Skin & Dermatology Ireland - Q1 2020

Q1 / 2020 AN INDEPENDENT PUBLICATION DISTRIBUTED ON BEHALF OF MEDIAPLANET WHO TAKE SOLE RESPONSIBILITY FOR ITS CONTENTS

CAITRIONA RYAN INSTITUTE OF DERMATOLOGISTS The psychological impact of psoriasis » p2

KEVIN O’HAGAN IRISH CANCER SOCIETY “Skin cancer is the most common cancer in Ireland.” » p6

DR SONJA BOBART “Understanding your eczema to help find the best treatment” » p8

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Skin & Dermatology Laura Dowling discusses acne and how to manage the common condition Read more on p4

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Psoriasis in Ireland is damaging young people’s mental health Thousands of people suffering with acne and psoriasis in Ireland also experience negatively impacting psychological distress on their personal and professional lives.

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soriasis in Ireland is a chronic skin disease that a f fe c t s a b o u t 2 - 3 % o f the population. It causes skin irritation, itching and joint pain in up to a quarter of patients. But more importantly, it can cause significant psychological morbidity and relationship difficulties.

Sometimes patients spend too long trying to solve the condition t hem selves before seek i ng medical help.

Psoriasis in Ireland Con su lta nt Der matolog ist, Professor Caitriona Ryan from the Blackrock Clinic in Dublin, has published a textbook on psoriasis.

She reports that psoriasis patients can suffer from depression, anxiety and low self-esteem. “ The on s et of p s or i a s i s i s

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typically in the second or third decade. This can be a formative period in the life of a patient.

This is a time when patients are getting into relationships and choosing careers. Psoriasis can have a detrimental impact on their psychological state, social life and quality of life,” she says.

“They often recall the difficulties they have faced since childhood. For example, the embarrassment they felt at the swimming pool or when playing with friends.”

Severe acne can a lso cause significant psychological distress in teenagers and young adults.

Without appropriate treatment, irreversible scarring can occur, which further impacts the patient.

Intimacy issues with psoriasis in Ireland

PROFESSOR CAITRIONA RYAN Consultant Dermatologist, Institute of Dermatologists and Blackrock Clinic; Associate Clinical Professor, University College Dublin

Psoriasis patients can suffer from depression, anxiety and low self-esteem

She adds that psoriasis can affect a person’s confidence and how intimate they want to be with people they love. Especially if the condition also affects their genitals.

“It can impact their sexual health and often their sexual frequency.”

Some people with psoriasis can struggle at work Psoriasis in Ireland can also affect the career choices of sufferers.

Some patients admit to choosing job where they don’t have to deal with the public due to the visible nature

of their disease. Absenteeism and the chances of unemployment can also increase.

“There are compelling reasons to make psoriasis and acne treatment a priority when it affects the mental health of young people, especially if the condition is visible on the face, neck, on intimate parts of the body in the case of psoriasis or is causing scarring in acne patients,” says Ryan.

S h e p o i nt s o u t t h at s k i n conditions can also cause additional stress because people feel so

self-conscious and anxious, and this stress can make the psoriasis or acne worse.

Seek professional help “I urge people to visit their GP or dermatologist and let their doctor k now how t heir condition is impacting their mental as well as their physical health,” says Ryan.

“Sometimes patients spend too long trying to solve the condition themselves before seeking medical help.” Psoriasis in Ireland is a treatable but serious condition.

WRITTEN BY STEVE HEMSLEY

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Acne - one of the most common skin disorders LAURA DOWLING Pharmacist Manager, Lloyds Pharmacy Ireland

Acne is one of the most common disorders treated by dermatologists. The prevalence of acne vulgaris globally was 681.2 million in 2016, an increase of 10% from 612 million in 20061.

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cne is a common, chronic, i n f l a m m ator y d i s e a s e of s eb ac e ou s fol l icle s, the glands that produce sebum.

Approximately 80% of people are affected by acne between the onset of puberty and 30 years of age1.

Psychological impacts of acne Acne can range in severity from person to person and can lead to prom i nent emot iona l a nd psychological issues.

Acne is more than just a cosmetic nuisance – it can cause anxiety, depression and other psychological problems that affect lives in ways comparable to arthritis or other disabling illnesses1.

Your pharmacist is here to help Pharmacies are usually the first port of call when a person begins to show symptoms of mild acne. Most people will require advice as the sheer number of products to choose from can be bewildering.

A good skincare regime, especially in the early stages, can really help to keep acne under control, and many options are now available over the counter without prescription.

The use of salicylic acid to treat acne Salicylic acid helps shed cells from the surface of the skin and can decrease redness and swelling. This decreases the number of spots that form and encourages healing.

Salicylic acid can dry out the skin, however, so it is important to get the correct advice about maintaining skin’s integrity.

I myself suffer with hormonal cystic breakouts and find that a good skincare regime, with products containing alpha hydroxy acids as active ingredients, has really helped control my acne.

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It is imperative to start on very low percentages of these active ingredients and work your way up to the more concentrated versions to allow your skin to build tolerance.

The same instructions apply to retinol products, which are usually associated with anti-ageing, but work excellently for breakout-prone skin too.

If the problem persists, consult your GP If a good skincare regime is not giving you the results that you want, a visit to your GP is always a good idea.

Your GP can prescribe you a variety of alternative treatments. For example, the oral contraceptive pill is sometimes all a woman requires to get her acne under control.

If all else fails, your GP can refer you to a consultant dermatologist who can prescribe more potent products such as isotretinoin.

Laser can also be prescribed to help reduce acne scars.

Help and support is available It i s i mp or t a nt to se ek help for your acne and never suffer in silence. There are so many treatments available nowadays.

Treating your acne will result in clearer skin and a more confident you. Just ask for help.

References: 1: Global acne market report for 2016-2026, Dec 2011

Laura Dowling can be found on Instagram and Facebook @fabulouspharmacist

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Atopic dermatitis: who suffers and why?

MARIE THERESE BURKE Head of Skincare Training, GA Distribution

Atopic dermatitis is considered a severe form of eczema. It is a chronic, long-lasting skin condition that causes the skin to become inflamed and irritated, making it extremely itchy.

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topic means a sensitivity to allergens. It can run i n f a m i l ie s a nd of ten develops alongside other conditions like asthma and hay fever.

Atopic dermatitis occurs when a substance from outside or inside the body triggers the immune system to over react, causing inflammation. It is this inflammation that causes the skin to become red and itchy. Scratching inflamed skin can lead to redness, swelling, cracking, scaling, weeping and crusting.

Why do we get atopic dermatitis?

Atopic dermatitis is considered a genetic condition, meaning that some people may be born with an increased likelihood of developing it. Research has shown that children with one parent with this condition can have a 50% chance of developing it. That figure can increase to 85%, if both parents are affected.

Sometimes, when your skin comes i nto contac t w it h a substance in the environment that you are allergic to, it may react by starting to itch and become red.

Research has shown that children with one parent with this condition can have a 50% chance of developing it.

That figure can increase to 85%, if both parents are affected This is called contact dermatitis.

Resea rch shows t hat some people with eczema, especially atopic dermatitis, have a mutation of the gene responsible for creating a natural protein called filaggrin.

Filaggrin is found in our bodies and helps maintain a healthy, protective barrier on the very top layer of our skin.

W it ho u t e n o u g h f i l a g g r i n to build a strong skin barrier, moisture can escape from the skin and bacteria, viruses and more can enter. That is why babies, children and adults with atopic-prone skin can have skin that is more vulnerable to infection.

Flare ups in atopic-prone skin In some cases, t he condition fluctuates between very severe, commonly known as flare ups, and times when the condition improves, known as remission.

Some people only have small patches of dry skin, while others can ex per ience w idespread inflamed skin all over their body.

Babies will have dry, scaly, and itchy patches on their skin: most commonly scalp, forehead and face, especially the cheeks.

Children aged two and up will often have a rash and scaly, itchy patches: most commonly in the creases of the elbows or knees, neck, wrists, ankles, and the creases between the buttocks and legs.

In adults, it most often affects the hands, feet, face or scalp.

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Skin cancer trends and sunbed use Skin cancer is the most common cancer in Ireland. Almost 12,000 people are diagnosed in this country every year.

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ost cases of skin cancer a re d i re c t ly c au s e d

by U V rays from the sun, so it is really important that everyone protects their skin from sun damage as much as possible.

Recently, we are seeing more men than women being diagnosed with skin cancer, even though it’s often seen, inaccurately, as a cancer more prominent in females.

The major risk factor when it comes to skin cancer is exposure to the sun and to UV rays. Past research has also pointed to the fact that skin cancer increasing among young people who are living in urban areas, which is likely a result of repeated sunburn during leisure activities2.

Skin cancer can take 10-15 years to develop Protection of the skin in childhood and adolescence is vital in reducing the risk of skin cancer in later years.

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Skin cancer takes approximately 10-15 years to develop and young people who get sunburnt in their formative years also increase the risk of melanoma, the most serious form of skin cancer in adult life.

Sunbed use pre-35 increases the risk of melanoma by 75% It is also alarming that people continue to use sunbeds regularly, given the clear link with skin cancer. Analysis shows that almost 90% of first-time sunbed users were under the age of 293. There is a 75% increased risk in melanoma when p e ople b eg i n t a n n i n g regularly before the age of 35.

According to research we carried out, two out of five sunbed operators a re not comply i ng w it h t he requirement to ask customers their age, and many are making bookings for under 18s 4. The Irish Cancer Society is concerned to see operators

It is also alarming that people continue to use sunbeds regularly, given the clear link with skin cancer. Analysis shows that almost 90% of firsttime sunbed users were under the age of 293. flouting sunbed legislation. We feel that greater resources must be made ava i lable so hea lt h officials who check for compliance and safety can carry out more inspections of sunbeds and sunbed operators, and that those found to be breaching the law are punished.

High UV levels – typically in summer – cause skin damage

KEVIN O’HAGAN Cancer Prevention Manager, Irish Cancer Society

Over the summer months, we all need to be sun smart in order to reduce our risk of skin cancer. Many people think because we live in a country with a mild climate, that we don’t have to be as concerned about getting sunburnt. However, in Ireland, 90% of the days between April and September have a UV level high enough to cause skin damage.

How to stay smart in the sun: • Cover up when there’s no shade around.

• Wear loose clothing and a cool, wide-brimmed hat.

• Seek shade! It is really important to do this from 11am to 3pm when UV levels are at their strongest.

• Wear sunglasses. Whether you are young or old, make sure to get sunglasses that give UV protection.

• Use sunscreen with SPF of 30

and UVA protection. Apply sunscreen 20 minutes before going out in the sun and reapply every two hours.

Finally, always remember to check your skin regularly. If you notice any changes at all, like a mole changing colour or shape, or a new growth or sore that doesn’t heal in a few weeks, please talk to your GP. Reference 1 Cancer In Ireland 1994-2016 with Estimates For 2016-18: Annual Report of the National Cancer Registry Reference 2 Deady.S, Sharp. L, Comber, H. (2014): Increasing skin cancer incidence in young, affluent, urban populations: a challenge for prevention. Dublin: National Cancer Registry of Ireland.

Reference 3 Ipsos MRBI research, July 2017 Reference 4 Ipsos MRBI research, 2018

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Understanding your eczema to help find the best treatment Eczema is a complex, relapsing medical condition that occurs when the skin is red, dry and irritated. Typically there is a family history of hay fever, asthma or allergic rhinitis (atopic illness). Eczema affects 20% of children and less than 10% of adults.

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ost children will grow out of eczema by late c h i ld ho o d b u t m ay flare again in adulthood. Eczema accounts for one in 30 general practice consultations and about 15% of dermatology referrals. Although the majority is mild, it can have a significant psychological effect on the individual.

Eczema often presents where you flex your joints and on the face Eczema can occur anywhere but common sites are the flexural areas (behind knees, wrists and front elbows) and face. It is initially itchy then the skin becomes scaly, red, dry and inflamed.

In fair-skinned patients, these areas may be red. Among darkerskinned people it appears light grey or black. If untreated, the skin can become weeping, blistered, scaling

and lichenified (thickened).

The cause of eczema is unknown The exact cause of eczema is unknown but it may be due to an immune response to any irritant (such as pets, paints, pollens, dust) due to a defect in the skins barrier.

This barrier allows moisture out, therefore the epidermis is vulnerable to bacteria, viruses or even fungus.

Moisturisers are the best form of management As most patients present with itchiness, the treatment is geared towards relieving and preventing it c h i n g , w h ic h c a n l e a d t o infection. As the skin is dry and itchy (itch-scratch cycle) lotions and creams are recommended to keep the skin moist. It is best to use these emollients and washes when the skin is damp to keep the

skin moist. Applying emollients should be in the direction of hairs as this will prevent blocked pores/ infection.

Eczema can be kept under control by knowing triggers and applying emol l ient s, wa shes a nd cold compresses for itch. If emollients are stored in the fridge, they are effective for itch management.

Treatment If Eczema does not settle, you should see your general practitioner for stronger topical steroids, a topical or oral antibiotic or antifungal.

Good communication between the GP and the patient is essential as treatment failure due to poor adherence is common. Education a nd c om mu n ic at ion i s ver y important and information should be provided with regards to steroids, the management of f lares and recognising infected atopic eczema.

DR SONJA BOBART General Practitioner, D4Medical, Donnybrook, Dublin - Ireland

E d u c at i o n p r o v i d e s b e t t e r t r e at me nt ad he r e nc e . HC P s (health care professionals) need to take time to educate the affected individual and families and provide information leaflets, feedback and follow up at regular intervals.

New product feedback pathways should be provided by HCPs in order to assess compliance, autonomy and progress.

Referrals Few patients will need a dermatology r e fe r r a l . T h e y m ay r e q u i r e potent steroids, phototherapy or immunomodulators.

Systemic immunosuppressive therapies are used when topical treatments and phototherapy have been unresponsive. These treatments may require in hospital monitoring.

Prevention The patient should know and avoid irritants. They should keep their nails short and use emollient washes and creams daily. They should use non-bio detergents and avoid fabric softener, as well as avoiding irritant fabrics. They should avoid extreme of temperatures, (internal or external) and reduce stressors.

More info There are very good online resources such as: www.irishskin.ie www.eczema.org

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Relizema cream TM

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MY SKIN SAYS HOW I FEEL. Relizema cream Indicated for the treatment of itching and flushing associated with dermatitis and eczema. Helping to maintain and restore the skin barrier.

To find out how Relizema cream can help you and your family ask your Doctor or Pharmacist.

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