COMPLIMENTARY www.canadianskin.ca 2ISSUE�13VOLUMECANADIAN EXERCISE AND SKIN HEALTH CLOSE UP ON LICHEN PLANUS (LP)The Official Publication of the Canadian Skin Patient Alliance Summer 2022 dermatologyNavigating as a person of colour Common skin, hair, and nail changes while on hormone therapy health:Trans
SUGGESTIONSANDTIPSFOR SKIN PATIENTS AND THEIR FAMILIESSKINfac Canadian Skin Patient Alliance: 111-223 Colonnade Road South, Ottawa, ON K2E 7K3 Toll Free: 1-877-505-CSPA (2772) • E-mail: info@canadianskin.ca Canadian Publication Mail Sales Product Agreement No 40065546. Printed in Canada. Summer 2022 • Volume 13 • Issue 2 ISSN CraigPublisher:1923-0729Kelman& Associates www.kelman.ca All rights reserved. ©2022 Contents may not be reproduced. To subscribe today to this complimentary magazine, call 1-877-505-2772 or email us at info@canadianskin.ca CANADIAN CLOSE UP ON LICHEN PLANUS (LP) Summer 2022 dermatologyNavigating as a person of colour nail changes while on hormone therapy health:Trans Follow us @CanadianSkin
HidraWear clothing
HidraWear is an award-winning line of wound management clothing designed for people who have hidradenitis suppurativa (HS). It was founded by Suzanne Moloney, a woman who has been living with HS since she was a teen. She was an active member of many HS communities and knew that there was a need in her community for garments designed specifically to support to people living with HS.
Made
Age spots may affect people of all skin types, but they’re more common in adults with lighter skin types. Unlike freckles, which are common in children and fade with no sun exposure, age spots don’t fade. They are very common in adults older than 50, but younger people can get them if they spend time in the sun. Protect your lips from the weather If you spend a lot of time out in the sun, your lips can get chapped from too much sun exposure. To prevent sun-chapped lips, use a lip balm with protective ingredients like titanium oxide or zinc oxide. Products with an SPF of 30 or higher will help protect your lips from the sun. If you don’t live in a sunny climate, you still need to take care of your lips. Windy or cold weather can be just as damaging to sensitive lips as the sun is. To be safe, reapply your chapstick or lip balm every few hours to keep your lips protected from the elements. One of the most important things you can do to take care of your dry lips is to stay hydrated. Your lips don’t have any oil glands, so they dry out easily. Drinking lots of water can help to combat lip dryness.
Freckles are extra patches of colouring (pigment) under your skin. Freckles often show up during childhood, and you may continue to get more until you’re in your 20s. People with fair skin or red hair are most likely to have them. Freckles usually occur in clusters across larger areas of the skin. Age spots are flat brown, grey, or black oval areas on the skin. They usually occur on sun-exposed areas, like the backs of your hands, tops of feet, face, and shoulders. Age spots are also called liver spots or sun spots. Age spots tend to emerge by themselves but may group together, making them more noticeable. Both freckles and age spots are caused by skin pigmentation called melanin.
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Freckles and age spots
HidraWear,informationbriefsforunisexincludematerials,seamsoutward-facingwithandsoftproductsacroptop,T-shirt,briefswomen,andformen.Formoreonvisit hidrawear.com.
• Continue to use prescribed anti-acne treatments.
Q I have hair loss. Is microblading or tattooing safe to provide the look of hair where desired (e.g., my eyebrows)? A Microblading is a form of superficial micropigmentation, where pigment is deposited in the uppermost layer of the skin, with the help of stacked needles that are arranged like a scalpel. The resulting hair-like incisions simulate the appearance of eyebrow hair to give a natural look. The results are semi‐permanent and last between 12 to 18 months. In recent years, there have been several improvements in Concerns about acne and microblading/tattooing
ASK THE EXPERT
• Clean your skin properly once you’re back indoors.
A For most people, acne gets better during the summer. However, it may worsen in others.
First, the hot weather causes the skin to create more sweat and oil, so the skin pores become clogged more easily, leading to summer acne breakouts.Second, the UV light has a keratolytic effect on skin cells, which means skin cell turnover increases when you’re in the sun. Those dead skin cells can also clog up your pores and contribute to acne flare-ups. Simply changing your skincare routine may help prevent summer breakouts.
A Canadian healthcare professional answers your questions.
• Adjust your skincare routine: switch to a lighter moisturizer and consider switching to a water-based formula, which can offer excellent moisture retention without running the risk of clogging up your pores.
• To prevent trunk acne, wear breathable fabrics; sweat that gets trapped under clothing can lead to body acne. Wear natural fibers like cotton and linen. Change into dry clothing after swimming.
By Dr. Isabelle Delorme this procedure. Microblading has now found applications not only in cosmetic treatments but also in dermatological conditions such as alopecia areata, drug-induced hair loss, etc. Microblading results in very few complications. The most common complications are misapplication of the pigment, pigment migration, colour change, and unintended hyperpigmentation. Serious complications are uncommon. As with all forms of tattooing, the risks associated with microblading include reactions to pigment ingredients and the transmission of a range of infections, particularly if the needle is not sterile or is shared among persons, resulting in a range of infections (bacterial, fungal, and viral). There is the potential for granulomas (foreign-body nodules) to form on the tattooed areas. On the other hand, tattooing of skin implies depositing pigment particles and ink ingredients deeper in the skin, for permanent results. As the popularity of tattoos is rising, more skin and systemic tattoo-associated adverse events have beenAllergicreported.reaction to tattoos is the most common skin side effect, particularly to red pigments. Another reaction, called foreign body reaction, may present as red nodules (bumps) or plaques within the tattoo, appearing within a few weeks to years after the tattoo placement. Tattooing may also induce flare-up of chronic skin disease, such as psoriasis. Although rare, adverse reactions can occur as a result of tattooing. The person wishing to get a tattoo should be informed of these risks before the procedure.
Dr. Isabelle Delorme is a certified dermatologist working in Drummondville, Quebec. Got a question? Send it to info@canadianskin.ca.
3Summer 2022 | www.canadianskin.ca |
• Use as little makeup as possible.
Learn m e, li er.
TIPS ON HOW TO PREVENT SUMMER ACNE BREAKOUTS:
Q I find my acne gets worse in the hot summer months. What can I do to not break out as much?
By Sabrina Ribau, R.Kin Exercise and skin health
4 | www.canadianskin.ca | Summer 2022
E xercise can be great for our overall health and wellbeing. However, different skin conditions can make it difficult or uncomfortable to be physically active. Many studies have shown that exercise, even something as simple as a 10-minute walk outside per day1, may help to improve our physical and mental health by reducing the risk of cardiovascular diseases, improving inflammatory conditions2, and decreasing the severity and onset of mental health conditions like depression and anxiety. 3 People impacted by skin, hair, and nail conditions can sometimes struggle because of low self-esteem related to how they think others might be judging their appearance. Physical activity can also be a fun way of socializing and getting out and meeting people. Since it has been shown time and time again that many people who are impacted by skin conditions often have other physical and mental health conditions (or symptoms of these conditions)4, it’s important to find ways to help improve our health – and exercise can be an effective tool to do so. What kinds of exercise help me stay healthy? In Canada, the guidelines5 say that adults should aim for 150 minutes of moderate to vigorous physical activity per week. Some examples of moderate physical activities include going for a brisk walk, mowing the lawn, gardening, and golf. Vigorous activities include running, cycling, tennis, soccer, shovelling or carrying heavy loads, and cross-country skiing. Incorporating strength training twice a week into your routine is also recommended, and this can help with muscle, bone, and joint health, with joint health being very important in certain conditions like psoriatic arthritis. Strengthening activities are any activities that work your muscles, including weightlifting and performing body weight exercises, whereas weight-bearing exercises – like walking, running, or lifting weights – can also strengthen your bones and joints.
5
Exercising inflammatorywithconditions
REFERENCES 1.. Mammen G., Faulkner G. Physical activity and the prevention of depression: A systematic review of prospective studies. Am J Prev Med. 2013 Nov;45(5):649-57. doi: 10.1016/j.amepre.2013.08.001. PMID: 24139780 2. Zheng, G., Qiu, P., Xia, R., Lin, H., Ye, B., Tao, J., & Chen, L. (2019). Effect of aerobic exercise on inflammatory markers in healthy middle-aged and older adults: A systematic review and meta-analysis of randomized controlled trials. Frontiers in Aging Neuroscience, 11. https://doi.org/10.3389/fnagi.2019.00098 3. Schuch, F. B., & Vancampfort, D. (2021). Physical activity, exercise, and mental disorders: It is time to move on. Trends in Psychiatry and Psychotherapy. https://doi.org/10.47626/2237-6089-20210237 4. Wakkee, M., & Nijsten, T. (2009). Comorbidities in dermatology. Dermatologic Clinics, 27(2), 137–147. https://doi. org/10.1016/j.det.2008.11.013 5. Canadian 24-hour movement guidelines: 24 Hour Movement Guidelines. (n.d.). Retrieved May 15, 2022, from http:// csepguidelines.ca/ 6. Lederman, O., Ward, P. B., Firth, J., Maloney, C., Carney, R., Vancampfort, D., Stubbs, B., Kalucy, M., & Rosenbaum, S. (2019). Does exercise improve sleep quality in individuals with mental illness? A systematic review and meta-analysis. Journal of Psychiatric Research, 109, 96–106. https://doi.org/10.1016/j. jpsychires.2018.11.004 Sabrina Ribau is a registered kinesiologist and program manager for the CSPA.
Speak with a healthcare professional, like a registered kinesiologist, to help you create an exercise program that works for your health and lifestyle needs. Summer 2022 | www.canadianskin.ca |
For people with inflammatory conditions like hidradenitis suppurativa (HS), psoriasis, and atopic dermatitis (eczema), it can sometimes be uncomfortable exercising. Sweating can irritate the skin and worsen symptoms like itch. It’s important to wear breathable fabrics (e.g., cotton, performance fabrics) during exercise, and exercising in a cool environment may also help. Be sure to shower and put on clean, dry clothes as soon as you can after exercising and reapply any creams or medication after your shower as recommended by your doctor. Among people with HS, movement can further irritate the folds of the skin between body parts where HS usually occurs, like the armpits and groin area. To help reduce discomfort, do your best to listen to your body. If you have a particularly sore spot, you can try focusing your workout on a different part of your body and/or slowing down the movements to reduce the amount of friction that can happen between the parts of the body that are touching. For example, if you have a painful, inflamed lump in your groin area, you could try doing an upper body workout to reduce the chances of a flare. Loosefitting clothes can help to minimize irritation too, so wear baggier tops and bottoms when possible. Exercising with excessive sweating (hyperhidrosis) If you experience excessive sweating (hyperhidrosis) in daily life, it can feel daunting to exercise, knowing it will make you sweat. To feel more confident while exercising with hyperhidrosis, try wearing dark colours or bold prints to help hide sweat marks. Wearing breathable fabrics like cotton or synthetic fabrics designed for exercise and changing out your socks and shoes after exercise can help manage the sweat and keep you feeling fresh. Exercise can help improve mental health and sleep Exercise can help manage mental health conditions like depression and anxiety, as well as symptoms like fatigue and trouble sleeping. 6 Exercise can help to improve sleep quality and mood, including among people who have mental health conditions. Participating in supervised and structured exercise may have the greatest effects on sleep quality. 6 Even getting outside for a 10- or 20-minute walk every day has shown to have a positive impact on self-confidence and may prevent future depression, too1 –something is better than nothing when it comes to exercise. How to start exercising If you can, speak with a healthcare professional, like a registered kinesiologist, to help you create an exercise program that works for your health and lifestyle needs. They can work with your doctors as a part of your healthcare team so that you can have a plan that is safe, sustainable, and enjoyable for you.
• Limit stress in your environment
• Activities that trigger or worsen eruptions Where can I find support?
• Apply cool compresses to relieve itchiness
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Mucosal LP May affect the mouth as oral LP (inside the cheek, lips, gums, and on the tongue), or as genital LP (on the vulva, vagina, and penis). Mucosal LP generally appears as raw sores, a burning pain, or with no symptoms. Pain from oral LP might interfere with eating, and genital LP can lead to scarring, sexual dysfunction, and painful urination. Chronic lesions have been linked to an increased risk for squamous cell carcinoma. Nail LP Can cause vertical ridges across the length of the nails, nail splitting at the tip, nail thinning, and separation from the nail bed. Scalp and hair LP (lichen planopilaris) May begin slowly or rapidly, and is accompanied by redness, scaling, and hair loss (although the pattern of hair loss can vary). What are common treatments for LP? Depending on the type and severity, LP may be treated with phototherapy, topical or systemic corticosteroids, retinoids, and immunosuppressants.
To learn more about LP, visit the CSPA website at conditions.www.canadianskin.ca/skin-
Talk to a doctor who can treat and prescribe medication when needed. What can I do to heal and prevent LP?
• Apply sunscreen when exposed
• Take care of your mental health and seek support
• Smoking, alcohol, and spicy or acidic foods that irritate your mouth
• Practice good oral hygiene (oral LP) Avoid
Lichen planus can have a significant physical, emotional, and mental toll.
It’s important that your lichen planus is treated with regular follow-up. Consider joining an in-person or online support group for support.
Lichen planus is not contagious and often resolves on its own, yet can also be a painful and recurring disease.
Close-up on: Lichen planus
Adrienn Bourkas is a medical student at Queen’s University with an MSc degree in biochemistry from the University of Toronto.
Do • Seek help from a health care provider
• Scratching the site of the rash/sore
Matthew Hynes is a medical student at Queen’s University and a master’s student in epidemiology and public policy at the University of Oxford.
What type of LP do I have? Cutaneous (skin) LP Often found as itchy, shiny, red, raised areas on the skin that may appear with a web of white lines (known as “Wickham striae”) that give a lacy appearance. Newer rashes may be purple/violet on lighter skin tones, grey/brown on darker skin tones, and yellow/brown on the palms or soles.
BY MATTHEW HYNES AND ADRIENN BOURKAS
What is lichen planus (LP)? Lichen planus (LP) is a chronic inflammatory autoimmune disease that affects the skin, nails, hair, mouth, genitals, and rarely the throat (pharynx) or esophagus. LP cannot spread from one person to another, and may be grouped in several ways, including cutaneous LP (skin), mucosal LP (mouth or genitals), scalp LP, and nail LP. What causes LP? Most people develop LP without a clear cause. LP may occur with certain immune conditions or viral infections (e.g., hepatitis C), from a genetic predisposition, or due to certain allergens and drugs (e.g., blood pressure medications and antimalarials). The most common forms of LP affect an estimated 1% of the population.
• Fragranced products
M any skin differentlycancers,rashesincludingconditions,variousandskinmayappearonthose with brown or black skin. Research has shown that Black patients are dissatisfied with the dermatology care that they receive.¹ ² Patient dissatisfaction comes from frustration with dermatologists who lack knowledge regarding black skin and hair, perceived discomfort throughout the interactions, and racial insensitivity.¹ Black patients are generally less likely to see a dermatologist, less likely to undergo screening for skin cancer, and less likely to be prescribed treatments for skin conditions.3 These disparities can be discouraging and concerning for patients with brown or black skin. For those with darker skin types, seeing a dermatologist can be especially anxiety-provoking.
Questions and concerns about the doctor’s training and knowledge in treating darker skin types can cause many to abandon the appointment; however, we’ll go over some things to consider, some tips, and some things to look out for to improve your experience at the doctor’s office. Your first appointment
Many patients exclusively seek dermatologists of colour due to the comfort and understanding evoked throughout the interaction.1,4 However, the factor most crucial to comfort was found to be the dermatologist’s interaction style.1 Although it is reasonable to ask for a dermatologist with expertise in brown or black skin, it is ultimately the dermatologist’s communication style that was found to help patients to feel confident in the assessment. Feeling heard, having your skin condition normalized, and being involved in decision-making is how you should feel at all your dermatology appointments. During the appointment, you will be asked about your medical history, family history, previous treatments, and condition-dependent risk factors. You may even undergo a full skin examination. It is essential to ensure your comfort throughout the appointment. If at any point you do not wish to proceed, tell them that you are uncomfortable so that they can make changes. and tips to overcome them
By Rawaan Elsawi, BHSc, Temerty Faculty of Medicine, University of Toronto
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dermatologyNavigating as a person of colour
Challenges
List of resources:
• DermNet NZ – https://dermnetnz.org/
3. J. Barbieri et al., “Association of Race/Ethnicity and Sex With Differences in Health Care Use and Treatment for Acne.” JAMA Dermatol., vol. 156, no. 3, pp.312–319, 2020, doi:10.1001/ jamadermatol.2019.4818. 4. J. McKesey et al., “Cultural competence for the 21st century dermatologist practicing in the United States.” J Am Acad Dermatol vol. 77, no. 6, pp.1159-1169, 2017. doi:10.1016/j.jaad.2017.07.057.
The dermatology field has historically underrepresented darker skin types, resulting in inadequate training and misdiagnoses.5,6 This can be deadly when skin conditions like melanoma are not diagnosed properly. Estimates of the five-year survival rate for Black patients diagnosed with melanoma were 70%, compared to 94% for white patients.8 A similar trend was seen when looking at prescription treatments. Black patients with psoriasis were 70% less likely to receive oral or biologic (systemic) treatments than White patients.9 Although there has been an increase in research and training in recent years to help bridge these gaps, patients with darker skin types unfortunately must be able to effectively self-advocate. This includes accessing appropriate resources to learn about your condition and remaining positive and hopeful following interactions that do not yield the desired outcome.
6. E. Bellicoso et al., “Diversity in Dermatology? An Assessment of Undergraduate Medical Education.” J Cutan Med Surg., vol. 25, no. 4, pp. 409-417, 2021. doi: https:doi. org10.1177/12034754211007430. 7. J. Onasanya, and L. Chaocheng, “Dermatology education in skin of colour: where we are and where do we go?.” Can Med Educ J., vol. 12, no.6, pp.124-125. Dec. 2021, doi:10.36834/cmej.73112.
1) Central centrifugal cicatricial alopecia is a form of alopecia that results in permanent hair loss.
2. S. Taylor, “Meeting the unique dermatologic needs of black patients.” JAMA Dermatol. 2019, doi: https://doi.org/10.1001/ jamadermatol.2019.1963.
2) Keloids are firm growths due to spontaneous scar formation. These are more likely to occur in darker-skinned people and can be very resistant to treatments. Hair conditions to look out for:
8. A. Gupta et al., “Skin Cancer Concerns in People of Color: Risk Factors and Prevention.” Asian Pac J Cancer Prev., vol. 17, no. 12, pp. 5257-5264. Dec. 2016, doi:10.22034/APJCP.2016.17.12.5257.
“Remember, you know your skin best! If you feel unheard regarding your skin condition, learn about your diagnosis and be open-minded in your interactions.”
• American Academy of Dermatology –www.aad.org Hair & skin conditions
1) Melanoma is a skin cancer caused by the uncontrolled growth of pigment cells, also known as melanocytes. Although having darker skin is associated with a reduced risk of developing skin cancers, it is still possible to develop any skin cancer, including melanoma!10 When diagnosed in skin of colour, people tend to have thicker melanomas at diagnosis and higher mortality rates.11 This is why it is essential to wear sunscreen, check your skin for abnormal growths or changing moles, and not delay seeking medical advice.11
Although this list of conditions is not exhaustive, it can provide a look into some of the unique challenges facing Black and Brown patients when it comes to their hair and skin. Remember, you know your skin best! If you feel unheard regarding your skin condition, learn about your diagnosis and be open-minded in your interactions. Make sure to reach out to resources and supporting organizations when needed, such as the Canadian Skin Patient Alliance and other patient organizations for your condition to help you through this process. This will allow you to build trust with your dermatologist and ultimately get the help you need!
2) Traction alopecia is an acquired hair loss due to repetitive tension (pulling) on scalp hair. This can happen due to tight ponytails, hair extensions, cornrows, dreadlocks, weaves, braids, and chemical relaxers.
Barriers to identifying skin conditions & self-advocacy
Skin conditions to look out for:
1. K. Gorbatenko-Roth et al., “Assessment of Black Patients’ Perception of Their Dermatology Care.” JAMA Dermatol 2019; doi: 10.1001/jamadermatol.2019.2063.
10. O.N. Agbai et al., “Skin cancer and photoprotection in people of colour: A review and recommendations for physicians and the public.” J Am Acad Dermatol., vol. 70, no. 4, pp. 748-62, 2014. doi:10.1016/j.jaad.2013.11.038. 11. H.M. Gloster, and K. Neal, “Skin cancer in skin of colour.” J Am Acad Dermatol., vol. 55, pp.741–60, 2006. doi: 10.1016/ j.jaad.2005.08.063.
REFERENCES
5. R.I. Nijhawan, S.E. Jacob, and H. Woolery-Lloyd, “Skin of colour education in dermatology residency programs: does residency training reflect the changing demographics of the United States?” J Am Acad Dermatol., vol. 59, no. 4, pp. 615-618, 2008. doi:10.1016/j.jaad.2008.06.024.
9. W.T. Hodges et al., “Biologics utilization for psoriasis is lower in black compared with white patients.” Br J Dermatol., vol. 185, no. 1, pp. 207-209. Jul. 2021. doi: 10.1111/bjd.19876. Epub 2021 Apr 18. PMID: 33567102.
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Indigenous treatments for skin conditions Long before colonization, Indigenous Peoples developed natural remedies for skin conditions. Iroquoian and Algonquian-speaking communities used natural treatments to heal their injuries and diseases and later shared these remedies with colonizers after their arrival in what is now North America. What they found Indigenous views on health before colonization had more of a focus on “healing” than “curing,” with greater importance placed on the relationship between physical and spiritual wellbeing and the natural world. The researchers looked at written documents from colonizers and oral history from Indigenous knowledge keepers. Many skin conditions were recognized by early Indigenous communities, including atopic dermatitis (AD) and fungal infections. They determined that the sassafras tree was able to reduce swelling and itching in AD, willow bark was used for its antifungal properties to heal infections, and many more. Recent evidence shows that colonization from Europe brought syphilis, and different Indigenous nations used various remedies, including teas, resins and volatile (evaporating) oils to help treat the skin symptoms caused by the disease. Why this is important for the skin patient community Indigenous medicine knowledge has been used long before colonization to improve both the physical and spiritual wellbeing of people impacted by skin conditions. With a growing trend toward research on natural therapies and these natural medicines being implemented into European literature, it’s important that we acknowledge and support the contributions of Indigenous communities to the current state of dermatology.
REFERENCES 1. Shen, M., Xiao, Y., Jing, D., Zhang, G., Su, J., Lin, S., Chen, X., & Liu, H. (2022). Associations of combined lifestyle and genetic risks with incident psoriasis: A prospective cohort study among UK Biobank Participants of European ancestry. Journal of the American Academy of Dermatology. https://doi.org/10.1016/j.jaad.2022.04.006
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By Sabrina Ribau Impact of lifestyle behaviours and genetics on psoriasis Psoriasis has been long considered a genetic, inflammatory skin condition. However, research has shown that lifestyle behaviours like smoking, physical activity, and diet can impact the development of psoriasis as well. Since lifestyle and genetics have often been researched separately in psoriasis, the research team wanted to know if lifestyle behaviours that people have control over impacted the risk of psoriasis for people with different genetic profiles. What they found The researchers looked at data collected from more than 500,000 people in the United Kingdom. They sorted the participants by a lifestyle score into an ideal, intermediate, and poor group, and grouped the participants into low, intermediate, and high genetic risk. They then compared the risk of developing psoriasis of each genetic group to each of the lifestyle groups. They found that an ideal lifestyle was related to a lower psoriasis risk at each genetic risk level and that a healthy lifestyle had a stronger impact on decreasing the chances of developing psoriasis than genetic risk. How this impacts patients If the impact of lifestyle behaviours is greater than that of genetic risk, it’s important that healthcare providers inform patients about the different lifestyle changes that they can make to prevent psoriasis. Working with a healthcare team to manage lifestyle factors like physical activity, diet, and smoking habits then becomes an essential part of reducing the risk of developing psoriasis.
2. Perlmutter, J., Cogan, R., & Wiseman, M. C. (2021). Treatment of atopic dermatitis, dermatophytes, and syphilis by Indigenous peoples prior to 1850. Journal of Cutaneous Medicine and Surgery 26 (2), 198–200. https:// doi.org/10.1177/12034754211058403 Sabrina Ribau, R.Kin, holds a Bachelor of Kinesiology from the University of Toronto and is the Program Manager at the CSPA.
Top Stories in Research
What’s new the research t? The articles from which these summaries of the latest in skin research are taken are hot off the press!
SJS Canada’s vision is to facilitate an umbrella of services for the SJS/TEN patient community in Canada, through health promotion by providing people suffering from SJS/TEN, their families, and caregivers with access to related counselling, education, support groups, and information programs. http://sjscanada.org/home/ there will be healing. For those of us going through it, with time your skin can come back with some normalcy, and I want people to know that it can take many years, but it can. It’s just a phase of my life. I encourage people to find support groups. Even if it’s not specific to your condition, the support from you being connected to someone, somewhere, is important because it’s not a journey that one should take on theirSupport,own. understanding, and patience are important for survivors. When you realize you aren’t going through this alone, and that together we can be stronger, tomorrow can be a better day. When you realize you aren’t going through this alone, and that together we can be stronger, tomorrow can be a better day.
Li ng With…
I created Stevens-Johnson Syndrome Canada so that no one else has to go through this alone. Stevens-Johnson Syndrome (SJS), and its more severe version, Toxic Epidermal Necrolysis (TEN), is a rare condition that affects the skin and mucous membranes. It is usually caused by a bad reaction to a medication, and it results in a painful, spreading, blistering rash. It affects every system in the body, inside and out. A hidden aspect of SJS that we all must live with is the mental health impacts. It’s often not seen – and often misunderstood – because for the most part, an SJS survivor tends to bounce back physically (unless they end up with blindness or another trait everyone can see), and because they visibly look okay everyone assumes they are okay. Survivors tend to go through the grieving process in the same way you grieve the loss of a loved one or the loss of a limb. The things you used to do, places you used to go, the things you used to take for granted – you can’t do the same things as before. Something we have to be mindful of is that as we are grieving, our loved ones are also grieving the person we used to be alongside us. I used to be the person who would host parties and cook delicious meals, and I loved watching movies. Seeing them watch me go through the process of not being able to do the things I used to love to do and having them remind me of my limitations has been hard. Supporting each other is so important to our healingPsychologically,journey.
dealing with stares from people is hard. You know they’re staring at the surface, but they don’t know who you are or why you look the way you do, and the stares can be very distressing. What I’ve found over the years is that when people are staring at me, and I feel like I don’t have control, I just smile. As difficult as it might be, I smile because when you do, you take the power back from them and you feel empowered. We tend to hide ourselves behind what’s going on physically, but there’s more to you than that, so leave them with a smile – it goes a long, long way. When I was going through it, there was no one to say that, with time,
By Sonia Croasdaile
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Stevens-Johnson Syndrome
• Choose clothing made of natural fabrics, like cotton, that are breathable and absorbent
• Wear fun patterns or dark-coloured clothing to help hide sweat marks
• Wear moisture-wicking clothing like cotton, wool, and special clothing made for exercise to help keep you dry
• Put on dry socks and shoes after you play or exercise
Word Search SUMMER HEATFOCUSSWEATINGGLANDBREATHABLESWEATMARKSWATERHEATEXERCISEFEVERWICKMOISTURE Answers can be found on page 14. All about sweat R E A T A B I S A E B E H G B U B E E E T M E E M O N D W R E S I C R E X E S H T S K E A G T L A K W A T E R W I V G N I T A E W S S D M E W E A G O L B A T A W V O A R F R L T R X I B A R A I T E W E A L F E T E A F N S M B I E N F S U E T N S A T A E H S D E W I C K L H R U R A M E L B A H T A E R B R K S A C L R L H A W A E T E S W G E F S G W U K C A E T T N R A F C A S W R W T E E E
• Wash your underarms and other areas that sweat a lot with an antibacterial soap to help reduce the smell
https://thewordsearch.com 11Summer 2022 | www.canadianskin.ca |
Sweating can be uncomfortable, but it’s an important job that the human body does to help keep us safe and healthy. Sweat helps to control our body’s temperature. As it evaporates off our skin, our skin cools, and this is how it controls our body temperature. Sweat is mainly made up of water and somePeoplesalts.can sweat for many reasons, like from heat (when you run outside on a summer day), when you’re nervous, or if you’re feeling sick and have a fever. Sweating is a completely normal thing that our bodies do but it can be uncomfortable if we find ourselves sweating a lot, or if our sweat shows through our clothes. Here are some tips to help manage sweating so that you can feel your best!
• Wear baggy or loose clothing
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Feminizing hormone therapy (HT) is often an early step in transitioning, and may involve testosterone blockers (anti-androgens), estrogen, and progesterone. HT commonly causes changes in the skin, hair, and nails, particularly with reduced sebum production (an oily substance that your body produces that is meant to protect your skin) and the thinning of hair and nails.
SKIN CONSIDERATIONS Dry skin (xerosis) is commontransitionduringduetoreducedsebumproduction.Findingamoisturiserthatworkswithyour
Trans
is an exciting time to live as your authentic self and explore new parts of your identity. Folks on the spectrum of gender identity and expression –whether transgender, non-binary, two-spirit, gender fluid, intersex, or more – may have unique skin needs and face new skin challenges. Hormones have a large influence on our skin, hair, and nails, and it’s normal to see changes if you decide to begin hormone therapy. There is no one way to transition, and in recognition of the wide spectrum of gender diversity, there may be useful information in this article for those that do (or do not) identify as transfeminine or are elsewhere on the gender spectrum.
Taking steps to transition
2. Fitzpatrick’s Dermatology in General Medicine, 8e New York, NY: The McGraw-Hill Companies; 2012.
By Matthew Hynes, François Lagacé, MD, and Mathieu Powell, MD Summer 2022 | www.canadianskin.ca |
Dr. Mathieu Powell is a board-certified dermatologist and Associate Clinical Professor at the McGill University Health Centre.
Nail fragility may happen on your hands and/or feet, with noticeable weakness and splitting of the nail (onychoschizia). You can reduce further damage to your nails by avoiding repeated exposure to water, harsh chemicals, and manicures. Other ways to help include moisturizing frequently and wearing gloves. Hair fragility often occurs with the changing pattern of hair growth on your body, and reduced thickness of individual hairs. You can protect fragile hair by ensuring you keep it hydrated with a good conditioner or hair mask. Avoiding damage to your hair, such as from dyeing, heating, or bleaching, may also help. If you experienced hair loss pre-transition, you may notice a regrowth of hair on your scalp. Ingrown hair or razor burn (pseudofolliculitis barbae) may be common if you continue to shave hair on your face and body. Pseudofolliculitis barbae is very common, and up to 80% of people with Black or Latinx descent may experience it. It is best not to pick at bumps to avoid further damage, infection, or hyperpigmentation (darker patches of skin). Improving your shaving technique (one direction, passing over each area only once) and avoiding multi-blade razors may help. One of the most common treatments is permanent hair removal, such as through laser hair removal (LHR) or electrology. LHR requires multiple sessions and may pose its own challenges –both in terms of accessibility and cost – but will reduce or remove the need to shave. Electrology is another option to permanently remove hair, which delivers electricity via a small probe to kill each individual hair. Your doctor may also be able to prescribe medications to improve skin health, reduce hair growth, or reduce inflammation. Melasma is a type of hyperpigmentation that may present as brown, blue, and/or purple spots. Melasma is more common on darker skin tones, and most often appears on the face as dark patches. Avoiding the sun is one of the best ways to prevent melasma and wearing broadspectrum sunscreen every day is recommended. Your doctor may also be able to prescribe medications to lighten the dark patches or improve your skin’s health. Any number of surgeries or procedures throughout your transition have the potential to leave scars. Scars that become larger than expected are known as hypertrophic or keloid scars, and may be very visible, particularly on dark skin tones. If you or someone in your family have experienced hypertrophic or keloid scarring, talk with your doctor about managing potential scars before undergoing any procedures. Your doctor may be able to provide an injection or cream to reduce its size, and surgically remove more serious scars. Each person is unique, and you may experience many (or none) of these skin, hair, and/or nail changes throughout your transition. Remember to check your body regularly for changes, and speak with your healthcare provider if you have any concerns.
REFERENCES 1. Yeung, H., Kahn, B., Ly, B. C. & Tangpricha, V. Dermatologic Conditions in Transgender Populations. Endocrinology and Metabolism Clinics of North America 48, 429–440 (2019).
3. therapyhttps://transcare.ucsf.edu/article/information-estrogen-hormone-
François Lagacé is a dermatology resident and PhD candidate at McGill University.
Common skin, hair, and nail changes while on hormone therapy
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4. Specht S, Persaud Y. Asteatotic Eczema. [Updated 2021 Jul 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. Matthew Hynes is a medical student at Queen’s University and a master’s student in epidemiology and public policy at the University of Oxford.
skin is important and moisturising frequently can help avoid severe dryness. Avoiding warm showers and irritating fabrics (wool, synthetic fibres), limiting the use of soap while showering and washing your hands, and covering areas particularly prone to dryness, such as your elbows and knees, are all important. Xerosis may lead to a form of eczema known as asteatotic dermatitis. Asteatotic dermatitis may appear in dry areas as itchy scaly skin – often resembling a “dried-up riverbed” – with red or pink cracks on pale skin tones, and with dark brown or purple cracks on dark skin tones. Moisturising may improve the itch and dryness, and you may need to speak with your doctor for a prescription medication.
R E A T A B I S A E B E H G B U B E E E T M E E M O N D W R E S I C R E X E S H T S K E A G T L A K W A T E R W I V G N I T A E W S S D M E W E A G O L B A T A W V O A R F R L T R X I B A R A I T E W E A L F E T E A F N S M B I E N F S U E T N S A T A E H S D E W I C K L H R U R A M E L B A H T A E R B R K S A C L R L H A W A E T E S W G E F S G W U K C A E T T N R A F C A S W R W T E E E REVEF 14 | www.canadianskin.ca | Summer 2022
4. Diversify funding, which will help us develop broader programs and patient supports throughout the skin patient community. As an alliance of people impacted by more than 3,000 conditions, we can help skin patient communities throughout the country learn from each other’s successes. For example, the atopic dermatitis (eczema) community in Canada has seen important changes in how the condition is treated and managed. At the CSPA, we have been involved in different initiatives that have helped us better understand the impact of this potentially devastating inflammatory condition and brought new insights into advocacy, supports, collaboration, and research that we can share with other skin patient communities in theIncountry.particular, a new international initiative on atopic dermatitis has helped us understand what eczema patients in eight different countries experience and the importance of shared decision-making with their healthcare providers. In fact, people in Canada have the second-worst access to dermatologists among peer countries: there are only 1.7 dermatologists for every 100,000 people in Canada. We are beginning to understand the many different reasons patients face challenges when trying to see a dermatologist. If you are having trouble getting an appointment with a dermatologist, we want to hear from you. We have also completed a years-long process to identify the unanswered questions that skin patients in Canada want researchers
2. Educate the public and healthcare providers about mental health issues experienced by skin patients, including the impact of stigma and the reality of the severity of many skin conditions.
1. Advocate for the needs of people affected by skin, hair, and nail conditions, with a particular focus on access to treatments, healthcare systems strengthening, virtual care, and primary healthcare.
Rachael Manion, Executive Director, CSPA Word search answers
CSPA IN ACTION CSPA in action: A spotlight on our latest activities, events and other information of importance to skin patients in Canada to address! As part of CSPA’s work with the Skin Investigation Network of Canada (SkIN Canada), we are proud to share the results of nine priority setting initiatives to establish these Top 10 lists of research questions. Thank you to all those who are impacted by atopic dermatitis, psoriasis, hidradenitis suppurativa, squamous cell carcinoma, basal cell carcinoma, Merkel cell carcinoma, burns, scars and chronic wounds and participated in this process! SkIN Canada is now looking for applications for small team-building grants to encourage collaboration among researchers, patients and caregivers, and clinicians throughout the country to advance our understanding of skin conditions. If you are interested in helping to shape research as a patient research partner who works with the research team to design and complete a research project, please let us know at info@canadianskin.ca. We hope you enjoy the articles and information in this issue of the magazine – and if you’re reading it at the beach, don’t forget the sunscreen!
3. Raise CSPA’s profile with the public, healthcare providers, skin patients, and their caregivers.
The CSPA has been here for you since 2007 and we are excited to launch a new chapter in our organization’s history with a new strategic plan. After consulting with dermatologists, researchers, patients and Affiliate Member organizations, as well as our friends at the Canadian Dermatology Association, we have identified four strategic priorities to guide our work over the next five years:
We all know that bad things happen to good people. However, we live with an inescapable truth. Bad things happen in life; sometimes, parents or other loved ones and essential people in a child’s life get sick. In your child’s life, this is related to your skin condition and how it impacts your life. Our instinct is to shield our children from feeling scared, hurt, different from their friends, or any other of the myriad of big emotions they can struggle with in life. Your diagnosis can lead to many emotions and questions in both the short and long term. Being straightforward, honest, and confident will help your child or youth cope.”
Chronic Urticaria Society –Société d’urticaire chronique: en.urticairechronique.ca 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 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 support the work of the CSPA. For an updated list of names, visit canadianskin.ca/about-us.
SPONSOR OF CANADIAN SKIN MAGAZINE CSPA CORPORATE SPONSORS CANADIAN SKIN MEDICAL ADVISORS + BOARD MEMBERS +
CSPA AFFILIATE MEMBERS 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
VOLUNTEERSAbbVie is the Founding Sponsor of the Canadian Skin Magazine and an ongoing supporter of CSPA’s 2022 publications.
Thank you to the Medical Advisors, Board Members, and Volunteers who
AbbVie is not providing editorial support for the magazine. The CSPA is responsible for the final content featured in Canadian Skin
This is an excerpt from the first of many resources that the CSPA is developing to empower our community to live their lives to the fullest – our self-empowerment toolkit. To learn more about how to talk to kids about your condition, visit the education section of our website at www.canadianskin.ca/education. (Also available in French at https://apropeau.ca/education.)
Perhaps you have been living with your condition for a long time, but things are changing, and the condition is causing more symptoms. Life as you know it is different and life as your children know it is different. How do you talk to your children, youth, and adult children about your condition and how it will affect your daily lives? Why is it essential to have these conversations?
Canadian Association for Porphyria: canadianassociationforporphyria.ca Canadian Burn Survivors Community (CBSC): canadianburnsurvivors.ca Canadian Psoriasis Network: cpn-rcp.com Canadian Skin Cancer Foundation: canadianskincancerfoundation.com
A guide for talking to kids about your skin condition “You have just been diagnosed with a serious skin condition. This condition may cause physical changes to your appearance. It may cause inflammation in your body, chronic pain, itchy skin, or many other uncomfortable and, at times, debilitating physical and emotional symptoms.
Skin conditions are a leading cause of overall disability and death in Canada. Canadian researchers have made substantial contributions to address the heavy burden of skin disease, but much of the work is conducted by a widespread community of scientists and clinicians in relative isolation. The Skin Investigation Network of Canada (SkIN Canada) is working to expand skin research expertise, create new collaborations, and enhance skin health through innovation.
We have brought together patients and a team of researchers and clinicians across the country who are tackling a variety of questions about a broad range of skin conditions, including the way diseases develop, the way they are diagnosed and treated, and the health care systems involved.
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Guided by insights from patients, SkIN Canada announces its Top 10 unanswered research questions that have been identified for each of these nine skin conditions. See the Top 10 lists and learn more about SkIN Canada at https://canadianskin.ca/research/ skin-canada/top-10-questions.
SkIN Canada decided to focus on three disease areas with three conditions per disease area: Inflammatory skin conditions: atopic dermatitis (eczema), psoriasis, and hidradenitis suppurativa Wound healing: chronic wounds, burns, and scars Skin cancer: basal cell carcinoma, Merkel cell carcinoma, and squamous cell carcinoma
