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Research reveals mechanisms behind “COVID toes”

Redness and swelling of the hands and toes, known as chilblain-like lesions, have been reported during the COVID-19 pandemic. A new study published in the British Journal of Dermatology uncovers the underlying mechanisms involved in such “COVID toes” symptoms. 

The study included 50 participants with COVID toes and 13 with similar chilblains lesions that arose before the pandemic. The mechanisms behind both types involved an immune response with high levels of certain autoantibodies as well as type I interferon, a key protein in the antiviral response.  

In addition to the immune system, endothelial cells that line blood vessels also appeared to play a critical role in the development of COVID toes and chilblains. 

“The epidemiology and clinical features of chilblain-like lesions have been extensively studied and published, however, little is known about the pathophysiology involved,” said senior author Charles Cassius, MD, of Hôpital Saint-Louis, in Paris, France. “Our study provides new insights.”

Additional Information

Link to Study: https://onlinelibrary.wiley.com/doi/10.1111/bjd.20707

About Journal

British Journal of Dermatology, BJD, is a top-ranked international dermatology journal, publishing the highest-quality research to advance the understanding and management of skin disease to improve patient outcomes. The journal publishes high impact global research, including that coming from the United States and Canada.

The British Journal of Dermatology is owned by the British Association of Dermatologists (BAD) 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 Wiley

Wiley is a global leader in research and education, unlocking human potential by enabling discovery, powering education, and shaping workforces. For over 200 years, Wiley has fueled the world’s knowledge ecosystem. Today, our high-impact content, platforms, and services help researchers, learners, institutions, and corporations achieve their goals in an ever-changing world. Visit us at  Wiley.com, like us on Facebook and follow us on Twitter and LinkedIn.

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Lower socioeconomic status linked with more severe skin disease, including melanoma

Systematic Review | Not Peer Reviewed | Dermatoses

Socioeconomic factors impact the severity of inflammatory skin conditions such as atopic eczema and psoriasis, research being presented at the British Association of Dermatologists’ Annual Meeting suggests. Furthermore, skin cancers, such as melanoma, also have a worse prognosis in those with a lower socioeconomic status (SES).

Low-income households, a lower level of paternal or maternal education and dilapidated housing were consistently linked to an increase in the severity of five common skin conditions: atopic eczema, psoriasis, melanoma, hidradenitis suppurativa and sarcoidosis.

This study, presented by researchers from Betsi Cadwaladr University Health Board, examined sources from meta-analysis and reviews to analyse the link between socioeconomic factors and the severity and incidence rate of various dermatological conditions.

Whilst melanoma incidence was increased in individuals with a higher socioeconomic status, a worsened prognosis was associated with a lower socioeconomic status. The chances of having a more advanced melanoma at diagnosis was significantly higher in groups with lower education level and the risk of mortality was increased for those with a low SES.

Similarly, a review using the Global Burden of Disease study data found that the incidence of psoriasis is greater in high-income European countries. However, lower household incomes are linked to more clinically severe psoriasis cases. Patients that have a low socioeconomic status also have a higher impairment to their health-related quality of life than those from a high-income household.

Using a 2018 US survey of 2,137 patients with childhood-onset atopic eczema, education levels were also found to be inversely associated with the severity of a patient’s eczema. What is more, a higher concentration of children suffering with severe eczema lived in unsafe, unsupportive, or underdeveloped neighbourhoods.

Hidradenitis suppurativa severity was found to be higher in low SES households and a higher proportion of patients with severe-to-very severe sarcoid were from lower-income households (13% compared to 3%).

Dr Siwaporn Hiranput, Dermatology specialist registrar at Glan Clwyd hospital, North Wales deanery said:

“The data from this study gives robust evidence that while skin disease can affect all members of society, the burden of diseases do not fall equally. Consistently, the most deprived in society tend to face more severe disease. We want to emphasise the importance of socioeconomic factors in patients with common skin conditions.”

Harriet Dalwood of the British Association of Dermatologists, said:

“It is really important to have research which clearly demonstrates health inequalities amongst people with skin disease. We know that melanoma is a disease which disproportionately affects the more advantaged in society, but it is less well recognised that that the severity of the disease tends to be worse amongst those with lower socioeconomic status. Health inequalities such as these are not just a health issue, they require joined-up thinking across government supported by organisations across the country.”

The researchers have acknowledged that there are limitations to this study, including difficulty determining the sequence of the observed association and reverse causality. For example, the severity of dermatoses may influence SES rather than the other way round.  

Further research is needed to ascertain the potential link between SES and skin diseases. This would include larger studies examining the association of SES with other common skin conditions, and the use of specific study designs to and minimise bias, in particular recall bias.

Notes to editors:

If using this press release, please ensure you mention that this research was presented at the British Association of Dermatologists’ Annual Meeting.

The virtual meeting will be live from the 6th-8th July 2021 and is attended by approximately 1,500 UK and worldwide dermatologists and other healthcare professionals.

For more information please contact: harriet@bad.org.ukor call 07769000415

Website: www.skinhealthinfo.org.uk

Study Details:

Socioeconomic factors influence severity rather than incidence of dermatoses 

S. Hiranput,1 Y. Hafouda,2 J. Callander3 and 

P.D. Yesudian31Betsi Cadwaladr University Health Board, Bangor, UK; 2Betsi Cadwaladr University Health Board, Bodelwyddan, UK; and 3Betsi Cadwaladr University Health Board, Wrexham, UK 

 

About the British Association of Dermatologists

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

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

 

 

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Winners of the Archibald Gray Medal and the Clinician of the Year Award Announced

The BAD is pleased announce this year’s winners of the Archibald Gray Medal and the Clinician of the Year Award.  

Professor Nick Levell, Consultant Dermatologist at Norfolk and Norwich University Hospitals NHS Foundation Trust, has been awarded the prestigious Sir Archibald Gray Medal at this year’s British Association of Dermatologists’ (BAD) Annual Meeting.  

Named after the founder of the BAD, the Sir Archibald Gray Medal is awarded as the BAD's ultimate accolade for outstanding services to dermatology.  

Professor Levell is a Past-President of the BAD and Chair of the BAD’s Therapy and Guidelines Committee. He is also the National Clinical Lead (Dermatology) for NHS Improvement, leading on the GIRFT programme which is improving quality of care by reducing unwarranted variation between hospitals. 

Doctor Tamara Griffiths, Director of Education at the British Association of Dermatologists, has been awarded the British Association of Dermatologists’ (BAD) Clinician of the Year which will be presented at the 101st Annual Meeting.  

The Clinician of the Year award was designed to recognise a clinical dermatologist who has made a real difference and impact in their local area.  

Dr Tamara Griffiths was appointed the first Education Director in 2015, leading the Education Unit at the British Association of Dermatologists. She addresses workforce needs of dermatologists through education initiatives, working tirelessly to ensure members of all levels receive the materials they need to excel in their career.  

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UVC lamps effective at disinfecting the air in occupied rooms of COVID particles, simulations show

Simulation/Modelling | Not Peer Reviewed | SARS-CoV-2

Ultraviolet C (UVC) emitting lamps have been shown to be fast, effective, and safe at inactivating SARS-CoV-2, the virus responsible for COVID-19, in real-world environments, a new study shows.

Simulations found that a 99.9% reduction of particle load can be achieved in a standard classroom in 30 minutes.

-based, animal, and limited human studies have previously shown that far-UVC excimer lamps, with a peak emission wavelength of 222 nm, can be used to inactivate influenza and coronavirus particles, though not specifically SARS-CoV-2, essentially disinfecting the air.

This study, being presented by researchers from NHS Tayside and the Universities of Dundee and St. Andrews at the British Association of Dermatologists’ Annual Meeting, examined whether these findings held true for SARS-CoV-2, in real-world environments.

The researchers used a two-pronged approach to this study:

  1. Computer modelling was used to simulate air flow, particle generation and far-UVC irradiation of a typical classroom
  1. A sophisticated skin model, TenSkin™, was used to mimic intact, living skin, to see the impact that these lamps have on skin, particularly in terms of whether they increase the risk of skin cancer, by looking for signs of DNA damage

For the computer modelling, a standard classroom was simulated, measuring 12 m x 6 m x 3 m, with four air inlets, each 20 cm x 20 cm, producing six air changes an hour(ACH). With a uniform release of SARS-CoV-2 particles, at a height of 0.5 m, the mechanical ventilation alone reduces the particle load to six percent in 30 min. The addition of 18 commercially available far-UVC lamps located in the ceiling, irradiating the room below, resulted in a reduction to three percent in 30 min.

Far-UVC lamps which distribute UVC radiation more broadly would further reduce the SARS-CoV-2 particle load to 0.1% at 30 min.

These simulations accounted for the legal limits required when exposing people to these types of lamps. However, exposure of the skin model to a filtered far-UVC lamp resulted in little DNA damage at a dose 260 times higher than current legal limits, and this was restricted to minor cell damage to the outermost layer of the skin. This suggests that there may be a case for increasing current exposure limits for these devices.

With this knowledge, the classroom simulations were then repeated with higher irradiation restrictions. When set at 20 times the current exposure limits a 99.99% reduction of particle load was achieved within four and half minutes. When set at 100 times the current exposure limits this reduction was achieved within one minute.

Dr Ewan Eadie, Head of Scientific Services at the Photobiology Unit, NHS Tayside, said:

“This research is still at an early stage, but it shows a model by which the air in rooms can be disinfected safely and effectively with little to no impact on the skin. To put this in context, our research tells us that current legal limits for far-UVC exposure would cause a fraction of the DNA damage caused by a short spell outside. We found that it would take between 30 and 30,000 hours of exposure to far-UVC to produce the same DNA damage as just 10-minutes of springtime English sun exposure.”

Dr Kenneth Wood, of the School of Physics and Astronomy at the University of St Andrews, said:

“Currently there is limited evidence specifically looking at the effectiveness of far-UVC lamps in inactivating SAR-CoV-2 in the air. This is an important area of research as there is a clear need for practical methods for reducing the transmission of COVID-19 in indoor settings. Without this, the focus tends to be on disinfecting surfaces, which while a sensible step, does not prevent transmission of the disease through the air.

“This research is the result of computer modelling, as with any model, it is limited by information we feed into it, that said there is lots of supporting evidence which suggests that the results are accurate. Further real-world research would be useful to directly validate what we have found in our simulations”.

Ultraviolet C radiation has long been used to kill microorganisms and to disinfect air, surfaces, objects, and liquids. It works on SARS-CoV-2 by destroying the outer protein coating of the virus, which inactivates it.

Notes to editors:

If using this press release, please ensure you mention that this research was presented at the British Association of Dermatologists’ Annual Meeting.

The virtual meeting will be live from the 6th-8th July 2021 and is attended by approximately 1,500 UK and worldwide dermatologists and other healthcare professionals.

For more information please contact: harriet@bad.org.ukor call 07769000415

Website: www.skinhealthinfo.org.uk

Study Details:

Skin safety and efficacy of filtered far ultraviolet C for SARS-CoV-2 inactivation

E. Eadie,1 R.P. Hickerson,2,3 M.J. Conneely,2,3R. Hammond,4 S.K.H. Tsutsumi,2 C.P. Cabrera,5A. Wood,6 A.W. Longbottom,6 A.J. Parker,6S.H. Ibbotson7 and K. Wood5

1Photobiology Unit, NHS Tayside, Dundee, UK;

2School of Life Sciences and 7Photobiology Unit, University of Dundee, Dundee, UK;

3Ten Bio Ltd, Dundee, UK;

4School of Medicine and 5SUPA, School of Physics & Astronomy, University of St Andrews, St Andrews, UK;

6Fluid Gravity Engineering Ltd, St Andrews, UK

About the British Association of Dermatologists

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

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

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Professor Hywel Williams recognised in the Queen’s Birthday Honours

A leading expert in dermatology from the University of Nottingham has been recognised in the Queen’s Birthday Honours.

Professor Hywel Williams

Hywel Williams, Professor of Dermato-Epidemiology & Co-Director of the Centre of Evidence-Based Dermatology in the School of Medicine at the University; honorary consultant paediatric dermatologist at Nottingham University Hospitals NHS Trust; and former Director of the NIHR Health Technology Assessment Programme, has been awarded an Order of the British Empire (OBE). The award is for his services to the national Covid-19 research response and his lifelong research into skin diseases.

In his role as NIHR HTA Director and more recently as NIHR Scientific and Coordinating Centre Programmes Contracts Advisor, Professor Williams worked tirelessly to galvanise a joined-up research response to the pandemic. He was, and still is, a key advisor to a number of funding and oversight groups set up to help manage the Covid-19 research response, and to ensure that effective treatments reach NHS patients in record time.

Within dermatology, Professor Williams contributed to national guidance on shielding for patients taking immunosuppressive medications at the request of the Chief Medical Officer. He co-ordinated efforts to ensure consistent advice to people with eczema on how to handwash during the pandemic; producing a training video which has been used worldwide

Outside of the pandemic, Professor Williams is one of the most cited dermatologists in the world. He is a champion of patient and public involvement in research and for promoting an independent and evidence-based approach for people with skin problems. In 1998 he founded the Centre for Evidence-based Dermatology and in 2013 he was awarded a higher doctorate (DSc) for his international research into the causes and treatment of eczema. In 2014, he was nominated to become a fellow of the Academy of Medical Sciences and in July 2017, he was awarded the Sir Archibald Gray medal by the British Association of Dermatologists. The Medal is the highest accolade for outstanding services to British dermatology.

Professor Williams said on his OBE: “Well, this came as a bit of a shock, but it feels good to be appreciated. I owe so much to the wonderful people that I work with at the NIHR, the University and the Trust. At the end of the day, whether it is research about Covid-19 or dermatology, our teamwork is all about enabling people to benefit from unbiased high quality evidence to make informed choices.”

Ends

More information is available from Charlotte Anscombe, Media Relations Manager in the Press Office at the University of Nottingham, on +44 (0)115 74 84417charlotte.anscombe@nottingham.ac.uk

Notes to Editors

Our academics can now be interviewed for broadcast via our Media Hub, which offers a Quicklink fixed camera and ISDN line facilities at Jubilee campus. For further information please contact a member of the Press Office team on +44 (0)115 951 5798, email  pressoffice@nottingham.ac.uk

For up to the minute media alerts, follow us on Twitter

The University of Nottingham is a research-intensive university with a proud heritage. Studying at the University of Nottingham is a life-changing experience, and we pride ourselves on unlocking the potential of our students. We have a pioneering spirit, expressed in the vision of our founder Sir Jesse Boot, which has seen us lead the way in establishing campuses in China and Malaysia – part of a globally connected network of education, research and industrial engagement. Ranked 103rd out of more than 1,000 institutions globally and 18th in the UK by the QS World University Rankings 2022, the University’s state-of-the-art facilities and inclusive and disability sport provision is reflected in its crowning as The Times and Sunday Times Good University Guide Sports University of the Year twice in three years, most recently in 2021. We are ranked eighth for research power in the UK according to REF 2014. We have six beacons of research excellence helping to transform lives and change the world; we are also a major employer and industry partner – locally and globally. Alongside Nottingham Trent University, we lead the Universities for Nottingham initiative, a pioneering collaboration which brings together the combined strength and civic missions of Nottingham’s two world-class universities and is working with local communities and partners to aid recovery and renewal following the COVID-19 pandemic

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Experts concerned as COVID-19 pandemic causes a drastic fall in skin cancer diagnoses

Experts concerned as COVID-19 pandemic causes a drastic fall in skin cancer diagnoses 

 

Melanoma diagnoses fell 28% from April to November 2020 during the COVID-19 pandemic compared to the previous year. This equates to an estimated 2,671 fewer diagnoses than expected. 

It is thought that the drop in skin cancer cases is due to a reduced number of people seeing their GP about potential skin cancers during the pandemic. 

The data comes from the National Cancer Registration and Analysis Service and has been accepted for publication in the British Journal of Dermatology. 

Melanoma is the fifth most common cancer in the UK, causing around 2,300 deaths every year. Projections, based on case numbers from previous years, indicate that incidence rates should have increased in 2020. 

To mark Sun Awareness Week 2021 (3rd-9th?May), dermatologists from the British Association of Dermatologists’ Skin Cancer Prevention Committee are urging the public to check their skin for the signs of skin cancer and raise any concerns with their GP.

May 2020, which is melanoma awareness month, saw the steepest drop off in melanoma diagnoses, with just 54% of the expected number of diagnoses for the month, in June this figure rose to 64%, and in August it was 69%. 

Estimates suggest that there were even larger drops in the number of keratinocyte cancers diagnosed. Keratinocyte cancers, also known as non-melanoma skin cancers, include basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC). While less deadly than melanoma skin cancer, these cancers are far more common.

The number of BCCs and cSCCs biopsied in April 2020 was just 22% and 58%, respectively, of the number biopsied in April 2019. 

Dr Zoe Venables, Dermatology consultant at the Norfolk and Norwich University Hospital and Dermatology Clinical Lead, National Cancer Registration and Analysis Service commented:   

“We are becoming increasingly aware that the COVID-19 pandemic has effects far beyond those immediately infected by the virus. Undoubtedly, fewer cancer diagnoses are being made during the pandemic and it is of grave concern that this represents patients who are likely to present later, resulting in worse outcomes. We strongly encourage the public to do routine body checks including a full body skin check and attend their GP should they have any concerns.”   

Dr Bav Shergill, Chair of the British Association of Dermatologists’ Skin Cancer Prevention Committee, said: 

“This is another tragic side effect of the pandemic and is of massive concern to us. These missing cases will turn up eventually, sadly for the people concerned, the cancer will be more advanced, which will worsen their prognosis, and result in more complicated and costly treatment. 

“We are highlighting these figures during Sun Awareness Week to open a dialogue with the public on how important it is to frequently check your skin for signs of cancer. If you have been putting off going to see your doctor about changes to your skin due to the pandemic, please book in an appointment as soon as you can.” 

  -Ends-

Notes to Editors

Sun Awareness Week runs from the 3rd to the 9th of May 2021. 

Information on how to check your skin for melanoma and other skin cancers can be found here.  

Sun advice for skin of colour: 

Although skin cancer is less common for those with brown or dark brown skin types, it can still happen, and it is important to be aware of the signs. One subtype of melanoma called acral lentiginous melanoma is more common in skin of colour. Acral lentiginous melanoma arises on the palms, soles, fingers, or toes, including under nails, and starts as a patch of discoloured skin. It can also be recognised using the ABCDE method for checking your skin. Sun protection advice for skin of colour is available here

For more sun protection information visit the Sun Awareness page of the BAD’s Patient Hub. 

For more information contact the media team: comms@bad.org.uk, 07769000415. 

Website: www.skinhealthinfo.org.uk

The research letter can be found here from 8am on the 3rd May: https://onlinelibrary.wiley.com/doi/abs/10.1111/bjd.20409

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.skinhealthinfo.org.uk  

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

Study details:

The impact of the COVID-19 pandemic on skin cancer incidence and treatment in England, 2020 

Zoe C Venables1,2, Shehnaz Ahmed4, Tanya Bleiker3,4, John Broggio2, Marta Kwiatkowska2,4, Nick J Levell1, George WM Millington1,4, Lizz Paley2, Elsita Payne2, Charlotte Proby5, Sally Vernon2, Sean McPhail2

Institutions 

  1. Norfolk and Norwich University Hospital, Norwich, U.K. 
  2. National Cancer Analysis and Registration Service, Public Health England, London, U.K.;  
  3. University Hospital of Derby and Burton NHS Foundation Trust 
  4. British Association of Dermatologists, London, U.K 
  5. Ninewells Hospital & Medical School, University of Dundee, Dundee, U.K 
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Higher Orange Consumption Linked To Increased Risk of Melanoma, New Study Suggests

Individuals who consume more citrus fruit, especially oranges and orange juice, are at higher risk of melanoma compared to those with no consumption, according to research published in the British Journal of Dermatology. Findings suggest that consuming more than two servings of citrus a day is associated with a 63% increased risk of melanoma, relative to those with no consumption.

The researchers, from Indiana University, investigated the association between citrus consumption and melanoma, whilst taking into account a number of other factors which are already known to be risk factors for the disease, such as age, tanning habits, and having fair skin.

Using data from the UK Biobank, the researchers were able to review a large sample of 198,964 people, made up of 1,592 people with a melanoma diagnosis and 197,372 controls. Citrus intake data was collected via five rounds of questionnaires, asking participants to recall their citrus intake over the previous 24 hours.

Furthermore, the study found that consumption of oranges was independently associated with an increased risk of melanoma, relative to those with no consumption. The research found that those consuming more than one serving of oranges per day had a 79% increased risk for melanoma compared to those with no consumption and consuming more than one serving of orange juice increased the risk by 54%.

While a relationship between citrus consumption and melanoma risk was observed among this UKBB sample, participants with a fair or very fair skin complexion were found to be particularly at risk with higher citrus intake.

Dr Andrew R. Marley, lead author of the research, said:

“Psoralen has known photosensitising and photocarcinogenic properties and is found in abundance in citrus products. This fact has spurred studies to investigate whether high citrus consumption is associated with melanoma risk due to psoralen photocarcinogenicity. This research suggests a significant increase in melanoma risk associated with a higher citrus intake and these findings could well shape sun-exposure guidance and how we approach advising patients that are already at high risk of developing melanoma.”

Harriet Dalwood of the British Association of Dermatologists, said:

“As melanoma rates continue to rise, improved prevention strategies are needed. Research into contributing factors, such as citrus consumption, are useful in reducing skin cancer rates, particularly amongst those most at risk.

“Citrus fruits, especially oranges and orange juice, are consumed widely in the UK, with fruit juice consumption reported to be increasing year-on-year. This research could help medical professionals better advise patients who already have established risk factors such as a family history of melanoma to lower their citrus intake.”

Previous studies in this area have yielded inconsistent results and have been subject to limitations in their sample pools. For example, the Nurses’ Health Study and Health Professionals Follow-Up Study consisted of health care professionals who would have greater knowledge of UV protection, and the Women’s Health Initiative study, which found there was no significant association between citrus and melanoma risk, could be due to the postmenopausal respondents, who typically are less likely than younger women to engage in certain melanoma-risk behaviours.

There are around 16,200 cases of melanoma in the UK every year, this represents a 135% increase in annual melanoma cases since the early 1990s. It is the 5th most common cancer diagnosis among UK residents and is growing in incidence faster than any other cancer.

The researchers acknowledge the study’s limitations, including the reliance on self-reported citrus consumption data. Results were further limited due to inability to control for unmeasured confounding factors, such as family history of melanoma.

Dr. Xin Li, senior author of the research, said:

"Despite our study limitations, we leveraged data from a large, population-based sample and we were able to control for several key sociodemographic and skin cancer-related variables. We believe that these results, based on biological plausibility, provide evidence in support of an association between high citrus consumption and melanoma risk."

Notes to editors

More statistics on melanoma rates in the UK can befound here. Please notethat the statistics in this press release represent relative risk.

UK Biobank is a large prospective cohort with more than 500,000 participants aged 40-69 years old when recruited in 2006-2010.

Only White/Caucasian participants were included in the analyses due to low melanoma incidence in ethnic minorities in the UK.

This study shows that further research on this topic is necessary, particularly focussing on how the relationship may vary among individuals with different pigmentary phenotypes.

 

Study details:

The Association between Citrus Consumption and Melanoma Risk in the UK Biobank

A.R. Marley,1 M. Li,2 V. L. Champion,3,4 Y. Song,1 J. Han*1,4 and X. Li*1,4

1Department of Epidemiology, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, USA

2Department of Epidemiology and Biostatistics, Indiana University School of Public health,

Bloomington, USA

3Department of Community Health Systems, Indiana University School of Nursing, Indianapolis, USA

4Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, USA

Link to the full study:

https://onlinelibrary.wiley.com/doi/epdf/10.1111/bjd.19896

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

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

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Dermatologists warn of risks to medics from HPV, COVID, and other viruses in surgical smoke

The British Association of Dermatologists (BAD) is calling for smoke extractors to be available in all settings where dermatology surgery takes place, following growing concern that surgical smoke plume can transmit viral infections such as HPV. The organisation is also calling for further occupational health research into the risks of viruses being carried from patient to healthcare professionals through surgical smoke

Surgical smoke is formed during surgical procedures that use lasers or cauterisation to destroy skin tissue. As the skin tissue is destroyed, viral particles are aerosolised, remaining suspended in smoke, which can then be breathed in by healthcare professionals.

Dermatologists are spending a larger proportion of their week in the operating theatre than ever before, meaning the risks of catching viral infections have increased. Viral DNA has been observed on the face of surgeons following operations wherein surgical smoke was present.

The viruses which are thought to pose the biggest long-term health concern, include:

  • Human papillomavirus (HPV)
  • Merkel cell polyomavirus (MCPV)
  • COVID-19 – though the risk is currently reduced by the current widespread use of personal protective equipment (PPE)

HPV infection has been shown to be a necessary component in the development of all cervical cancers, as well as a proportion of other genital cancers. The infection is also a contributing element in head and neck squamous cell carcinomas (HNSCCs), especially oropharyngeal, tonsillar and laryngopharyngeal cancers.

Concern over the severity of the issue has been growing over the last 30 years and while the threat of COVID-19 transmission has encouraged hospitals to widely adopt PPE, the BAD is calling for the use of appropriate PPE for all surgeries where surgical smoke is present, to prevent transmission of viral infections.

Professor Nick Levell of the British Association of Dermatologists commented: 

“In our hospitals, all kinds of precautions are taken to reduce the risks of cross infection. However, despite being aware of the potential risks for 30 years, surgeons are still breathing in smoke generated by human tissue, along with any viral particles present in the skin.

“Recent data reviews by the Centers of Disease Control and Prevention (CDC) and Health and Safety Executive (HSE) have found that the number of healthcare professionals known to have developed a HPV-associated disease is small, however, there are concerns that this is severely under-reported issue due to the fact that HPV can lie dormant in the body for decades. We are aware of reports of head and neck infections, including cancers, in specialists from ENT surgery, gynaecology, and dermatologists specialising in genital disease.

“More research must be done looking into this issue as an ever-increasing number of dermatologists find themselves in the operating theatre day-in-day-out. We are also urging hospitals to ensure that appropriate PPE and smoke extractors are available for use in all surgeries where surgical smoke may be generated.”

Editor’s Notes

The full position statement from the British Association of Dermatologists on the risk of cancer from viral particles in surgical plume can be viewed here.

For more information contact harriet@bad.org.ukor call 07769000415 

About the British Association of Dermatologists

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

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BAD Officer Election Results 2021

The BAD 2021 Officer elections have now concluded, the results are as follows:


President Elect 2021-2022 (leading to President 2022-2024) – Dr Mabs Chowdhury
Academic Vice President 2021-2023 – Professor Richard Warren
Assistant Honorary Secretary 2021-2023 (leading to Honorary Secretary 2023-2025) – Dr Tom Lucke

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