Burton NHS Foundation, said:

“For the face, protecting the skin with medical-grade silicon tape before donning tight-fitting masks, then rechecking the fit of the mask, may be helpful. Facial skin should be regularly moisturised when not at work. Where possible, regular breaks should be taken during shifts in which the PPE, such as masks, goggles and gloves, is removed to reduce the amount of contact time with the skin. We would also recommend that people dry their hands fully after washing by patting them dry, not rubbing them. Moisturisers (emollients) are an essential part of treating dermatitis and should be applied generously after handwashing and whenever the skin feels dry. In severe cases, or if an infection is suspected, further treatment from a GP or an Occupational Health doctor may be required.”

Holly Barber, a spokesperson for the British Association of Dermatologists, said:

“PPE and frequent handwashing are essential for healthcare workers during the COVID-19 pandemic, however, the resulting skin irritation can cause enormous problems at work. Many members of the public will also have been affected by frequent handwashing, but this audit does give an indication of the spectrum of the issue for healthcare workers.

“Hopefully, these occupational skin disease clinics and skin management resources, such as the guidelines written by the British Society of Cutaneous Allergy, will help healthcare professionals manage their skin through this difficult period.”

An update on occupational skin disease, written by the British Society of Cutaneous Allergy, is available here.

 

-Ends-

 

Notes to editors:

* The update on occupational skin disease by the British Society of Cutaneous Allergy states that a total of 97% of 542 front-line doctors and nurses in Hubei Province, China (77.4% response rate of 700 clinical staff surveyed) were reported to have developed problems of the skin of the face and/or hands.

If using this presentation, please ensure you mention that it was given at the British Association of Dermatologists’ Virtual Annual Conference.

The virtual conference will be held in September 2020, and is attended by approximately 1,500 UK and worldwide dermatologists and dermatology nurses.

For more information please contact:comms@bad.org.uk
Website:www.skinhealthinfo.org.uk

Study details:

“Occupational dermatoses during the COVID-19 pandemic: a multicentre audit in the U.K. and Ireland”
I. Narang,1 H. O'Neill,1 D.A. Buckley,2 T.A. Phillips,3 C. Bertram,4 G.A. Johnston,5 D. Thompson,6 T. Bleiker,1 N. Stone,7 J.E. Sansom,8 S. Abdul Ghaffar,9 M.M.U. Chowdhury,10 L. Kiely,11 S.M. Cooper12 and P. Banerjee13

1University Hospitals of Derby and Burton NHS Foundation, Derby, U.K.; 2Circle Hospital, Bath, U.K.; 3Department of Statistics, University of Warwick, Coventry, U.K.; 4Royal Infirmary of Edinburgh, Edinburgh, U.K.; 5Leicester Royal Infirmary, Leicester, U.K.; 6Birmingham Skin Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, U.K.; 7Aneurin Bevan University Healthboard, Newport, U.K.; 8Bristol Dermatology Centre, Bristol Royal Infirmary, Bristol, U.K.; 9Ninewells Hospital, Dundee, U.K.; 10The Welsh Institute of Dermatology, The University Hospital of Wales, Cardiff, U.K.; 11Cork University Hospital and South Infirmary Victoria University Hospital, Cork, Ireland; 12Oxford University Hospitals NHS Trust, Oxford, U.K.; and 13University Hospital Lewisham, Lewisham and Greenwich NHS Trust, London, U.K.

About the British Association of Dermatologists

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.skinhealthinfo.org.uk  

The British Association of Dermatologists publishes two world-renowned dermatology journals, both published by Wiley. 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/journal/10.1111/(ISSN)1365-2133  

 

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Over half of people who have ever had acne feel it has affected their self-confidence

A new survey, released today to mark the launch of Acne Support (www.acnesupport.org.uk), shows that 54 per cent of British adults who have ever experienced acne feel that it has had a negative impact on their self-confidence, and 22 per cent feel that it has had a negative impact on their social interactions.

The Acne Support website, sponsored by Frezyderm, is the British Association of Dermatologists’ new flagship acne resource, providing information on acne types, causes, treatments, prevention, scarring, as well as emotional support, and practical tips for covering acne.

Acne, unlike most common skin conditions, doesn’t have a dedicated charity or patient support group offering advice to the public, even though 48 per cent of people reported having had acne*, and 19 per cent of adults 25 and older reported having had adult acne**. Because of this, misinformation is rife and many people, even those we severe forms of acne, are ignorant about effective treatments. When prompted with a list of treatments and remedies, 34 per cent of people didn’t know which were effective and safe acne treatments, of those that did provide an answer, 22 per cent picked the option ‘sweating it out’, a completely ineffective approach.

The website, developed by consultant dermatologists with an expertise in acne, features over 40 videos, covering every topic. These include videos filmed with top makeup artists and skin camouflage experts, explaining common mistakes people make when covering their acne and showing how best to do it.

Acne can have a significant impact on various aspects of people’s lives, which should not be underestimated or trivialised. To illustrate this, survey respondents were asked a series of ‘would you rather’ statements, to see how experiencing a month-long case of severe acne compared to other scenarios.

? 24 per cent would rather see their favourite sports team lose
? 15 per cent would rather see the party they voted for lose a general election
? 11 per cent would rather get a speeding ticket
? 10 per cent would rather forget a parent’s birthday
? 7 per cent would rather go over their overdraft by £500
? 5 per cent would rather a friend lost their job
? 3 per cent would rather be dumped by their partner

Amongst people who reported that they had had severe acne before, these statistics almost doubled across the board:

? 41 per cent would rather see their favourite sports team lose
? 28 per cent would rather see the party they voted for lose a general election
? 21 per cent would rather get a speeding ticket
? 20 per cent would rather forget a parent’s birthday
? 15 per cent would rather go over their overdraft by £500
? 11 per cent would rather a friend lost their job
? 7 per cent would rather be dumped by their partner

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

“We launched the Acne Support website because there are so many people with acne out there who will never see a dermatologist, but who find many aspects of their lives are harder owing to this condition. We hope that this will help them.

“What we wanted to illustrate with this survey, is that for many people this is not a trivial condition, and that they need and deserve impartial, expert advice on how to manage their acne.

“Although it may be surprising to some people, for those with experience of severe acne, being acne-free can be more important than sports, politics, financial stability, even relationships in some cases. This shouldn’t be viewed as a weakness, or anything of the sort, rather it is an indication of quite how awful an experience it is for many.”

John Anastasiou, President and CEO of Frezyderm, said:

“As a condition which has an impact on how we look, acne can have a big emotional toll. If we are unhappy with our appearance then this can often spill into other areas of our lives, for example the 19 per cent of those who’ve ever had acne who felt that their acne had negatively affected their romantic relationships.

“What these people need is more information, to help them manage all aspects of the condition and understand what works for them. This is why we supported the development of this website, Acne Support is an impartial resource that people can trust, which will provide advice to people in need.”

About Acne

Acne is a very common skin condition characterised by comedones (blackheads and whiteheads) and pus-filled spots (pustules). It usually starts at puberty and varies in severity from a few spots on the face, neck, back and chest, which most adolescents will have at some time, to a more significant problem that may cause scarring and impact on self-confidence.

Acne can develop for the first time in people in their late twenties or even the thirties. It occasionally occurs in young children as blackheads and/or pustules on the cheeks or nose.

What causes acne?

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

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

Some acne can be caused by medication given for other conditions or by certain contraceptive injections or pills. Some tablets taken by body-builders contain hormones that trigger acne and other problems.

Acne can be associated with hormonal changes. If you develop unusual hair growth or hair loss, irregular periods or other changes to your body, then mention this to your doctor in case it is relevant.

-Ends-

Notes to editors:

* Interestingly this is much lower than rates identified by clinical observations, though this could be to do with issues of self-reporting
** Adult acne refers to acne in people over the age of 25

All figures, unless otherwise stated, are from YouGov Plc. Total sample size was 2147 adults. Fieldwork was undertaken between 24th and 25th May 2018. The survey was carried out online. The figures have been weighted and are representative of all GB adults (aged 18+).

Acne Support is brought to you by the British Association of Dermatologists (BAD) to offer you expert, impartial advice on acne. Website: www.acnesupport.org.uk

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

FREZYDERM was established in 1986 and is a respected brand name, currently present in 20 countries. We specialise in high quality dermoceuticals and medical device products which are created using the finest raw materials (of pharmaceutical grade). We invest more than 15% of our turnover in research and development (R&D) and our products are manufactured in our plant in Greece, where they also pass through stringent quality control checks. Our dermoceutical products aim to provide care to every skin type and relief from the symptoms of various skin conditions. Our range of products offers dermatologists the opportunity to recommend effective regimens to work synergistically with pharmaceutical therapies or on their own, tailored to each patient’s needs.

FREZYDERM's R&D studies oily and acne-prone skin and combines its findings with scientific data to create formulations for FREZYDERM’s Ac-Norm range. FREZYDERM Ac-Norm products are designed to target the symptoms of acne and provide optimum care for oily, acne-prone skin. With a wide range of products, Ac-Norm offers solutions and innovative regimens, tailored to each skin’s demands. The products can be used alongside prescribed acne medication or as part of an independent skincare regime. The line consists of cleansers, oil-regulating products, sunscreen protectors, lip care products and emollients. Our range for acne treatment can be used long-term and is suitable for every patient, including teenagers, pregnant women and breastfeeding mothers.

Acne can significantly affect our mood and quality of life. In FREZYDERM we understand the importance of using products designed for our own skin’s needs and avoiding products that will deteriorate skin conditions. We have designed the Ac-Norm range to cover each of your skin’s needs and therefore improve your quality of life through restoring your self-confidence.

To learn more about FREZYDERM and our acne products, please visit: https://www.frezyderm.co.uk
 

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Smokers twice as likely to develop debilitating skin disease

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

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

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

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

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

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

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

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

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

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

-Ends-
Notes to editors:

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

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

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

Manuscript ID BJD-2017-1419.R1

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

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

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

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

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

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

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

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

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

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

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

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

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

Facts about acne and acne treatments

What is acne?

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

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

What causes acne?

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

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


NICE Clinical Knowledge Summary recommendations:

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

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Notes to editors:

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

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

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

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


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

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

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

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

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

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Smoking worsens acne scarring, study finds

It is well known that smoking has a negative impact on the health. Now new research, presented this week at the British Association of Dermatologists’ Annual Conference in Manchester, will reveal that it may worsen skin scarring in people with spots.

Smoking is known to cause changes to the skin, such as wrinkles, but this is the first study to suggest there may be a link between smoking and acne scarring.

A team of dermatologists from Harrogate conducted a study of 992 people with acne vulgaris (the most common type of the disorder) referred to a hospital dermatology department over an eight year period.

At the first appointment, each patient’s skin was examined and the severity of their acne and any scarring noted. Lifestyle factors that might affect the skin were also recorded, including smoking.

Scarring was noted in 91 per cent of patients but was not more common in smokers. However, a higher percentage of moderate to severe scarring, rather than mild scarring, was noted in those that smoked. Over half (53.7 per cent) of smokers showed moderate to severe scarring compared to just over a third of non-smokers (35 per cent). This appeared to be independent of acne severity.

Dr Raman Bhutani, one of the study’s authors, said: “The correlation seen between smoking and severity of facial scarring could suggest that smoking can increase the severity of scarring in a susceptible person with acne. Further work is required to confirm this finding and to understand the mechanisms by which this may occur.”

Nina Goad of the British Association of Dermatologists said: “Acne affects a huge proportion of the population, with 80 per cent of teenagers affected at some point. While for most people the disorder will eventually clear, some are left with scarring which can be for life. This can be hard to treat and can make people feel self-conscious and affect their self-esteem. We already know that smoking is bad for our health, so perhaps this latest finding will provide an extra impetus for people to quit.”

Acne occurs when the sebaceous (oil-producing) glands are particularly sensitive to normal blood levels of certain hormones, causing the glands to produce an excess of oil. The build-up of oil creates an ideal environment in which acne bacteria, known as Propionibacterium acnes, can multiply. At the same time, the dead skin cells lining the pores are not shed properly and clog up the follicles, producing blackheads and whiteheads.

The study team are conducting a study to understand how acne is treated across the UK. Please consider answering a short questionnaire via this link https://www.surveymonkey.com/s/Acne_treatment_survey_patient

-Ends-
Notes to editors:

If using this study, please ensure you mention that the study was released at the British Association of Dermatologists’ Annual Conference.
The conference will be held at Manchester Central from July 7th to 9th and is attended by approximately 1,300 UK and worldwide dermatologists.

For more information please contact: British Association of Dermatologists Communications Team, 0207 391 6096 or Nina Goad, Head of Communications, mobile 07825567717 during conference week, or email: nina@bad.org.uk, Website: www.bad.org.uk

Study details: Exhibition poster P56, Smoking and scarring severity in acne, R. Bhutani, P. Kadiyala, E. Fryatt and A.M Layton; Harrogate District Foundation Trust, Harrogate, UK.

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.
 

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Sunbed use starts at age 12, study finds

A study due to be presented at the British Association of Dermatologists annual meeting in Manchester this week has found that the average age at which young people start using sunbeds is just 12 years old.

The research, involving 755 secondary school pupils from across Ireland, is the country’s largest study ever undertaken looking at avoidable skin cancer risk factors among the 14-18 age group.

The aim was to assess sunburn history, sun-protection habits (including sunscreen use), sunbed usage rates and attitudes towards sun and sunbed exposure among teenagers.

Eight per cent of respondents had used sunbeds, increasing to 11 per cent in the capital city, Dublin. Worryingly, six per cent had used sunbeds over 25 times in the previous year.

The average age of sunbed use was 16.2 years, with the average age of first sunbed use being 12.9 years. The youngest age of reported use was, shockingly, seven-years-old.

Further to this, only 26 per cent of sunbed users had been given any advice prior to use and 66 per cent of users were left unsupervised.

The study also found that 91 per cent of students had been sunburned. Teenagers were twice as likely to apply sunscreen regularly while abroad on sunshine holidays, than to apply it during the summer months in Ireland, suggesting a lack of understanding that sunburn can occur at home as well as abroad.

42 per cent of sunbed users were male, and most teenagers used sunbeds in beauty salons (29.3%). 20 percent were spending 11 to 30 minutes at a time on sunbeds, a worrying figure since 20 minutes on a sunbed can be equivalent to spending four hours in the sun*.

86 per cent of sunbed users believed that a tan makes you more attractive; 81 per cent believed a tan looked healthy; 61 per cent thought that sunbeds are a good way to create a base tan before going on holiday; and 53 per cent believed sunbeds to be a good treatment for acne. Whereas 72 per cent of non-sunbed users believed a tan makes your more attractive; 70 per cent thought a tan looked healthy; 22 per cent thought it useful to create a base tan; and 18 per cent believed sunbeds to be a good treatment of acne.

Sunbeds are a group 1 carcinogen, with indoor tanning placing users at a 48 per cent higher risk of developing non-melanoma skin cancer. 72 per cent of interviewed sunbeds users were aware that sunbeds were harmful, suggesting that concerns over skin cancer are being outweighed by the desire to be tanned.

Miriam Fitzgerald, co-author of the study said: “Studies have shown that first use of a sunbed when aged under 35 years increases the risk of later developing melanoma by 75 per cent, so our findings that eight per cent of teenagers are using sunbeds is a worry. Even more concerning is that those who use sunbeds are starting, on average, at age 12. National legislation banning the use of sunbeds by persons aged under 18 years was introduced in 2014, four months after our study ended. We plan to revisit schools to assess whether the ban, once established, has any effect on the above results.

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Notes to editors:

Study details: Ambient and sunbed ultraviolet radiation exposure: exposure rates, protection habits and attitudes of Irish teenagers aged 14–18 years before introduction of national sunbed legislation
M. Fitzgerald,1 S. Daly,2 D. McKenna,2 J. Bourke3 and A. Kelly3
1Mater Misericordiae University Hospital, Dublin, Ireland, 2Sligo Regional Hospital, Sligo, Ireland and 3South Infirmary Victoria University Hospital, Cork, Ireland

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

The conference will be held at Manchester Central from July 7th to 9th and is attended by approximately 1,300 UK and worldwide dermatologists.

For more information please contact: Nina Goad, Head of Communications, 0207 391 6094 or mobile 07825567717 during conference week, or email: nina@bad.org.uk, Website: www.bad.org.uk

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.

*http://www.bbc.co.uk/newsbeat/article/21057439/newsbeat-guide-to-sunbeds-and-tanning
 

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Antibiotic usage for acne and skin infections is leading to drug resistant bacteria, doctors warn

Doctors are being warned to limit the use of antibiotics for the treatment of acne, amidst growing rates of antibiotic resistance in patients with the disorder.

For more than 40 years, antibiotic therapy directed against the acne-causing bacterium, Propionibacterium acnes, has been the mainstay of treatment for moderate (rather than mild or severe) acne. Commonly used antibiotics for acne include erythromycin, clindamycin and a group of antibiotics called tetracyclines.

This week, Dermatologists and Microbiologists from Harrogate will present findings at the British Association of Dermatologists’ Annual Conference in Manchester that may challenge this practice, while a study from King’s College Hospital in London will show growing rates of antibiotic resistance among all dermatology patients.

The Harrogate researchers measured the numbers of Propionibacterium acnes colonising the skin of 994 patients referred to the hospital Dermatology department between 2004 and 2013 and assessed what proportion of them were resistant to common antibiotics used to treat acne.

The study, supported by a grant from the British Skin Foundation, revealed that up to 79.5 per cent of patients were colonised by bacteria resistant to erythromycin or clindamycin or both.

The proportion of patients colonised by tetracycline-resistant bacteria was lower (14.2 to 25 per cent), but did rise to 68.2 per cent one year (2011) for reasons that are currently unclear. Most patients were colonised by a mix of both resistant and non-resistant bacteria.

There is evidence to suggest that patients carrying antibiotic resistant Propionibacterium acnes may respond less well to antibiotic therapy used to manage their acne. It has also been shown that these resistant bacteria can be spread by direct contact from one person to the next.

A second study due to be released at the conference looked at the resistance to antibiotics of another bacterium, called Staphylococcus aureus, which is a common cause of skin infections. The researchers, from King’s College Hospital in London, found that 30 per cent of samples taken from general dermatology patients (rather than acne patients specifically) in 2014 were resistant to the antibiotic erythromycin compared to 17 per cent in 2007. 24 per cent of samples in 2014 were resistant to clindamycin, but it is not known if this is an increase from previous years.

Nina Goad of the British Association of Dermatologists said: “The growing resistance to antibiotics among skin patients generally and among acne patients more specifically, as highlighted by these two studies, is of concern. Antibiotics are important for treating skin infections, which are common in many skin diseases like eczema. Acne affects a huge number of people – 80 per cent of teenagers experience acne and while for most people it will disappear with age, for some it continues well into adulthood. If left untreated it can have a big psychosocial impact and cause scarring, so clearly this is a problem that needs to be managed.”

Consultant Dermatologist Dr Alison Layton from Harrogate, one of the acne study’s authors, explained: “Against a background of global concern about rising antibiotic resistance rates in major bacterial pathogens, GPs
may be unaware that resistance rates in skin propionibacteria are so high. These results highlight the need to use antibiotics judiciously when managing acne and to ensure that alternative effective agents are used, such that reliance on antibiotics is reduced whenever possible.”

Acne occurs when the sebaceous (oil-producing) glands are particularly sensitive to normal blood levels of certain hormones, causing the glands to produce an excess of oil. The build-up of oil creates an ideal environment in which Propionibacterium acnes can multiply. At the same time, the dead skin cells lining the pores are not shed properly and clog up the follicles, producing blackheads and whiteheads.

Dr Layton and the team in Harrogate are now conducting a study to understand how acne is being treated and are asking patients (via https://www.surveymonkey.com/s/Acne_treatment_survey_patient) and professionals who prescribe for acne (via https://www.surveymonkey.com/s/Acne_treatment_survey) to complete a survey to confirm this, so they can then provide relevant educational material to support improved treatment outcomes.

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Notes to editors:

If using this study, please ensure you mention that the study was released at the British Association of Dermatologists’ Annual Conference.
The conference will be held at Manchester Central from July 7th to 9th and is attended by approximately 1,300 UK and worldwide dermatologists.

For more information please contact: Nina Goad, Head of Communications, 0207 391 6094 or mobile 07825567717 during conference week, or email: nina@bad.org.uk, Website: www.bad.org.uk

Study details:
1. A decade later, has the prevalence of skin colonization by resistant propionibacteria increased in our patients with acne? K.H. Kuet,1 C. Finch,1 E. Fryatt,1 A. Eady1 and A. Layton1,2
1Sheffield Teaching Hospitals NHS Trust, Sheffield, U.K. and 2Harrogate and District NHS Foundation Trust, Harrogate, U.K.
This study was supported by a grant from the British Skin Foundation: www.britishskinfoundation.org.uk

2. Trends in antibiotic resistance patterns of Staphylococcus aureus isolates from dermatology patients in the U.K. over 12 years. A. Sears, M. Rossabi, N. Desai, J. Wade, R. Hay and R. Morris-Jones
King’s College Hospital, London, U.K.

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.
 

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New studies reveal impact of most common diseases on work, relationships and even decision to have children

New research into a range of common skin diseases affecting hundreds of thousands of Britons will this week reveal the true impact of the conditions on the lives of patients.

A series of studies, to be presented at the British Association of Dermatologists’ conference in Manchester, will show the influence that diseases such as acne, eczema and psoriasis, can have on people’s relationships, work and everyday lives.

In total, nine out of ten (90 per cent) patients with a chronic skin condition said it had influenced a major life-changing decision – with one in five (22 per cent) saying that their disease had even influenced their decision on whether or not to have children.
One study* found:

• Almost half (46 per cent) said their skin disease had a bearing on their choice of clothing they wore.

• One in five said it influenced whether they wore make-up (22 per cent).

• The same proportion said that their condition prevented them from socializing and a third (34 per cent) had stopped swimming.

• Two thirds (66 per cent) said their skin disease had influenced a major life-changing decision relating to their career, while decisions relating to education (44 per cent) were also affected.

• One in five (20 per cent) said their disease had a bearing on whether they took early retirement.

Another study(1) found that skin conditions are the most frequent reason for people to consult their GP with a new problem, more so than respiratory problems, musculoskeletal disorders and mental illness.

A third study(2), relating just to psoriasis, found that:
• Two thirds of patients with severe symptoms said the disease has had a negative impact on their working life.

• Four out of ten (42 per cent) said the disease had limited their income, or restricted their future employment or career choice.

• A third of such patients (32 per cent) reported discrimination in the workplace on the basis of their condition, while one in five (19 per cent) said that their disease had contributed to them resigning or being dismissed from a job.

• More than a third (37 per cent) felt that, owing to their disease, they have not performed as well in education as they could have done.

• Nine out of ten (87 per cent) felt that their mood, mental health and general enjoyment of life suffers, with three-quarters (73 per cent) saying they have reduced drive and 69 per cent saying they have reduced aspirations because they have psoriasis.

• Psoriasis was also found to influence patients’ personal relationships, with 67 per cent saying that their disease has prevented them pursuing intimate relationships. Three out of ten (29 per cent) have ended an intimate relationship because of their condition.

• Most patients (87 per cent) believed there to be a lack of understanding about psoriasis among the public.

Chief Executive of The Psoriasis Association, Helen McAteer said: “This is the largest UK web-based survey to assess quality of life issues in psoriasis. Our findings illustrate that severe psoriasis has a significant and long-lasting impact on people’s lives in the UK – far greater than was previously appreciated.”

Nina Goad of the British Association of Dermatologists said: “I work with skin disease patients on a daily basis so I am aware of the profound effect that symptoms can have on people’s lives, but despite this I was still stopped in my tracks by some of the findings of this research.

“The fact that such a high number of people cite having a skin disease as a major consideration in the decision of whether to have children, or say that it has brought about the end of a relationship or caused them to stop socializing, is just so sad.

“Add to this the statistics about job losses and discrimination in the workplace, and a clear picture begins to emerge of what so many people in the UK are having to endure. Of course not all patients will be influenced to this degree, but it is worrying that so many are. And we are not talking about one rare disease here, which would be bad enough. Skin conditions are incredibly common.” 
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Notes to editors:

1. Background statistics – prevalence of skin disease

• 24% of a GP’s case load is for skin conditions1
• 26% of people report having suffered from a skin rash/allergies/irritated skin, 13% from eczema and 12% from acne/spots, over the preceding 12 months. (‘A Picture of Health’; PAGB / Reader’s Digest 2005, http://www.pagb.co.uk/information/PDFs/Pictureofhealth.pdf)
• Acne affects 80 to 90% of adolescents in the UK, and for 30% of these, their acne will be severe enough to warrant medical attention. 14% of women in the UK aged between 26 and 44 suffer from facial acne.
• Psoriasis is a common skin problem affecting about 2% of the population. It occurs equally in men and women, at any age, and tends to come and go unpredictably. It is not infectious, and does not scar the skin.
• Eczema (atopic eczema) affects at least 1 in 6 school children and about 1 in 20 adults. (Patient UK - http://www.patient.co.uk/health/Atopic-Eczema.htm)
• For information on other skin diseases visit www.bad.org.uk

2. Study details

*Patients with the following diseases were interviewed: psoriasis, eczema, acne, hidradenitis suppurativa, ichthyosis, palmoplantar genodermatosis, alopecia areata, Dariers disease. The influence of chronic skin diseases on major life-changing decisions as a parameter for the assessment of long-term impact.
Z.U. Bhatti, S. Salek* and A.Y. Finlay
Department of Dermatology, School of Medicine, Cardiff University, Cardiff, Wales, U.K. and *Centre for Socioeconomic Research, Welsh School of Pharmacy, Cardiff University, Cardiff, Wales, U.K.

(1)Updated Dermatology Health Care Needs Assessment: Skin conditions are the commonest new reason people present to general practitioners in England and Wales: implications for education and training.
J. Schofield, D. Fleming,* D. Grindlay† and H. Williams†
United Lincolnshire Hospitals Trust, Lincoln, U.K.; *Royal College of General Practitioners Research and Surveillance Unit, Birmingham, U.K. and †Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K.

(2)Survey of 1760 UK adults. 52% defined their disease severity as ‘very active’ or ‘extremely active’ and for the purpose of this study are therefore defined as having severe psoriasis. Severe psoriasis has a greater negative effect on quality of life than previously appreciated: a U.K. web-based patient survey.
A.V. Anstey, G. Edwards* and A. Lass† [m/f]
Aneurin Bevan Health Board, Gwent, U.K.; *Psoriasis Association, London, U.K. and †Abbott UK, Maidenhead, U.K.

Further information and contacts:

If using this research, please mention that the study was released at the British Association of Dermatologists’ Annual Conference.
The conference will be held at Manchester Central conference centre, from July 6th to 8th 2010, and is attended by UK and worldwide dermatologists and dermatology nurses. Case studies and interviews with the researchers available on request. 

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