GETTING THE RIGHT SUPPORT AT SCHOOL AND WORK:
What accommodations can be made for skin conditions?
Two accredited continuing medical education (CME) courses that support front-line medical professionals in screening for and diagnosing skin cancer in patients with darker skin types have been developed by Melanoma Canada, formerly The Melanoma Network of Canada.
“From what we understand, very little time is spent in medical school on dermatology and skin cancer, and even less on skin of colour,” said Falyn Katz, Executive Director of Melanoma Canada, in an interview with Skin Spectrum Weekly.
The two courses are available through the MD BriefCase website. The first, titled “Melanoma in people with skin of colour: Diagnosis and treatment,” reviews how melanoma presents in darker-skinned individuals, how to screen for the most common types of melanoma in this population, when to refer, and treatment options. It is 30 minutes long and is accredited for one-half of a MainPro credit.
For more information on these courses, visit www.mdbriefcase. com/course/melanoma-in-people-with-skin-of-colour-diagnosisand-treatment/.
A keloid scar is an enlarged, bumpy or raised scar that can be pink, red, skin-coloured or darker than the surrounding skin. These can develop after very minor skin damage, such as a pimple or a piercing, and spread beyond the original area of skin damage.
When skin is injured, fibrous scar tissue forms over the wound to repair and protect the injury. In some cases, extra scar tissue grows, forming smooth, hard growths called keloids.
Keloids can be much larger than the original wound. They’re most commonly found on the chest, shoulders, earlobes, and cheeks. However, keloids can affect any part of the body.
While keloid scars may be itchy, they’re usually not harmful to your health. You may experience discomfort, tenderness, or possible irritation from your clothes or other types of friction.
An estimated 10% of people experience keloid scarring. People with darker skin tones are more prone to developing keloids.
ISSN 1923-0729
Melasma is a common, non-cancerous skin condition in which the body overproduces melanin, creating dark brown or blue-grey patches or freckle-like spots — usually on the face, forehead, upper cheeks, and around the mouth. This discoloration is also known as hyperpigmentation.
Melasma can be triggered by a number of external factors like sun exposure, heat, or skin trauma. It can also be genetic. But the real culprits are hormones. Melasma mostly affects women — and is sometimes referred to as “the mask of pregnancy,” because it frequently appears during pregnancy due to hormonal changes. It can also be triggered by birth control or hormonal therapies.
Unfortunately, because melasma is largely caused by hormonal fluctuations, it can be hard to treat. For example, it may not be practical to stop taking birth control even though you have melasma. Thankfully, most people with melasma do not need treatment. Melasma may fade away slowly if you stop taking birth control pills or hormone replacement therapy. When melasma is related to pregnancy, it may go away a few months after the baby is born.
However, there are options that you can discuss with your doctor to help keep dark patches from worsening.
• Retinoids: Retinoids promote skin cell turnover, which can help even skin tone. However, retinoids are not recommended during pregnancy. As an alternative, azelaic acid (cream, lotion, or gel) is safe for pregnant women to use.
• Low-potency steroids: Dermatologist-prescribed, lowpotency, topical steroids (like hydrocortisone) can help with inflammation, which in turn can fade the patches of dark pigment.
• Hydroquinone: Hydroquinone bleaches your skin by decreasing the number of melanocytes present. Melanocytes make melanin, which is what produces your skin tone. The lightening cream can help to fade patches over time.
Canadian
A Canadian healthcare professional answers your questions.
QHow do I know if I have frostbite and what should I do?
AFrostbite is a severe form of tissue injury due to exposure to sub-freezing temperatures. It may develop within minutes to hours, and the risk is increased with lower air temperatures, increased wind chill effects, and higher altitudes. Further risks include wet clothing, smoking, and conditions with poor blood circulation to the upper and lower extremities such as diabetes or Raynaud’s phenomenon. The most commonly affected body parts are the fingers and toes, nose, cheeks, and ears. Symptoms may include feeling cold, numbness, paresthesia (pins and needles sensation), and if the hands and feet are affected, clumsiness. The skin will appear pale, blue, or grey and feel waxy or hard. These signs may be less apparent in people with darker skin.
If you are concerned you have frostbite, the first thing to do is minimize any further tissue damage. Get to a warm, dry shelter and remove any wet clothing. Do not attempt to rewarm the skin if there is a chance it may re-freeze before it is properly managed – this can worsen tissue damage. Avoid intense heat as your ability to feel heat may be altered and you might burn or scald yourself. Do not rub the skin vigorously as this can also worsen tissue damage. You may wrap yourself in dry clothing and blankets. The next thing to do is go to the emergency room for medically-supervised rewarming. How the skin reacts during the rewarming period predicts the severity of frostbite, so depending on how quickly you get to the hospital, the extent of tissue damage may not be evident. It may be painful and your doctor can prescribe medication. The team that sees you in hospital will help you know what to expect and will provide further instructions.
QI think my child has molluscum; how do I make it go away?
AMolluscum, also known as molluscum contagiosum, is a common and non-serious viral skin infection. It presents as itchy, soft, skin-coloured papules (raised bumps) that sometimes contain pus. Molluscum is typically found in the creases of the body, such as the underarms and groin, but it can also be more spread out. The virus is spread via direct contact between people, shared surfaces such as towels or sports equipment, and through self-inoculation (when you transfer a disease from one part of your body to another).
Molluscum may look like chicken pox or common warts.
If you think your child has molluscum, have them seen by a healthcare provider. Most cases resolve on their own within one year and nearly all resolve within two years. In mild cases, no treatment is needed. In patients with dry skin or eczema, it is important to keep the skin moisturized and to follow your treatment plan as the breakdown in the skin can result in further spread of the virus. To minimize the spread of the virus and speed up healing, practice regular hand hygiene, cover bumps with clothing or bandages, avoid picking the papules, and do not share personal items. Children with molluscum should continue to attend daycare or school. For the bumps not covered by clothing, you can cover them with bandages.
Treatment options are available to alleviate discomfort, reduce spread to other areas of the skin or to other people, and decrease the risk of complications including secondary infection and scarring. Treatments include cryotherapy (freezing the papule so that it blisters and falls off), curettage (scraping or cutting away the papule), and topical creams. Both cryotherapy and curettage have risks including pain, blistering, bleeding, and scarring, which can limit their use in young children. Topical creams may be gentler for young children, but they must be applied by a healthcare professional. Do not attempt to remove the bumps yourself as it increases the risk of spreading the virus, infection, and scarring.
Dr. Raed Alhusayen is a consultant dermatologist at Sunnybrook Health Sciences Centre, in Toronto, ON.
Dr. Dimitra Bednar is a dermatology resident at the University of Toronto.
Got a question? Send it to info@canadianskin.ca.
BY RACHAEL MANION AND
Historically, skin patients’ concerns have been diminished, dismissed, and disregarded. As a result, skin patients do not always have optimal access to dermatology care, treatments for their conditions in their circumstances, and other supports, including mental health services.
The Canadian Skin Patient Alliance (CSPA) is dedicated to improving the health and well-being of people across Canada affected by skin, hair, and nail conditions, through collaboration, advocacy, and education.
At the CSPA, we envision a world where people affected by skin, hair, and nail conditions live healthy and fulfilling lives. To help get us there, we have developed advocacy reports on the experiences of different skin patient communities in accessing care, treatment, and supports. By sharing what we hear from skin patients about what it feels like to live with a skin condition with the public, healthcare professionals, and policy makers, we can increase compassion and understanding and encourage them to make decisions that would positively affect the lives of patients and their loved ones.
SABRINA RIBAU
“With chronic diseases like eczema, you need to listen to the patient experience. We live with our skin 24/7.”
CSPA’s advocacy reports help us present a bigger picture of the challenges faced by a particular skin patient community. By better understanding patients’ experiences in Canada, we can identify ways to address the many challenges that skin patients face.
and often one of our Affiliate Member organizations that focuses on that condition. Working in collaboration with other organizations dedicated to specific skin patient communities in Canada helps the CSPA bring a more consistent approach to the process used and the information collected in these reports.
These reports help us find similarities as well as critical differences between the experiences of people living with acne, for example, and atopic dermatitis. Where we find similarities among different skin patient communities, the CSPA can build more inclusive programming and develop more comprehensive resources that help more people across the country. For example, it is very clear from these three reports that people with skin conditions have a heavier burden on their mental health and self-esteem.
parts of Canada where there are fewer doctors, we tended to see more atopic dermatitis patients accessing care in the hospital. A surprisingly high number of HS patients visit the emergency department. As a result, we made recommendations to improve integrated care in the community and keep patients healthier and out of hospitals.
The process of requesting and analyzing this data gave us insights into the needs for better pan-Canadian health data infrastructure. We have advocated in support of improvements in collecting, comparing, and sharing (aggregate) patient data so that we can, in turn, develop better ways for patients to access medical care across the country.
In recent years, we have updated two earlier reports on the experiences of people living with hidradenitis suppurativa (HS) (May 2020) and with atopic dermatitis (November 2022), and created a new report on the experiences of people living with acne in Canada (September 2022). To create these reports, we collaborated with patient organizations that focus on serving these specific patient communities: an HS patient who went on to found HS Heroes for the HS report, Eczéma Québec for the one on atopic dermatitis, and the Acne and Rosacea Society of Canada for our acne report. Each report asked dozens of questions to get a better picture of what life is like with these conditions. We appreciate the time and attention that skin patients and their loved ones take when filling out the surveys that form the basis of these reports!
These reports are developed by a team that includes people with lived experience of the condition, a dermatologist with expertise in the specific condition, CSPA staff members,
It is also clear that while atopic dermatitis can have an important impact on people’s sleep, for example, because of its characteristic itch, people living with HS more often suffer from the pain of the condition. For conditions that are often perceived by the public and decision-makers as more cosmetic in nature, like acne, being undertreated (resulting in scarring) is a pressing issue.
These reports can also allow us to better understand common issues. When patients have to purchase products that are not covered by their insurance plan (if they have one), living with the condition can be very expensive. For people with HS, there are often additional expenses for wound care products; for people with atopic dermatitis, there are often ongoing needs for specific clothing or laundry products that do not aggravate their condition; and for people with acne, the abundance of over-the-counter options and poor insurance coverage of prescription options places an elevated financial burden directly on patients.
For two of these reports, CSPA and our collaborators purchased data from the Canadian Institute for Health Information. This gave us insights into how often these patient communities access hospitals. For example, in
By better understanding patients’ experiences in Canada, we can identify ways to address the many challenges that skin patients face. We share these reports with policy makers in Canada and use this evidence regularly in our advocacy work. We believe that if our policymakers really could understand what it feels like to live with a skin condition, they could and would make decisions that would positively affect our lives.
Visit our site to learn more about our advocacy reports: www.canadianskin. ca/advocacy/advocacy-reports.
“Acne has left my face unrecognizable. My mental state is very depressed, prone to psychological disorders. This seriously affects my quality of life.”
“My 7-year-old son’s eczema has a huge impact on his mood and his sleep, as he is constantly uncomfortable in his own skin.”Rachael Manion is the Executive Director of the CSPA.
BY IAN TIN YUE WONG, BSC (PHARMACY), MD AND GILLIAN DE GANNES, BSC(HON), MSC, MD, CCFP, FRCPC, DABD
Dermatitis is a broad term that refers to the inflammation that underlies a red, itchy skin rash; for people with darker skin types, it can appear dark brown, purplish, or grey. This inflammation can be the result of various patient and environmental exposures. Common causes of dermatitis include atopic dermatitis (eczema) and contact dermatitis. Patients with eczema have a genetic predisposition to an impaired skin barrier that fails to retain hydrating moisture and fails to protect the skin from irritants and microorganisms that result in dermatitis.
Contact dermatitis is an umbrella term that encompasses both irritant contact dermatitis and allergic contact dermatitis. When a substance or chemical is in contact with the skin and injures the skin barrier, causing a rash, this is called irritant contact dermatitis. This could be a short period of contact with a strong chemical, or a longer period of time in contact with a weak chemical. When a substance or chemical triggers the immune system to have an immune response resulting in a delayed skin rash, this is called allergic contact dermatitis.
• Irritant contact dermatitis is diagnosed based on clinical history and physical examination.
• Allergic contact dermatitis is diagnosed based on clinical history, physical examination, and patch testing.
A specialized process used by dermatologists to investigate whether a chemical causes a patient to have allergic contact dermatitis.
The dermatologist tailors the chemicals tested in patch testing to each individual patient’s exposure history. In Canada, patients are also screened for the most common problematic chemicals used in North American manufacturing. For example, chemicals tested include nickel, preservatives, fragrances, rubber, adhesives, and dyes. These chemicals may not be the first thing a person looks at under the ingredients list of a product, however, many of them are found across the marketplace.
Patch testing starts with a referral to a dermatologist who offers patch
• Irritant contact dermatitis accounts for ~80% of contact dermatitis cases
• Allergic contact dermatitis accounts for ~20% of contact dermatitis cases
• Examples of common causes of irritant contact dermatitis: sweat, soap, bleach, detergents
• Examples of common causes of allergic contact dermatitis: nickel, fragrances, preservatives
testing. The dermatologist will review the patient’s skin disease history and chemical exposure history to identify if allergic contact dermatitis is suspected. If patch testing is deemed necessary, the dermatologist will organize a series of visits for the patch testing to take place. At our centre in British Columbia, patients attend at least three appointments over a seven-day period.
Dermatitis can be caused by a variety of reasons and allergic contact dermatitis may be one of these causes of dermatitis. Patch testing is a valuable tool, ideally performed by dermatologists, that can help to investigate the potential for allergic contact dermatitis in patients experiencing dermatitis.
For more information on contact dermatitis, you can read this article from our Spring 2021 issue: https://issuu. com/kelmanonline/docs/canadianskin_ spring2021/4
Ian Tin Yue Wong, BSc(Pharmacy), MD, was a practicing pharmacist and is now a final-year 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 at St. Paul’s Hospital and a Clinical Assistant Professor in the Department of Dermatology & Skin Science at the University of British Columbia.
The skin is the body’s first line of defense against infection, but some viruses can get past these defenses. Warts, cold sores, genital herpes, shingles, and molluscum contagiosum are among the most common skin infections caused by a virus. So, what are they and how do people get them?
Warts
Warts are common skin growths caused by a virus called human papillomavirus, or “HPV.” Warts can appear on the skin or genitals. They can be bumpy or flat; isolated or in a cluster; and the same colour as the skin or darker1. Warts are usually not painful, but in some people,
they can feel itchy or sensitive. The virus that causes warts (HPV) can spread through skin-to-skin or sexual contact. Sometimes warts go away on their own. Other times, the doctor or nurse may need to remove the wart by freezing it, burning it, using a laser, or cutting the wart off 1. Removing the wart does not mean that the HPV infection is gone. Warts can come back, and the infection can still spread to other people2. Importantly, some types of HPV have been linked to cancer. There is an HPV vaccine that can prevent infection and it is recommended that people get the vaccine before becoming sexually active 3
stress, or fever4. If someone is infected, they can still spread it to someone else even when the symptoms go away. For individuals with symptomatic oral or genital herpes, limiting skin-toskin contact can reduce the spread of infection to others4
Cold sores and genital herpes
Cold sores (also called oral or labial herpes) and genital herpes are both caused by herpes simplex viruses (HSV). Herpes simplex virus type 1 (HSV-1) more commonly causes cold sores, while herpes simplex virus type 2 (HSV2) more commonly causes genital herpes4. When someone is infected with HSV, groups of painful blisters can appear around the mouth or genitals which can last for up to two weeks5. The first time someone gets infected they may also have flu-like symptoms. Some people infected with HSV have no symptoms, making it easier for the virus to spread. The virus spreads through skin-to-skin contact with the part of the body that is infected4. Most cases of HSV require no treatment, but antiviral and over-the-counter pain medication are available. Importantly, treatment only improves symptoms and does not get rid of the HSV virus5. Symptoms can come back, and this can happen when someone is exposed to extreme temperatures (very hot or very cold),
Shingles (or herpes zoster) is a painful rash with blisters caused by the varicella zoster virus. This is the same virus that causes chicken pox. Following an episode of chicken pox, the virus remains inactive in the body’s nerve cells. The virus can wake up and spread to the skin, causing rashes that look like a band on the body6. Shingles tends to affect individuals with weakened immune systems, like older adults7 Much like chicken pox, shingles usually develops in stages starting with general skin discomfort (burning, pain, itching) and sometimes general illness. Within one to two days a painful rash with blisters appears, which can lead to open sores called “ulcers.” The rash will usually scab and heal within one to two weeks7 People with shingles should avoid sharing clothes and towels, wear loosefitting clothes, and avoid scratching the rash. Treatment for shingles includes over-the-counter pain medication and anti-viral drugs. Rare, but serious, complications of shingles include postherpetic neuralgia, a continuous pain that lasts long after the rash disappears. Shingles can be prevented with a vaccine, which is recommended for adults over 50 years old8
Molluscum contagiosum is caused by the molluscum contagiosum virus (MCV). The virus causes small, skincoloured or white bumps on the skin with a dimple in the center. The bumps can be anywhere on the body, except for the palms of the hand and the soles of the feet9. These bumps are not painful but may feel itchy. It’s important not to scratch the bumps to avoid spreading the virus to other parts of the body. Infection can spread to others by skinto-skin contact or by sharing objects, like towels, that have touched infected skin10 In people without other health concerns, the bumps will stay on the skin for a few months, and then they will usually
go away on their own. If someone has a weakened immune system, the bumps may stay for longer or they may reappear. Most people do not need treatment, but it can be used to make the bumps go away more quickly. The doctor may remove the bumps by freezing them (cryotherapy), scraping them off (curettage), or using a laser on them. Alternatively, the doctor may prescribe a medication to get rid of the infection9
These skin infections are common, but there are many ways to protect yourself from them. Remember, if you or someone else has an infection, avoid touching the affected area, limit the use of shared items, and practice safe sex. Anti-viral medications work best if they are taken as soon as possible after infection occurs. Learning what the symptoms look like and how viruses spread, and getting vaccinated, can help prevent infection.
To learn more about these conditions, visit www.canadianskin.ca/skin-conditions
1. Grennan, D. (2019). Genital warts. JAMA, 321(5), 520. https://doi. org/10.1001/jama.2018.20181
2. Drake, L. A., Ceilley, R. I., Cornelison, R. L., Dobes, W. L., Dorner, W., Goltz, R. W., Lewis, C. W., Salasche, S. J., Chanco Turner, M. L., Lowery, B. J., Shama, S. K., Androphy, E. J., Galen, W. K., Heaton, C. L., Lynch, P. J., & Chanco Turner, M. L. (1995). Guidelines of care for warts: Human papillomavirus. Journal of the American Academy of Dermatology, 32(1), 98–103. https://doi.org/10.1016/0190-9622(95)90192-2
3. Harper, D. M., & Paavonen, J. (2008). Age for HPV vaccination. Vaccine, 26. https://doi.org/10.1016/j.vaccine.2008.01.013
4. Crimi, S., Fiorillo, L., Bianchi, A., D’Amico, C., Amoroso, G., Gorassini, F., Mastroieni, R., Marino, S., Scoglio, C., Catalano, F., Campagna, P., Bocchieri, S., De Stefano, R., Fiorillo, M. T., & Cicciù, M. (2019). Herpes virus, oral clinical signs and QOL: Systematic review of recent data. Viruses, 11(5), 463. https://doi.org/10.3390/v11050463
5. Cernik, C. (2008). The treatment of herpes simplex infections: An evidence-based review. Archives of Internal Medicine, 168(11), 1137. https://doi.org/10.1001/archinte.168.11.1137
6. Patil, A., Goldust, M., & Wollina, U. (2022). Herpes zoster: A review of Clinical Manifestations and management. Viruses, 14(2), 192. https:// doi.org/10.3390/v14020192
7. Cohen, K. R., Salbu, R. L., Frank, J., & Israel, I. (2013). Presentation and management of herpes zoster (shingles) in the geriatric population. P & T: A peer-reviewed journal for formulary management, 38(4), 217–227.
8. McDonald, B. M., Dover, D. C., Simmonds, K. A., Bell, C. A., Svenson, L. W., & Russell, M. L. (2017). The e ectiveness of shingles vaccine among Albertans aged 50 years or older: A retrospective cohort study. Vaccine, 35(50), 6984–6989. https://doi.org/10.1016/j. vaccine.2017.10.067
9. Meza-Romero, R., Navarrete-Dechent, C., & Downey, C. (2019). Molluscum contagiosum: An update and review of new perspectives in etiology, diagnosis, and treatment. Clinical, Cosmetic and Investigational Dermatology, 12, 373–381. https://doi. org/10.2147/ccid.s187224
10. Nguyen, H. P., Franz, E., Stiegel, K. R., Hsu, S., & Tyring, S. K. (2014). Treatment of molluscum contagiosum in adult, pediatric, and immunodeficient populations. Journal of Cutaneous Medicine and Surgery, 18(5), 299–306. https://doi.org/10.2310/7750.2013.13133
Shabnum Teja is a second-year medical student at Western University.
“These skin infections are common, but there are many ways to protect yourself from them.”
The articles from which these summaries of the latest in skin research are taken are hot off the press!
The connection between atopic dermatitis and Attention-Deficit/ Hyperactivity Disorder (ADHD)
Atopic dermatitis (AD), also known as eczema, is a chronic skin disease that causes intense itch. Sleep disturbances are commonly reported in people with atopic dermatitis, and can lead to difficulties with attention and concentration during the day. Attention-Deficit/Hyperactivity Disorder, or ADHD, is a mental health condition that is diagnosed usually in children, but also in adults, who are easily distracted, have trouble paying attention, and who often act impulsively. A new study published in 2022 in the Journal of the American Academy of Dermatology used large sets of data to answer the question of whether people with AD are more likely to live with ADHD.
Using a nation-wide database of adults living in the United States, over 10,000 people with AD and around 47,000 people without AD were included in
this analysis. People with AD were found to be almost three times more likely to be diagnosed with ADHD, compared to people without AD, regardless of other factors including age, sex, and race.
While it is still uncertain how AD and ADHD are linked, an inflammatory reaction that was found to be similar in both AD and ADHD could explain how someone with one condition could be more predisposed to having the other. Alternatively, people are usually diagnosed with AD before being diagnosed with ADHD, and one theory is that the psychosocial stress from chronic itch and sleep disturbances for people with AD could be a trigger for mental health conditions such as ADHD. Understanding ways to reduce symptoms of AD that could cause stress, such as improving itch, sleep, and quality of life, could be related to improving symptoms of ADHD.
translation tools for use by Indigenous communities
Knowledge translation (KT) tools are resources that provide information to patients and families so that they can better understand their child’s illness and make informed decisions, for example, in the form of website pages, educational workshops, or child-friendly videos. Indigenous communities often face difficulties with accessing health resources and receiving the same level of care as other communities in Canada. A study published in 2022 by a research group based in Edmonton, Alberta used the KT tool of a video series to help parents
better understand common childhood conditions and adapted these videos to better relate to and be accessible to Indigenous communities.
What they found
Eighteen healthcare professionals serving Indigenous communities in Alberta were interviewed to discuss the KT videos and answered a series of questions related to their experiences using KT tools with their patients. The study found that factors like increasing accessibility to physical KT tools for families who may have limited access to the internet, using cultural norms and environments from these communities within the tools (such as scenery from a remote community), and building genuine relationships with the community members were important for effectively adapting KT tools for Indigenous families.
What does this mean for healthcare providers and patients?
KT tools that have been adapted to provide better accessibility and relatability to the communities they are intended for help to build strong relationships between healthcare providers and families. Involving feedback from members of the community in the development and adaptation of these tools is critical.
1. Fan, R., Leasure, A.C., Damsky, W., Cohen, J.M. (2022). Association of atopic dermatitis with attention-deficit hyperactivity disorder among US adults in the “All of Us” research program: A casecontrol study. J American Academy of Dermatol, 87(3):P691-692. https://doi.org/10.1016/j.jaad.2022.03.014
2. Elliott, S.A.,
S.D., Scott, S.D., Hartlin, L.
J., Wrist, K.S.,
child health knowledge translation tools for use by Indigenous communities: Qualitative study exploring health care providers’ perspectives. JMIR Form Res, 6(10):e36353. https://doi.org/10.2196/36353.
Kreutz, Lallo, (2022). Adapting
By Mona Fraser
It all started in the winter, 20 years ago: while outdoors, I got cold. All of a sudden, I felt itchy all over my body. My legs were burning, and then I discovered that I was full of hives. I was diagnosed with “cold urticaria.”
Cold urticaria is an autoimmune disorder where the skin has a reaction to the cold within minutes of cold exposure. My condition has progressed since that day, and I now get several painful reactions. All over my body, from my face to my toes, I get redness that looks like a burn, and a purple lacy rash that is a warning that hives are coming.
I get large red welts, wheals, and swelling that feels like rocks under my skin; it itches and burns and it feels like someone poured acid all over my body. I can feel sick, faint, and weak, my lips swell, my nostrils swell shut, and I feel like I cannot move.
When you feel that chill in the air, to me, it feels like a bite. My doctor instructed me to stay indoors during cold weather, wear a mask and a scarf, and not breathe in cold air – he is afraid I may go into anaphylactic shock. It can get cold here in Nova Scotia, and I need my house to be warmed to at least 25°C all year round. I constantly check the weather and wind chill because going outdoors for even two minutes can be dangerous for me. Even on a warmer, sunny day in winter, a lot of preparation goes into going out: two pairs of heavy socks, boots, mitts, hat, heavy coat, fur-lined pants, and of course a mask and scarf. I also have a remote start to warm my car and my doctor has supported me in getting an accessible parking permit so that I can park close to the door of where I’m going. When I get home, I immediately warm up with blankets, hot tea, hot soup, and a warm bath.
I look forward to summer, but I always have to be aware of my surroundings –a cool summer breeze, air conditioning, or walking by the freezer section causes a breakout. No cold drinks or ice cream for me, either. My close friends call to check on me during cold snaps, reminding me not to go out for even one minute to get the mail. I find I
worry about things a lot, like the power going out, and it can be scary. Recently the power went out for seven days due to a hurricane and I had no heat in the house. I got really sick and my condition has gotten worse since the storm. It deeply affects my mental and physical wellbeing, and it’s hard to cope at times because I know the cold can be lifethreatening for me.
People don’t think it’s a real condition. This makes me upset because it isn’t easy: all the little things you don’t even think about – grocery aisles, taking out the garbage, enjoying an ocean breeze – are events that I need to prepare for so that I can go about daily life. I go on social media to share and connect with others living with cold urticaria. My hope is that if people can better understand what it’s like living with this condition, we can build a more compassionate and supportive community for all.
Have you ever wondered why you start to sneeze every spring when flowers start to bloom, or why your eyes get itchy whenever you play with cats? You might have an allergy!
Every day, your body protects itself from many tiny little germs that can make you sick. We call these pathogens. If you imagine a grain of sand and divide it into 1,000 little pieces, some pathogens are that tiny! How does your body protect itself against these microscopic pathogens? Your body has an important team of defenders called the immune system
The immune system is very good at recognizing pathogens that don’t belong in your body, attacking, expelling them, and keeping your body healthy.
Sometimes when your body is exposed to something new and harmless, your immune system makes a mistake and reacts to it –it thinks it is dangerous! This is called an allergy and the substance your body is reacting to is called an allergen. The same immune response also happens when your body comes across specialized pathogens, called helminths and protozoa.
If specialized worm-like pathogens enter our body (left), our immune system recognizes these germs by a molecule called immunoglobulin E (IgE), which tells the immune system to mount an attack and stop the infection. IgE may also recognize harmless objects found every day (right) triggering an allergic response in some people. Image created with BioRender.
Scientists have identified different types of allergens that trigger an allergic response. They can enter the body when you eat a food or through the lungs or skin. Common allergens include pollen, foods such as nuts, seafood, and milk, pet dander, dust mites, and insect stings. Some people even develop allergies to medications and certain types of clothing!
How do I know if I have an allergy? Allergies appear in many ways. This may include having a runny nose, sneezing, itchy eyes, difficulty breathing, swelling, changes in your
The prevalence of allergies in Canada has been increasing for several decades and can cause significant distress and time away from school for children. Although many children ‘outgrow’ allergies, certain allergies to peanuts, tree nuts, and seafoods commonly persist into adulthood. The exact way in which allergies develop is unclear; some scientists think that environmental exposures during the first year of life are critical. These may include the time and route (mouth versus skin) that children are exposed to potential allergens.
skin such as rashes, hives, and itching, or even an upset stomach!
A possible dangerous risk of allergies is a life-threatening condition called anaphylaxis. If you or someone else suddenly experiences a rash with difficulty breathing, throat tightness, dizziness, or light-headedness, go immediately to your nearest hospital for treatment.
What should I do if I suspect my child has an allergy?
For allergy testing and treatment, speak to your primary care provider and visit ‘find an allergist’ near you at www.csaci.ca If you or your child think you are having an anaphylactic reaction, please go to your nearest emergency department.
For further information on allergies, please visit: www.allergyaware.ca and https://foodallergycanada.ca.
Glenn Walpole, PhD, is a medical student at the University of Toronto with an interest in immunology, pathology, and dermatology.
The definition of “accommodation” can bring out different feelings: adaptation, adjustment, or even compromise to what others need.
Many people with skin conditions might find they have specific health or disability needs that don’t fit into how workplaces and schools function, like getting time off to receive prescribed treatments, benefit plans that reimburse medications, and dealing with fatigue and a busy work or school schedule. Flares of skin conditions can mean what is needed today or next week changes, and employers and schools can find it difficult to respond to the dynamic nature of these conditions.
The duty to accommodate is a legal concept that requires employers or schools to remove barriers that have a negative impact on employees or people protected under human rights laws. There is a limit to the duty to accommodate – “undue hardship” – that considers costs, health, and safety. Many employers or schools have procedures in place where people can request changes to how the work is done to support their full participation at work or school. It often starts with identifying functional limitations –like difficulty concentrating, temperature sensitivity, stress, and suppressed immune systems – and then identifying alternative ways of getting the work done.
Sharon Janes works for Mysa, a start-up company in St. John’s (Newfoundland and Labrador), and her employer accommodated the time off needed for treatments prescribed by her dermatologist for the treatment of vitiligo, diagnosed after the birth of her first child. “I needed light therapy treatment two days a week for a year. It was only about 45 minutes out of my day, but it was a huge commitment since treatments were two days every week for 52 weeks. I wouldn’t have been able to do it if work wasn’t flexible allowing me to modify my schedule during these treatments.”
The process of asking for work or school accommodations can be challenging, however. Many don’t understand that they can ask for accommodations. Feeling comfortable asking for accommodations depends on existing relationships
with a supervisor, co-workers, and administrators. The process of getting accommodations is like a negotiation and the focus should be on collaboration between all parties. Carly Fox, Communications and Partnerships Director at the National Educational Association of Disabled Students (NEADS), lives with psoriatic arthritis and says her experience working at NEADS has been positive. As an organization by disabled people for disabled people, she says they understand the day-to-day challenges of living with chronic illness and disability. “I can just tell them I’m having a day of brain fog. No further explanation is needed.”
With the COVID-19 pandemic, we have seen a lot of schools and workplaces shift to virtual learning or work environments. New technologies were purchased and new approaches to school and work were implemented. With the easing of public health restrictions, there has been increased stress and anxiety felt by students at post-secondary institutions or families of children with medical complexities. Carly Fox notes, “In the summer, we weren’t sure if mask and vaccine mandates were continuing and whether online learning options would continue. Many disabled students felt alone so we launched a back-to-school advocacy campaign so they had a platform to share their experiences and connect with other disabled students and relay concerns to schools.”
What is considered “reasonable accommodation” rests with the employer or school. There is a clear requirement to involve employees
or students in the conversations and ensure respect and dignity for the person. Despite this requirement, Carly notes that many schools made attendance in person mandatory to complete many classes. “Disabled students were not consulted about many of the key decisions, like mask mandates. I have seen some disabled students drop out of school because of the lack of concern for their health.”
Being back to in-person school or work means people are subjected to awkward glances from coworkers, clients, and others as they see the visible effects of vitiligo, psoriasis, and other skin conditions poorly understood by the public. Sylvain, a mid-career executive in finance, says he feels the pressure to hide his psoriasis plaques because “people expect me to be presentable.” Working virtually enabled him to feel more comfortable at work and reduce the stigma he felt. This meant less stress and anxiety and kept him focused on work.
Work and school are such important parts of our lives. It is possible to find ways to navigate through school and work accommodations while staying healthy. Start by getting informed about the support available to you like a mapping tool (https://workingitout.ca/ en/2022/mapping-tool) that provides resources about finding and keeping a job and finding retraining opportunities. NEADS also offers resources for disabled students like accessing disability services on campus, scholarships for disabled students, and financial aid. Visit their website at www.neads.ca/en.
There is a reason to be optimistic. Many employers and schools are becoming aware of the needs of workers and students with disabilities and heeding the call to action. Do your homework and get involved to make work and school responsive to your health needs.
Laurie Proulx is self-employed and provides consulting services focused on workplace inclusion for people with disabilities, community and patient engagement, and health and social policy. She lives with a disability and brings her lived experiences to this work.
• theprocessofadaptingoradjustingto someoneorsomething.
• a convenient arrangement; a settlement or compromise.
CSPA in action: A spotlight on our latest activities, events and other information of importance to skin patients in Canada
Since the Canadian Skin Patient Alliance (CSPA) helped to found the Canadian Association of Psoriasis Patients (CAPP) in 2012, the two organizations shared a unique relationship. Both have always been distinct organizations that operated independently but used a shared staffing model. This shared staffing model provided many benefits to the organizations over the years and kept the overhead low so that funding could be directed to patient-focused advocacy and education. Ultimately, it allowed both CSPA and CAPP to successfully grow into strong, reputable patientcentred organizations.
On December 1, 2022, we celebrated bright new futures for both CSPA and CAPP with the end of the shared staffing model. Now, each organization has its own dedicated staff team to support their respective communities. CSPA and CAPP will continue to collaborate on select projects with the shared goal of improving the future for people with psoriatic disease in Canada.
The CSPA and CAPP are currently collaborating with the Canadian Psoriasis Network to better understand how teledermatology and virtual care can improve psoriatic disease care. If you are interested in learning more or getting involved to share your perspectives, please contact us!
CSPA is proud to continue to support research conducted by teams that include patients and caregivers. The Skin Investigation Network of Canada (SkIN Canada), which includes the CSPA, has awarded Team Development Grants to nine skin research teams across the country who will build research projects on frostbite, hidradenitis suppurativa (HS), eczema, hypertrophic scars, morphea, skin cancers – including rare Merkel cell carcinoma, and epidermolysis bullosa (EB). Congratulations to all the teams who received these grants for their research projects!
Looking ahead, we are planning the launch of two new resources as part of our Self-Empowerment Toolkit. The first is a guide for people who have
been newly diagnosed with a skin, hair, or nail condition. Developed by a registered clinical psychologist, this resource talks about the cascade of emotions that we all feel when we are handed a new diagnosis and walks through how to handle them and set ourselves up for success. The second resource is a guide for getting the most out of your dermatology appointment. It discusses what you can expect before, during, and after your dermatology appointment and how you can best be prepared to use this precious time with your dermatologist.
We encourage you to get involved with the CSPA. Whether you’re a patient, a caregiver, a student, or a health professional, there are many ways to get involved. Check out our website for more information on volunteer opportunities and how to donate to our organization.
Wishing you all the best for 2023!
Rachael Manion, Executive Director, CSPA
AbbVie is the Founding Sponsor of the Canadian Skin Magazine and an ongoing supporter of CSPA’s 2023 publications.
We want to hear from you!
What do you like most about our magazine?
What would you like to see us talk about?
Your feedback is important to us and it helps us better understand the needs of our skin patient community. Let us know by completing this one-question survey –we’d love to hear from you!
https://forms.office.com/r/ GKAcazqpc6
Thank you to the Medical Advisors, Board Members, and Volunteers who support the work of the CSPA. For an updated list of names, visit canadianskin.ca/about-us.
AboutFace: aboutface.ca
Acne and Rosacea Society of Canada: acneaction.ca (acne) rosaceahelp.ca (rosacea)
Alberta Lymphedema Association: albertalymphedema.com
BC Lymphedema Association: bclymph.org
Camp Liberté Society: campliberte.ca
Canadian Alopecia Areata Foundation (CANAAF): canaaf.org
Canadian Arthritis Patient Alliance: arthritispatient.ca
Canadian Association for Porphyria: canadianassociationforporphyria.ca
Canadian Burn Survivors Community (CBSC): canadianburnsurvivors.ca
Canadian Chronic Urticaria Society –Société canadienne d’urticaire chronique: chronicurticaria.ca
Canadian Psoriasis Network: cpn-rcp.com
Canadian Skin Cancer Foundation: canadianskincancerfoundation.com
DEBRA Canada (epidermolysis bullosa): debracanada.org
Eczéma Québec: eczemaquebec.com
Eczema Society of Canada: eczemahelp.ca
Firefighters’ Burn Fund: burnfundmb.ca
Hidradenitis & Me Support Group: hidradenitisandme.ca
HS Heroes: hsheroes.ca
Lymphedema Association of Ontario: lymphontario.ca
Mamingwey Burn Society: mamingwey.ca
Melanoma 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 Atlantic: sclerodermaatlantic.ca
Scleroderma Canada: scleroderma.ca
Scleroderma Manitoba: sclerodermamanitoba.com
Scleroderma Society of Ontario: sclerodermaontario.ca
Stevens–Johnson Syndrome Canada: sjscanada.org
Tumour Foundation of BC: tumourfoundation.ca
AbbVie is not providing editorial support for the magazine. The CSPA is responsible for the final content featured in Canadian Skin
www.canadianskin.ca
TALKING TO KIDS: How to Talk to Children, Youth, and Adult Children About Your Skin Condition
At the CSPA, we strive to improve the lives of people affected by skin, hair and nail conditions – both patients and loved ones alike. To support this goal, the CSPA has developed the Self-Empowerment Toolkit, a series of resources to educate, guide, and support skin patients and those around them.
The first resource, Talking to Kids: How to Talk to Children, Youth, and Adult Children About Your Skin Condition, is an infographic booklet that dives into why it’s important to talk to children about your health condition and how to do so in a way that is age appropriate and relevant to the child. This guide is designed for parents, teachers, coaches, and other adults with skin, hair or nail conditions.
Our goal is to support skin patients and open communication channels between patients and their families, friends, coworkers, and healthcare professionals. By having a better understanding of the impacts of living with a skin, hair, or nail condition and ways to navigate your relationships, we strive to improve the quality of life of skin patients and their loved ones across Canada.
Visit www.canadianskin.ca/education/self-empowerment-toolkit to learn more about the Self-Empowerment Toolkit and to check out our resources on managing the psychological and social impacts of a new diagnosis and navigating your dermatologist appointment.
