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Covid-19 (Coronavirus): Immunosuppressive treatments in dermatology

Last updated 3rd April 2020

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

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

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

These can be found on the Guy’s website: https://www.guysandstthomas.nhs.uk/our-services/dermatology/dermatology-and-coronavirus-frequently-asked-questions.aspx#na – scroll down to “Immunosuppressants and medication”.

NHS England FAQ on shielding for patients

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

Risk stratification grid for healthcare professionals

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

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

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BAD statement on shielding of higher risk dermatology patients

Last updated: 3rd April 2020

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

NHSE FAQ (frequently asked questions) on shielding for patients

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

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Bereaved individuals may face higher risk of dying from melanoma

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

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

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

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

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

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

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

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

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

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

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

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

Dr Walayat Hussain of the British Association of Dermatologists said:

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

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

 

Notes to Editors

For more information, please contact the LSHTM press office on 0207 927 2802 or press@lshtm.ac.uk.

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

Publication

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

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

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

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

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

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

This statement was last updated on 24th March 2020

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

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

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

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

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

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

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

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

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

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

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

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