Managing Skin Conditions

What’s your go-to skincare product that you can’t leave the house without?

It’s all about balance. I live in Hawaii, and the sun is strong here. I always want to make sure I have a sunscreen protecting my skin. For a product that I must use on a day-to-day basis, I would say Selfless by Hyram salicylic acid. I tend to get oily, and it’s hard to find products that are lightweight enough that can handle my oily skin or the humidity here. The salicylic acid really helps to keep my oily skin at bay and fight against breakouts that come along with wearing masks on a day-to-day basis.

I recommend starting off simple. It can be tempting to want to totally switch up your routine... focus on finding a rich moisturizer that can properly nourish your skin throughout the day.

couraged for men to go into beauty. When I was getting into college, I noticed there was a lot of deep-set damage in my face, to the point that my friends were telling me I should start using skincare. That’s when I was able to see the transformative results of skincare. That moment showed me the importance of consistently taking care of my skin, and that it needs to be a day-to-day practice — like brushing your teeth or taking care of your health.

improve their skin and how they feel about themselves through recommendations and skincare advice.

What's your advice for transitioning from summer skincare to winter skincare?

Why is skincare a priority for you?

I grew up on a cattle ranch in Arizona, so I was in an environment where skincare was not even brought up for discussion. Partly because we lived a simple life on the ranch, but also because it was dis-

Another level is being able to help people improve their skin. More than anything, that is what has pushed me to keep wanting to dive deeper into the skincare world, and it’s where my passion for skincare has arisen. I think, had it been transformative results alone, I still would be having a skincare routine, but I wouldn’t have been as passionate about it as I am now. I love being able to help people

Skin on Fire

I recommend starting off simple. It can be tempting to want to totally switch up your routine, but because your skin is having to deal with the changing temperatures, which is already harsh on the moisture barriers, you want to make sure that your products aren’t a reason that you could be seeing more sensitivity or irritation. Focus on finding a rich moisturizer that can properly nourish your skin throughout the day.

A step that people generally overlook is switching out their cleanser. We often don’t realize that cleansing can be one of the most damaging steps of the skincare routine. Some cleansers can suck a lot of the hydration and moisture out of your skin and make your skin potentially even more dry.

Have you ever experienced dry, inflamed, itchy, or burning skin?

If you're living in Canada, you probably have!

Maybe you went out for an enjoyable hike in the forest this past summer and ended up with poison ivy acute allergic contact dermatitis (eczema) with huge blisters, swelling, and pruritus. Or your skin gets so dry in the cold winter, you develop itchy red scaling patches on your lower legs that we call asteatotic eczema or eczema craquelé (like dry cracked pavement). Worse still, you may be one of the many patients suffering from atopic dermatitis (up to 20 percent of children, and 3-10 percent of adults).

What can be done to prevent this skin inflammation?

Firstly, daily bathing is recommended; however, we suggest limiting time to

five minutes, using tepid not hot water, and mild cleansers or syndets. This hydrates the skin and removes any debris, scales, and bacteria that could otherwise accumulate.

Following this, liberally apply a hydrating cream or moisturizer. This may be once or twice a day depending on the dryness of the skin. These moisturizers have different characteristics, depending on whether they are emollient, occlusive, humectants, or protein rejuvenators.

Minimize exposure to dry heat, smoke, and allergens such as certain pets, airborne pollens, dust mites, and occasionally food allergens.

What treatments are available if I get eczema despite using moisturizers?

Topical corticosteroids are critical for acute flares and resistant plaques. Milder ones are used on the face and

folds. Calcineurin inhibitors, phosphodiesterase inhibitors, topical or oral antibacterials, and narrow band UVB phototherapy play a role. For severe cases, we've used off-label immunosuppressive medications such as methotrexate, mycophenolate mofetil, and cyclosporin to decrease inflammation. Now new oral and topical Jak inhibitors hold promise. In addition, more targeted injectable biologics block specific interleukins, such as IL-4, IL-13, IL-5, IL-31, and demonstrate dramatic efficacy.

So where do we go from here? Enjoy the winter! Hopefully you can find a winter sport that helps you enjoy the snowfall. Useful resources include the Canadian Dermatology Association website, as well as the Skin Patient Alliance of Canada, and the Eczema Society of Canada.

Publisher: Meredith Burt Strategic Account Director: Jessica Golyatov Business Development Manager: Chelsea Siemon Country Manager Nina Theodorlis Content & Production Manager: Raymond Fan Designers: Giuliana Bandiera, Lauren Livingston Web Editor: Karthik Talwar

Dr. Catherine C. McCualg FRCPC, DABD, Canadian Dermatology Association President

PHOTO COURTESY OF HYRAM YARBRO

In Canada, 1,999 Melanomas Have Gone Undiagnosed Since the Start of the COVID-19 Pandemic

The devastation of the COVID19 pandemic is felt beyond the immediate impact of the virus itself. The volume of patients that flooded hospitals and healthcare facilities prevented many would-be patients from visiting their health care teams for regular appointments, including skin checks. A global survey of over seven hundred dermatologists estimates twenty-one percent of early-stage melanoma went undiagnosed due to one third of all professional skin-check appointments being missed during COVID-19 lockdowns. Those who have managed to access care since lockdowns have lifted are presenting with larger, more advanced tumours, and are being diagnosed at a later stage.

less deadly than melanoma, they can cause substantial illness, disfi gurement and significantly affect quality of life. A recent study from Ontario suggests, “Death rates seem to be increasing from these non-melanoma skin cancers, over the twenty year period — an average of eight to nine percent increase per year!” 1

Twenty-one percent of early-stage melanoma went undiagnosed due to one third of all professional skin-check appointments being missed during COVID-19 lockdowns.

“It took months of my partner pestering me to get it checked. By the time I did, the melanoma on my leg had reached the point of invasion… it invaded other tissues,” said Fran Ure, a patient supported by the Melanoma Network of Canada from Nakusp, B.C. Fran needed to have major surgery to remove her melanoma and surrounding lymph nodes.

The pandemic also resulted in delayed diagnoses for non-melanoma skin cancers like basal cell carcinoma and squamous cell carcinoma, which account for over 80,000 skin cancers in Canada each year. While these types of skin cancers may be

The incidence rates of melanoma and skin cancer are on the rise in Canada. This alarming trend can be curbed as the diseases can often be prevented and detected by the patient. The overwhelming majority (65-85 percent) of melanoma and skin cancers are caused by exposure to the sun’s harmful ultraviolet (UV) radiation. One sunburn before the age of twenty significantly increases the chance of a melanoma or skin cancer diagnosis. Tanning bed usage further increases the odds! There is no safe tan!

Help find the 1,999 melanomas that went undiagnosed during the pandemic... how to detect melanoma Melanoma and skin cancer affect anyone regardless of age, gender, or race. It is important to conduct monthly skin checks and talk to your health care team about any concerns. Early diagnosis is key to survival and minimizing the impact of the disease on quality of life.

- https://globalnews.ca/news/8240835/non-melanoma-skincancer-ontario-study/amp/

3 Ways to Block the Rays:

Wear Sunscreen SPF 50+, and reapply every two hours or more often if prespring or in the water. Sunscreen should be worn all year round, as UV rays reflect off concrete, snow, and ice.

Cover Up Wear thick woven fabrics or UPF protective apparel, broad brimmed hat, and sunglasses.

Seek Shade During peak UV hours 11am-3pm.

Hot tip: Sun protective clothing isn’t just for the pool or beach. Brands like Coolibar make UPF 50+ clothing for all activities under the sun.

Spending time outdoors is an accessible way to reduce stress and stay physically active. But while absorbing some necessary vitamin D, it’s important to stay protected from the sun’s harmful ultraviolet (UV) rays, no matter the season.

Damaging UVA rays cause wrinkles, pigmentation disorders, and a loss of skin elasticity, while overexposure to UVB rays causes skin to burn. Plus, both UVA and UVB rays can lead to skin

Sun’s Harmful Rays Spoiling the Fun? Here’s a Great Way to Stay Safe

cancer. Even when it’s cloudy, up to 80 percent of the sun’s rays still hit Earth.1 Using sunscreen, the right way, is key to enjoying time outside while reducing UV radiation exposure. It should be applied to all unclothed parts of the body 15 minutes prior to going into the sun and must be reapplied every two hours. It’s important to select sunscreen that’s properly formulated for optimal protection. For trusted and proven UV ray defence, consider the number-one brand recommended by pharmacists and physicians since 1997: Ombrelle.

Formulas you can trust

Founded over thirty years ago by a Canadian dermatologist, Ombrelle is dedicated to helping everyone stay safe under the sun. Their patented Mexoryl Technology creates Broad Spectrum UVA and UVB protection in a collection of formulations that are all hypoallergenic, fragrance free, colorant free, and cruelty free. In addition, all products are recognized by the Can-

adian Dermatology Association.

Ombrelle is designed for families, with a product for every family member and moment under the sun, from Ombrelle Complete, a hypoallergenic body lotion for all purposes, to the Ombrelle Sports, a high protection lotion with 80-minute water and sweat resistance. There’s a reason why Ombrelle is the most recommended OTC brand by pharmacists and physicians for over two decades.

Options for anyone

For the little ones in the family, Ombrelle’s Kids sunscreen is water resistant and can even be applied on wet skin.

For parents looking for a non-chemical sunscreen, there’s Ombrelle SPF50+ Mineral, made with 100 percent mineral sun fi lters. For those looking for daily face protection (highly recommended), there is Ombrelle Face SPF 60. Not only is it non-greasy and non-comedogenic, it’s also enriched with Vitamin E, a powerful antioxidant that helps maintain healthy skin.

Falyn Katz

1 According to a Women’s College Hospital study

Melanoma Network of Canada is the leading national organization dedicated to the elimination of melanoma and skin cancer. Through patient, caregiver, and physician education and public awareness, our goal is to reduce the incidence of the disease and improve overall patient outcomes. Melanoma Canada offers patient and caregiver support services to those newly diagnosed, and helps those affected navigate their cancer journey by way of Certified Patient Care Specialist and Cancer Coach, Peer2Peer Support Programs, and Group Support Services.

Falyn Katz Executive Director, Melanoma Network of Canada

Fran Ure Melanoma Survivor

This article was sponsored by the Melanoma Network of Canada.

For more information visit melanoma network.ca

Ombrelle is the Canadian brand making the sun safer with its trusted sunscreen products. To discover the full range of Ombrelle products and find which ones you need, visit ombrelle.ca.

This article was sponsored by Ombrelle

Katherine Cappellacci

Leading Canadian sunscreen brand provides trusted sun protection for Canadian families — rain or shine.

After Beating Skin Cancer, the Holiday Season Takes On New Meaning

In August 2015, Lyall Woznesensky noticed what he thought was a blood blister on his chest. He poked it and blood came out. When it came back, his wife, Debbie, told him he better go to the doctor.

His doctor sent him for a biopsy. The result was that Woznesensky had melanoma and he would require surgery to treat it. During the surgery a few weeks later, his surgeon found that the cancer tumour in his chest went all the way to his bone and had spread to a lymph node.

“The toughest part for me was telling my wife and two kids,” says Woznesensky, who is now 68.

“Fortunately, I have the greatest, most supportive family in the world. My wife is a rock and has taken on the challenge of keeping our family positive.”

Melanoma, a type of skin cancer, starts in melanocyte cells of the skin. A cancerous tumour is a group of cancer cells that can grow into and destroy nearby tissue. It can also spread (metastasize) to other parts of the body.

Melanoma often starts as an abnormal mole anywhere on the skin. Since most people have a few moles, which are non-cancerous, melanoma can be difficult to find. These small, round or oval spots are usually brown, tan or pink and can be raised or flat.

Treatment options for melanoma depends on its stage and location A change in the colour, size or shape of a mole is usually the first sign of melanoma. These changes can happen in a mole that's already on your skin or can appear as a new mole. Other possible signs of melanoma include an area of the skin that doesn’t heal, for example, a mole or sore that oozes or bleeds, or broken skin with an open wound.

Treatment for melanoma varies, depending on the stage of the cancer, where it’s located, and even your personal

preferences. Options can include surgery, radiation therapy, chemotherapy, targeted therapy, or immunotherapy.

“When I was a medical student and a patient had stage 4 melanoma, there was very little we could do to help them,” says Dr. Marcus Butler, Medical Oncology Disease Site Lead for Melanoma and Clinical Head of the Immune Monitoring Team at the Princess Margaret Cancer Centre in Toronto, Ontario. “About a decade ago, immunotherapies started to revolutionize treatment of late-stage cancers, including melanoma.”

Immunotherapy activates immune cells to attack the cancer Dr. Butler explains that cancer cells exploit the body’s own systems to hide from the immune system. Immunotherapy works by activating the immune cells so they can invade tumours and attack the cancer cells. “Immunotherapy treatments lift the veil, so the immune system can see the cancer,” says Dr. Butler, adding that these therapies can improve the longterm survival of people with cancer. When facing a cancer diagnosis, he encourages patients to learn about all of the treatment options.

“There are many options for patients that weren’t available years ago,” he says. “We are now able to deliver more effective therapies to help people live fuller lives.”

After his initial diagnosis, Woznesensky had two surgeries to remove the tumour and 18 lymph nodes, followed by treatments everyday for one month. Six months after his diagnosis,

tumours were discovered in his liver. His cancer had spread and was now stage 4 metastatic melanoma. He started on an immunotherapy, which finished in 2017. Since then, Woznesensky had been having regular checkups every three months, which was recently extended to every six months. He’s now considered to be in remission.

Grateful for the moments with family

“I’m a very fortunate person,” he says. “I know it sounds cliché, but I try to keep a positive outlook and stay as active as possible. Your mind plays tricks on you sometimes. If I’m feeling tired, I worry about whether I’m getting sick or if it’s just a regular part of being older. But I usually feel like the luckiest guy in the world.”

Woznesensky says his illness has taught him not to take anything for granted. Six years later, he’s most grateful to be able to spend time with his sons and watch them enjoying successful careers. His favourite moments happen when he gets together with his kids for birthdays, Christmas or another special day. He also loves when he and his wife, Debbie, cuddle on the couch watching sad movies. The two recently celebrated their 34th wedding anniversary.

“When I see Debbie and the kids fooling around and laughing, mostly making fun of me, it’s just the greatest feeling in the world. I am so lucky to still have the opportunity to share these experiences with my family and friends,” he says.

“I have become much more open in telling people how much I appreciate them. Most of us know how much we love our family and friends, but don’t share it. In our family, everyone says ‘I love you’ at least once a day.”

“Every day is a miracle in our lives and that’s what we are grateful for.”

Immunotherapy

Survival

Survival

Immune

Throughout

Treatment options for melanoma depends on its stage and location.

Lyall Woznesensky Melanoma Survivor

Dr. Marcus Butler Medical Oncology Disease Site Lead for Melanoma & Skin Oncology, Clinical Director for the Immune Monitoring Team — PMH

Abigail Cukier

Treatment for melanoma varies, depending on the stage of the cancer, where it’s located, and even your personal preferences.

Atopic Dermatitis: Addressing Misconceptions and Offering Hope

We spoke with Alyssa Hansen about the challenges of living with atopic dermatitis and her advice for others managing the skin condition.

Tell us about your experience managing atopic dermatitis (AD). Managing my AD wasn’t a challenge at first. In the beginning, topical ointments made a difference and cleared it up temporarily. However, as my condition got worse, the ointments and lotions and anything else I tried eventually stopped making any difference at all. It wasn’t until I got referred to a dermatologist that I was able to be put on a treatment that kept my condition under control. I was finally able to go without AD flares and to feel comfortable again after starting my treatment.

What impact has this had on your overall quality of life?

When my AD was at its worst, it had a significant impact on my life. I basically lived around my condition in an attempt to just deal with it. I dressed in ways that would cover the majority of my flare-ups, I avoided going out and doing most activities that I knew would irritate my skin in any way, and I eventually started to isolate myself in

sweat would irritate my skin significantly. Other challenges that I had included spending time with family and friends because I tried to avoid anyone seeing my condition or how badly it had been affecting me. It even made it difficult to care for my pets. Also, when I was in school, it made it challenging for me to focus on my classes.

What other areas of your life were affected by the pain of AD?

One of the biggest areas of my life that had been affected was my social life. I avoided spending time with anyone close to me because I hated the way I looked, and the constant discomfort caused me to become a very irritable person, which is the opposite of how I normally am. Physically, I was exhausted and in pain no matter what I did to try and relieve it. Mentally, I was irritable, depressed, and struggling on a daily basis to do nearly anything. My AD had come to control almost every aspect of my life and I really came to base most of my daily decisions around my condition. There wasn’t much in my life that hadn’t been affected by AD.

What myths or misconceptions about AD do you feel the general public has?

order to hide my condition. At the worst point of my struggle with my AD, I had very little quality of life. Suffering from it had caused me to become severely depressed due to the constant discomfort I was in. I didn’t want to be around anyone, my family included, and I struggled to do most daily tasks.

My skin constantly hurt, I had difficulty sleeping due to the discomfort, I avoided being around anyone, and I did as little as I possibly could every day to avoid hurting any more.

What are some day-to-day challenges of living with AD?

Some of the day-to-day challenges that I faced included some of the most basic things like sleeping and showering. I struggled to get out of bed some days, I had a difficult time with cleaning and completing other chores, and I was unable to do most physical activities because anything that caused me to

One of the biggest misconceptions about AD, in my opinion, is that it’s just dry skin. There is so much more to it than just having dry skin. That’s really just the tip of the iceberg. It can be such a painful and uncomfortable condition that can affect your physical and mental health, and it can be a very isolating condition to suffer from. People need to understand that it isn’t always just dry skin that putting some lotion on will fi x.

What advice can you offer to others living with AD?

My best advice to anyone suffering from AD is to take control of your condition and seek help from a dermatologist. If you aren’t already seeing a dermatologist, get your doctor to refer you to one. Don’t wait for your condition to become unbearable or to get any worse, and don’t allow it to control your life. If you’re living with AD, you don’t have to suffer through it. There are treatments available that you might not know of, and it’s so worth it to find something that works for you!

Talk to your doctor and obtain a referral to a dermatologist if you think you might have AD.

This article was sponsored by an IMC Member Research-Based Pharmaceutical Company.

There wasn’t much in my life that hadn’t been affected by AD.

My best advice to anyone suffering from AD is to take control of your condition and seek help from a dermatologist.

PHOTO COURTESY OF ALYSSA HANSEN

What are the biggest stressors on an individual’s skin health?

Our outermost skin, the stratum corner, acts as a permeable layer. It's really an amazing feature of evolution, as it keeps water in, bacteria and chemicals out and is less than the diameter of a human hair. Our skin's total diameter is around 1-4 mm depending on the location on our bodies, with eyelids and groin having the thinnest. This thin organ has tensile strength, and also has its own immune system, which, along with the skin microbiome, helps train out the immune system from birth to identify what is good and bad.

If we consider the function of our skin — essentially its permeability, strength and immune systems, what stressors can disrupt these functions?

Our skin's outermost layer is similar in structure to that of a brick wall — with the cells being the bricks and the mortar our natural lipids/oils. Water and detergents break down our

skin's barrier function. Our skin has developed a mechanism to replace these bricks and mortar but excessive washing and scrubbing exhaust these mechanisms leading to a disrupted skin barrier or crumbled brick wall. This will allow bacteria and chemicals more ready access.

High pH (9-10) old-fashioned soap bars and liquid soaps also damage our skin microbiome, which functions at a normal skin pH of 4-6. A healthy functioning skin microbiome is integral in the first years of life to help train our immune system.

Cold weather or wind, resulting in low humidity, is also a stress on the skin as it depletes the skin's natural lipids. Antiseptics and antibiotics used when not necessary also likely affect our skin microbiome. However, research has shown that in adults the skin microbiome is quite stable with repeat insults and it recovers. Research in this area is still evolving.

Pollution and UVL rays damage our skin through oxidative stress — breaking

down collagen and elastin and potentially causing damage to genetic material that can lead to skin cancer years later.

How has COVID been a burden to patients in relation to their skin health?

One of the biggest stressors to our skin health is washing and cleaning. As dermatologists, the number of patients with hand eczema has skyrocketed. We also saw this after SARS. Health care workers are especially affected, and it has led to problems. It's important to clean your hands, but contrary to popular belief, alcohol hand sanitizer is less damaging to your skin's barrier than washing with a cleanser or soap, and water. Furthermore, using a cleanser (Dove, Cetaphil or Aveeno bars) over a true soap bar, is better for your skin barrier and is sufficient for hygiene purposes.

It's important to clean your hands, but contrary to popular belief, alcohol hand sanitizer is less damaging to your skin's barrier than washing with a cleanser or soap, and water.

Is technology changing the game for dermatological treatments?

Telehealth has finally advanced in Canada and has been helpful for doctors to see patients virtually, but this still doesn't replace examining patients when necessary. I think we need, as doctors, to come to a happy medium where telemedicine will allow us to be more effective as physicians while helping our patients with availability. As far as other technologies, Dermatology screening apps are now available and, if used properly, they could help triage patients who need to be seen more urgently.

How Zyderma’s Innovative Formula is Changing Skincare

When understanding a skin issue like acne, it’s necessary to investigate the root of the problem. Scientific research and discovery pertaining to our body’s microbiome demonstrates an individual should consider the balance of the skin’s microbiome — a naturally comprised community of microbes.

The skin’s main function is to serve as a protective barrier from potential harm from foreign organisms and toxic substances. Skincare brand Zyderma®, takes a forward-thinking, eco-scientific approach to daily skincare.

Rather than replace the body’s mechanisms, products should support and strengthen our skin’s biome or microflora. This is a more responsible approach to skincare than relying on conventional products with harsh ingredients that strip healthy organisms that our skin needs to maintain a healthy and balanced appearance.

Zyderma®’s Clarifying Cream is formulated with micronized silver. Not to be confused with colloidal silver, this powdered form of high-grade silver has a large particle size that cannot penetrate skin tissue. It is a medical grade ingredient that is currently used by the medical industry for wound healing.

Co-founder Kelly Muciy shares, “When the moisture on our skin interacts with the micronized silver particles, they produce a continuous supply of positively charged ions, which bind to bacteria and deactivate their ability to feed and reproduce. Unlike other silvers, micronized silver does not absorb into the skin, and continuously works on the skin’s surface until washed off. Transient pathogenic organisms are prevented from colonizing on the surface while preserving native microflora within the epidermis that are essential for a healthy appearance. This is a game changer for people who naturally have an excess of skin straining bacteria upon their skin.”

The dermatologist-tested, lightweight Clarifying Cream can be used for face and body, with devotees using it for everything from makeup primer to aftershave.

Kelly Muciy Co-Founder, Zyderma

Expert Voice: Dr. Skotnicki

Dr. Sandy Skotnicki

Founding Director of the Bay Dermatology Centre, Assistant Professor at the University of Toronto, Department of Medicine in the Divisions of Dermatology and Occupational and Environmental Health