Your Skin - Q2 2021

A Mediaplanet campaign focused on

Your Skin

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How handwashing impacts psoriasis ~ Helen McAteer, Chief Executive, Psoriasis Association

Q2 2021 | A promotional supplement distributed on behalf of Mediaplanet, which takes sole responsibility for its content

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Helping patients with skin conditions ~ Rebecca Penzer-Hick, Dermatology Nurse Specialist, Senior Clinical Lecturer and President, British Dermatological Nursing Group (BDNG)

Read more at www.healthawareness.co.uk

Donate now to put From common conditions to potential killers, we work an end to skin disease and skin cancer. to understand skin disease Britishskinfoundation.org.uk inside out.

Skin cancer in skin of colour Summer time is a carefree period punctuated by trips to the beach, foreign holidays and lazy afternoons in the park.

For those with white skin, sun-seeking behaviour is counterbalanced against the ever-present risk of sunburn in the short term, and in the long run, skin cancer.

T WRITTEN BY

Dr Derrick Phillips Senior Dermatology Registrar, Mersey Deanery and British Skin Foundation Spokesperson

Dr Derrick Phillips will be taking up a Consultant post at Imperial College Healthcare NHS trust in August

o reduce the risks of sunburn and skin cancer, dermatologists and healthcare professionals have consistently advised members of the public to take appropriate precautions during sun exposure, these include; use of a high factor sunscreen (SPF 30+ with 5 UVA stars), wearing appropriate clothing (e.g. hat, sunglasses and t-shirt) and staying in the shade between 11am and 3pm. But does this advice hold true for all ethnicities and skin types? Should individuals with skin of colour use sunscreen to protect against skin cancer?

The causal link between exposure to ultraviolet (UV) radiation from the sun and skin cancer in white populations has been consistently demonstrated by clinical research, however such studies have often excluded individuals with skin of colour. There has been a tendency for the results from these studies to be generalised and the recommendations applied to all individuals regardless of ethnicity, skin colour and tanning ability. Whilst it is true that skin cancer can affect individuals with skin of colour, it is a much rarer occurrence and does not seem to be associated with UV exposure.

New research into UV exposure A recent systematic review conducted by Dr Adewole Adamson’s team at Dell Medical school (University of Texas at Austin), compiled data from 13 international studies to determine whether UV exposure was a risk factor for melanoma in individuals with skin of colour.

Of the 439,009 melanomas reported across the included studies, 1.76% occurred in individuals with skin of colour.

The data from this review suggested that UV exposure was not an important risk factor for the development of melanoma in individuals with skin of colour. This evidence

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supports what is seen in practice by dermatologists treating skin cancer. In addition, the predominant type of melanoma occurring in individuals with skin of colour is acral lentiginous melanoma, a tumour that affects non-sun exposed sites (e.g. palms, soles and nail beds) and is not related to sun exposure.

The data from this review suggested that UV exposure was not an important risk factor for the development of melanoma in individuals with skin of colour.

If UV exposure is not an important risk factor for the development of skin cancer in skin of colour, should we continue to promote the precautionary use of sunscreen in these individuals? It is clear that we need to move away from one size fits all medicine and provide more nuanced advice tailored to the individual. Sunscreen may be a less important intervention for individuals with skin of colour than increasing awareness of the signs of acral lentiginous melanoma, a disease that is often detected at a later, more advanced stage. Nevertheless, there are other benefits of using sunscreen and taking the precautions described. Pigmentary disorders such as melasma and post-inflammatory hyperpigmentation are common afflictions of individuals with skin of colour and can be exacerbated by sun exposure. The use of sunscreens with broadband UVA/UVB cover can protect against this, as well as preventing photoaging.

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How I hope my Stevens-Johnson Syndrome story will inspire others My name is Marian Adejokun and I am 29 years old. I was diagnosed with a deadly, rare illness called Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TENS) back in January 2011.

I WRITTEN BY Marian Adejokun British Skin Foundation Ambassador

remember the day as if it was yesterday, my eyes had been itching at college and after a quick chat with the doctor I was advised to use over the counter eye drops. Within half an hour of using them, blisters started to appear on my feet and spread across my entire body. My normally high pain threshold was experiencing something I had never felt before. This was a different kind of pain, as if I were burning from the inside out. My mum called an ambulance as my airways began to close and I was finding it hard to breathe. At this point, I could no longer stand as the blisters had completely taken over my feet.

I’ve been through various medical ordeals in my life – including being born premature weighing only one pound – along with various surgeries.

My initial thought was that this would be another challenge to overcome. Never in a million years did I think my entire skin would peel off and I’d end up in an induced coma due to a severe allergic reaction know as Stevens-Johnson Syndrome (SJS).

Understanding the diagnosis At first, doctors thought I had swine flu and I spent time in an isolation ward. At this time, I was coughing up blood and bleeding from my eyes, still unaware it was an allergic reaction. Later I was moved to a hospital where a doctor recognised that I had SJS and put me into an induced coma due to the severe nature of the condition.

My mum is a single mother to four girls, of which I’m the eldest. When I was in a coma my sisters didn’t see me but they, along with our pastor and friends, prayed for me. They helped my mum through the tough times and told her that everything would be alright.

I was in such a terrible state from the reaction that my own mother said I looked like Freddy Krueger with blisters, swollen lips and skin that was tearing off. Doctors told her I was unlikely to survive but my mum didn’t listen to their negative reports, instead she had faith and prayed for my health, playing gospel music at my bedside.

“Marian, you’ve been accepted to university, that’s your dream,” my mum said to me as I lay there, and I moved my toe in response.

Against all the odds I pulled through, with doctors hailing my recovery a miracle. Healing has been an ongoing process with a consultant dermatologist and an ophthalmologist helping me through.

I must use special eye drops for the rest of my life to keep my eyes lubricated and from time to time I experience blurry vision. Luckily, I didn’t need skin graft surgery and my tracheotomy scar healed well.

At first, I avoided going out in public as I feared how people would perceive me. After a few months I began to feel more comfortable in my own skin and I shared my story to inspire others – turning my own negative experience into a positive one. This experience has boosted my confidence in a strange way. Now I teach primary school children, I’ve written two books and I’m an inspirational speaker.

I would never have coped so well with this disease if it weren’t for my mum, sisters and faith.

Although I live a normal life now, I am mindful and cautious when it comes to my health.

Pulling through against the odds Against all the odds I pulled through, with doctors hailing my recovery a miracle. Healing has been an ongoing process with a consultant dermatologist and an ophthalmologist helping me through.

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Tips for reducing the impact of handwashing on psoriasis Psoriasis on the hands can be painful and irritating and can make day-to-day tasks more difficult.

P WRITTEN BY

Helen McAteer Chief Executive, Psoriasis Association

soriasis is an immune-condition which affects between approximately 2-3% of the UK population and causes raised ‘plaques’ to form on the skin, which can also be flaky, scaly and red on Caucasian skin, darker patches on darker skin tones, and itchy. Psoriasis can occur anywhere on the body and as well as being painful and uncomfortable, people with psoriasis often suffer with low confidence and selfesteem. In turn, this can impact on relationships and social lives.

How handwashing impacts psoriasis Early in the pandemic, the UK population were advised to adopt regular handwashing or hand sanitising as a preventative measure against spreading COVID-19. This remains important as we begin to return to some of our day-to-day activities.

Psoriasis can affect the hands and nails, for many people with symptoms in this area frequent handwashing can worsen symptoms or, in some cases, may trigger new patches of psoriasis to occur. Psoriasis on the hands can be distressing because it is very visible and can be painful, irritating and make it difficult to carry out everyday tasks.

There are steps you can take to reduce the impact of handwashing on psoriasis such as:

9 Wash hands with soap and water, then re-wash with an emollient soap substitute. Emollient soap substitutes are more moisturising than regular soap and can be helpful to prevent the skin from drying or cracking. To use them you should mix a small amount in your hand with a little warm water and spread it over damp or dry skin.

9 Dry your hands gently and moisturise them afterwards using your preferred emollient. It may be a good idea to keep tubes of moisturiser by the sink at home, as well as in your handbag or pocket for when you are out. Ask your GP or pharmacist for advice if you need help selecting a suitable emollient.

9 Apply moisturiser to the hands before bed and then wear cotton gloves overnight. Cotton is a ‘breathable’ fabric and gloves made with the material can help moisturiser to penetrate the skin and work more effectively.

9 Use plastic or rubber gloves with cotton linings when doing the washing up or hand washing clothes, this will help to prevent unnecessary drying resulting from activities other than washing your hands.

9 Wearing rings, watches and other jewellery may aggravate your skin if your psoriasis is already sore from handwashing.

Try removing your jewellery for a few days and see what effect (if any) this has.

For more information about COVID-19 and psoriasis, including tips for managing your skin and staying well, please visit the Psoriasis Association website at psoriasis-association.org.uk If you have psoriasis, please also consider taking part in the PsoProtectMe survey at psoprotectme.org - a survey to support vital research into COVID-19 and psoriasis.

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Why psoriasis is more than a skin condition Most people are aware of psoriasis as a skin disorder, but few understand how this complex condition can impact all aspects of your life.

P INTERVIEW WITH Dr Susanne Farwer Medical Solutions Lead Dermatology, UCB

INTERVIEW WITH Dr Catherine O’Leary Psoriasis Patient and Clinical Psychologist

WRITTEN BY Judith Oskan

soriasis affects around 1 in 50 people in the UK and is linked to a problem with the immune system which causes skin cells to be produced more quickly than usual.

Symptoms include dry, red patches, known as plaques, covered with silvery scales often found on the elbows, knees, scalp and torso. These patches can be painful and itchy and will wax and wane as flare-ups, lasting weeks or months, are often triggered by infection, stress or medication.

Around one third of people living with psoriasis will develop arthritis, a similar proportion diabetes, high blood pressure or obesity, and an even greater number will experience feelings of social isolation, low mood and anxiety.

Psoriasis must be understood as more than a skin condition, says Dr Susanne Farwer: “Although it is not life-threatening, psoriasis can be life-ruining for many, impacting confidence, education, relationships, career choices and participation in everyday activities.”

Recognising your feelings is key Dr Catherine O’Leary is a consultant clinical psychologist who was diagnosed with psoriasis as a teenager. She agrees that psoriasis can impact people’s mental health as much as their skin: “As a young person, it was often tricky trying to manage psoriasis. I was ashamed of the way I looked and very conscious of what other people were thinking.

Even now I sometimes feel this way.”

Working with a sympathetic healthcare professional is key. Although there have been improvements in treating psoriasis, there is a long way to go towards providing consistent, holistic care. Catherine says: “Many people don’t get offered psychological input or asked about their feelings, and they don’t know how a psychologist can help. It can feel hard to reach out for psychological support if you are embarrassed about struggling emotionally but it can make all the difference in helping you cope.”

Psychological support helps empower people

Talking about your feelings can help and reminding yourself that there are many people with psoriasis out there living fulfilling lives.

to use techniques such as cognitive behavioural therapy (CBT) to keep stress in check and help reduce the vicious circle of flare-ups.

“Because psoriasis is associated with multiple co-morbidities, there is growing evidence that stopping smoking and reducing alcohol intake as well as healthy eating and regular exercise can make a positive difference,” says Dr Farwer. “But apart from working toward a healthier body, it is as important to strive for a healthier mind.”

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Greater general awareness of what psoriasis is and how it impacts mental health could help end the stigma and isolation that people feel and allow them to feel comfortable in their own skin.

A listening ear is often enough Healthy routines and being kind to yourself are important agrees Catherine: “Think about what you can build into your life that relaxes and soothes you. Talking about your feelings can help and reminding yourself that there are many people with psoriasis out there living fulfilling lives. Although growing up with psoriasis was hard, I am the person that I am today because of my experience.”

Dr Farwer believes healthcare professionals should offer compassion as well as medication and be willing to listen. Families and friends need to understand that just being there for people who are struggling is important and often more helpful than trying to ‘fix’ their problems.

Greater general awareness of what psoriasis is and how it impacts mental health could help end the stigma and isolation that people feel and allow them to feel comfortable in their own skin.

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Find out more at Dr Catherine O’Leary’s website copingwithpsoriasis.com

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Helping patients with skin conditions Dermatological nurses are offering cradle-to-grave care for patients of all ages with skin conditions.

S INTERVIEW WITH Rebecca Penzer-Hick Dermatology Nurse Specialist, Senior Clinical Lecturer and President, British Dermatological Nursing Group (BDNG)

WRITTEN BY Mark Nicholls

pecialist dermatology nurses care for patients of all ages with skin conditions.

From skin cancer to eczema and psoriasis, dermatological nurses are using their expertise to help people live with conditions that can be uncomfortable and affect them psychologically, as well as physically.

Rebecca Penzer-Hick, who is a specialist dermatology nurse attached to a GP practice in Cambridgeshire, says: “One of the things that is unique to dermatological nursing is that we tend to look after patients from the cradle to grave.

“Every age group can get a skin condition; such as babies with eczema, teenagers with acne, or older people psoriasis. We look after the whole age spectrum and that is quite unusual in nursing, which normally focuses on a particular age group of people.”

Complex area The skin is a complex organ and the dermatology nurse’s role may range from supporting people with a skin cancer diagnosis, through skin surgery, or more routinely delivering and monitoring treatments.

Penzer-Hick, who is President of the British Dermatological Nursing Group (BDNG), says: “That may also be supporting patients psychologically because skin conditions can be very sore, itchy, and uncomfortable and often have a huge impact on mental-health well-being.

Patients cope with skin conditions in different ways and for the dermatology nurse it is about having the flexibility and knowledge to respond accordingly. “There is a lot of specialist knowledge that helps when looking after someone with a skin condition,” she adds. “With planning treatment, particularly for chronic conditions such as eczema or psoriasis, you need to understand how treatments work and the various options that are available and then fit them into the individual’s life.”

Connecting with patients Skin conditions can flare up without warning and that may result in a patient needing to use specialist treatments such as steroid ointments or creams.

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“This is where expert nursing skills come into play.

It is about having specific competencies and being able to connect with patients and understand this waxing and waning of a chronic skin condition and plan treatments accordingly” says Penzer-Hick, who is also a Senior Clinical Lecturer in the School of Postgraduate Medicine at the University of Hertfordshire.

“Many dermatological nurses are independent prescribers, so while they use their counselling skills to help people feel better, they also use their knowledge of the therapeutic range to make sure patients have the right treatment to use at the right time.” Patients also need rapid access to dermatological nurses when a condition worsens.

With planning treatment, particularly for chronic conditions such as eczema or psoriasis, you need to understand how treatments work and the various options that are available and then fit them into the individual’s life.

Specialist training Dermatology nurses, who are part of a multiprofessional team working closely with medical colleagues, have a general nursing background and develop an interest in skin conditions from there.

Specialist training offers the opportunity to develop sub-specialisms, such as surgical skills, skin cancer care and chronic disease management.

Care is normally delivered in hospitals through outpatient departments, but increasingly dermatology nurses are also working in community settings.

However, the COVID-19 pandemic had an impact on care delivery, particularly during the first lockdown where dermatology nurses were often relocated to more acute parts of hospitals.

Technological solutions such as video consultations have been introduced, although Penzer-Hick stresses: “We remain very mindful that we do not want to lose that direct face to face contact with patients.”

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Everyday tasks can be painful with eczema Most people have heard about eczema, but few realise just how difficult and painful it can be. The skin is often unbearably itchy and uncomfortable, and the relentless daily challenge to care for it can be exhausting.

WRITTEN BY Andrew Proctor Chief Executive, National Eczema Society

F

or some people with eczema, doing everyday tasks like cooking or even bathing can be extremely painful, because the skin is so cracked, sore and raw. Alongside the painful physical symptoms, many children and adults experience related sleeplessness, low self-esteem, bullying, anxiety and other mental health problems.

Eczema is a serious, debilitating, long-term medical condition that has a huge impact on millions of children, adults and their families. The most common form, atopic eczema, affects one in five children and up to one in 10 adults in the UK. Around a third of those with eczema have either moderate or severe symptoms.

Eczema and dry skin Using emollients is essential to help repair and protect the body’s natural skin barrier and reduce the itch association with eczema. Skin is made up of several layers, each containing skin cells, water, oils and fats. Together these help maintain and protect the condition of the skin. If you have eczema, your skin is less able to retain water. Gaps open up between the skin calls and the protective barrier doesn’t work as well as it should. Moisture is lost from the deeper layers of the skin, allowing bacteria or irritants to pass through more easily. Emollients are therefore needed to repair and protect the skin barrier, to stop the skin from drying out and being damaged.

How should emollients be used?

Emollients should be used for moisturising the skin several times a day, and for washing, even when the skin isn’t red and inflamed.

Emollients come in various forms, lotions, creams, gels and ointments.

You’re likely to need more than one kind of emollient, depending on the dryness of your skin, the part of the body affected and the time of year.

NHS emollient rationing Having a good skincare routine is crucial if people are to self-manage their eczema well, and in doing so reduce the need for more expensive medical treatments.

It is not always straightforward to find the right emollient, with such a wide range of products available.

Different emollients suit different people and finding the best ones for you usually involves sone trial and error. The best emollients are the ones that people are willing to use regularly because they work best for them.

This is why National Eczema Society is so concerned about moves by the NHS to restrict availability and range of emollients on prescription, for both children and adults. We hear from many people that they are having their emollient prescriptions changed, reduced or stopped.

NHS England prescribing guidance on leave-on emollients says that emollients can be prescribed for people with eczema. Even so, this is not always followed. The Society has produced its own guidance for people on how to advocate with their GP or nurse for access to emollients on prescription, citing the research evidence and clinical guidelines.

The Society is also hugely concerned about the latest moves to stop making bath emollients and therapeutic silk garments available on prescription too, including for people with more severe eczema.

Despite strong feedback from patients and compelling research evidence, decision makers are seemingly not listening.

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Using emollients is essential to help repair and protect the body’s natural skin barrier and reduce the itch association with eczema.

MEDIAPLANET

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Early in the pandemic, the UK population were advised to adopt regular handwashing or hand sanitising as a preventative measure against spreading COVID-19. This remains important as we begin to return to some of our day-to-day activities. ~Helen McAteer, Chief Executive, Psoriasis Association

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