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Sun protection advice for the UK during lockdown

The British Association of Dermatologists (BAD) is taking the opportunity ahead of Sun Awareness Week (4th-10th May) to provide its top tips on sun protection during the COVID-19 lockdown, with much of the UK experiencing unseasonably warm weather since lockdown began.

Whilst lockdown may mean for some that they are getting less sun than usual, many people are spending more time on balconies, in gardens, outside queuing for shops, or taking exercise. Since lockdown started, the UV index, which measures the sunburning strength of UV radiation in a particular time and place, has repeatedly reached levels at which sun protection is advised for lighter skin types.

It is important to get to know your skin type, using the Fitzpatrick scale, as this influences which measures you should be taking to protect your skin from the sun. Your skin type cannot be changed and does not vary according to how tanned you are – it is determined by your genes.

The BAD’s sun protection tips for skin types at risk of sunburn and UV skin damage are as follows:

• Shade and protective clothing should be your first line of defence against the sun
• Protective clothing includes a broad-brimmed hat and sunglasses (make sure sunglasses provide 100% UV protection) and, where possible, longer sleeves and trousers
• Apply a generous layer of sunscreen 20 minutes before going outside, and again when you go out. This is to ensure you are applying a sufficient amount, and the second layer also helps cover any patches you may have missed with the first application
• We recommend a minimum of SPF 30, with good UVA protection (look for 4 UVA stars or the UVA circle logo)
• Reapply sunscreen regularly, at least every two hours
• If you are out exercising, or working up a sweat in the garden, then you should reapply more regularly, as sunscreen is easy to sweat off or wipe away in these circumstances
• If you aren’t wearing a broad-brimmed hat, don’t forget sunscreen on areas like the ears, back of the neck, and scalp if your hair is thinning, as these are often missed but are common sites for skin cancer

Skin types 5 and 6 are the most deeply pigmented skin types. This level of pigmentation provides natural UV protection, meaning that additional sun protection is unlikely to be required in the UK, where UV levels do not tend to get sufficiently high to cause damage to these skin types. Instead, the aim should be to ensure that you are getting sufficient vitamin D, either through sun exposure or supplements.

Small amounts of incidental sunlight, as you might get through your daily activities such as a short walk in the sunshine, will allow most people with lighter skin types to maintain reasonable vitamin D levels, especially during the spring, summer, and autumn. People with darker skin types may require longer periods in the sun to maintain optimal vitamin D levels.

For those isolating, particularly without access to a garden or balcony, Public Health England has recommended taking 10 micrograms of vitamin D a day to keep bones and muscles healthy.

Dr Bav Shergill, Chair of the BAD’s Skin Cancer Prevention Committee, said:

“For some people, I imagine the good weather we have experienced in much of the UK at the start of the lockdown has felt like a blessing during an otherwise very difficult time. We hope that our advice will help people make the most of this weather whilst staying safe from sun damage, and an increased risk of skin cancer. We also strongly urge people to follow the government’s lockdown guidance.

“Skin cancer is now the most common type of cancer in the UK, and the number of cases we see every year continues to rise. As well reducing your risk of developing skin cancer, UV protection also has cosmetic benefits, as excessive sun exposure is the main external cause of skin ageing.

“It is important that there isn’t a one-size-fits-all approach to sun protection advice as people with more deeply pigmented skin are at a much lower risk of developing skin cancer.”

Skin cancer can broadly be placed into three different categories, basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma. Collectively, BCCs and SCCs are commonly referred to as Keratinocyte Cancers (KCs).

Melanoma accounts for 16,000 new cancer cases and 2,300 deaths in the UK every year. KCs are far more common, with estimates of over 200,000 cases every year, but far fewer deaths (580 in England).


Notes to Editors:

Sun Awareness Week takes place from May 4th to 10th 2020 and is owned by, and trademarked to, the British Association of Dermatologists. The hashtag for Sun Awareness Week 2020 is #SunAwarenessWeek.

For more information, or to arrange an interview with an expert, contact the media team:, 07837 734620 Website:

More advice on sun protection can be at

Sun protection advice for skin of colour can be found here:

Information on Fitzpatrick skin types can be found here:

Information on the UV Index can be found here:

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. 

Five common skin manifestations of COVID-19 identified

Five common skin manifestations of COVID-19 have been identified by Spanish dermatologists, collaborating through the Spanish Academy of Dermatology, according to new research published in the British Journal of Dermatology.

Please note: skin lesions and rashes are common, and on their own should not necessarily be a cause for concern. Expertise is needed to identify the skin symptoms described below.

Previous reports

Twenty per cent of patients in an Italian medical ward had skin lesions, described as rash, urticaria or one case of “chickenpox -like” lesions.
Other case reports describe a rash mistaken for Dengue, acral ischaemia in children and critical patients, and urticaria.
Most of these reports lack clinical images, due to safety concerns, and describe few patients in hospital settings. There is no previous detailed classification nor description of the manifestations of COVID-19 on the skin.

The study

Through the Spanish Academy of Dermatology, all Spanish dermatologists were asked to contribute. All patients with an unexplained skin eruption in the last two weeks, and either suspected or confirmed COVID-19, using the definitions of the European Centre for Disease Control, were included. The total number of patients in the final sample was 375.

A standardised questionnaire was used, and pictures taken in most cases. An initial 120 images were reviewed by four dermatologists, without knowing any other clinical information, and a consensus was reached on patterns of COVID-19 effect on the skin. These patterns were then applied to the rest of the images and further refined.


Five major patterns were identified by the research, into which nearly all patients could be classified. These were:

1. Acral areas of erythema-oedema with some vesicles or pustules (pseudo-chilblain) (19% of cases).

These lesions, affecting hands and feet, may resemble chilblains (small, itchy swellings on the skin) with small red or purple spots, caused by bleeding under the skin. They were usually asymmetrical.

Associated with: younger patients, lasted for a mean of 12.7 days, took place later in the course of the COVID-19 disease and was associated with less severe disease (in terms of hospital admission, pneumonia, intensive care unit admission or mortality). They could cause pain (32%) or itch (30%).

2. Other vesicular eruptions (9%).

Vesicular eruptions are outbreaks of small blisters, some of these presented on the trunk. They may also affect the limbs, may be filled with blood, and become larger or more spread out.

Associated with: middle aged patients, lasted for a mean of 10.4 days, appeared more commonly (15%) before other symptoms and were associated with intermediate severity. Itching was common (68%).

3. Urticarial lesions (19%):

These consist of pink or white raised areas of skin resembling nettle rash, known as wheals (also spelled weals), which are usually itchy. Mostly distributed in the trunk or spread across the body. A few cases were on the palms of the hands.

Associated with: see below ‘4. Other maculopapules’

4. Other maculopapules (47%).

Maculopapules are small, flat and raised red bumps. In some cases these were distributed around hair follicles, there was also varying degrees of scaling. Some had been described as similar to pityriasis rosea, a common skin condition. Blood spots under the skin may also be present, either in the form of spots/dots or on larger areas.

Associated with: lasting for a shorter period (6.8 days mean for urticarial and 8.6 for maculopapular), usually appeared at the same time than the rest of the symptoms and were associated with more severe COVID-19 disease (2% mortality in the sample). Itching was very common for urticariform lesions (92%) and 57% for maulopapular.

5. Livedo or necrosis (6%).

Livedo is a skin condition where circulation in the blood vessels of the skin is impaired. It causes the skin to take on a blotchy red or blue appearance with a retiform (net-like) pattern. Necrosis refers to the premature death of skin tissue. These patients showed different degrees of lesions suggesting occlusive vascular disease, where a narrowing or blocking of arteries occurs, limiting blood flow to certain areas of the body (in this case the trunk or extremities).

Associated with: older patients with more severe disease (10% mortality). However, the manifestations of COVID-19 in this group were more variable, including transient livedo, with some suffering COVID-19 that did not require hospitalisation.

Further findings of the study

Severity of associated disease followed a gradient, from less severe disease in pseudo-chilblain to most severe in patients with livedoid presentations, as shown by the increasing percentages of pneumonia, admission, and intensive care requirements. More severe COVID cases are not represented due to the issues with obtaining consent.

The researchers noted that some of the skin manifestations associated with COVID-19 are common and can have many causes, particularly maculopapules and urticarial lesions. As such, they may not be particularly helpful as an aide to diagnosis. Livedoid and necrotic lesions on the other hand are relatively uncommon, and mostly appeared in elderly and severe patients. However, it is hard to tell if they are directly caused by COVID-19, or simply indicate complications.

For these reasons, members of the public should be very cautious about trying to self-diagnose COVID-19 based on skin symptoms; rashes and other skin lesions are common and hard to differentiate between without expertise.


Notes to Editors:

For more information please contact the media team:

Link to full study and doi:

British Journal of Dermatology: Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases

C. Galván Casas,1* A. Català,2* G. Carretero Hernández,3 P. Rodríguez-Jiménez,4 D. Fernández Nieto,5 A. Rodríguez-Villa Lario,6 I. Navarro Fernández,7 R. Ruiz-Villaverde,8 D. Falkenhain,9 M. Llamas Velasco,4 J. García-Gavín,10 O. Baniandrés,11 C. González-Cruz,12 V. Morillas-Lahuerta,13 X. Cubiró,14 I. Figueras Nart,15 G. Selda-Enriquez,5 J. Romaní,16 X. Fustà-Novell,17 A. Melian-Olivera,5 M. Roncero Riesco,18 P. Burgos-Blasco,5 J. Sola Ortigosa,19 M. Feito Rodriguez20 and I. García-Doval21

1Hospital Universitario de Móstoles, Madrid, Spain

2Hospital Plató, Barcelona, Spain

3Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas, Spain     

4Hospital Universitario de la Princesa, Madrid, Spain

5Hospital Universitario Ramón y Cajal, Madrid, Spain

6Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain     

7Hospital Universitario “Marqués de Valdecilla”, Santander, Spain

8Hospital Universitario Clínico San Cecilio, Granada, Spain

9Hospital Universitario 12 de Octubre, Madrid, Spain

10Gavín Dermatólogos, Vigo, Spain          

11Hospital General Universitario Gregorio Marañón, Madrid, Spain

12Hospital Universitari Vall d’Hebron, Barcelona, Spain   

13Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain

14Hospital de la Santa Creu i Sant Pau, Barcelona, Spain 

15Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain

16Consorci Sanitari Parc Taulí, Sabadell, Barcelona, Spain              

17 Althaia, Xarxa Assistencial Universitària de Manresa, Manresa, Barcelona, Spain

18Complejo Asistencial Universitario de Salamanca, Salamanca, Spain

19Hospital General de Granollers, Barcelona, Spain

20Hospital Universitario La Paz, Madrid, Spain    

21Research Unit, Fundación Piel Sana Academia Española de Dermatología y Venereología, Madrid, Spain

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  

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.

Covid-19 (Coronavirus): Immunosuppressive treatments in dermatology

Last updated 3rd April 2020

The British Association of Dermatologists (BAD) is aware of the concerns about Covid-19 of people who are taking medicines that affect the immune system such as biologic therapies and/or immunosuppressants.

Immunosuppressants and medication Frequently Asked Questions (FAQs)
Information for dermatology patients

St. John’s Institute of Dermatology at Guy’s and St Thomas’ hospital in London has developed a set of FAQs about immunosuppressive treatments in general so that patients can better understand their risks. The FAQs cover a range of common questions including those on shielding, social distancing, decision making on continuing or stopping treatment and much more.

These can be found on the Guy’s website: – scroll down to “Immunosuppressants and medication”.

NHS England FAQ on shielding for patients

The NHSE FAQ on shielding for patients is available here:

Risk stratification grid for healthcare professionals

The BAD has provided a grid for healthcare professionals which will help them to identify patients for whom, due to their disease and treatment, Covid-19 poses a higher risk. The grid can be viewed here:

This will help to guide decision making, however decisions will always be made on an individual basis depending upon your specific circumstances.

BAD statement on shielding of higher risk dermatology patients

Last updated: 3rd April 2020

The British Association of Dermatologists (BAD) has been working with other health agencies to identify those patients for whom, due to their disease and treatment, Covid-19 poses a higher risk. This takes into account factors like the patient's age, their co-morbidities (meaning other diseases they may have), and the medicines they are taking that might affect their immune system. We have been working closely with other medical specialties to avoid confusion where patients are being treated with the same drug for a number of different conditions. Doctors will use this risk stratification guidance to help inform their decision-making, but each doctor will need to make recommendations and decisions based on individual patients and their specific needs.

NHSE FAQ (frequently asked questions) on shielding for patients

The government FAQ on shielding for patients is available here:

Bereaved individuals may face higher risk of dying from melanoma

Individuals who experience the loss of a partner are less likely to be diagnosed with melanoma but face an increased risk of dying from the disease, according to research published in the British Journal of Dermatology.

The researchers, led by the London School of Hygiene & Tropical Medicine and Aarhus University Hospital, investigated whether bereaved individuals had a higher risk of being diagnosed with, or dying from, melanoma than the non-bereaved. They used data from two large population-based studies between 1997 and 2017 in the UK and Denmark.

They found that melanoma patients who experienced bereavement had a 17% higher risk of dying from their melanoma compared with those who were not bereaved, with similar results seen in both the UK and Denmark.

This study also showed that those who had lost a partner were 12% less likely to be diagnosed with melanoma compared with non-bereaved persons.

While previous studies have suggested a link between various types of stress and progression of melanoma, which may have played a role in the finding, the researchers suggest that an alternative explanation could be that bereaved people no longer have a close person to help notice skin changes.

This delays detection of a possible melanoma, and therefore diagnosis, until the cancer has progressed to later stages, when it is generally more aggressive and harder to treat.

Each year, 197,000 people are diagnosed with melanoma globally. Melanoma makes up around 5% of all cancer cases in the UK and Denmark. The survival rate of melanoma patients is relatively high, depending on what stage the cancer is at detection. Early detection and treatment are crucial for improving survival.

Angel Wong, lead author and Research Fellow at the London School of Hygiene & Tropical Medicine, said:

“Many factors can influence melanoma survival. Our work suggests that melanoma may take longer to detect in bereaved people, potentially because partners play an important role in spotting early signs of skin cancer.

“Support for recently bereaved people, including showing how to properly check their skin, could be vital for early detection of skin cancer, and thus improved survival.”

The researchers also encourage family members or caregivers to perform skin examinations for the remaining partner, and call for clinicians to lower their threshold for undertaking skin examinations in bereaved people.

They acknowledge the study’s limitations, including the lack of information on some risk factors of melanoma, such as sun exposure or family history, but consider that this had limited impact on the conclusions drawn from this study.

Dr Walayat Hussain of the British Association of Dermatologists said:

“Detecting melanoma early can greatly improve survival and partners are key to this. Those without a partner should be vigilant in checking their skin, particularly in hard to reach locations such as the back, scalp, and ears.

“Skin cancer is a disease which is most common in older people, who are also most likely to be bereaved, so targeting skin checking advice at this group should be a priority.”


Notes to Editors

For more information, please contact the LSHTM press office on 0207 927 2802 or

For queries about skin cancer, please contact the British Association of Dermatologists’ communications team on 0207 391 6084 or


A. Wong, T. Frøslev, L. Dearing, H. Forbes, A, Mulick, K. Mansfield, R. Silverwood, A. Kjærsgaard, H. Sørensen, L. Smeeth, A. Lewin, S. Schmidt, S.M. Langan. The association between partner bereavement and melanoma: cohort studies in the UK and Denmark. British Journal of Dermatology.

TheLondon School of Hygiene & Tropical Medicine (LSHTM) is a world-leading centre for research, postgraduate studies and continuing education in public and global health. LSHTM has a strong international presence with 3,000 staff and 4,000 students working in the UK and countries around the world, and an annual research income of £140 million.

LSHTM is one of the highest-rated research institutions in the UK, is partnered with two MRC University Units in The Gambia and Uganda, and was named University of the Year in the Times Higher Education Awards 2016. Our mission is to improve health and health equity in the UK and worldwide; working in partnership to achieve excellence in public and global health research, education and translation of knowledge into policy and practice.

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

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.

Statement on frequent hand washing to reduce coronavirus risk for people with skin diseases affecting the hands

This statement was last updated on 24th March 2020

Please note: This advice is solely on managing the impact of frequent handwashing on the skin. See the News & Media section of the website for our other Covid-19 advice.

Hand sanitation is a crucial part of infection control strategies, and regular handwashing, for at least 20 seconds is recommended. For handwashing instructions, please click here.

Although handwashing is preferable, hand sanitisers can also be used to reduce the risk of coronavirus spreading.

Repeated exposure to water and use of soap, alcohol hand gel, and other detergents can cause dry skin, and what is known as irritant contact dermatitis – a form of eczema. Irritant contact dermatitis can cause the skin to itch, become sore and red, and develop small blisters or painful cracks (fissures). If you already have dry skin either from a skin condition, from medication (such as isotretinoin) or because you are washing your hands more than normal then you may be particularly susceptible to this.

Hand management tips:
Here are some tips on minimising the impact of frequent handwashing on the skin:

• Wash hands in line with government guidance, using soap and water. This can be difficult for people with dry and cracked skin, but we advise to follow the government guidance as much as is practical.
• ?Dry your hands fully after washing by patting them dry, not rubbing.
• Moisturisers (emollients) are an essential part of treating hand dermatitis. They help repair the damaged outer skin and lock moisture inside the skin making it soft and supple again. They should be applied generously after handwashing, repeatedly through the day, and whenever the skin feels dry.
• Some people find overnight moisturising treatments beneficial. Apply a generous layer of a plain moisturiser just before you go to bed, then put on a pair of clean cotton gloves and leave overnight.
• When the hands are going to come into contact with water or detergents, but when not specifically washing the hands (such as when washing up, shampooing a child’s hair, or using cleaning products), wearing gloves that provide a barrier (such as nitrile gloves which are available from chemists or from online stores) will help to keep the skin’s barrier intact.?

Severe hand dermatitis
If you have severe hand dermatitis or suspect an infection (for example, your skin is oozing) you may need to see your GP. You may need prescription treatments to reduce inflammation.

General Guidance:
Follow general advice provided to the general public in minimising the risk of infection:

• cover your mouth and nose with a tissue or your sleeve (not your hands) when you cough or sneeze
• put used tissues in the bin immediately and wash your hands afterwards
• wash your hands with soap and water as often as is practical – do this for at least 20 seconds
• always wash your hands when you get home or into work and before eating
• if you have dry skin then use moisturiser after washing your hands
• use hand sanitiser gel if soap and water are not available
• try to avoid close contact with people who are unwell

• do not touch your eyes, nose or mouth if your hands are not clean

If you become unwell or develop a fever, follow the advice given by the NHS.

Study finds rise in allergy to natural skincare ingredient

Skin allergy to an ingredient found in many natural skin products has more than doubled since 2007, according to a study in the British Journal of Dermatology.

The analysis of 125,436 people tested for skin allergy between 2007 and 2018 across Germany, Austria and Switzerland, found a significant rise in allergy to propolis, also known as ‘bee glue’.

Propolis is created and used by bees to help construct their nests. It consists of materials from living plants mixed with an enzyme present in the bees’ saliva, partially digested and added to beeswax to form raw propolis. It has antibacterial, antifungal, and antiviral properties and is available as a dietary supplement, in health products, and as a constituent of many ‘natural’ cosmetics and skincare products.

Contact allergy occurs when the skin comes into contact with allergens, causing sensitisation. This means that if the skin is exposed to the same allergen again, it can develop an eczematous reaction known as allergic contact dermatitis. Symptoms of contact allergy include redness and swelling of the skin, blisters, pimples and itching.

Patch testing is used by dermatologists to determine which substance is causing the reaction, by applying a range of known allergens, called the baseline series, to small areas of skin to see which trigger a reaction.

This latest study uses data gathered from people undergoing patch tests across 56 centres forming The Information Network of Departments of Dermatology.

It found that in the period of 2007 to 2010, 2.35% of patch tested people were found to be allergic to propolis, compared to 3.94% in 2015 to 2018, an increase of 68%.

Nina Goad of the British Association of Dermatologists said: “Currently, propolis is not routinely included in patch testing in the UK, so the level of allergies here cannot be fully established. However, if trends in its use in the UK show an increase, a similar situation would be expected in our allergy clinics.

“While there may be benefits to natural skincare products, it shouldn’t be assumed that they are safer for the skin than their non-natural counterparts. If you experience a skin reaction, don’t rule out a natural skin product as the culprit, and let your doctor know about anything that your skin has been in contact with.”

Professor Wolfgang Uter, lead author of the study, said: “The increase in allergy to propolis that we have observed certainly warrants targeted investigation of what is driving sensitisation. At present, we do not know the full extent of its availability and how widely it is used. If the allergy trend continues, we will need to consider a reassessment of risk, and probably risk management such as a limit on the concentration of propolis allowed in products that are left on the skin.”

Propolis can be found in a range of cosmetics including shampoos, conditioners, ointments, lotions, lipsticks and lip balms, and toothpastes.

It has been used by humans for thousands of years. In ancient Egypt, it was used for embalming the dead. Aristotle, in around 330 BC, reported the first use in medicine, and records from the 12th century describe medicinal preparations with propolis. Later, it was often used to treat skin wounds and to protect raw skin before bandages were available. Nowadays, it is used across a wide spectrum of healthcare and cosmetic products.

Study details:

British Journal of Dermatology: Trends and current spectrum of contact allergy in Central Europe: Results of the Information Network of Departments of Dermatology (IVDK), 2007 — 2018
W. Uter,1 O. Gefeller,1 V. Mahler2 and J. Geier3.
1Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen/Nürnberg, Erlangen, Germany.
2Paul Ehrlich Institut, Langen, Germany.
3Information Network of Departments of Dermatology, University Medical Center, Göttingen, Germany

Link to full study:

For more information please contact the media team:, 0207 391 6084. Website:

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

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. 

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