Canadian Skin

Page 1

COMPLIMENTARY

Spring 2021

North Dermatology in the

Contact dermatitis –

patch testing www.canadianskin.ca The Official Publication of the Canadian Skin Patient Alliance

CLOSE-UP ON PSORIASIS LIVING WITH MELANOMA

VOLUME 12 • ISSUE 1

CANADIAN


SKINfacts Beard benefits

Have you been staying home and letting your facial hair grow out? If you keep your beard clean and well kept, you may benefit from: 1. Blemish prevention: When you shave, you risk exposing your skin to bacterial infection. By letting your beard grow, you’re not only able to hide blemishes, but may prevent them from happening in the first place. 2. Sun shield: Although sunscreen should still be applied, research has shown that a beard can help protect your skin from harmful UV rays. 3. Moisturizer: A beard is basically a natural scarf, which makes the cooler months a perfect time for no shaving. By shielding your face from the cold, dry air, your skin stays moisturized with the natural oils in your beard.

TikTok tip for pimples

A new TikTok trend has seen people using hydrocolloid bandages on their faces to treat acne. Hydrocolloid bandages, which absorb fluid and pus while protecting the skin, are typically used to treat wounds. However, as numerous people on TikTok have recently learned, they can also be used to treat pimples by absorbing the pus and protecting the skin. Using hydrocolloid bandages to treat certain types of acne is not a new treatment, as the material is often used in pimple patches, which are just smaller versions of the bandages. As for whether it is effective, and safe, to use hydrocolloids on pimples, dermatologists recommend them for a fast acne treatment.

Spring 2021

VOLUME 12 • ISSUE 1

CANADIAN

Spring 2021 • Volume 12 • Issue 1

COMPLIMENTARY

ISSN 1923-0729 Publisher: Craig Kelman & Associates www.kelman.ca

North Dermatology in the

All rights reserved. ©2021 Contents may not be reproduced.

Contact dermatitis –

patch testing www.canadianskin.ca The Official Publication of the Canadian Skin Patient Alliance

CLOSE-UP ON PSORIASIS LIVING WITH MELANOMA

2 | www.canadianskin.ca | Spring 2021

SUGGESTIONS AND TIPS FOR SKIN PATIENTS AND THEIR FAMILIES

Managing rosacea

For people with rosacea, managing the skin condition can be a challenge since what triggers redness and inflammation of the skin in one person may not trigger it in another. Here are some additional tips for managing rosacea: • Don’t overheat. Extremely hot temperatures often aggravate rosacea. • Protect your face from wind and cold. Covering your face with a scarf helps protect your skin. Just make sure that the material touching your face is not made of wool or a fabric that feels rough to the touch. These fabrics can irritate the skin. • Apply a sunscreen before going outside since sun exposure can cause rosacea to flare. Look for sunscreens that: • contain zinc oxide or titanium dioxide as these ingredients are the least irritating. • have broad-spectrum protection. • have a Sun Protection Factor (SPF) of at least 30. A sunscreen that contains silicone also can help protect the skin and minimize stinging and redness. On the list of ingredients, silicone may be called dimethicone or cyclomethicone. • Take good care of your skin. Avoid rubbing, scrubbing, or massaging the face. • When using hair spray, make sure the spray does not get on your face. • Keep your skin care routine simple. Using too many products may irritate the skin.

Canadian Skin Patient Alliance: 111-223 Colonnade Road South, Ottawa, ON K2E 7K3 Toll Free: 1-877-505-CSPA (2772) • E-mail: info@canadianskin.ca Canadian Publication Mail Sales Product Agreement No 40065546. Printed in Canada.

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ASK THE EXPERT

Learn more, live better. A Canadian health care professional answers your questions.

Wearing a mask with a skin condition, plus HS and aging By Dr. Isabelle Delorme

Q

COVID-19 has made mask wearing mandatory in most public places. I find wearing a mask difficult with a skin condition. What should I keep in mind about when wearing a mask for long periods?

A

Exacerbation of a pre-existing condition such as acne, rosacea, or seborrheic dermatitis explains the facial skin damage that is made worse by wearing a mask. Less frequently, a new contact dermatitis, related to wearing a mask, can occur.

These steps can help you prevent face mask skin problems. Cleanse and moisturize your face daily. Gentle skin care can prevent skin problems. When washing your face, use a mild, fragrance-free cleanser. Apply moisturizer immediately after washing your face. Use a moisturizer formulated for your skin type.

1

2

Protect your lips by applying petroleum jelly. Dry skin and chapped lips are common face mask skin problems. You can prevent chapped lips by applying petroleum jelly to your lips.

3

Skip the makeup when wearing a mask. Beneath a mask, makeup is more likely to clog your pores and lead to breakouts. If makeup is necessary, use only products labeled “non-comedogenic” or that “won’t clog pores.”

4

Avoid trying new skin care products that can irritate your skin. Wearing a mask for even a short time can make your skin more sensitive. To reduce skin problems, avoid trying harsh products for the first time, such as a chemical peel, exfoliant, or retinoid.

5

Use less of certain skin care products if your face becomes irritated. When you cover your face with a mask, some skin care products that you’ve used in the past may irritate your skin. Cut back on products that can irritate your skin, such as leave-on salicylic acid and retinoid.

6

Wear the right mask. To reduce skin problems, look for masks that offer a comfortable fit, at least two layers of fabric, and soft, natural, and breathable fabric, such as cotton. A snug, comfortable fit also reduces skin problems. If the mask feels too tight or slides around on your face, it can irritate your skin. You’re also more likely to adjust a poorly fitting mask. When you touch your mask, you can transfer germs to your mask and your face.

7

Take a 15-minute mask break every four hours. Health care workers on the frontlines of the coronavirus pandemic have found that this helps save their skin. Of course, only remove your mask when it’s safe to do so and after washing your hands.

8

Wash your cloth masks. Many health care organizations now recommend that you wash a cloth mask after each use. Washing it also removes oils and skin cells that collect inside the mask, which could lead to a skin problem.

Q A

What is the effect of aging on HS?

There is still little that is known about hidradenitis suppurativa (HS) and what causes it. HS typically has an onset in the second or third decade of life, and is more predominant in women than men, so it is believed that hormones play a role in that pathogenesis of HS. Doctors don’t see a lot of women post-menopause with HS, so it is possible that the hormone change that comes with menopause can affect the severity of the disease. With increased awareness of HS, more patients in their 60s and 70s present with the disease, so it is possible that there are multiple factors that contribute to the disease, and while hormones may play a major role in the disease for some patients, they could also play a minimal role for others. There is still a lot to be learned about HS, including the effects that aging has on its progression. Dr. Isabelle Delorme is a certified dermatologist working in Drummondville, Quebec. Got a question? Send to info@canadianskin.ca. If your question is published you will receive a $25 gift card. Good luck! Spring 2021

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Contact dermatitis – An introduction to

patch testing By Dr. Ian Tin Yue Wong and Dr. Gillian de Gannes

Introduction Dermatitis is a term that dermatologists often use to describe inflammation in the skin that leads to a red, itchy rash. Dermatitis can be a result of a variety reasons including atopic dermatitis (commonly known as eczema) and contact dermatitis. Eczema is the genetic predisposition to a skin barrier that does not function properly and hyperactive immune system that can lead to dermatitis. There are two types of contact dermatitis. Irritant contact dermatitis occurs when a substance or chemical is in contact with the skin (e.g., a strong chemical and short contact time, or weak chemical and prolonged contact time) and injures the skin barrier, causing a rash. Irritant contact dermatitis accounts for ~80% of contact dermatitis diagnoses. An example of this can be seen when an individual wears rubber gloves for a prolonged time and the sweat inside the gloves irritates the skin and causes a rash. When a person’s own immune system mounts an immune response to a substance or chemical and causes a rash, this is called allergic contact dermatitis and accounts for ~20% of contact dermatitis diagnoses. An example of this can be seen in 4 | www.canadianskin.ca | Spring 2021

individuals who have a nickel allergy and wear a necklace with nickel with no issues initially, but subsequently develop a red, itchy rash around their neck after a few days. The specialized process by which dermatologists investigate whether a substance or chemical causes a patient to have allergic contact dermatitis is called patch testing.

dermatologist will review the patient’s skin disease history and chemical/ substance exposure history to identify if allergic contact dermatitis is suspected. If patch testing is recommended, the dermatologist will organize a series of visits to do the patch testing. For example, at our centre in British Columbia, patients attend at least three appointments over a seven-day period.

What is tested in patch testing?

Schedule

The dermatologist tailors the chemicals/substances tested in patch testing to each individual patient’s exposure history. Patients are also screened for the most common problematic chemicals/ substances used in North American manufacturing. For example, chemicals/substances tested include nickel, preservatives, fragrances, rubber, adhesives, and dyes. These chemicals/substances may not be the first thing a person looks at in the ingredients list of a product, however, many of these chemicals/substances are very common.

Appointment 1: Chemicals/substances are applied on to patches, stuck on to the patient’s back, and labelled. Patches are left in place for 48 hours to ensure sufficient contact time between the patch and the skin for an accurate test. During this time, patients are required to avoid showers, excessive hot temperatures to limit profuse sweating, and upper body workouts.

Getting a patch test Patch testing starts with a referral to a dermatologist who offers patch testing. During a consultation, the


Appointment 2 (~48 hours later): Patches are removed. The dermatologist looks for a positive reaction (red, itchy bumps) and, if present, matches the location of the positive reaction to the labelled chemical/substance on the test patch area. The patient is sent home and can resume normal activities (e.g., showering, exercising daily), but has to return in two to five days for a second reading.

Appointment 3 (two to five days later): The dermatologist looks for any delayed positive reactions on the back and documents these before concluding the patch test. The dermatologist then discusses the findings and management strategies with the patient and provides counselling on allergen avoidance and resources to help the patient identify allergen sources in their surroundings.

What is the difference between patch testing and skin prick testing? PATCH TESTING

SKIN PRICK TESTING

Provider

Performed by dermatologists (specialists in the prevention, recognition, and treatment of diseases of the skin, hair, and nails)

Performed by allergists (specialists in the management of allergic conditions including hay fever, food allergies, and asthma)

Purpose of test

Used to identify chemicals/ substances that cause a specific skin rash (allergic contact dermatitis, a delayed type of hypersensitivity reaction) when in contact with the skin.

Used to identify allergens that cause an allergic reaction (an immediate type of hypersensitivity reaction occurring within minutes to hours, e.g., anaphylaxis, hives, runny nose, teary eyes) when ingested or inhaled.

*Patch testing does not test for food allergies, or environmental allergens that cause hay fever.

*Skin prick testing does not test for skin reactions that are caused by contact with chemicals/substances.

How test is performed

A series of chemicals/substances (e.g., fragrances, preservatives, foaming agents) are put on patches and stuck onto a patient’s back and left in contact with the skin for two days before removed and checked for a skin reaction. The patient returns for follow-up in an additional two to five days for re-assessment of any delayed skin reactions.

A series of allergens (e.g., pollen, mold, pet dander, foods) are manually needlepricked or scratched onto the skin by the healthcare provider on the forearm and observed for development of an allergic skin reaction during a 20–40-minute appointment.

Duration of test

Typically, three appointment visits scheduled over a seven-day span

Typically, one appointment visit

Want to win a

$25 gift card?

Simply answer this question: Do you have questions about COVID-19 vaccines? *Photos courtesy of Dr. Gillian de Gannes and used with patient consent for educational purposes.

Ian Tin Yue Wong, BSc (Pharmacy), MD, was a practicing pharmacist and is now a dermatology resident at the University of British Columbia, with a special interest in patient education. Gillian de Gannes, BSc (Hon), MSc, MD, CCFP, FRCPC, DABD, is the Director of the Contact Dermatitis Clinic and a Clinical Assistant Professor in the Department of Dermatology & Skin Science at the University of British Columbia.

Submit your questions to info@canadianskin.ca by March 31, 2021, along with your name and contact information, and you will be entered in a draw to win a $25 gift card. Good luck! In the Fall 2020 issue, we asked how many global COVID-19 related registries there are for skin patients. Congratulations to our contest winner: Christine V., from Ontario!

Subscribe To subscribe today to this complimentary magazine, call 1-877-505-2772 or email us at info@canadianskin.ca.

Spring 2021

| www.canadianskin.ca | 5


Close-up on: Psoriasis Focusing on new treatment approaches and guidance to management BY NADIA KASHETSKY

Psoriasis is a chronic skin condition causing areas of skin to become inflamed, thickened, and covered with silvery scales.1 For individuals with darker skin tones, areas with psoriasis may look purple, dark brown, or dark grey, as compared to red in individuals with lighter skin tones.2–4 Plaque psoriasis accounts for 80–90% of psoriasis cases, in which skin plaques occur most commonly on the elbows, knees, back, and scalp. Lesscommon types of psoriasis include guttate psoriasis, pustular psoriasis, and erythrodermic psoriasis.1,3,5 Psoriasis affects males and females equally with the highest incidence amongst age groups 30–39 or 50–69. Although it occurs mainly in adults, children and adolescents can develop psoriasis too.1 The cause of psoriasis has yet to be identified but is thought to develop from a combination of genetic, immune, and environmental factors. Psoriasis is neither contagious nor infectious and is not caused by poor hygiene.1 How is psoriasis diagnosed? Psoriasis is diagnosed by examination of the skin. Sometimes, a skin biopsy may be performed to rule out other medical conditions.1 How psoriasis is treated: The most recent evidence-based guidelines Two recent important guidelines for the management and treatment of psoriasis include the “Joint American Academy of Dermatology and National Psoriasis Foundation (AAD-NPF) Guidelines of care for the management and treatment of psoriasis” and “The Canadian Guidelines for the Management of Plaque Psoriasis.” For mild psoriasis, the guidelines suggest treatment with topical medications that you apply to your skin. These medications include 6 | www.canadianskin.ca | Spring 2021

corticosteroids; steroid-sparing agents such as vitamin D analogs, retinoids, and calcineurin inhibitors; and other topicals including emollients, coal tar, anthralin, and salicylic acid.6–9 For moderate to severe disease, topical treatment options may not be enough and systemic therapy combined with topical treatments will likely be needed. Recommended systemic therapies include phototherapies, nonbiologic oral medications, and biologics. Phototherapy options include ultraviolet B (UVB) and psoralen UVA (PUVA).9,10 Nonbiologic options include oral retinoids (acitretin) and systemic immunosuppressants (cyclosporine, apremilast, and methotrexate).9–11 Biologics can be very effective; however, they are generally reserved for people who have not responded to other treatments due to their high cost and potential side effects. These include TNF-alpha inhibitors (etanercept, infliximab, adalimumab, certolizumab), IL-12/IL-23 inhibitors (ustekinumab), IL-17 inhibitors (secukinumab, ixekizumab, brodalumab), and IL-23 inhibitors (guselkumab, risankizumab).12 Unfortunately, psoriasis is a lifelong disorder which may improve or worsen with time and currently has no cure. However, these treatment options may help to control the condition.1 Are biologics in the treatment of plaque psoriasis safe to use for women of child-bearing potential? In 2020, researchers concluded that TNF-alpha inhibitors and IL-12/IL-23 inhibitors have not demonstrated negative maternal-fetal outcomes, while data for IL-17 and IL-23 inhibitors is currently limited.13 Additionally, certolizumab is the only biologic which demonstrates that it does not actively cross the placenta between the mother and the baby during pregnancy.

Further, all biologics are likely safe during breastfeeding. Risks and benefits of biologic therapies should be determined individually by discussing disease severity, quality of life, your medical history, your preferences, and the biologic in question with your health team. For more information, talk to your doctor about the right options for you. Nadia Kashetsky, MSc, is a medical student at Memorial University. REFERENCES

1. Patient education: Psoriasis (Beyond the Basics) – UpToDate. www.uptodate.com/contents/psoriasis-beyond-the-basics. Accessed October 6, 2020. 2. Treating Skin of Color: National Psoriasis Foundation. www.psoriasis. org/advance/treating-skin-of-color. Accessed October 6, 2020. 3. Dermatology Secrets Plus – 5th Edition. www.elsevier.com/ books/dermatology-secrets-plus/fitzpatrick/978-0-323-31355-1. Accessed October 6, 2020. 4. Psoriasis in Patients of Color: Differences in Morphology, Clinical Presentation, and Treatment | MDedge Dermatology. www.mdedge.com/dermatology/article/226947/mixed-topics/ psoriasis-patients-color-differences-morphology-clinical. Accessed October 22, 2020. 5. Erythrodermic psoriasis in adults – UpToDate. www.uptodate. com/contents/erythrodermic-psoriasis-in-adults?search=psorias is&topicRef=5664&source=see_link. Accessed October 6, 2020. 6. Treatment of psoriasis in adults – UpToDate. www.uptodate.com/ contents/treatment-of-psoriasis-in-adults#H6. Accessed October 23, 2020. 7. Elmets CA, Korman NJ, Prater EF, et al. Joint AAD-NPF Guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures. J Am Acad Dermatol. 2020;0(0). doi:10.1016/j. jaad.2020.07.087 8. Kleyn EC, Morsman E, Griffin L, et al. Review of international psoriasis guidelines for the treatment of psoriasis: recommendations for topical corticosteroid treatments. J Dermatolog Treat. 2019;30(4):311-319. doi:10.1080/09546634.2019.1620502 9. Papp K, Gulliver W, Lynde C, Poulin Y, Ashkenas J. Canadian guidelines for the management of plaque psoriasis: Overview. J Cutan Med Surg. 2011;15(4):210-219. doi:10.2310/7750.2011.10066 10. Kim WB, Jerome D, Yeung J. Diagnosis and management of psoriasis. Can Fam Physician. 2017;63(4):278. www.cfp.ca. Accessed October 29, 2020. 11. Menter A, Gelfand JM, Connor C, et al. Joint American Academy of Dermatology – National Psoriasis Foundation guidelines of care for the management of psoriasis with systemic nonbiologic therapies. J Am Acad Dermatol. 2020;82(6):1445-1486. doi:10.1016/j.jaad.2020.02.044 12. Menter A, Strober BE, Kaplan DH, et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics. J Am Acad Dermatol. 2019;80(4):1029-1072. doi:10.1016/j.jaad.2018.11.057 13. Yeung J, Gooderham MJ, Grewal P, et al. Management of Plaque Psoriasis With Biologic Therapies in Women of Child-Bearing Potential Consensus Paper. J Cutan Med Surg. 2020;24(1_ suppl):3S-14S. doi:10.1177/1203475420928376


North Dermatology in the

An under-serviced specialty caring for some of the most vulnerable populations BY MIRANDA WAUGH AND DR. LYNE GIROUX

N

A northern perspective

orthern Ontario is a geographically large and unique region that is home to approximately 850,000 citizens.1 Northern Ontarians are dispersed throughout 645,000 square kilometers of land, in which 60% of the population lives in rural and remote communities across the North.1 It is known that Northern Ontarians are generally more at risk of morbidity and mortality due to poor health outcomes related to living conditions, healthcare access, and higher rates of obesity than the rest of the province.1 For this reason, diagnosing and treating diseases that affect the skin is often more complex due to patients’ social situations, when compared to Southern Ontario populations. An example of this would be the lack of access to clean water for basic hygienic purposes,

like bathing, that could exacerbate infection and the overall severity of a given skin disease like eczema. Moreover, there are cultural barriers that impact healthcare for Northern Ontario’s most vulnerable populations: francophone and Indigenous peoples.1 These include language barriers, long-distance travel to specialist appointments, and discrepancies in the integration of traditional medicine into western medicine regimes. The overall shortage of highly demanded specialist physicians like dermatologists is a major challenge in Northern Ontario healthcare. The Northern Ontario School of Medicine was created to help the overall physician shortage in the region, and it continues to do so every year. However, dermatology remains a specialty that continues to have shortages despite the high number of medical graduates who stay in the North.

As a result, getting an appointment with a dermatologist in Northern Ontario can be very difficult. Until a few years ago, Dr. Giroux was Dr. Lyne Giroux, one of the only one of Northern dermatologists for Ontario’s only the entire region dermatologists along with one other in a smaller community nearby. Luckily, two more dermatologists have started practicing in the region, which has made it easier for patients who have been waiting to see a skin specialist for months – and sometimes years – to get an appointment. To help make care more accessible, there are a variety of locum dermatologists that visit rural communities across Spring 2021

| www.canadianskin.ca | 7


FOUR dermatologists for 850,000 Northern Ontarians Photo taken by Miranda Waugh on Lake of the Woods in Kenora, ON.

the North on a monthly basis to help bridge the gap in care. At the moment, all four dermatologists currently practice in and around one of the two larger centres: Sudbury and Thunder Bay. Although closer in proximity, this remains a challenge for patients who are located in fly-in reserves or remote locations that are not necessarily close to these centres. Fortunately, due to the highly visual component of dermatology, telemedicine is a very useful tool in the field for diagnostic

Erythema migrans from tick bite 8 | www.canadianskin.ca | Spring 2021

and follow-up purposes, especially during challenging times like the COVID-19 era. Let’s take a look at some skin conditions that may be more present in the North due to environmental conditions that are somewhat distinctive to the northern outdoors. Two conditions that are important to mention are: Lyme disease and, although rare, cutaneous blastomycosis. The first sign of Lyme disease can appear as a rapidly expanding classic “bull’s eye” rash that develops after a tick bite called erythema migrans. 2 If not treated, the disease can spread and affect other organs, and lead to significant lifelong symptoms. 2 There are certain areas in Northern Ontario that are well known for their high prevalence of Lyme disease, making it an important condition to consider when trying to differentiate skin lesions. 3 Blastomycosis is a fungal infection that usually occurs when Blastomyces dermatitidis are inhaled after disruption of moist and infested soils in certain areas of North America.4 The disease usually manifests itself in the lungs and can secondarily manifest in the skin.4 In rare instances, the skin can be directly

inoculated by the fungus and produce a skin lesion similar to pyoderma gangrenosum, potentially making the diagnosis challenging.4 It is evident that Northern Ontario has many obstacles to navigate when it comes to servicing its diverse population with the care that they need. Not only is it a beautiful place to live and explore, but it also is a great place to learn medicine with the vast learning opportunities and hands-on training that it provides to medical learners. In the upcoming years, we hope patients will be able to see a dermatologist more easily in the North, where dermatologists are committed to continuing to provide excellent and culturally competent care to all Northern Ontarians.

REFERENCES

1. Strasser RP, Lanphear JH, McCready WG, Topps MH, Hunt DD, Matte MC. Canada’s new medical school: The northern Ontario school of medicine: Social accountability through distributed community engaged learning. Acad Med. 2009. doi:10.1097/ACM.0b013e3181b6c5d7 2. Borchers AT, Keen CL, Huntley AC, Gershwin ME. Lyme disease: A rigorous review of diagnostic criteria and treatment. J Autoimmun. 2015. doi:10.1016/j.jaut.2014.09.004 3. D Scott J, L Clark K, F Anderson J, E Foley J, R Young M, A Durden L. Lyme Disease Bacterium, Borrelia burgdorferi Sensu Lato, Detected in Multiple Tick Species at Kenora, Ontario, Canada. J Bacteriol Parasitol. 2017. doi:10.4172/21559597.1000304 4. Ladizinski B, Joy N, Reid DC. Primary Cutaneous Blastomycosis After Inoculation From A Woodworking Blade. J Emerg Med. 2018. doi:10.1016/j.jemermed.2017.09.034


What ’s new on the research front? The articles from which these summaries of the latest in skin research are taken are hot off the press!

Top Stories in Research By Irma Shaboian

Association found between drug use and subsequent diagnosis of lupus Researchers in Denmark examined the association between drug use and a subsequent diagnosis of systemic lupus erythematosus (SLE) or cutaneous lupus erythematosus (CLE). SLE is the most common type of lupus where a body’s immune system attacks its own tissues and causes widespread inflammation and tissue damage. SLE can affect the joints, skin, brain, lungs, kidneys, and blood vessels. CLE is a type of lupus where symptoms are restricted to the skin, such a butterfly rash that appears on a person’s cheeks. The study included all patient cases of CLE and SLE registered between 2000 and 2017 in the Danish National Patient Register (3,148 patients), matching patients by age and sex with individuals from the general population (31,480). All drugs filled at pharmacies by and administered in hospitals to research participants were included to identify drugs to examine for an association with CLE or SLE, and those filled by patients in the 12 months prior to a diagnosis were analyzed. Researchers found evidence that drugs used for inflammatory bowel disease, symptoms of slow stomach emptying, thyroid hormone medication for treating underactive thyroids, and antihistamine drugs used for seasonal allergies were plausibly related to a subsequent diagnosis of CLE and SLE. The researchers noted that the results of the study may reflect certain drugs that are prescribed for early symptoms of lupus, which should be researched further. Nevertheless, the study suggests that new cases of CLE or SLE may be drug induced. Study information: Haugaard, J. H., Kofoed, K., Gislason, G., Dreyer, L., & Egeberg, A. (2020). Association Between Drug Use and Subsequent Diagnosis of Lupus Erythematosus. JAMA dermatology.

Suicidality and psychological adverse events in patients treated with Finasteride Finasteride is often used for treating male pattern hair loss in patients with alopecia by blocking the body’s metabolism of testosterone. To investigate reports of suicide and finasteride use, researchers examined the link between suicidality (ideation, attempted, and completed suicide) and depression and anxiety with finasteride use using VigiBase, the World Health Organization’s international database of individual case safety reports. The researchers studied spontaneous reports of all adult patients using finasteride and reports of any adverse event in VigiBase. In total, there were 356 reports of suicidality and 2,926 reports of psychological adverse events in finasteride users under 45 years of age. The study found that other drugs that also treat hair loss by a different mechanism of action did not have the same associations as finasteride. These findings suggest that physicians should consider suicidality, depression, and/or anxiety when prescribing finasteride to younger patients who may be more vulnerable to the drug’s adverse effects. Study information: Ali, A. K., Heran, B. S., & Etminan, M. (2015). Persistent Sexual Dysfunction and Suicidal Ideation in Young Men Treated with Low-Dose Finasteride: A Pharmacovigilance Study. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 35(7), 687-695.

Sebaceous carcinoma incidence and survival among solid organ transplant recipients The risk of cancer is elevated among solid organ transplant recipients (SOTRs), in part because of immunosuppressive medications that prevent organ rejection. SOTR recipients have an elevated risk of developing sebaceous carcinoma (SC), a rare type of skin cancer that begins in the oil glands of the skin. In a new study, researchers assessed SC incidence and patient survival after solid organ transplantation using a cohort study from 1987 to 2017 that used data from the US Transplant Cancer Match Study, which links transplant and cancer registry data. A total of 326,282 transplant procedures were performed for 301,075 patients and a total of 102 SCs were diagnosed in 301,075 SOTRs, which corresponded to a 25-fold increased risk for SC overall after transplantation. Lung transplant and post-transplant diagnosis of cutaneous squamous cell carcinoma (caused by UV radiation) were both strong risk factors for SC for transplant recipients. Patients with SC and a prior transplant were associated with increased overall mortality – though few deaths were attributable to SC – compared with other patients with SC in the general population. The results of the study highlight the role of immunosuppression and its etiologic importance, as well as suggest a possible role for UV radiation in carcinogenesis. Study information: Sargen, M. R., Cahoon, E. K., Lynch, C. F., Tucker, M. A., Goldstein, A. M., & Engels, E. A. (2020). Sebaceous Carcinoma Incidence and Survival Among Solid Organ Transplant Recipients in the United States, 1987-2017. JAMA dermatology.

Irma Shaboian holds bachelor of science and law degrees, and is currently articling in Ottawa. Spring 2021

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FOCUS

Hey kids! Can you spot all the differences between the left side and the right side of this? Answers can be found on page 14.

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ECZEMA INFLAMED CREAM HYDRATE REDNESS FLARE ALLERGIES MOISTURIZER SCRATCHING PRESCRIPTION RESEARCH TRIGGERS ITCHY RASH Answers can be found on page 14.

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Living With…

Living with melanoma Chris’ story

Chris Isfeld’s story with melanoma began in 2017, but not how you might expect. After experiencing persistent back pain for several months, a sudden intense pain in his side dropped him to the floor one evening. An ultrasound revealed lesions on his liver and large masses on his adrenals. Scans revealed advanced melanoma with multiple tumours that were growing rapidly. Very quickly, the pain intensified and he was back in the hospital. He became partially paralyzed. Just as the doctors thought Chris’ journey was coming to an end, he began receiving life-saving immunotherapy. The treatment was very challenging, but it proved effective. After a rough start, the cancer stopped growing and the side effects gradually

became more manageable. Soon, he was walking again. Chris struggled physically and emotionally to define his new normal, exploring nutrition, spirituality, and different types of exercise.

The race

Chris decided to start running again and soon he was training almost daily. What began as a joke with his childhood friend Sean, turned into an ambitious plan to race each other 30 kilometres across frozen Lake Winnipeg in the dead of winter. True to their Viking routes, neither could back down from a challenge, so on March 14, 2020, the two crossed the finish line in Gimli, Manitoba, having completed a feat that would have seemed utterly unthinkable to Chris just a year and a half earlier. In the race they dubbed ‘A Viking’s Challenge,’ the pair raised nearly $20,000 to help fellow melanoma and skin cancer patients and proved to Chris how far he had come since his diagnosis. The results of his latest PET/CT scan last year showed an almost complete metabolic response. Chris is now considered NED (No Evidence of Disease). Today, Chris enjoys time with his family and friends in his home in B.C. He remains an active member of a community of melanoma patients and survivors.

Save Your Skin Foundation By Amy Rosvold Save Your Skin Foundation (SYSF) is a national patient-led not-for-profit group dedicated to the fight against non-melanoma skin cancers, melanoma, and ocular melanoma through nationwide education, advocacy, and awareness initiatives. Save Your Skin Foundation is committed to playing an active role in reducing the incidence of skin cancer in Canada, and to providing compassionate support for all Canadians living with skin cancers. SYSF was founded by North Vancouver resident and melanoma survivor Kathleen Barnard. In 2003, Kathleen was diagnosed with stage IV malignant melanoma, and by the time Save Your Skin Foundation was established in 2006, Kathleen’s cancer had spread to her vital organs and her treatment options were limited. Fortunately, one of her sons

discovered a trial treatment taking place in Alberta; this trial would save Kathleen’s life. While her cancer treatments have finished, the battle with melanoma is not over for Kathleen. Save Your Skin Foundation is committed to ensuring equal, timely, affordable, and appropriate access to skin cancer treatment for all Canadians, by engaging in public and private industry, health policy, and systemic treatment access issues with cancer agencies, government, and drug-approval bodies across the country. Amy Rosvold is the Marketing Director of Save Your Skin Foundation. She is passionate about patient advocacy and improving cancer care.

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A rising tide floats all boats: R A I S IN G T HE PR O FIL E O F S K IN PAT IEN T S By Rachael Manion, Executive Director, CSPA Leah Stephenson, Consultant

As a home

for all people in Canada affected by a skin, hair, or nail disorder, the Canadian Skin Patient Alliance (CSPA) regularly works with other organizations that represent distinct skin patient communities across the country. Many of these organizations are Affiliate Members of CSPA (www.canadianskin.ca/affiliate-members/currentaffiliate-members). WHAT ARE OUR BIGGEST CHALLENGES? When asked about the challenges facing the communities they represent, Affiliate Members told us how important it was that people were aware and educated about the impacts of different skin disorders. Prevention and early diagnosis of skin, hair, and nail disorders are critical to better outcomes. There are many supports available for people living with skin disorders, including in the face of COVID-19, and raising awareness of these can help people with the struggles they are facing. To improve health outcomes and quality of life for skin patients, it is crucial that we continue to invest in research for better treatment options and optimal care practices. Throughout all of this work, challenging the stigma associated with skin disorders is important and will remain at the heart of our work. When the people we support reach out to the health system for help, there are many barriers to access. Referrals and wait times to dermatologists can often be discouraging for patients and impede optimal treatment and care. Understanding the different paths to accessing treatments

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in Canada – through private or public drug benefits – is often not an easy task, with new treatments becoming available and policies that determine who can access them and when in a constant state of flux. Throughout all this, access to supports that make living well with skin disorders – including mental health supports – can also be challenging. HOW CAN WE WORK TOGETHER TO BREAK BARRIERS? In November 2020, the CSPA gathered with our Affiliate Member organizations to explore the top challenges facing distinct skin patient communities. Everyone was asked about the top challenges facing their communities, and facilitator Leah Stephenson led the group in a discussion of how collaboration could help address them. Enhancing our ability to communicate together, share opportunities, share promising and best practices, and speak with a unified skin patient voice are important and valuable. Skin is our largest organ. Vehicles like this magazine, social media, the CSPA website, are all helpful. The more options that enable this, the better. The CSPA’s participation in policy discussions with governments often complements the work of smaller Affiliate Members, including the research leadership, pre-budget submissions, and the work to help patients navigate how to fill their prescriptions. The CSPA works with Affiliate Members to present a unified skin patient voice while reflecting how different skin patients experience their conditions distinctly. The group explored options to help promote and share the


Af filiate Mem be top challenge rs’ s:

1. EDUCATIO N A ND AWARENES S-R AISING R EL ATE •

Skin Patient Charter of Rights (www.canadianskin.ca/ advocacy/skin-patient-charter) with their communities. This is a valuable tool to share with specific audiences (for example, in educational videos for students and medical schools). It can also help patients and organizations when advocating for themselves or for a specific goal, such as skin cancer prevention, optimal treatment options, or understanding wound care practices. There was consensus that mental health unites us all. The COVID-19 pandemic has exacerbated and highlighted the importance of protecting and fostering strong mental health. Skin disorders and burns cause stigma, internalized discrimination, and shame. People can experience discrimination as others think the skin disease or damage is contagious. All of this results in negative mental health. We are the proactive voice saying we’re all proud of the way we look and helping the skin patient community feel Iike they have an army of support. The CSPA expanded its annual #ShedTheShame mental health campaign to cover more types of skin disorders and raise the profile of the mental health impacts of skin disease and damage. HOW WILL THE CSPA HELP? The skin patient community benefits when we come together to collaborate and share our strengths and resources. Often, we are all struggling with similar challenges. Working together to support diversity and

D TO: Different type s of skin cond itions • Prevention and early diag nosis • Supports fo r people livin g with skin co nditions, including in the face of CO VID-19 • Research fo r better treatm ent options • Challengin g stigma 2 . ACCESS TO

• Specialists (e

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atologists) ecially non-m edical therap switches of bi eutic ologics to bios im ilars, medicat covered by ph ions not armacare) • Supports to stay healthy (especially m ental health/psych o-social supp orts), in gene ral and during COVI D-19 • Treatments (esp

inclusion can help us all connect with harder-to-reach groups that need our support. Moving forward, CSPA will work with Affiliate Members to create opportunities to learn from one another and develop collaborations that help patients access resources, understand co-morbidities (for example, many people living with alopecia also have psoriasis), and encourage best practices across the skin patient community. Spring 2021

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CSPA IN ACTION

CSPA in action: A spotlight on our latest activities, events and other information of importance to skin patients in Canada

Art contest winners We are pleased to showcase the winners of our Eczema Awareness Month 2020 youth art contest winners on the back cover of this issue. Eczema is one of the skin conditions that affects a significant number of youth and this contest was an opportunity for them to showcase the mental health impacts of the disease and how they stay strong.

Advocacy initiatives The CSPA was proud to convene our Affiliate Members in November 2020 to discuss the challenges facing our organizations and the skin patients we serve. Out of that meeting emerged common priorities that will inform CSPA’s advocacy initiatives. If you are struggling with getting the care or treatments you need, reach out to us at info@canadianskin.ca.

Shed the Shame campaign Skin patients often navigate the mental health impacts of their disorder. To help support our patient community, the CSPA raised awareness about the stigma facing skin patients in its recent #ShedTheShame2021 mental health awareness campaign (www.canadianskin.ca/advocacy/ shed-the-shame). Launched on Bell Let’s Talk Day, this initiative helps shed light on misconceptions faced by skin patients – check out the campaign on our social channels @CanadianSkin!

SkIN Canada survey Research is critical to paving the way for a brighter future for skin patients. The Skin Investigation Network of Canada (SkIN Canada) has been hard at work launching research initiatives intended to help researchers in Canada answer questions that are important to patients. The Steering Committee welcomed stage IV melanoma survivor and founder of Save Your Skin Foundation Kathleen Barnard and Canadian Burn Survivor Community Secretary/Treasurer and Nova Scotia Burn Support Group President Deborah Ward as Patient Research

Spot the differences answers

Our board of directors The CSPA board of directors (www.canadianskin.ca/about-us/ who-we-are/board-of-directors) is delighted to welcome four new members: • Tochi Omoloye (Treasurer) • Barbara-Anne Hodge • Chris Peralta • Thomas Dornoy Is this covered? Have you ever been handed a prescription and wondered: Is this covered? Stay tuned for a new resource on the CSPA website that walks you through the eligibility requirements for government drug plans across Canada to help you answer that very question!

Word search answers

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Partners. SkIN Canada is developing a survey that asks patients living with nine different skin disorders about their top priority questions for research, which you will find on the CSPA website (http://skincanada.org/prioritysetting-initiative).

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Patient engagement in skin research Skin conditions are a leading cause of overall disability and death in Canada. Canadian researchers have made substantial contributions to address the heavy burden of skin disease, but much of the work is conducted in isolation by a dispersed community of scientists and clinicians. CSPA is proud to help lead the Skin Investigation Network of Canada (SkIN Canada). The research network is dedicated to advancing skin research in Canada by creating a national forum, guided by patients and knowledge users, to strengthen and harmonize collaborations and capacity in the skin research community. Patients are a critical part of the network and help to shape the work that it does. Patient Research Partner opportunities SkIN Canada is excited to welcome Patient Research Partners to shape how research on skin diseases will be fostered across Canada. This is different from being a research subject. A research subject participates in research by agreeing to be part of an experiment whereas a Patient Research Partner works with researchers to help them understand patient perspectives as they: • Build research networks • Create and design biobanks • Organize clinical trials for skin diseases • Train students and early career researchers to work with patients and on issues that are important to patients, and • Help share the results of research with patients and the public. SkIN Canada will be reaching out to nine specific skin patient communities with surveys asking patients about their top research questions. This process will also be useful for other skin patient communities. Organizations that provide research grants and funding want to know what unresolved questions are important to patients. Researchers will then use these priorities to help shape their research. For more information on the priorities of skin patients, the results of research like this, and how to get involved in future projects, please visit www.canadianskin. ca/education/skin-canada or email us your questions at info@canadianskin.ca.

SPONSOR OF CANADIAN SKIN MAGAZINE AbbVie is the Founding Sponsor of the Canadian Skin Magazine and an ongoing supporter of CSPA’s 2021 publications.

CSPA CORPORATE SPONSORS

CPSA AFFILIATE MEMBERS AboutFace: aboutface.ca Acne and Rosacea Society of Canada: acneaction.ca (acne) rosaceahelp.ca (rosacea) Alberta Lymphedema Association: albertalymphedema.com Alberta Society of Melanoma: melanoma.ca BC Lymphedema Association: bclymph.org Camp Liberté Society: campbliberte.ca Canadian Alopecia Areata Foundation (CANAAF): canaaf.org Canadian Association for Porphyria: canadianassociationforporphyria.ca Canadian Association of Scarring Alopecias: casafiredup.com Canadian Burn Survivors Community: canadianburnsurvivors.ca Canadian Psoriasis Network: cpn-rcp.com Canadian Skin Cancer Foundation: canadianskincancerfoundation.com DEBRA Canada (epidermolysis bullosa): debracanada.org Eczema Society of Canada: eczemahelp.ca Firefighters’ Burn Fund: burnfundmb.ca Hidradenitis & Me Support Group: hidradenitisandme.ca HS Heroes: hsheroes.ca Melanoma Network of Canada: melanomanetwork.ca Myositis Canada: myositis.ca Neurofibromatosis Society of Ontario: nfon.ca Save Your Skin Foundation: saveyourskin.ca Scleroderma Association of B.C.: sclerodermabc.ca Scleroderma Canada: scleroderma.ca Scleroderma Manitoba: sclerodermamanitoba.com

CANADIAN SKIN MEDICAL ADVISORS + BOARD MEMBERS Thank you to the Medical Advisors and Board Members who support the work of the CSPA. For an updated list of names, visit: canadianskin.ca/about-us.

Scleroderma Society of Ontario: sclerodermaontario.ca Stevens–Johnson Syndrome Canada: sjscanada.org

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Eczema Awareness Month 2020 YOUTH ART CONTEST WINNERS

PRIMARY WINNER

Luke Varghese

INTERMEDIATE WINNER

Victoria Philip

SENIOR WINNER

Manjari Manickam

This project was supported by Pfizer Canada.


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