Skin & Dermatology IE - Q1 - Mar 2019

Q1 / 2019 A SUPPLEMENT BY MEDIAPLANET DISTRIBUTED WITHIN THE IRISH INDEPENDENT

Skin & Dermatology

Skin diseases in Ireland are on the rise

Skin disease is extremely common. In Ireland, 54% of the population is affected by skin disease annually with up to 33% of people at any one time having a condition that would benefit from medical care.

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ome of the most common skin diseases are increasing in frequency, in particular, skin cancer. There has been a significant improvement in treatments available for skin disease, and thus the expectations of successful outcomes to treatment.

Skin cancer is on the rise Skin cancer is the most common form of cancer in Ireland. Between 1994 and 2011, an average of 6,899 cases of invasive skin cancer were diagnosed per year. The figure for 2018 exceeded 12,000. The high rates of skin cancer are driven by our fair skin type and increased longevity.

1994. By the year 2040 it is projected that incidence will further increase by up to 327% in males and by up to 175% in females when compared with 2010 incidence.

Melanoma is disproportionally high in younger people. Over 20% of all melanomas diagnosed in men and 27% in women were aged 1544 years. Since 2012, the National Cancer Control Programme has introduced a referral pathway for patients with suspected melanomas to pigmented lesion clinics, which are run throughout the country.

This has greatly increased access and streamlined the care of patients with melanoma.

Melanoma is much more prevalent in younger people Melanoma is the fourth most common invasive cancer in Ireland and it accounts for 5.2% of all malignant neoplasms in women and 3.9% in men. Over 1,200 cases are diagnosed per year.

Incidence has increased by 112% for females and 253% for males since

Non-melanoma skin cancers The remaining skin cancers comprise squamous cell carcinomas and basal cell carcinomas in a ratio of 1:3 approximately. A key aim of the dermatology community and the health service is to reverse this trend through skin cancer

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prevention and an action plan engaging numerous stakeholders has been devised under the auspices of Healthy Ireland.

Inflammatory skin disease Approximately 73,000 patients in Ireland have psoriasis and a third will require treatment with systemic medication.

The development of systemic treatments such as anti-TNF agents, anti-IL-12/23, anti IL-17, anti IL23, jak-kinase inhibitors, fumaric acid esters have given patients the real expectation of skin clearance.

The increasing recognition of psoriasis as a systemic disease with potential joint, metabolic and psychological co-morbidity has also ensured that patients are more thoroughly screened at dermatology clinics.

Up to 20% of children have atopic eczema Atopic eczema affects up to 20% of children and 12% of adults. Many patients are managed successfully

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DR ANNE-MARIE TOBIN National Clinical Lead, Dermatology, HSE Ireland

with topical treatments, but a certain percentage require systemic treatments such as methotrexate or ciclosporin. New treatments, such as anti-IL4, has also broadened the spectrum of treatments.

What is hidradenitis suppurativa?

Hidradenitis suppurativa (HS) has long been recognised but has remained refractory to many treatments. The approval of the anti-TNF agent adalimumab has improved medical treatment for these patients along with the recognition that in a manner analogous to psoriasis HS can be a systemic disease.

primary care. Certain types of acne such as scarring acne, acne conglobata and fulminant acne require treatment in secondary care with Isotretinoin.

In addition to the above common conditions many patients have rare skin diseases such as genodermatoses, vascular anomalies, blistering disorders to name a few.

If you have noticed an irregularity to your skin, contact your GP or check the HSE website for advice.

Acne can leave physical and emotional scars Acne is a very common complaint among adolescents and young adults. It causes significant distress and, in a minority of patients, has the potential to leave permanent scars. Most acne is managed in

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Psoriasis and acne are damaging young people’s mental health

PROFESSOR CAITRIONA RYAN Consultant Dermatologist, Blackrock Clinic, Dublin Byline: Steve Hemsley

Chronic skin diseases, such as psoriasis, and common conditions like acne can have a devastating effect on sufferers’ psychological health and their lives at home and work.

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housands of people suffering with psoriasis and acne also experience psychological distress that has a negative impact on their personal and professional lives.

Psoriasis is a chronic skin disease that affects about 2-3% of 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.

Consultant Dermatologist, Professor Caitriona Ryan from the Blackrock Clinic in Dublin, has published a textbook on psoriasis and reports that psoriasis patients can suffer from depression, anxiety and low self-esteem.

“The onset of psoriasis is typically in the second or third decade, a formative period in the life of a patient – 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 also 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 She adds that psoriasis can affect a person’s confidence and how intimate they want to be with the 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 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.

She points out that skin 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 help “I urge people to visit their GP or dermatologist and let their doctor know how their 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.”

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Emollients: essential daily care for your child’s eczema MICHELLE DOLAN Health Promotion Manager, Irish Skin Foundation

Emollient therapy plays a crucial role in protecting and restoring the skin barrier as part of the over-all management strategy to achieve long-term control. In atopic eczema, the skin’s protective barrier is weakened, which allows moisture to be lost and irritants and allergens to pass through the skin more easily. Some common everyday substances, like soap, contribute to the weakening of the skin’s barrier and should be avoided.

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t is important to remember that on-going (daily), frequent and generous use of emollients and the avoidance of trigger factors form the basis of eczema management. When your child’s eczema flares up, other treatments, such as topical steroids, are needed and are usually prescribed by your healthcare professional. If your child’s skin is not improving, see your doctor to establish if infection is present, which would need additional treatment.

emollient is often a matter of trial and error, but the best are those that you (or your child) prefer to use and will continue to use every day.

Remember, a higher price doesn’t necessarily indicate a better product – ask your healthcare professional for advice.

Essential daily care for managing eczema Emollients are an essential part of daily care, even when skin is clear.

Emollients are moisturisers that are used in two ways – applied directly to the skin as a leave-on moisturiser, and as a soap substitute instead of soap or shower gel.

Used several times a day, emollients help to soothe dry, itchy skin and repair the skin’s barrier, thereby preventing entry of irritants and allergens, which can trigger eczema flares.

2. Don’t stop moisturising when your child’s skin is clear.

Remember no bubbles!

Choose soap substitutes/ emollient wash products Ordinary soaps, bubble baths and shower gels should be avoided as they dry out the skin by stripping away its natural oils. Instead, choose emollient wash products when bathing, which leave the skin coated with a protective film afterwards.

Choosing an emollient Emollients come as lotions, creams and ointments. Finding the right

10 tips for emollient therapy: 1. Establish a good daily skin care routine and stick to it.

3. A child with atopic eczema often needs 250g of ‘leave-on’ emollient per week, minimum.

4. Apply emollients in a smooth, downward motion, in the direction of the hair growth.

Circular rubbing, particularly with heavy moisturizers, can block pores, especially in hot weather and cause acne-like spots, called folliculitis. If this happens, use the correct technique and a lighter moisturiser until they clear.

5. Empower your kids - teach them how to apply their emollients correctly from a young age.

6. While heavier moisturiser can be very effective, some children don’t like them under clothing, so consider using a lighter moisturiser during the day and a heavier one at night.

7. Remember – avoid soap, bubble bath and shower gel! Use soapfree products for bathing and specially-formulated shampoos.

8. Bathwater should be a lukewarm temperature; five minutes with an emollient bath additive is sufficient.

9. After bathing, gently pat skin dry. A great time to apply emollient all over is when the skin is still ‘slightly humid’.

10. Change your tub of emollient at least every six weeks, as it can become contaminated, or use a pump dispenser. If using a tub rather than pump dispenser, remove what you need with a clean spoon to avoid contamination by hands.

It is very important to establish the right diagnosis, so if you are concerned about your child’s skin, you should always speak with your doctor.

For more information about eczema, please see The Irish Skin Foundation’s ‘What you need to know about eczema’ booklet available to download free at irishskin.ie, or contact the ISF helpline for information and support on 01 486 6280

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Uriage products are recommended by Dermatologists throughout the world. Uriage, one of the leading dermo-cosmetic brands on the international market is now available in Ireland in pharmacies nationwide. Thermal Spring Water is the key ingredient unique to the Uriage dermatological skincare range and it is the basic ingredient in all of the Uriage product ranges. Uriage Thermal Water from the French Alps, cannot be compared to others sold in Ireland as it’s very different.

Uriage XEMOSE is a treatment for anyone with psoriasis or severe dryness, and the linked symptoms: irritation, scaly skin, inflammation, itchiness. This highly effective thermal water range is available in pharmacies nationwide.This product range, XEMOSE has an antiinflammatory effect, a restructuring soothing effect so relieves irritation and the desire to itch.

Uriage Keratosane 30 is a gel cream that eliminates roughness and flaky patches on the skin. Its concentration in Urea produces a powerful keratolytic action on rough or very thick skin areas of the body. This product is for adults to use on the body, is fragrance free, has excellent tolerance and a non-greasy feel.

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

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ost cases of skin cancer are directly caused

by UV 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 activities.

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.

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 before 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 29. There is a 75% increased risk in melanoma when people begin tanning regularly before the age of 35.

According to research we carried out, two out of five sunbed operators are not complying with

KEVIN O’HAGAN Cancer Prevention Manager, Irish Cancer Society

the requirement to ask customers their age, and many are making bookings for under 18s. The Irish Cancer Society is concerned to see operators flouting sunbed legislation. We feel that greater resources must be made available so health 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.

However, in Ireland, 90% of the days between April and September have a UV level high enough to cause skin damage.

High UV levels – typically in summer – cause skin damage 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.

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

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

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

• 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.

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Skin cancer focus S

kin cancer is the most common form of cancer in Ireland. Most skin cancers can be cured if detected early.

Skin cancer is an uncontrolled growth of skin cells and most often develops on skin exposed to ultraviolet (UV) radiation. It can also develop on parts of the skin that have not been directly exposed to sunlight.

Melanoma, often growing from a mole or as a new lesion resembling a mole, is one of the more aggressive forms of skin cancer and can be a major health concern if it is not caught early. Early detection is the key to successful treatment.

When it comes to finding melanomas, patients are often the ones to sound the alarm, so ordinary people can and should get better at noticing changes on their skin. Keeping an eye on your skin is one way you can be proactive about your own health.

Look out for skin changes It’s important both to look out for changes in your existing moles and to be aware of any new moles or

marks on your skin. In adults, over 70% of melanomas show up as new moles or marks on the skin. Pay attention to new pigmented lesions if you are over 35 and remember to check difficult to see areas such as your back. A sore that doesn’t heal within a few weeks or a lesion that itches or bleeds are also clear signs that you need to get it checked. If you are in doubt, see your doctor.

Keep track of skin changes with the camera on your phone Leading experts recommend using photos to keep a record of the appearance of moles and wider areas of skin so that it’s easier to identify changes over time.

Miiskin is a convenient and secure app designed to keep such a photo record.

Miiskin securely documents skin changes over time and was the first app to be dermatologically endorsed by the Skin Health Alliance. Within the app you can compare closeup photos taken at different times to see if anything has changed.

It also lets you photograph wider

areas of your skin and to access and compare the photos on your computer or tablet to look out for new moles and marks. Convenient reminders are provided to help users remember to take regular photos over time. Importantly, the app does not provide any diagnoses or risk assessments of the photographs.

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Get 20% off Miiskin Premium €25.49 > €20.39 Go to miiskin.com/save Visit miiskin.com for more skin cancer information and to download the app

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