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Cannabinoid medications could have an important role in managing a severe genetic skin condition, research shows

Pharmaceutical grade cannabinoid-based medications (CBMs) could improve the treatment of epidermolysis bullosa (EB), a severe and debilitating genetic skin disease, according to research published in the British Journal of Dermatology.

The research, by doctors in the Netherlands, highlights the lack of effective pain relief options for people with EB, and demonstrates the effectiveness of CBMs as an alternative in a sample of EB patients.

EB is blistering condition, in which even minor knocks and friction can cause the skin to blister or ulcer. Children with EB are often know as butterfly children due to the fragility of their skin.

There are three main types reflecting the severity and location on the body of the blistering, EB simplex, junctional EB, and dystrophic EB. It is estimated that approximately 5,000 people in the UK are currently living with EB.

Cannabinoids are chemical compounds which occur naturally in the cannabis plant. Cannabis contains over 100 cannabinoids, the two most abundant being tetrahydrocannabinol (THC) and cannabidiol (CBD). CBD, unlike THC, does not possess psychoactive properties, meaning it does not alter mood, perception and behaviour in the ways often associated with recreational use of cannabis. The CBM used in this case was a mixture of CBD and THC in an oil base, which seemed to avoid unwanted side effects such as sedation and intoxication. The treatment was administered under the tongue.

Pain is an extremely debilitating symptom of all the sub-types of EB. Daily use of opioids, a class of drug which includes powerful painkillers such as morphine, is the current mainstay of EB pain relief. Opioids often fail to effectively manage this pain and are associated with development of tolerance, meaning that with repeated use, it takes a higher dose to get the initial benefits, and addiction.

Three adult EB patients with chronic, severe pain were treated with CBM oil as part of this study. All three participants reported a significant reduction in pain levels experienced whilst undergoing CBM oil treatment relative to their previous drug regime. An additional benefit was reduction in itching.

Before this study, all three participants had a complicated daily pain treatment regimen made up of paracetamol, ibuprofen and multiple opioids including topical morphine.

Mr. Nicholas Schräder of the University Medical Center Groningen and the study’s lead author said “Pain management and itch control in EB are two symptoms that underpin the burden of suffering. The complex nature of this disease probably means no single treatment is able to address the pain and itch alleviation needs of all patients.

“The cases reported in this study indicate that there is a possibility that patients with EB may be able to respond to treatment with a CBM oil, and call for in-depth controlled scientific studies to understand the true effect and impact this type of treatment may have on patient with EB, especially with regard to pain and itch.”

Holly Barber of the British Association of Dermatologists said: “The last year has seen some really exciting developments in EB research, however, we are still lacking really effective pain and itch management which works over the long-term, and which has minimal side effects. Hopefully, further research on this topic will reveal if cannabinoid oils are the answer. If they are, this could provide a long sought-after source of relief for EB patients.”

Home Secretary Sajid Javid announced in July 2018 that specialist doctors in the UK will be able to legally prescribe cannabis-based medicinal products, however, few have been approved by the Medicines and Healthcare products Regulatory Agency (MHRA). Sativex, a cannabis-based spray combining equal parts THC and CBD, is one of the few which been approved for use in the UK, as a treatment for multiple sclerosis. The European Medicines Agency (EMEA) has also approved two safety and efficacy studies of Sativex as adjunctive therapy to opiates in children with cancer-related pain.

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Study details:

Combined tetrahydrocannabinol and cannabidiol to treat pain in epidermolysis bullosa: a report of three cases
N.H.B. Schräder,1 J.C. Duipmans,1 B. Molenbuur,2 A.P. Wolff3 and M.F. Jonkman1

Departments of 1Dermatology, 2Anaesthesiology and 3Anaesthesiology Pain Center; University of Groningen, University Medical Center Groningen, Groningen, the Netherlands

Citation: N.H.B. Schräder, J.C. Duipmans, B. Molenbuur, A.P. Wolff and M.F. Jonkman (2018), Combined tetrahydrocannabinol and cannabidiol to treat pain in epidermolysis bullosa: a report of three cases. Br J Dermatol. DOI 10.1111/bjd.17341

Link to full study: https://onlinelibrary.wiley.com/doi/10.1111/bjd.17341

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

About us:

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

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

 

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Early gut bacterial colonization may help prevent eczema, research shows

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

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

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

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

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

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

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

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

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

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

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

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

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

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Notes to editors:

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

Nina Goad of the British Association of Dermatologists, said:

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

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

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Notes to editors:

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

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

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

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

Nationwide Incidence of Metastatic Cutaneous Squamous Cell Carcinoma in England

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

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

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

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

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

About us:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

-Ends-

Notes to editors:

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

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

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

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

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

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The letters of Vladimir Nabokov highlight the psychological impact of psoriasis

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

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

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

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

Nabokov himself struggled with suicidal thoughts, writing in 1937:

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

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

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

Also:

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

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

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

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

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

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

Daragh Rogerson of the British Association of Dermatologists said:

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

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

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Notes to editors:

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

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

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

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

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

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

The British Association of Dermatologists publishes two world-renowned dermatology journals, both published by Wiley-Blackwell. The British Journal of Dermatology is one of the top dermatology journals in the world, and publishes papers on all aspects of the biology and pathology of the skin.
https://onlinelibrary.wiley.com/doi/abs/10.1111/bjd.17331
 

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Appointment of New Editor of Clinical and Experimental Dermatology

Clinical and Experimental Dermatology, the prominent UK dermatology journal owned by the British Association of Dermatologists, has today announced the appointment of Dr Alexa Shipman as Editor of the journal. Dr Shipman will take over from Dr George Millington in January 2019.

Dr Shipman trained in Oxford, doing her foundation jobs in the Oxford deanery. She then went on to do her medical training in Stoke Mandeville, Norfolk and Norwich and numerous hospitals in the West Midlands dermatology training scheme, she is now a consultant at St Mary’s Hospital, Portsmouth.

Dr Shipman is a general dermatologist but has interests in research and education, supervising trainees, and teaching and examining for Southampton medical school. She has previously sat on the editorial board of Clinical and Experimental Dermatology and the International Journal of Women’s Dermatology.

Dr Shipman also has a keen interest in medical history, sitting on the historical committee at the British Association of Dermatologists.

Shehnaz Ahmed, Managing Editor for the British Journal of Dermatology and Clinical and Experimental Dermatology, said:

“Dr Shipman has been working on CED for the past four years, we are now delighted that she can continue with us as editor. Dr Shipman is a very talented dermatologist who we’re proud to have working alongside our CED team, she has track record of dedication to dermatological research and editing from her work here and at the International Journal of Women’s Dermatology”.

“On behalf of the team at CED I’d like to thank Dr George Millington for all the work he has done for the journal, it has been a pleasure to work with him”.

Dr Alexa Shipman said:

"I am delighted to be taking over from George Millington and look forward to working with the excellent team of editors and staff at the CED.”

“I am happy to discuss article ideas if you think it is something we might not normally accept. The website is a good source of up to date author's guidelines."

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Notes to editors:

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

About us:

Clinical and Experimental Dermatology (CED) is a unique provider of relevant and accessible material of educational value to practising clinicians and dermatological researchers. In supporting the continuing professional development (CPD) of dermatology specialists, the journal aims to advance understanding, management and treatment of skin disease and improve patient outcomes.

In addition to a dedicated CPD section, CED publishes review articles, original papers, concise reports and items of correspondence. CED is an official organ of the British Association of Dermatologists but attracts contributions from all countries in which sound clinical practice is conducted, and its circulation is equally international.

Journal content and further information—including author guidelines and submission details—can be found online at www.clinexpdermatol.net

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

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Dermatologists issue warning about UK artificial nail allergy epidemic

The British Association of Dermatologists has today issued a warning that (meth)acrylate chemicals, the key ingredients in acrylic nails, gel nails and gel polish nails, are causing a contact allergy epidemic in the UK and Ireland.

Their concerns are based on a study which has found that 2.4 per cent of people tested had an allergy to at least one type of (meth)acrylate chemical. This trend is a Europe-wide phenomenon, overwhelmingly affecting women.

The study looked at three main types of nail enhancements containing (meth)acrylates:

Gel nails are derived from meth(acrylates) that can be applied over the natural nail or used to sculpt extensions. The gel needs to be ‘cured’ or hardened under a UV (ultraviolet) lamp. It cannot be removed by soaking and must be buffed off from the nail.

Acrylic nails are mixed in the salon; the paste is applied over a natural nail or used to create length by adding tips. It is then left to harden with exposure to air. Acrylic nails are recommended to be removed by soaking in acetone.

Gel polish, possibly becoming the most popular of the three options, is a premixed product and a hybrid of gel and nail varnish. It has a similar consistency to nail polish and is applied in a similar way. Once applied it also requires ‘curing’ (hardening) with the use of a UV lamp. Gel polish is recommended to be removed by soaking in acetone.

Concerns have been raised about all three options, even if professionally applied. It is when the uncured products come into contact with any part of the skin that sensitisation to the chemicals can occur. This is very likely when people apply a product themselves, or if insufficient training has been given to the nail technician. Dermatologists are urging the public to be particularly wary of gel and gel polish home kits, where insufficient curing can also increase the risk of an individual developing an allergy.

Allergic reactions may involve the nails loosening, or a severe red, itchy rash, not just on the fingertips, but potentially anywhere on the body that has come into contact with the nails, including the eyelids, face, neck and genital region. Very rarely, symptoms such as breathing problems can occur.

(Meth)acrylates are also the main substance used in the production of acrylic plastics. They are used in the graphic and printing industry, aircraft manufacture, adhesives, orthopaedic cement, dressings and dentistry.

However, it is their use in the nail enhancement industry and subsequent increasingly widespread exposure which is causing alarm amongst dermatologists,

As (meth)acrylates are not routinely included in allergy assessments, known as patch tests, the rate of allergy has largely remained under the radar. There are now calls for this to change.

In an audit of 13 UK and Irish dermatology units during 2017*, a total of 4931 patients were tested for (meth)acrylate allergy. 1.5 per cent tested positive to 2-hydroxyethyl methacrylate (2-HEMA), the most common (meth)acrylate to cause allergic sensitisation, and 2.4 per cent tested positive to at least one type of (meth)acrylate. After 2-HEMA, the next two top acrylates eliciting a positive reaction were 2-hydroxypropyl methacrylate (1%) and ethyl acrylate (0.9%); the latter can also be found in medical and other adhesives.

Sixty per cent of patients in the study developed their allergy through what was termed ‘recreational exposure’, in all cases due either to the use of nail enhancements, or to nail and/or eyelash glue. In 33 per cent of cases, occupational sensitisation was the issue, and an overwhelming number of these people worked as nail beauticians. In the remaining seven per cent of cases, exposure was due to other sources such as medical adhesives and dental materials.

The audit also found that this allergy is predominantly found in women, who made up 93 per cent of those affected.

A separate survey** run by the British Association of Dermatologists, with the help of Stylfile from Apprentice Winner Tom Pellereau and Lord Sugar, of 742 people attending dermatology clinics found that 19 per cent of respondents had experienced adverse effects from acrylic nails applied in salons, and 16 per cent from gel polish nails applied in salons. Adverse effects included nail damage and allergic dermatitis such as itching and swelling of the hands, eyelids, cheeks and neck. This study also found that 26 per cent of people were applying nail enhancements at home, with 11 per cent stating they found the kit instructions inadequate.

Dr David Orton, of the British Association of Dermatologists, said:

“It is really important that people know they can develop allergies from artificial nails. The truth is that there will be many women out there with these allergies who remain undiagnosed, because they may not link their symptoms to their nails, especially if the symptoms occur elsewhere on the body. It is important that they get a diagnosis so that they can avoid the allergen, but also because developing an allergy to these chemicals can have lifelong consequences for dental treatments and surgeries where devices containing these allergens are in common use.

“The risk is particularly high for beauticians and other professionals who work with nail enhancements. Wearing protective gloves is not enough as (meth)acrylates will pass directly through many glove types. Salon owners need to consider the level of training they offer staff in this area as there is a genuine occupational hazard that should be mitigated. An important precaution is to use nitrile gloves which are replaced and disposed of every 30 minutes and removed with a ‘no touch’ technique. (Meth)acrylates should be kept away from all direct skin contact. The training also needs to reduce the chances of initiating an allergy in their clients.“

Dr Deirdre Buckley, from the Royal United Hospital Bath, President of the British Society of Cutaneous Allergy and the Consultant Dermatologist leading the 2017 audit of 13 dermatology units, said:

“Allergy to (meth)acrylates has the potential to behave like many of the other significant contact allergy epidemics that have occurred in the last few decades. Although the rate of allergy to (meth)acrylates is continuing to increase, many doctors are unaware of the issue, and these chemicals are not routinely included in patch tests. We are now recommending that all dermatologists patch test to (meth)acrylates routinely.“

“We would particularly urge people to be careful when using home kits. If you do use one, make sure that you use the recommended UV lamp for curing, and read the instructions carefully. Using the wrong lamp may mean that the gel polish does not cure properly, and this means an increased chance of allergy. Avoid any direct skin contact with the (meth)acrylate nail product.”

The researchers also noted that the issues with nail enhancements are not just limited to allergic reactions to the nails themselves, but also to nail glues, used to glue on pre-sculpted nails. The glues contain chemicals called cyanoacrylates, which are also used in ‘super glues’ and can cause severe allergic reactions.

Acrylate-containing nails can also cause physical damage to the nails and cuticles when they are removed, either by buffing, scraping or acetone soaking.

Tom Pellereau, Inventor of Stylfile, said:

“Few would believe that almost 1 in 5 respondents had experienced negative adverse effects from acrylic nails applied in salons. We hope that this study will raise awareness and encourage greater education.”

-Ends-

Notes to editors:

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

Please note that all percentages refer to the patch-tested population in the UK.

*Epidemic of (meth)acrylate allergy in U.K. requires routine patch testing
S Rolls1, A Shah2, JF Bourke3, MM Chowdhury4, P Cousen5, AM Flynn3, A Howarth6, SA Ghaffar7, C Green7, GA Johnston2, K Naido5, DI Orton8, C Reckling9, NM Stone10, D Thompson11, S Wakelin12, SM Wilkinson13, DA Buckley1.
1Royal United Hospital, Bath, UK; 2Leicester Royal Infirmary, Leicester, UK; 3South Infirmary Victoria University Hospital, Cork, Ireland; 4University Hospital of Wales, Cardiff, UK; 5South Tees Hospital NHS Foundation Trust, UK; 6Portsmouth Hospital NHS Trust; 7Ninewells Hospital, Dundee; 8Royal Free Hospital, London, UK; 9Kent and Canterbury Hospital, Canterbury, UK; 10Royal Gwent and Nevill Hall Hospitals, Newport, UK; 11Sandwell and West Birmingham Hospitals NHS Trust; 12Imperial College Healthcare NHS Trust; 13Leeds Teaching Hospital NHS Trust, Leeds, UK.

(Meth)acrylates are potent sensitizers and a common cause of allergic contact dermatitis (ACD). The frequency of (meth) acrylate ACD has increased recently with soaring demand for acrylic nails. (Meth)acrylates are not routinely tested in the baseline patch test series in the U.K. and Europe. The European Society of Contact Dermatitis (ESCD) suggests that an allergen might be included in the baseline series when the proportion of consecutively patch tested patients with a positive test to a specific allergen exceeds 0.5–1.0%. Our preliminary retrospective audit in nine U.K. dermatology centres between 2008 and 2015 found the frequency of sensitization to any (meth)acrylate to be a minimum of 1.3%; and to 2-hydroxyethyl methacrylate (2-HEMA) to be 0.7%. Patients had been selectively patch tested to (meth)acrylates based on history of exposure, therefore, the true rate of sensitization to 2-HEMA remains unknown. We performed a prospective multicentre audit, including 2-HEMA [2% in petrolatum (pet.)] in an extended baseline series in 13 U.K. dermatology units during 2017. Patients with a history of (meth)acrylate exposure, or who tested positive to 2-HEMA, were selectively tested with a series of eight (meth)acrylate allergens. A total of 4931 patients were tested, of whom 545 were also tested to the acrylate series. Of 4931 patients, 76 (1.5%) tested positive to 2-HEMA and 116 (2.4%) to at least one (meth)acrylate. Had 2-HEMA been excluded from the baseline series, 21 (0.4% of 4931) (meth)acrylate positive patients would have been missed. The top (meth)acrylates eliciting a positive reaction were 2-HEMA (n = 76; 1.5%), 2-hydroxypropyl methacrylate (n = 48; 1%) and ethyl acrylate (n = 43; 0.9%). We have shown an increase in the number of (meth)acrylate ACD cases identified when 2-HEMA is included in the baseline series, rather than relying on a history of (meth)acrylate exposure. Had 2-HEMA not been added, treatable cases of (meth)acrylate ACD would have been missed. We believe that such patients remain undiagnosed in many U.K. dermatology units. We recommend that 2-HEMA 2% pet. be added to an extended British baseline patch test series. We also suggest a standardized short (meth)acrylate series, including the most popular (meth)acrylates to test positive, which is likely to detect most cases of (meth)acrylate ACD.

**Secondary nail survey of 742 individuals conducted by the British Association of Dermatologists in dermatology clinics across the UK in 2016 and 2017.

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

About StylFile:

Styfile is a range of curve nail files invented by Tom Pellereau. The company is 50:50 by Lord Alan Sugar and Tom who won the BBC Apprentice in 2011. The company aims to reinvent beauty accessories. Their most recent invention StylPro Makeup Brush Cleaner has won multiple awards and is sold around the world.
 

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Untested skin cancer apps endangering the public

In the scramble to bring successful apps for the diagnosis of skin cancer to market there is a concern that a lack of testing is risking public safety, according to researchers at the British Association of Dermatologists’ Annual Meeting in Edinburgh (3rd-5th July 2018).

The researchers, led by the University of Birmingham, reviewed the medical literature on skin cancer apps to explore the number of apps on the market, ascertain how accurate they are, and what the benefits and limitations of these technological solutions are. Examples of apps include tele-dermatology (which involves sending an image directly to a dermatologist), photo storage (which can be used by individuals to compare photos monthly to look for changes in a mole), and risk calculation (based on colour and pattern recognition, or on fractal analysis).

The researchers found that some of these apps have a comparatively high success rate for the diagnosis of skin cancer. Teledermatology correctly identified 88 per cent of people with skin cancer and 97 per cent of those with benign lesions. Apps which use fractal theory analysis algorithms (detecting irregularities in a fractal pattern) were the next most successful category, these correctly identified 73 per cent of people with skin cancer and 83 per cent of people with benign lesions. These types of technology have huge potential, as in the UK 50 per cent of dermatology referrals relate to skin cancer. Early diagnosis results in up to 100 per cent five-year survival, compared with 25 per cent in women and 10 per cent in men diagnosed at a later stage. Technology that can help with triaging would help alleviate pressure on dermatology departments and could also increase survival rates.

However, the researchers point to three major failings with some of the apps: a lack of rigorous published trials to show they work and are safe; a lack of input during the app development from specialists, to identify which lesions are suspicious; and flaws in the technology used, namely how the photos are analysed.

The researchers explain that without specialist input, the apps may not recognise rarer or unusual cancers. Even where the technology is efficient, if it has not been combined with specialist input from a dermatologist, it may not pick up on all red-flag symptoms.

In terms of technology, an area where colour and pattern recognition software apps seem to particularly struggle currently, is in recognising scaly, crusted, ulcerated areas or melanomas which do not produce pigment (amelanotic melanomas). This increases the number of false negatives and delays treatment.

Some apps that compare images on a monthly basis or ‘advise’ users to seek dermatologist review, based on a risk calculation, are not able to differentiate between finer details which would be identified using a dermatoscope (a magnifier that can be handheld or attached to a phone), or in person when touched by a dermatologist. If the app is based on advising patients whether to seek professional advice, then they may advise wrongly as they have not correctly identified finer details which may point to a more sinister lesion.

There are also certain criteria that an app cannot always register, in clinic this person would be advised that the mole should be removed, however, an app may not be able to provide such personalised advice.

Maria Charalambides from the University of Birmingham’s College of Medical and Dental Sciences, who conducted the literature review, said:

“Future technology will play a huge part in skin cancer diagnosis. However, until adequate validation and regulation of apps is achieved, members of the public should be cautious when using such apps as they come with risk. Any software that claims to provide a diagnostic element must be subject to rigorous testing and ongoing monitoring. Apps specifically based on patient education of skin cancer can offer public health benefits in terms of how to stay safe in the sun, or the warning signs to look out for. But as per the British Association of Dermatologists recommendations, most apps cannot currently substitute dermatologist review when it comes to actual diagnosis.”

Matthew Gass of the British Association of Dermatologists, said:

“These new technologies for the diagnosis of skin cancer are exciting, but the varying quality available makes it a difficult landscape for people to navigate. These apps are not a replacement for an expert dermatologist, but they can be a useful tool in the early detection of skin cancer. We urge people who are thinking about using these apps to research how they work and to be cautious regardless of their recommendations. If a patch of skin such as a mole is changing in shape or size, not healing or just doesn’t seem right, go and see your GP regardless of what any app tells you.”

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

Sun protection tips:

1. Spend time in the shade during the sunniest part of the day when the sun is at its strongest, which is usually between 11am and 3pm in the summer months.
2. Avoid direct sun exposure for babies and very young children.
3. When it is not possible to limit your time in the sun, keeping yourself well covered, with a hat, T-shirt, and sunglasses, can give you additional protection.
4. Apply sunscreen liberally to exposed areas of skin. Re-apply every two hours and straight after swimming, sweating or towelling to maintain protection.

Checking for skin cancer:

There are two main types of skin cancer: non-melanoma, the most common, and melanoma, which is less common but more dangerous. The following ABCDE rules describe a few changes that might indicate a 'melanoma', which is the deadliest form of skin cancer. As skin cancers vary, you should tell your doctor about any changes to your skin, even if they are not like those mentioned here. If your GP is concerned about your skin, make sure that you are referred to a dermatologist. Your GP can refer you via the NHS.

Asymmetry - the two halves of the area may differ in shape or colour
Border - the edges of the area may be irregular or blurred, and sometimes show notches
Colour - this may be uneven. Several different shades of black, brown and pink may be seen
Diameter - most melanomas are at least 6mm in diameter. Report any change in size, shape or diameter to your doctor
Evolution – if you see progressive changes in size, shape or colour over weeks or a few months, you must seek expert help.

If in doubt, check it out! If your GP is concerned about your skin, make sure you see a dermatologist. Your GP can refer you via the NHS.

Non-melanoma skin cancer

Non-melanoma skin cancers can occur on any part of the body but are most common on areas of skin that are most often exposed to the sun such as your head and neck (including lips and ears) and the backs of your hands. They can also appear where the skin has been damaged such as old scars, ulcers, burns, X-ray damage or persistent wounds.

Non-melanoma skin cancers vary greatly in what they look like. They may appear gradually on the skin and will get bigger over time. They will not go away on their own without treatment. Some possible signs include:

- A scab or sore that won’t heal. It may also bleed occasionally
- A scaly or crusty patch of skin that looks red or inflamed
- A flesh coloured, pearly lump that won’t go away and appears to be growing in size
- A lump on the skin which is getting bigger and that may be tender or sore
- A growth with a pearly rim surrounding a central crater, a bit like an upturned volcano

-Ends-
Notes to editors:

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

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

The conference will be held at the EICC Edinburgh from July 3rd to 5th and is attended by approximately 1,300 UK and international dermatologists.

To interview Maria Charalambides, contact Emma McKinney, Communications Manager (Health Sciences), University of Birmingham, tel: +44 (0) 121 414 6681, or contact the press office on +44 (0) 7789 921 165.


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

About the University of Birmingham
The University of Birmingham is ranked amongst the world’s top 100 institutions. Its work brings people from across the world to Birmingham, including researchers, teachers and more than 6,500 international students from over 150 countries

BT08
Use of dermatology apps: a cause for concern or the future of healthcare provision?

M. Charalambides1 and S. Singh2
1Birmingham Medical School, Birmingham, U.K. and 2Worcester Royal Hospital, Worcestershire, U.K.

In the U.K., 50% of dermatology referrals relate to skin cancer. Early diagnosis results in 100% 5-year survival, compared with 25% in women and 10% in men diagnosed at a later stage. With 6.3 billion smartphone subscriptions estimated to be in use by 2021, the field of telemedicine and specifically teledermatology has begun a period of evolving growth and there is now widespread availability of skin cancer-related dermatology apps. The aim of this review is to explore the range of apps available, evaluate the benefits and limitations of such apps and assess their role in the effectiveness of teledermatology. Search engines, including Pubmed and Medline, have been used to view the literature. A variety of apps are available for public download. The best method for melanoma diagnosis was those who sent the image directly to a dermatologist for analysis (88% sensitivity, 97% specificity). The second most effective apps (73% sensitivity and 83% specificity) use fractal theory analysis algorithms. In the U.K., the use of store-and-forward teledermatology has been proposed as a service delivery model to manage capacity demands. The benefits of teledermatology include education, encouragement of personal responsibility and provision of equitable services to remote areas. Teledermatology is an effective triaging tool, ensuring patients are seen in the most appropriate setting at first appointment via the 2-week-wait, alleviating NHS pressures. This leads to timely treatment. Limitations include the lack of rigorous U.K. published trials supporting a safe, efficient service. There is a lack of validation, regulation, scientific and speciality input of apps. Currently, colour and pattern recognition software apps are unable to recognize scaly, crusted, ulcerated areas or amelanotic melanomas, increasing false negatives and delaying treatment. The experience of the teledermatologist influences the accuracy of apps and the possibility of user error in taking a quality photograph remains. As inferred by the BAD, teledermatology apps have benefits when integrated in care as a first step in early detection. Encryption of images and patient consent are essential. Concerns regarding accountability for inaccurate diagnoses made by apps should be addressed. Further U.K.-based research into efficacy and economic viability of teledermatology apps is required. According to NICE, patients with potential skin malignancy should be seen in person by specialists. Therefore, apps can currently supplement but not substitute standard medical care.
 

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Study finds new evidence that atopic eczema develops in the womb

Researchers have found new evidence that atopic eczema develops before birth and is linked to a child’s growth in the womb and shortly after birth, according to a new study being presented at the British Association of Dermatologists’ Annual Meeting in Edinburgh (3rd-5th July 2018).

The study found that infants with eczema demonstrated altered patterns of growth during pregnancy, including impairment in growth of length starting in early pregnancy, prior to eczema becoming evident. The findings suggest that growth is impaired prior to the start of the disease process and its treatment, and that there are important influences acting during pregnancy on this common skin condition.

Within the Southampton Women’s Survey, a mother-offspring study, 1759 infants had serial measurements of their length, head and abdominal circumference during pregnancy at 11, 19 and 34 weeks, at birth, and at ages 6 and 12 months, and were assessed for eczema at ages 6 and/or 12 months.

Evidence of faltering growth in length from 11 weeks’ of pregnancy and shorter femur length, smaller abdominal circumference and a higher head to abdominal circumference ratio at 34 weeks’ gestation were associated with 20% or greater increased risks of eczema at age 6 months. Infants who had had a larger head circumference in early pregnancy and a declining abdominal growth velocity from 19 to 34 weeks of pregnancy had a 33% greater likelihood of eczema at age 12 months.

One possible explanation for these findings is “brain sparing” responses where the growth of the head and brain takes priority over the growth of the rest of the body. One organ that could be affected is the thymus, which is important in regulating the immune system, and this could result in an imbalance in immune cells and chemicals producing the inflammatory response seen in atopic eczema.

Dr Sarah El-Heis, the study’s lead researcher from the University of Southampton and the MRC Lifecourse Epidemiology Unit, said:

“Infants with eczema have an increased risk of impaired growth, which is a clinical concern that underpins recommendations to monitor growth in all infants with eczema. A number of reasons for the impaired growth have been proposed and include effects of the inflammatory process, topical corticosteroid treatment or an inappropriately restrictive diet. However, we have shown that infants with eczema at age 6 and 12 months have altered growth patterns before they are born and before eczema becomes evident, suggesting that there are important influences acting during pregnancy.”

Nina Goad, of the British Association of Dermatologists, said:

“Research into this common disorder has taken some interesting turns in recent years, with discoveries relating to birthweight, maternal socioeconomic status and even maternal mood during pregnancy impacting on risk factors. What is becoming clear is that there is no one, simple answer to why some babies develop eczema, and instead there is a complex interplay of factors, some of which are genetic and some of which are environmental. This study provides more data to help scientists explore the possible causes and how they may relate to one another.”

Atopic eczema is a very common skin condition due to skin inflammation. It may start at any age but the onset is often in childhood. One in every five children in the UK is affected by eczema at some stage. It may also start later in life in people who did not have eczema as a child.

The term ‘atopic’ is used to describe a group of conditions, which include asthma, eczema and hay-fever and food allergy. These conditions are all linked by an increased activity of the allergy side of the body’s immune system. ‘Eczema’ is a term which comes from the Greek word ‘to boil’ and is used to describe red, dry, itchy skin which can sometimes become weeping, blistered, crusted, scaling and thickened.

For more information on eczema, see the British Association of Dermatologists’ Patient Information Leaflet.

-Ends-
Notes to editors:

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

The conference will be held at the Edinburgh EICC from July 3rd to 5th and is attended by approximately 1,300 UK and worldwide dermatologists.

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

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

The Medical Research Council (MRC) is at the forefront of scientific discovery to improve human health. Founded in 1913 to tackle tuberculosis, the MRC now invests taxpayers’ money in some of the best medical research in the world across every area of health. Thirty-two MRC-funded researchers have won Nobel prizes in a wide range of disciplines, and MRC scientists have been behind such diverse discoveries as vitamins, the structure of DNA and the link between smoking and cancer, as well as achievements such as pioneering the use of randomised controlled trials, the invention of MRI scanning, and the development of a group of antibodies used in the making of some of the most successful drugs ever developed. Today, MRC-funded scientists tackle some of the greatest health problems facing humanity in the 21st century, from the rising tide of chronic diseases associated with ageing to the threats posed by rapidly mutating micro-organisms. The Medical Research Council is part of UK Research and Innovation. https://mrc.ukri.org/

Developmental influences and the risk of atopic eczema during infancy.
S. El-Heis,1 S. Crozier,1 E. Healy,2 S. Robinson,1,3 N. Harvey,1,3 J. Baird,1,3 H. Inskip,1,3 C. Cooper1,3,4 and K. Godfrey1,3,5
1MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, U.K, 2Dermatopharmacology, Faculty of Medicine, University of Southampton, Southampton, U.K., 3NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, U.K., 4NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, U.K. and 5Institute of Developmental Sciences, University of Southampton, Southampton, U.K.

Evidence that atopic eczema partly originates in utero is increasing, where genetic predisposition and environmental exposures act together in determining the risk of developing this multifactorial condition. This research examined early life developmental influences on infantile atopic eczema at ages 6 and 12 months. In the well-characterized preconception Southampton Women’s Survey mother–offspring cohort, infantile atopic eczema was ascertained by trained research staff using modified U.K. Working Party Criteria for the Definition of Atopic Dermatitis. In cohort subsamples, data were available that enabled analyses of maternal stress and low mood (n = 3008), maternal serum nicotinamide and related tryptophan metabolite concentrations (n = 497), and fetal/infant growth patterns (n = 1759) in relation to infantile eczema. Maternal preconception perceived stress affecting health [OR 1.21 (95% CI 1.08–1.35), P = 0.001] and stress in daily living [OR 1.16 (1.03–1.30), P = 0.014] were associated with an increased risk of offspring atopic eczema age 12 months; this was independent of maternal postpartum mood and stress. Infants whose mothers had higher levels of nicotinamide during pregnancy had a lower risk of eczema at age 12 months [OR 0.69 (0.53–0.91) per SD change, P = 0.007]; findings were similar for the related metabolite anthranilic acid [OR 0.63 (0.48–0.83), P = 0.001]. Fetal and infant linear, head and abdominal size and growth velocity standard deviation scores were derived from anthropometric measurements at 11, 19 and 34 weeks’ gestation, birth and ages 6 and 12 months. Shorter femur length, smaller abdominal circumference and higher head to abdominal circumference ratio at 34 weeks’ gestation were associated with increased risks of eczema at age 6 months (eczema odds ratio per standard deviation (OR/SD) increase 0.81 (0.69–0.96), P = 0.017; 0.78 (0.65–0.93), P = 0.006; 1.37, (1.15–1.63), P = 0.001, respectively). A lower velocity of linear growth from 11 weeks’ gestation to birth was associated with eczema age 6 months (0.80 (0.65–0.98), P = 0.034). Infants with atopic eczema age 12 months had a larger head circumference in early gestation and faltering of abdominal growth velocity from 19 to 34 weeks’ gestation (0.67 (0.51–0.88), P = 0.003). The findings demonstrate impacts of maternal psychological well-being and micronutrient status on infantile atopic eczema. The impaired linear growth of infants with atopic eczema was shown to commence in utero, prior to the clinical onset of the condition. The findings provide new evidence that atopic eczema partly originates during prenatal development, and point to potential interventions to optimize maternal health beginning prior to conception to ultimately reduce the risk of infantile atopic eczema. Conflict of interest: KMG has received reimbursement for speaking at conferences sponsored by companies selling nutritional products and is part of an academic consortium that has received research funding from Abbott Nutrition, Nestec and Danone.
 

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Photographic evidence highlights shortcomings of moisturisers containing SPF

Moisturisers with sun protection factor (SPF) provide less sun protection than the equivalent strength sunscreen in real-world scenarios, and people are more likely to miss areas of their face when using them, according to a new study being presented at the British Association of Dermatologists’ Annual Meeting in Edinburgh (3rd-5th July 2018). Doctors are warning people not to rely on moisturisers with SPF for their main sun protection needs, particularly if spending extended periods in the sun.

Using a specially modified camera that only sees UV light, the researchers from the University of Liverpool assessed how effectively people apply sunscreen and sun protection factor (SPF) containing moisturiser to their face. When an area of skin is successfully covered, the product absorbs the UV light and this area appears black in the photos – the lighter the area the less successful the absorption.

Over two separate visits, people were asked to apply sun protection, in the first visit sunscreen, and in the second moisturiser with SPF. Pictures were then taken with the modified camera to see how effectively people applied the two products.

Analysis of the photos showed that when applying moisturiser people missed 16 per cent of their face on average, whereas when applying sunscreen this dropped to 11 per cent. When just the high-risk eyelid areas were analysed sunscreen users missed 14 per cent compared with 21 per cent with moisturiser. The eyelid area is a common site for skin cancers.

In addition to this, the study suggests that people do not apply the moisturiser as thickly as sunscreen, and therefore do not receive the full benefits of the SPF. The photos of people using the moisturiser are noticeably less dark on average, this indicates that the product is absorbing less UV light.

On average men were significantly better at applying the products than women, other groups that proved better at it were people with darker skin tones and older participants.

Participants were asked to rate their perceived ability to apply the products before and after viewing the images. For sunscreen, perceived ability dropped from 90 per cent positive to 42 per cent, and moisturiser from 85 per cent to 38 per cent, indicating that participants were not aware of their failure to achieve adequate coverage.

Mr Austin McCormick, Consultant Ophthalmic and Oculoplastic Surgeon, and one of the researchers, said:

“This research is very visual and fairly easy for people to understand: the darker the image, the more sun protection people are getting.

“We expected the area of face covered with moisturiser to be greater than sunscreen, in particular the eyelids because of the perception that moisturiser stings the eyes less than sunscreen. In fact we found the opposite: the area of the face covered effectively was greater with sunscreen than moisturiser. In addition, where it was applied, the moisturiser provided less UV protection than sunscreen.

“Although skin moisturiser with SPF does provide sun protection, our research suggests that it’s not to the same degree as sunscreen. We do recommend moisturisers and makeup that contain UV protection – it is better than no protection at all, but for prolonged periods in the sun we recommend the application of sunscreen with high SPF.”

Matthew Gass of the British Association of Dermatologists, said:

“Unfortunately, moisturiser with SPF just doesn’t perform particularly well in real world situations compared to sunscreen. Although it may say factor 30 on the box, this study is just further evidence that lab testing conditions for these products don’t reflect how they are used.

“Another important thing to take away from this research is that people often miss areas of their face when applying sun protection, a good way to prevent this from becoming an issue is to wear sunglasses and reapply sunscreen regularly. This should help protect the bits you miss from being exposed to excessive sun.”

When products are tested for their SPF, they are tested at a density of 2 mg per cm². SPF used in moisturisers is tested the same way as sunscreens, so an SPF 15 moisturiser should provide an SPF of 15, however, as this study demonstrates, they are likely to be applied a lot more thinly than sunscreen, and less uniformly. Applying less SPF will reduce the protection to a higher degree than is proportionate – for example, only applying half the required amount can actually reduce the protection by as much as two-thirds.

It is also worth noting that moisturisers containing an SPF may not contain any UVA protection and as a result will not protect against UV ageing, and are less likely to be rub-resistant and water resistant.

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Notes to editors:

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

The conference will be held at the Edinburgh EICC from July 3rd to 5th and is attended by approximately 1,300 UK and worldwide dermatologists.

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

Study:

Application of SPF moisturizers is inferior to sunscreens in terms of percentage coverage of facial and eyelid area

E. Lourenco, H. Pratt, K. Hamill, G. Czanner, Y. Zheng and A. McCormick

University of Liverpool, Liverpool, U.K.

In recent years, the popularity of SPF containing moisturizers has steadily increased. Indeed, as reported SPFs are equivalent to sunscreens, more users are turning to moisturizers for their sun-protection needs. However, there has been little research into moisturizer application habits compare to using sunscreen in terms of coverage achieved. Previously, we have demonstrated that during sunscreen application, users have a tendency towards missing or incompletely covering the eyelid and medial canthus regions. We aimed to determine if these tendencies differed in SPF moisturizer users. A study population of 60 (14 men, 46 women, age 18–57) were exposed to UV light and photographed using a tripod mounted, UV-sensitive DSLR camera on two separate visits. At visit one, images were acquired before and after applying SPF30 sunscreen, while at visit two, SPF30 moisturizer was used instead. Images were processed for facial landmark identification followed by segmentation mapping of hue saturation values to identify areas of the face that had been missed. Analyses revealed that application of moisturizer was significantly worse than sunscreen in terms of the area of the whole face missed (11.1% missed with sunscreen 16.1% for SPF moisturizer P < 0.001 paired t-test). This difference was primarily due to decreased coverage of the eyelid region (14.3% sunscreen, 21.1% moisturizer P < 0.001), face excluding the eye area; 9.7% missed with sunscreen, 12.4% SPF moisturizer (P < 0.001). Secondary analyses demonstrated significantly better coverage in men, people with darker skin tones and older participants. Upon study completion, we asked participants to rate their perceived ability to apply the products before and after viewing the images, sunscreen dropped from 90% positive to 42%, and moisturizer from 85% to 38%, indicating that participants were not aware of their failure to achieve adequate coverage. Together these data indicate, that despite potential advantages moisturizers have in terms of increased frequency of application, the areas of the face that are at higher cancer risk are likely not being adequately routinely protected, and importantly, participants are unaware that they are at risk.

Sun protection tips:

1. Spend time in the shade during the sunniest part of the day when the sun is at its strongest, which is usually between 11am and 3pm in the summer months.

2. Avoid direct sun exposure for babies and very young children.

3. When it is not possible to limit your time in the sun, keeping yourself well covered, with a hat, T-shirt, and sunglasses, can give you additional protection.

4. Apply sunscreen liberally to exposed areas of skin. Re-apply every two hours and straight after swimming, sweating or towelling to maintain protection.

Checking for skin cancer:

There are two main types of skin cancer: non-melanoma, the most common, and melanoma, which is less common but more dangerous. The following ABCDE rules describe a few changes that might indicate a 'melanoma', which is the deadliest form of skin cancer. As skin cancers vary, you should tell your doctor about any changes to your skin, even if they are not like those mentioned here. If your GP is concerned about your skin, make sure that you are referred to a dermatologist, the most expert person to diagnose a skin cancer. Your GP can refer you via the NHS.

Asymmetry - the two halves of the area may differ in shape or colour

Border - the edges of the area may be irregular or blurred, and sometimes show notches

Colour - this may be uneven. Different shades of black, brown and pink may be seen

Diameter - most melanomas are at least 6mm in diameter. Report any change in size, shape or diameter to your doctor

Evolution – if you see progressive changes in size, shape or colour over weeks or a few months, you must seek Expert help.

If in doubt, check it out! If your GP is concerned about your skin, make sure you see a dermatologist, the most expert person to diagnose a skin cancer. Your GP can refer you via the NHS.

Non-melanoma skin cancer

Non-melanoma skin cancers can occur on any part of the body, but are most common on areas of skin that are most often exposed to the sun such as your head and neck (including lips and ears) and the backs of your hands. They can also appear where the skin has been damaged by X-rays, and on old scars, ulcers, burns and persistent wounds.

Non-melanoma skin cancers vary greatly in what they look like. They tend to appear gradually on the skin, and slowly get bigger over time. They will not go away on their own without treatment. Some possible signs include:

- A scab or sore that won’t heal. It may also bleed occasionally

- A scaly or crusty patch of skin that looks red or inflamed

- A flesh coloured, pearly lump that won’t go away and appears to be growing in size

- A lump on the skin which is getting bigger and that may be scabby

- A growth with a pearly rim surrounding a central crater, a bit like an upturned volcano

About us:

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

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Microbiome modification mooted as a future treatment for metastatic melanoma patients

Dermatologists from Germany and the UK have called for more research into the so called “obesity paradox” in melanoma survival. Studies have shown that obesity at the onset of systemic treatment of metastatic melanoma is associated with improved survival rates in males compared to patients with a ‘normal’ BMI.

In a letter to the editor of the British Journal of Dermatology (BJD), the dermatologists have suggested that the gastrointestinal microbiome, the microorganisms in the gut which amongst other things break down food and protect us from germs, may be an important mechanism behind this apparent paradox. Several recent studies have reported that the gut microbiome may influence a patient’s response to immunotherapy, improving the effectiveness of treatment.

Twin studies have shown in the past that obesity is associated with a reduced overall gastrointestinal bacterial diversity. Subsequently the gut microbiome has been reported to potentially play an important role in the development of metabolic syndrome* and chronic inflammatory skin diseases, including psoriasis.

The authors of the BJD letter point to this as evidence that there is an important interaction between the various human microbiomes (skin and gut) and the immune system. However, more research is necessary to shed light on this.

If the link can be proven then it opens up the possibility of modifying the microbiome of individual metastatic cancer patients to improve their response to immunotherapies, thus increasing survival rates.

Dr Ewan Langan, one of the authors of the letter with joint affiliation to the universities of Manchester and Lübeck, said:

“At this stage we are working with limited data, long-term, prospective data is lacking. However, this is an intriguing field of study, and more research should be done to solve this “obesity paradox” in melanoma survival. If it can be solved then perhaps the answer can open up new approaches for the treatment of cancer.”

Matthew Gass of the British Association of Dermatologists said:

“An understanding of why men in the obese BMI category have better survival rates when it comes to the treatment of this advanced type of melanoma is important, and could lead to changes in how we treat this condition. With ever rising rates of skin cancer in the UK this call for more research is timely.

“This is not about the health benefits or risks of obesity, rather it is about understanding the mechanisms that mean some people respond better to treatments.”

-Ends-

Notes to editors:

If using this press release, please ensure you mention that the research letter was published in the British Journal of Dermatology.

*Metabolic syndrome is the term used to describe a combination which can include diabetes, obesity, high blood pressure and high cholesterol.

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

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

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Tired tropes in animated films reinforcing negative stereotypes of skin issues, according to new study

Animated films are falling into the trap of using skin disorders, blemishes, and wrinkles as a visual shorthand for negative traits, a study published in the British Journal of Dermatology claimed today.

The study found that 76.5 per cent of villainous characters or those with negative associations had any form of what the authors call dermatologic findings, this compares to 25.9 per cent of the characters meant to appear good. These dermatologic findings include a wide array of issues including scars, baldness, wrinkles, and moles.

The study analysed characters from the top 50 highest grossing animated films as of January 2017. The main protagonists and antagonists of each film were identified and examined for dermatologic findings. All animal characters were excluded from the analysis and four movies were excluded based on mechanical or robotic characters and one due to its PG-13 rating.

Two additional categories were used for characters that didn’t neatly fit into these clearly good or bad roles. Atypical protagonists were moral characters who also had attributes or roles with negative or evil connotations, such as being a caveman, thief, or vampire. In another cinematic context, these attributes would make them more likely to be villainous than good. Hidden antagonists were characters that initially presented as benevolent but were later revealed to have insidious motives when they betrayed protagonists.

Ninety-two per cent of the movies were released after the year 2000, and 50 per cent were released after 2010.

Previous studies have highlighted the same issue in prominent films of the 20th century and shown that notorious film villains have a statistically significant higher proportion of dermatologic findings compared to heroes.

Michael Ryan, one of the researchers from the University of Texas, said:

“The depiction of skin issues in movies and its association with evil over good could be a factor contributing to the stigma of skin disease. By repeatedly portraying protagonists as characters with flawless skin, there is the potential to cause distress in those whose appearance does not fit this unrealistic ideal.

“Real life examples of this can be seen in dermatology clinics where cosmetic treatments are performed to remove harmless moles, eliminate wrinkles, and alter many of the natural skin changes that develop with age and solar exposure. Societal perceptions and beliefs regarding beauty and youthfulness are likely underlying the desire for these treatments. The association between evil and skin findings in film could be one factor that contributes to these beliefs.”

Matthew Gass of the British Association of Dermatologists said:

“The animated films we watch as children tend to stick with us, with many of us being able to fondly recall our favourites with ease. We watch them in formative years when we are learning about good and evil, and whether they mean to or not, it’s likely that they impact our biases and associations.

“One thing that thing that we know is that the creators of these works are capable of producing emotional, nuanced, and thoughtful works. We hope that this means that they will be open to considering this research when making animated films in future.”

-Ends-
Notes to editors:

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

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

Dermatologic Depictions in Animated Movies BJD-2018-0144.R2

The abstract for this manuscript is as follows:

Background: Living with skin disease can be distressing for dermatology patients and can adversely affect their wellbeing. Inaccurate dermatologic depictions in media may contribute to this angst and reinforce the stigma of skin disease.

Objective: To determine if different dermatologic depictions exist among character categories in animated movies.

Methods: This cross sectional study examined major characters from the top 50 highest grossing animated movies and separated them into four categories based on roles. The metrics mean findings per character and proportion with one or more skin findings were compared between categories and tested for significance.

Results: Characters with villainous roles or negative attributes had a higher number of findings than characters meant to appear good. Only 25.9% of traditional protagonists and hidden antagonists had any skin findings at all and averaged 0.37 findings per character, while 76.5% of traditional antagonists and atypical protagonists had skin findings, averaging 1.56 findings per character (p< .0001).

Conclusion: Increased skin findings for evil characters in animated children’s movies can reinforce stigmas surrounding skin disease and may contribute to the distress felt by dermatology patients.
 

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

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

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

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

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

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

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

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

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

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

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

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

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

John Anastasiou, President and CEO of Frezyderm, said:

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

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

About Acne

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

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

What causes acne?

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

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

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

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

-Ends-

Notes to editors:

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

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

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

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

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

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

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

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

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

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

Updated 3rd February 2020

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Sun protection tips:

1. Spend time in the shade during the sunniest part of the day when the sun is at its strongest, which is usually between 11am and 3pm in the summer months.
2. Avoid direct sun exposure for babies and very young children.
3. When it is not possible to limit your time in the sun, keeping yourself well covered, with a hat, T-shirt, and sunglasses, can give you additional protection.
4. Apply sunscreen liberally to exposed areas of skin. Re-apply every two hours and straight after swimming, sweating or towelling to maintain protection.


Checking for skin cancer:

There are two main types of skin cancer: non-melanoma, the most common, and melanoma, which is less common but more dangerous. The following ABCDE rules describe a few changes that might indicate a 'melanoma', which is the deadliest form of skin cancer. As skin cancers vary, you should tell your doctor about any changes to your skin, even if they are not like those mentioned here. If your GP is concerned about your skin, make sure that you are referred to a dermatologist. Your GP can refer you via the NHS.

Asymmetry - the two halves of the area may differ in shape or colour
Border - the edges of the area may be irregular or blurred, and sometimes show notches
Colour - this may be uneven. Several different shades of black, brown and pink may be seen
Diameter - most melanomas are at least 6mm in diameter. Report any change in size, shape or diameter to your doctor
Evolution – if you see progressive changes in size, shape or colour over weeks or a few months, you must seek Expert help.

If in doubt, check it out! If your GP is concerned about your skin, make sure you see a dermatologist. Your GP can refer you via the NHS.

Non-melanoma skin cancer

Non-melanoma skin cancers can occur on any part of the body but are most common on areas of skin that are most often exposed to the sun such as your head and neck (including lips and ears) and the backs of your hands. They can also appear where the skin has been damaged such as old scars, ulcers, burns, X-ray damage or persistent wounds.

Non-melanoma skin cancers vary greatly in what they look like. They may appear gradually on the skin and will get bigger over time. They will not go away on their own without treatment. Some possible signs include:

- A scab or sore that won’t heal. It may also bleed occasionally
- A scaly or crusty patch of skin that looks red or inflamed
- A flesh coloured, pearly lump that won’t go away and appears to be growing in size
- A lump on the skin which is getting bigger and that may be tender or sore
- A growth with a pearly rim surrounding a central crater, a bit like an upturned volcano

-Ends-


Notes to editors:

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

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

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

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

www.thedontbakebake.com

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

References:

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

About us:

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

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

Response from BAD member Dr Carsten Flohr:

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

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

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Potential for sun damage should be carefully balanced with need for vitamin D in children, say scientists

Scientists at King’s College London are encouraging parents and carers to ensure even more rigorous protection of children against the harmful effects of the sun. The comments follow a study which has suggested that children may experience much more significant DNA damage from small amounts of sun exposure than adults.

Published in the British Journal of Dermatology, the new study of 32 children under the age of 10 was undertaken at a 12-day summer camp in Poland. Children’s skin types ranged from pale white skin that burns easily to olive skin that burns minimally. Researchers, led by Professor Antony Young at King’s College London, measured levels of vitamin D alongside a urine biomarker of DNA damage that can lead to skin cancer, known as CPD, which is produced as a result of the skin repairing this damage.

The scientists, in an EU funded collaboration with Professor Joanna Narbutt of the Medical University of Lodz, Poland and Dr Peter Philipsen of the Bispebjerg University Hospital in Copenhagen, measured exposure to UV rays via an electronic device on the wrist that absorbed the rays. Children filled in diaries with information about sunbathing, sunscreen use and sunburn.

The study, found a 25% increase in average vitamin D concentrations in blood but measured nearly thirteen times more CPD on average at the end of the 12-day beach holiday in comparison to levels at the start.

The final levels of CPD in the children were similar to those measured in Danish adults as part of a different study conducted by the same researchers which looked at sun exposure on a shorter holiday in Tenerife, despite the fact that the weather was not particularly sunny during the course of the children’s summer camp.

The researchers think the results may suggest that either children are more sensitive to the damaging effects of the sun than even previously thought, or that they could be better at repairing the damage.

Sun exposure is the main source of vitamin D, which is absolutely essential for healthy bone development in children. However, sunburn in childhood is a recognised risk factor for skin cancer in older age so researchers suggest that the findings support the need for a better understanding of the impact of UV rays on children, even in less sunny conditions. This is of concern because the incidence of skin cancer is increasing in most Western countries.

‘Many parents are already very careful about protecting their children from the harmful impact of the sun,’ commented the study’s senior author, Professor Antony Young from the St John’s Institute of Dermatology at King’s College London, ‘but it can be a confusing message when trying to balance this with the need for children to be healthy, exercise, play outside and produce sufficient levels of vitamin D.’

‘Our study suggests that only small amounts of exposure to the sun are needed to ensure vitamin D sufficiency so we should make sure that children always have ample sun protection when playing outside for long periods. This should be in the form of sunscreen, clothing and hats and the use of shade, even when you may not judge the weather to be that sunny.’

Nina Goad of the British Association of Dermatologists said: ‘We would recommend that parents use a number of methods to prevent sun damage. The first line of defence for children should be protective clothing, such as hats, t-shirts, and sunglasses. In addition to this, it’s important to make good use of shade between 11am and 3pm.

‘You should bolster this protection with sunscreen. Look for one with a minimum SPF of 30 and good UVA protection. It should be applied 15 minutes before going outside and then again shortly after heading outdoors to cover any missed patches. Reapply it at least every two hours, and immediately after swimming, perspiring and towel drying or if it has rubbed off.

‘If you are concerned about maintaining your family’s vitamin D levels then the answer isn’t to stop using sun protection, but consider options such as vitamin D supplements.’

Another recent study by Professor Young’s team, led by Dr Damilola Fajuyigbe from King’s College London,suggested that people with very fair skin should be routinely using sunscreen products with a protection factor (SPF) of around 60 or more in order to reduce skin cancer incidence to the very low levels usually seen in people with dark brown or black skin.

The scientists were examining the way in which melanin is distributed in different skin types and found that 70-80% of melanin in the skin was concentrated in the deepest layer (the basal layer that contains the crucial stem cells). For participants with black skin, who have higher overall concentrations of melanin, this equated to protection from DNA damage that was the equivalent of around SPF 60.

-ends-

For further information please contact Hannah Pluthero, Press Officer at King’s College London on 0207 848 3202 or hannah.pluthero@kcl.ac.uk

Notes to editors

‘Children sustain high levels of skin DNA photodamage, with a modest increase of serum 25(OH)D3 after a summer holiday in Northern Europe’ is published on 25 April 2018 in the British Journal of Dermatology.

This project has received funding from the European Union’s Seventh Framework Programme for research, technological development and demonstration under grant agreement no 227020. The research was also supported by the National Institute for Health Research Biomedical Research Centre based at Guy’s and St Thomas’ NHS Foundation Trust.

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Leading UK medical and aesthetic associations launch register to protect public from rogue cosmetic practitioners

London, U.K. 01 March 2018 - The Joint Council for Cosmetic Practitioners (JCCP) has launched a not-for-profit register for practitioners of non-surgical cosmetic treatments today. The procedures covered include the injection of botulinum toxin and fillers, chemical peels/skin rejuvenation, laser treatments and hair restoration surgery. The register is open for practitioners to register now and will open to public in April.

‘The JCCP Practitioner Register’ (available at: www.jccp.org.uk) requires members to meet standards set by the Cosmetic Practice Standards Authority (CPSA), a body of experts established for this purpose. These standards are set high and cover important check points like qualifications, safety, insurance, premises, complaints handling and much more.

The combined founding members of the JCCP and the CPSA include:

  • The British Association of Aesthetic Plastic Surgeons (BAAPS)
  • The British Association of Cosmetic Nurses (BACN)
  • The British Association of Dermatologists (BAD)
  • The British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS)
  • The British College of Aesthetic Medicine (BCAM)

Cosmetic interventions, including surgical, are already a multi-billion-pound industry. Yet unlike surgical interventions which have faced a tightening of regulations, non-surgical treatments remain largely unregulated. Although procedures carried out by doctors, nurses and dentists might be covered by their own professional codes of conduct, there are also many treatments carried out by non-regulated practitioners. Even within these disciplines, levels of training can be variable. This means that finding a suitable practitioner can be very difficult.

The aim of the register is to make finding safe and experienced practitioners easy for members of the public. The register is free to access, and will display members’ qualifications, practice competence and experience in delivering procedures. The JCCP also provides a process for dealing with complaints from members of the public regarding the conduct or fitness to practise of registered practitioners.

Members of the register can come from any discipline. However, everyone will be subject to one uniform set of education and practice standards and one set of rules regarding conduct. If a practitioner does not have sufficient training to perform a procedure, then that will be clear on the register.

In addition to the Practitioner Register, the ‘JCCP Register of Approved Education and Training Providers’ will ensure that the training that practitioners receive is fit for purpose.

The development of both registers has been informed by the engagement of more than 200 organisations and stakeholders, including patients, members of the public, professional associations, statutory regulators, government advisors, product manufacturers, pharmacies, education/training providers, industry experts, individual practitioners and many others.

The register has the backing of major bodies including:

  • The General Medical Council (GMC)
  • The Advertising Standards Authority (ASA)
  • Ofqual – The National Qualifications Regulator

Professor David Sines, Chair of the JCCP, said:

“I regard this to be a major step forward in the quest to deliver a new system of voluntary regulation to assist in the promotion of patient safety and public protection within the rapidly developing area of aesthetic treatments. I am most grateful for the support and time given by so many practitioners and stakeholders who together have worked tirelessly to assist us in our aim of creating a new overarching system of non-statutory regulation for the sector.”

Mr Simon Withey, Chair of the CPSA and President of the British Association of Aesthetic Plastic Surgeons, said:

“In 2013 the Keogh Report made it clear that an unregulated non-surgical cosmetic interventions industry was a disaster waiting to happen. That is still undeniably true. In fact, disaster has already struck for many individuals. Despite this, we probably have more untrained rogue traders than ever before, people who are risking the health and welfare of the public for a quick buck.

“Because of this I am extremely proud that the CPSA has managed to deliver the first ever framework of standards and competencies in non-surgical treatments and hair restoration surgery in the world. We’ve set the bar high, but we are sure practitioners from all backgrounds will rise to meet it, public protection must come first.”

JCCP Committee Patient Representative Dawn Knight, said:

““I have experienced some of the worst that the cosmetic industry has to offer, and there are many more like me. There is so much conflicting information it’s difficult to know where to start to find a safe, qualified practitioner. The register will make this so much easier and safer for patients, reassuring them that the right checks have been done on their behalf. Being able to find the right person first time, and getting redress if the need arises, is such a welcome step forward.”

--Ends--

 

Notes to editors:

Practitioners can join the register from March 1st 2018 at www.jccp.org.uk. The register will be accessible to the public in April.

Contacts:

To speak to a member of the JCCP about the register, contacts are as follows:

Strategic contact, Professor David Sines, CBE, Chair JCCP,

Email david.sines@jccp.org.uk

Operational contact, Paul Burgess MBE, Executive Support Officer JCCP,

Email paul.burgess@jccp.org.uk

To speak to a member of the CPSA about the new practice guidelines or any treatment-related / medical questions, contacts are as follows:

Strategic contact, Mr Simon Withey, Chair, CPSA

E Mail simon.withey@me.com / comms@bad.org.uk / 0207 391 6084

Treatments and guidelines: Dr Tamara Griffiths, British Association of Dermatologists

E Mail: comms@bad.org.uk / 0207 391 6084

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