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Response to Guardian article on skin diversity on www.covidskinsigns.com

In response to Guardian article: https://www.theguardian.com/world/2020/sep/28/covid-19-skin-rash-website-criticised-for-lack-of-bame-examples

The website hosts images taken and uploaded by members of the public themselves, rather than by doctors or medical photographers, through the COVID-19 Symptom Study app. The app was developed by health science company ZOE. The app launched a survey on social media and through the app which specifically called for images of suspected COVID-19 skin signs on darker skin to be uploaded, a proportionally low number of images on non-white skin were received compared to white skin. The reasons for this need to be examined, but may in part be because rashes on darker skin can be difficult to photograph.

The British Association of Dermatologists was keen to fund and help develop a free, easy to access website on which these Covid-19 rash images could be made available for the public and healthcare workers to see, and we wanted to get the available images online as soon as possible, in case they can help people in assessing their symptoms, and to help reduce the spread of the disease. Of the original images, the quality was very variable. A team of volunteers removed those which were blurry, of low quality, did not show a Covid rash, or had other issues such as the person being identifiable in the image.

It has been reported that only two of the images of the site are of darker skin types; this is not correct, although the number is still lower than we would like. Following feedback, we are now planning to upload images of darker skin tones even where the rash is less clear, as this may be preferable to not featuring images that fully represent all skin types. Our overall intention with this project was to provide a public service to help people during a difficult time, certainly not to cause division or distress, and we sincerely hope we can achieve this.

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Further evidence highlights mouth, lip, and skin lesions as signs of COVID-19

The results of a study published as a research letterin the British Journal of Dermatologytoday, provide further evidence to support the case that oral lesions and skin rashes, also known as mucocutaneous manifestations, are an important sign of COVID-19.

The study included 666 COVID-19 patients with mild to moderate pneumonia, being treated in a temporary field hospital set up during the pandemic’s peak in Madrid, Spain. The mean age of the patients was 56, 58% of them were female.

Forty-six per cent of patients had some form of mucocutaneous manifestation, with issues with the skin on the hands and feet being particularly common (40%), as well as findings inside the mouth (26%). The most common hand and foot issue was diffuse skin peeling (25%), and most common issue found in the mouth was transient lingual papillitis, also known as lie bumps, characterised by the appearance of small red or white bumps on the tongue.

Urticaria (6.9%), rash (2.9%) and vesicular eruptions (1.6%) were observed in a minority of patients.

The higher prevalence of COVID-19 associated mucocutaneous manifestations in this study compared to prior ones may be because this study included manifestations not previously described, particularly lesions inside the mouth. Conversely, skin rashes alone were relatively uncommon (11%) in this study compared to previous studies, the authors hypothesise several reasons for this, including the age of the group being studied.

The British Association of Dermatologists has set up an online gallery highlighting some of the common skin symptoms of COVID-19, to help improve understanding of the disease amongst healthcare professionals, researchers, and the public. This is available here: www.covidskinsigns.com

 

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Parliamentary report reveals worrying lack of mental health support for skin disease patients

New mental health funding promised to Clinical Commissioning Groups (CCGs)* must urgently be used to invest in and improve mental health services that are dedicated to dermatology patients, according to a report published today by the All Party Parliamentary Group on Skin (APPGS).

The call is prompted by survey data revealing that 98 per cent of skin disease patients feel their condition affects their emotional and psychological wellbeing, and five per cent have suicidal thoughts, yet only 18 per cent have received some form of psychological support. Over half of the patients surveyed for the report did not realise specialised support was available for people with skin conditions, in the form of psychodermatology.

The APPGS raises concerns that access to specialist mental health support for people with skin disease is limited throughout the UK, despite a growing need for such services. This is particularly worrying since the COVID-19 pandemic has exacerbated mental health distress in a skin community that was known already to experience significant appearance-related distress.

Evidence was collected in March and April 2020 from over 500 UK patients with a range of skin conditions, a hundred clinicians, and 16 organisations operating in the field of dermatology. Of the 16 skin organisations contributing to the report, all said that they felt NHS service provision in this area is either ‘poor’ (80 per cent) or ‘very poor’ (20 per cent).

The aim of the report was to gain insight into the state of mental health services available to patients with skin conditions in the UK and the psychological impact of these conditions.

Mandatory psychodermatology training, an increase in dermatology training numbers, and comprehensive dedicated psychodermatology services in each region of the UK were all identified as key recommendations for improving services. In addition, the report found that there is a need for all dermatology units to have named, dedicated staff either to manage patients with skin and mental health disease or refer patients to a nearby regional service. The density of dermatology units able to offer these services needs to reflect the UK population and needs to include all devolved nations, as currently there are no services in Wales and few in Scotland and Northern Ireland.

Another major issue identified by the report is the lack of paediatric psychodermatology clinics – currently there is only one in the UK. All too often, children are not offered support services, which has a profound impact on their long-term mental health, life course and wellbeing into adulthood. Therefore, a key recommendation of the report is that, at a minimum, there should be access to regional paediatric psychodermatology clinics.

Psychological burdens are extremely common in people with skin conditions. The impact can be debilitating and seen across all aspects of patients’ lives. The APPGS survey of people with skin conditions found:

  • 93% of people with skin disease reported a negative impact on their self-esteem
  • 87% of people with skin disease reported a negative impact on their social life or leisure and sporting activity
  • 83% of people with skin disease reported a negative impact on their sleep
  • 73% of people with skin disease reported a negative impact on intimate relationships
  • 69% of people with skin disease reported a negative impact on their work or education
  • 5% of people with skin disease reported having suicidal thoughts
  • 100% of the 27 children who responded to the survey indicated that their skin condition affected their psychological wellbeing, and 85% felt they had low self-esteem
  • Of the children with low self-esteem, 85% reported this being particularly in relation to engaging with peers at school


Sir Edward Leigh MP, Chair of the All-Party Parliamentary Group on Skin and Member of Parliament for Gainsborough, said:

“This timely report comes out during a period of unpresented psychological distress for many people living with a skin condition. The COVID-19 pandemic has exacerbated anxiety and stress amongst those already known to experience significant appearance-related distress.

I know from direct experience the impact skin conditions can have on your mental health. I have rosacea, which is an incurable condition causing red and visible blood vessels on the skin. On almost a daily basis I am mocked on social media for the noticeable visible difference caused by my rosacea. It is clear, from the powerful and moving testimony we received from skin patients, that many others experience similar episodes of discrimination, rejection and negative reactions. This can be alienating and deeply distressing.

People living with a skin condition deserve the right to be provided with excellent and appropriate psychological support to manage their condition. However, I was alarmed by the lack of psychological support that is available to people with a skin condition. Therefore, the NHS must urgently invest in, and expand, specialist mental health support for people with a skin condition.

The APPG on Skin will be discussing the findings and recommendations from our report with Government and key policy-makers within the NHS to ensure that vital improvements are made to services.”

Dr Tony Bewley, Consultant Dermatologist and Chair of the All Parliamentary Group on Skin’s Expert Committee, said:

“Skin conditions are extremely common, and it has been shown time and again that they often have a significant impact on peoples’ mental health. Despite this, the availability of specialised mental health services for people with skin conditions remains poor, and in some regions non-existent.

“As this vital report illustrates, children and young people, who can be particularly vulnerable to mental health issues and bullying related to their skin health and appearance, have been particularly let down in this area. As it stands there is only one paediatric psychodermatology clinic in the UK, which is clearly inadequate.

“Evidence is increasingly showing that providing comprehensive dedicated services for patients with skin and mental health disease is both cost and clinically efficient. We are keen to urge commissioners to recognise the evidence highlighted in this report which shows that investment in specialised mental health services for people with skin conditions is cost effective compared to the alternatives.”

Notes to Editors:

*NHS Mental Health Implementation Plan 2019/20 – 2023/24 – The funding available to CCGs for mental health services is set to increase from £596 million in 2019/20 to an indicative figure of £1,921 million in 2023/24.

This is a summary of the full report, which is available online here: http://www.appgs.co.uk/wp-content/uploads/2020/09/Mental_Health_and_Skin_Disease2020.pdf

The report contains further information about the surveys and data collection, as well as a list of participating organisations.

More than a dozen leading doctors, specialising in dermatology and mental health led the report, as well as the dermatology specialist groups, the British Association of Dermatologists, the Primary Care Dermatology Society, and the British Dermatological Nursing Group. Patient organisations involved in the membership of the Working Group which led the inquiry include:

  • Ichthyosis Support Group
  • British Association of Dermatologists
  • British Skin Foundation
  • Changing Faces
  • Psoriasis Association
  • British Dermatological Nursing Group
  • National Eczema Society
  • Vitiligo Society
  • Primary Care Dermatology Society


For more information contact the media team on: comms@bad.org.uk

Psychodermatology is a discipline and sub-speciality of dermatology that recognises the link between the skin and the mind. Psychological interventions, either alone or adjunctive to conventional dermatology treatments, can be helpful in both coping with and treating many skin conditions.

About the All Party Parliamentary Group on Skin

The All Party Parliamentary Group on Skin (APPGS) is a group comprising members from all political parties, health professionals and patients which aims to increase understanding of skin care issues and improve treatment.

The All Party Parliamentary Group on Skin was established in 1994 with an aim to increase understanding about skincare issues in Parliament, and to achieve improvements in the treatment and management of patients with skin disease in England. It also provides an unbiased means of responding to threats to dermatology services and acts as a forum for partners in skincare to engage with politicians with an interest in the issue.

The APPGS has a large and active membership that includes MPs from all political parties, members of the House of Lords, health professionals, patient groups and industry representatives. The APPGS benefits from clinical input from its Advisory Panel. The activities of the Advisory Panel are subject to the approval of the Group’s parliamentary Officers and, in particular, the Group’s parliamentary Chairman, Sir Edward Leigh MP.

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COVID Symptom Study App and British Association of Dermatologists launch COVID skin rash gallery

21st SEPTEMBER 2020, LONDON, UK. The COVID Symptom Study, ZOE and the British Association of Dermatologists today launches a website dedicated to images of COVID-19 related skin rashes: www.covidskinsigns.com. The new website includes over 400 images of the different types of related rashes. The most common are a hive-type rash (urticaria), ‘prickly heat’ or chickenpox-type rash (papular or vesicular rash) and COVID fingers and toes rash (chilblain-like).

The images were collected via the COVID Symptom Study app, which was launched by British health science company ZOE in March, to help scientists at King’s College London gather information from members of the public about the symptoms of COVID-19. It has since been downloaded by over four million people in the UK.

Early reports of rashes in hospitalised COVID-19 patients emerged from different parts of the world by late spring. As a result, rash as a symptom was added to the app to investigate further. This allowed the team who created the app to gather data about skin symptoms. App users were also invited to anonymously submit images of their rash to the COVID Symptom Study website. A total of 3,195 images were uploaded. A team of senior UK dermatologists reviewed all the images, classifying and curating them according to the different clinical types. Over 400 images were selected and are now available to view at www.covidskinsigns.com, which has been funded and created by the British Association of Dermatologists.

The research generated by the COVID Symptom Study app uncovered that 9% of swab-positive COVID-19 app users reported either a body rash or a rash on fingers or toes, suggesting that rashes are a key symptom of COVID. Rashes were twice as common in children as in adults. A new skin rash was a slightly better predictor of having a positive swab test than a fever or cough. According to the data, rashes may appear before, during or after the presence of other COVID symptoms and sometimes many weeks later. Importantly, rashes were the only sign of infection for 21% with a rash and a positive nasal swab.[*]

This new website is accessible to everyone to help doctors and the general public worldwide to identify whether an unusual rash may be a sign of COVID-19. The gallery will be updated as the research and understanding of COVID-19 related skin signs progresses.

Dr Tanya Bleiker, President of the British Association of Dermatologists, comments:

“The association between certain rashes and COVID-19 has become increasingly clear, and being able to recognise these is crucial for reducing the spread of the disease. We’re delighted to announce the launch of the COVID-19 skin signs image gallery, with the COVID Symptom Study team. The extensive library will be an invaluable resource for both healthcare professionals and members of the public in helping to identify rashes which may indicate COVID-19 infection, particularly in those who are otherwise asymptomatic.”

Veronique Bataille, Consultant Dermatologist, who led the COVID skin research, comments:

“We have created this COVID-19 rash gallery so that clinicians and any interested parties can have access to it and help them identify potential COVID-19 rashes. Our research shows that rashes can

be more predictive of COVID-19 than fever and cough, particularly in children. We found that one in six children gets a rash without any other classical symptoms. For most, COVID-19 rashes last for a few weeks and eventually disappear. In some cases, prescribed medication may be needed if the rash is very itchy.”

Tim Spector, Professor of Genetic Epidemiology at King’s College London, lead of the COVID Symptom app, comments:

“Thanks to our millions of app users we were quickly able to confirm the link between skin rashes and COVID-19 but also the timing of the rashes, their associations with other COVID-19 symptoms, as well as the different types of rashes across different age groups. We are extremely grateful to all app users who provided pictures via the app as without them none of this would have been possible. We have asked the government to add a new skin rash to the official NHS list of signs and symptoms of COVID-19 as it will reduce infections and save lives.”

Dr Justine Kluk, Consultant Dermatologist, involved in the research and curating of images for the website, comments:

“A group of different skin rashes are now recognised as possible indicators of COVID-19 infection and may be the first or only symptom of the disease in some sufferers. Early reporting of these rashes by members of the public and increased awareness and recognition of them by frontline health workers could help us detect more cases and avoid further spread. This new atlas of COVID rashes, the first of its kind, is an important step forward in helping to raise awareness.”

NOTES TO EDITORS

For the communications team at the British Association of Dermatologists please contact: comms@bad.org.uk
For more information about the COVID Symptom Study or  request an interview with Professor Spector or Dr Bataille, please contact Eleanor Griffiths: +44 (0)7950 335916, eleanor@joinzoe.com
[*] Using data collected on a subset of 336,847 eligible UK users of the COVID Symptom Study app observed that 8.8% of the swab positive cases (total: 2,021 subjects) reported either a body rash or an acral (hands/feet) rash
Diagnostic value of skin manifestation of SARS-CoV-2 infection; https://www.medrxiv.org/content/10.1101/2020.07.10.20150656v1
For more information about rashes and COVID visit; https://covid.joinzoe.com/post/skin-rash-covid
For more information about the COVID Symptom Study visit; covid.joinzoe.com/
For more information about the British Association of Dermatologists visit; www.skinhealthinfo.org.uk
To see the latest research on skin signs of COVID-19, visit the British Journal of Dermatology; https://onlinelibrary.wiley.com/journal/13652133

About The COVID Symptom Study app

The COVID Symptom Study app is a not-for-profit initiative that was launched at the end of March 2020 to support vital COVID-19 research. The app was launched by health science company ZOE with scientific analysis provided by King’s College London. With 4 million contributors globally, the Study is the world’s largest ongoing study of COVID-19 and is led by ZOE Co-Founder and King’s

College Professor, Tim Spector. The team has published over 15 research papers since March, most notably in Nature Medicine.

To date the app has been funded by ZOE and generous donations from app contributors. On 19 August 2020, the Department of Health and Social Care announced that it has awarded the COVID Symptom Study app £2million in funding. The funding was awarded to enable the app to continue collecting data from its 4million + users to facilitate hotspot detection and scale-up testing programmes with the ONS. The app provides unique insight on asymptomatic and symptomatic information across the UK with 1.2 million logging on a weekly basis.For more information on The COVID Symptom Study app visit covid.joinzoe.com.

About ZOE

ZOE is a health science company using data-driven research to tackle the world’s health issues. By using artificial intelligence combined with digital technologies like mobile phones, ZOE enables large-scale scientific studies to tackle issues like COVID-19, inflammation and the impact of nutrition on health.

Located in London and Boston, ZOE was founded by machine learning leader Jonathan Wolf and entrepreneur George Hadjigeorgiou along with Professor Tim Spector of King’s College London. ZOE has carried out the largest nutritional studies of their kind in the world, runs the COVID Symptom Study app with 4 million users around the world, and was named one of the Deloitte Fast 50 Rising Stars in 2019 for the company’s contribution to science enabled by technology and machine learning.

For more information on ZOE’s mission and science visit joinzoe.com. Find us on Instagram @ZOE.

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

To contact our press office, please email comms@bad.org.uk      

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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. http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-2133  

 

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Dermatologists warn against the use of private unvalidated food allergy tests

Individuals do not need to pay for private tests online as allergy testing is available on the NHS

Private food allergy tests may be causing people to follow unnecessary and potentially dangerous dietary restrictions, according to two studies being presented at the Virtual Annual Meeting of the British Association of Dermatologists (September 2020).

The studies show that many companies are not using laboratories with the relevant international accreditation for testing, and that the type of tests being used often lack scientific evidence* to support their use.

This means that the results provided to users may not be accurate and may lead to false representations of an individual’s allergy and intolerance status.

The growing interest around food allergies, and the rise of online shopping, has led to a boom in the number of private food allergy and intolerance tests available. Patients with inflammatory skin conditions such as eczema and psoriasis are understandably keen to understand their personal triggers to help get their condition under control. Particularly in the case of younger children, parents often ask whether certain foods could be causing their child’s eczema to flare.

Researchers of the first study identified 18 brands of online allergy tests and evaluated their quality based on whether the samples are tested in ISO15189-accredited laboratories and the type of test conducted.

ISO15189 accreditation is an international standard for medical testing and calibration laboratories, to demonstrate the quality and reliability of their services. Overall, only one of the 18 companies were found to use an ISO15189-accredited laboratory.

Seventy per cent of these brands perform only IgG testing for food intolerance, which has no scientific evidence to support its validity. Six companies also use an unproven ‘bioresonance’ test of hair samples to identify potential intolerances. As well as this, only one company requested the patient’s clinical history and had the test results reviewed by a physician.

Researchers of the second study identified seven common types of allergy tests that are available online. All but one of these techniques are not scientifically proven methods.

Dr Alice Plant, Dermatology Specialist Registrar at Portsmouth Hospitals University NHS Trust and researcher of one of the studies, said:

“Allergy test results require careful interpretation in the context of the patient’s clinical history by a skilled professional for them to be meaningful. Poorly informed health consumers are vulnerable to be misled about their allergy and intolerance status.

“There is a lack of evidence to suggest that certain foods trigger eczema, and we would encourage people to continue with their topical treatments as prescribed by their doctor rather than eliminating foods from their diet without first discussing this with a medical professional. In children with sensitivities, unnecessary dietary exclusions may actually cause a true allergy to develop.”

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

“It’s concerning to learn that several of the allergy tests available to purchase online may be unreliable. We would encourage anybody who suspects they have an allergy to visit their GP rather than seeking out tests online as allergy testing is available on the NHS. There is therefore no need for families or individuals to spend money on private tests with varying levels of quality.”

-Ends-

Notes to editors:

*The British Society for Allergy & Clinical Immunology (BSACI) published information on the evidence for commonly available alternative tests and the use of specific IgE to screen for food allergy in the context of eczema as part of the Choose Wisely campaign to help patients to make informed choices based on the evidence available. You can find this information here.

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

“Online allergy testing: enlightening and empowering or confusing and exploitative?”

A.W.Y. Wong, H.E.G. White and A. Shipman

Portsmouth Hospitals NHS Trust, Portsmouth, U.K.

“The rise of restrictive eating: commercial food allergy testing and its relevance to the dermatologist”

A. Plant, A. Livesey and A. Shipman

Portsmouth Hospitals NHS Trust, Portsmouth, 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. http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-2133  

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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).

-Ends-

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: comms@bad.org.uk, 07837 734620 Website: www.skinhealthinfo.org.uk

More advice on sun protection can be at https://www.skinhealthinfo.org.uk/sun-awareness/

Sun protection advice for skin of colour can be found here: https://www.skinhealthinfo.org.uk/sun-awareness/sun-advice-for-skin-of-colour/

Information on Fitzpatrick skin types can be found here: https://www.skinhealthinfo.org.uk/symptoms-treatments/skin-of-colour/

Information on the UV Index can be found here: https://www.who.int/uv/intersunprogramme/activities/uv_index/en/index1.html

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. 

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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.

Results

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.

-Ends-

Notes to Editors:

For more information please contact the media team: comms@bad.org.uk

Link to full study and doi: https://onlinelibrary.wiley.com/doi/abs/10.1111/bjd.19163

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 www.bad.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. http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-2133

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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: https://www.guysandstthomas.nhs.uk/our-services/dermatology/dermatology-and-coronavirus-frequently-asked-questions.aspx#na – scroll down to “Immunosuppressants and medication”.

NHS England FAQ on shielding for patients

The NHSE FAQ on shielding for patients is available here: https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/20200401-FAQs-Patients.pdf

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: https://www.bad.org.uk/healthcare-professionals/covid-19/covid-19-immunosuppressed-patients

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

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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: https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/20200401-FAQs-Patients.pdf

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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 press@lshtm.ac.uk.

For queries about skin cancer, please contact the British Association of Dermatologists’ communications team on 0207 391 6084 or comms@bad.org.uk.

Publication

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. www.lshtm.ac.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. For further information about the charity, visit www.bad.org.uk/public

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. http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-2133

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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:

DO:
• 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:
• 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.
 

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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: https://doi.org/10.1111/bjd.18946

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

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/public

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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