Your Skin - Q2 2022 by Mediaplanet UK&IE

Q2 2022 | A promotional supplement distributed on behalf of Mediaplanet, which takes sole responsibility for its content

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Lack of support for people living with a skin condition Living with a skin condition can have a devastating impact on mental health and wellbeing, but with the right support this needn’t be the case.

rowing up in a society that places so much value on how you look can be tough. When you have a visible difference, like a skin condition that affects your appearance, the impact can be devasting.

WRITTEN BY Gillian Owen Head of Campaigns and Communications, Changing Faces

Living life with a skin condition Changing Faces ambassador, Natalie Ambersley, has the skin condition vitiligo. Vitiligo leads to white patches appearing on the skin, also known as leucoderma. The condition causes the skin to lose its pigmentation and appear white or sometimes pink. Natalie explains: “Growing up with vitiligo was often very challenging. My teenage years were my worst because advertising and magazines had convinced me that there was such a thing as ‘ideal body types’ who were classified as ‘pretty’ or ‘beautiful’ and I simply didn’t fit into either category. This led to me developing a sense of hatred towards my skin. I became very uncomfortable with how I looked, lacked confidence and tried to avoid conversations in relation to my skin.” Natalie’s experience of how her skin condition has affected her mental health and wellbeing, as a young person and an adult is all too common. Research carried out for Changing Faces found that children with a visible difference, like a skin condition, have reported an increase in feeling unhappy, from 30% in 2019 to 42% in 2021. Whilst research with

adults found 51% citing that they have felt self-conscious or embarrassed as a result of their visible difference. Finding mental health support Despite research and the experiences of people like Natalie demonstrating a need for mental health support, there is still a lack of psychosocial support available to dermatology patients. A recent report by the All-Party Parliamentary Group on Skin, found that fewer than 5% of dermatology clinics across the UK provide any level of specialist mental health support for children and young people. For Natalie, talking about her condition and getting support to build confidence and self-esteem provided a turning point. Natalie says: “For years, I felt like it was my skin that defined me without even considering that I was a person admired and loved by family and friends because of who I was.” Changing Faces is the UK’s leading charity for anyone with a visible difference. They provide life-changing mental health, wellbeing and skin camouflage services, and work to transform understanding and acceptance of visible differences.

For advice or support visit changingfaces.org.uk or call 0300 012 0275.

The culture around our skin has shifted. We are now constantly photographed, curating an image of ourselves to share over social media. We have an unprecedented desire to look after our skin cosmetically and research shows that our skin is intrinsically linked with our self-confidence. ~Matthew Patey CEO, British Skin Foundation

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Changing public awareness of skin health over the years Skin health was not a common topic a few decades ago, but through advancements in technology, scientific research and cultural shifts, we are now understanding the importance of taking care of our skin.

ead back 25 years and you would find a world where the Spice Girls are still together, Titanic is in the cinema and the sound of dial-up internet is ringing in our ears. A lot has changed in the last two and half decades and amongst all the cultural shifts, the world of dermatology has seen a seismic change.

WRITTEN BY Matthew Patey CEO, British Skin Foundation

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Rise in skin health interest When the British Skin Foundation was launched in 1996, dermatology was reserved primarily for those within the medical profession. If you asked people on the street about their skincare routine, you would have been met with many blank faces, 25 years has changed that. With the invention of the internet and the democratisation of information, the perception of dermatology changed. The public slowly realised the importance of looking after their skin and began to take an interest, both medically and cosmetically. With this surge in interest, there was a clear demand for scientifically backed research presented in an easy-to-understand way. The culture around our skin has shifted. We are now constantly photographed, curating an image of ourselves to share over social media. We have an unprecedented desire to look after our skin cosmetically and research shows that our skin is intrinsically linked with our self-confidence.

Awareness of skin conditions We are also increasingly aware of the signs of skin disease, the treatments available to us and methods of prevention. Whilst 25 years ago sun cream might have been hastily applied on a summer’s day, the importance of daily SPF is now common knowledge. We are more aware than ever before of how important science and research is and being able to access that information gives us power over our skin health. Being able to carry out your own research, accessing information about your condition and contacting your doctor from a place of knowledge is not only beneficial to you but is often encouraged by medical professionals themselves. Accessing reliable information The British Skin Foundation began solely as a research body, funding projects that investigated all types of skin conditions. Whilst that is still a fundamental pillar of the charity, education and information has now become equally important. In a world of far-reaching misinformation, providing a reliable source that allows everyone to learn about their own skin conditions has never been so important.

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Scanners better assess and guide treatment of pressure ulcers

A new approach is needed to assess the risk of pressure ulcers

Technology modernises a standard of care that fails to fully protect patients, especially those with dark skin tones.

edsores, also known as pressure ulcers, occur most frequently on the bottom or heels. Usually caused by deformation of the skin due to poor mobility, they vary from small, reddened areas to large open wounds. “They can be painful, distressing and embarrassing,” explains Martin Burns, CEO of biometric sensor technology specialists Bruin Biometrics LLC.

Pressure ulcers are more likely to be missed in people with darker skin tones because of the technique used to assess the condition, according to research.

ressure ulcers are traditionally assessed through red discolouration on the skin, this approach results in them being missed, or picked up later, especially in people with darker skin. Research is reshaping the way pressure ulcers are assessed in people with darker skin tones. Skin tones Educator and researcher Dr Neesha Oozageer Gunowa, community pathway lead in community nursing at the University of Surrey, conducted a study on pressure ulcers in people with darker skin for her PhD. With a background in district and community nursing, she says: “I was working in an area highlypopulated with people with dark skin tone and recognised in my practice that dark skin tone patients with pressure ulcers were more likely to be picked up later.” She found little research had been conducted on why people with darker skin develop more severe pressure ulcers than people with lighter skin tones.

Nurse educators need to talk about skin tone differences and that not everyone is the same. Nursing education The investigations highlighted a gap in nursing education, with the diagnosis of pressure ulcers still determined by the so-called “react-to-red” approach. Red areas, she explains, show up on lighter skin but are not so prominent on darker skin tones but may be just as serious. “Nurse educators need to talk about skin tone

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differences and that not everyone is the same,” she says. “The evidence is saying that people with dark skin tones are more likely to be getting more severe pressure ulcers; therefore, we need to recognise that there are differences.” The language, she continues, needs to change from the “react-to-red” pressure ulcer prevention initiative to the Stop the Pressure programme, shifting the emphasis away from colour alone. Her research has influenced healthcare policy, with the National Wound Care Strategy Programme acknowledging the findings. Additionally, Wound UK recently published a best practice statement on wounds in people with dark skin tones. The role of technology to eliminate inequalities Emphasising that pressure ulcers are generally preventable wounds, Dr Oozageer Gunowa says technology also has a role with SEM (sub-epidermal moisture) scanners able to identify increased localised oedema in vulnerable areas of the skin (regardless of skin tone) at an earlier stage than the current pathway – allowing for earlier treatment to help prevent the condition worsening. She says an “element of systemic racism” surrounding pressure ulcers is leading to health inequalities for people with darker skin tones. “Once that is addressed, people are less likely to die from pressure ulcers and more likely to be picked up sooner. We as nurses and clinicians need to see people as individuals.”

Risk assessment He explains that current care requires healthcare practitioners to undertake a risk assessment, assess vulnerable areas like the heels and look for redness as an early indicator of ulceration. “Since redness is not readily observable on dark skin tones, this in particular fails the dark skin tone population. “Broken skin is observable but once the skin breaks, treatment complexity rises four-fold,” he says. Patients with dark skin tones are four times more likely to die from pressure ulcers.

Since redness is not readily observable on dark skin tones, this in particular fails the dark skin tone population. Scanner technology “The current standard of care is not good enough,” he adds. Localised oedema/ sub-epidermal moisture (SEM) is a recognised biomarker for pressure ulcer management and identified by hand-held medical devices, such as Bruin Biometrics’ Provizio® SEM Scanner technology. Irrespective of skin tones, it identifies skin damage on average five days earlier than nursing staff can see them on the skin surface, says Burns and can be used in different care settings.

INTERVIEW WITH

INTERVIEW WITH Dr Neesha Oozageer Gunowa PhD, DN, RN, QN, SFHEA Pathway Lead in Community Nursing - Teaching Fellow

Martin Burns CEO, Bruin Biometrics LLC WRITTEN BY

Mark Nicholls

WRITTEN BY Mark Nicholls Scan the QR code for more information about Bruin Biometrics LLC

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A reconstructive innovation is giving skin cancer patients another option A synthetic dermal scaffold used in reconstructive operations is providing an effective alternative for skin cancer patients who, until recently, had no surgical options left.

atients who undergo numerous operations to remove multiple skin cancers can have increasingly complex reconstructive needs, admits Mrs Aenone Harper Machin, consultant plastic surgeon, St Helens and Knowsley NHS Trust. In some cases — particularly when the patient is elderly and frail — surgery to remove a tumour may be impossible if postoperative wounds and skin grafts will not heal. “We are seeing an ever-increasing cohort of elderly patients with multiple nonmelanoma skin cancers, most commonly on the head and neck, and squamous cell carcinomas, most commonly on the scalp,” says Mrs Harper Machin. “Unfortunately, once patients have a number of these cancers, their reconstructive options become extremely limited.” However, a synthetic dermal scaffold — known as biodegradable temporising matrix (BTM) — is being used by the NHS and provides an effective reconstructive alternative for skin cancer patients who, until recently, had no treatment options left. This is a sponge-like sheet that temporarily closes the wound, creates a foundation for the skin and encourages the body to generate new tissue. As such it can be applied to a range of wounds including traumatic injuries, burns, and necrotising soft tissue infections. A game-changer for wound treatment “Patients with multiple skin cancers, or those who are very frail, can now be treated adequately under local anaesthetic,” says Mrs Harper Machin, who has been using BTM in her surgical operations for almost three years. “They can even undergo radiotherapy afterwards which is a game-changer because, previously, radiotherapy would have destroyed their skin grafts.” Apart from being life-altering for patients, it has been beneficial for surgeons, too. “Other dermal matrices can be expensive and their results can be mixed,” says Mrs Harper Machin. “But this latest innovation is straightforward to use. It generates a blood supply faster than other dermal matrices so any infections can be treated with antibiotics. Recovery time is quick and outcomes are extremely good. While it won’t necessarily change the course of a patient’s disease it can give them a more comfortable life.” Read more at polynovo.com

INTERVIEW WITH

Aenone Harper Machin Consultant Plastic Surgeon, St Helens and Knowsley NHS Trust

Acne is linked with social isolation, low self-esteem and poor body image.

Don’t wait to seek support for your acne Acne affects more than 640 million people worldwide and this incidence is increasing. Although it typically begins around the time of puberty, it can affect all ages.

cne is an inflammatory disorder of the skin’s oil producing (sebaceous) glands. It predominantly affects face, back or chest, presenting as red spots (papules or nodules), yellow heads (pustules), cysts or blocked pores (comedones). Common causes of acne Acne results from an interaction between genetics and environmental factors (exposomes). There is a significant genetic contribution, with estimates of heritability between 50-80%. External influences include nutrition, medication and lifestyle. Increasingly westernised diets, high glycaemic index foods (such as refined grains and sugary food) and high dairy intakes have all been linked with acne. Hormonal abnormalities such as polycystic ovaries may underlie some cases. Acne cosmetica is the term for acne associated with skincare, as certain cosmetic ingredients are pore blocking (comedogenic).

Acne is a treatable condition, although there is frequently considerable delay to definitive treatment, resulting in scarring and long-term psychological impacts. Finding a suitable treatment The loss of hydration results in a reduction in skin’s natural robustness and it can become increasingly sensitive. People may notice reactions to harsher products like acids or fragrances and the skin may feel uncomfortable with burning and stinging. Hot flushes of menopause may exacerbate this and redness may also be a problem.

WRITTEN BY

Tony Greenway

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Skin thinning Acne is a treatable condition, although there is frequently considerable delay to definitive treatment, resulting in scarring and long-term psychological impacts.

Simple cleansing and over the counter ingredients such as salicylic acid and benzyl peroxide can be helpful, alongside avoidance of pore blocking ingredients such as coconut oil or cocoa butter. A low glycaemic index diet may be helpful, however, very restrictive diets are not advised. The first line of treatment involves vitamin A based creams (retinoids). Topical retinoids are effective, but acne may take up to three months to show improvement. Slow introduction and gentle skincare can help manage skin irritation. Other medicated creams include benzyl peroxide, topical antibiotics and azelaic acid. Oral treatments for severe cases In more severe acne, tablets may be required. There are three classes of tablets which can be used: 1. Antibiotics. These rebalance the microbiome and reduce inflammation and are usually used for a minimum of three months. 2. Hormonal treatments - combined oral contraceptive pills and anti-androgens. These are useful treatments in women who experience premenstrual flares. 3. Oral isotretinoin (roaccutane) is indicated for severe acne. However, it has a number of potential side effects. Acne is often perceived as a mild skin condition or a rite of passage in teenagers. However, it can have a significant impact on psychological wellbeing. Depression, anxiety and suicidal thoughts are all more common in acne sufferers. In addition, acne is linked with social isolation, low self-esteem and poor body image. It is a manageable condition and effective treatment should be instituted as soon as possible to reduce the risk of scarring and the psychological burden.

WRITTEN BY Dr Emma Wedgeworth Consultant Dermatologist

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Finding an innovative approach to skin cancer care A non-invasive treatment for skin cancer could improve the patient experience and lead to enhanced quality of life.

raditionally, people with non-melanoma skin cancer face several courses of outpatient treatments, including surgery or radiotherapy, with more vulnerable patients admitted to hospital overnight. Now, a new trial of an innovative patient-friendly therapy will be held at King’s College Hospital in London as a step towards making it available in the NHS.

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Non-surgical treatment The paint-like treatment - RheniumSCT - uses the Rhenium-188 isotope that emits beta-radiation to target skin cancer. A special applicator enables clinicians to apply the compound to deliver this epidermal radio-isotope therapy to kill cancerous cells, usually in a single session and with little to no resulting scarring.

“Hopefully this treatment will provide these patients a way forward,” he says. “Compared to surgery, the advantages are that the patient does not have a procedure, or be anxious about anaesthetic injection, or aftercare.” He said the NHS would benefit because there is less impact on resources and time of skilled personnel.

Image provided by Oncobeta

Dermatologist Dr Saqib Jawaid Bashir, lead clinician for skin cancer at King’s College Hospital NHS Foundation Trust, says: “The aim is to provide patients with a nonsurgical treatment for their cancer and also see multiple skin cancers treated in one visit.” Painless therapy The manufacturer, OncoBeta, is confident the painless therapy can effectively treat non-melanoma skin cancers, he adds, and this includes basal cell and squamous cell carcinoma, which are common conditions. Dr Bashir explains that sun-exposed patients can face multiple surgeries over consecutive years, with the anxieties of anaesthetic and stitch removal from wounds.

A new app helps you understand your skin microbiome Understanding your unique skin microbiome can literally save your skin and save money too.

D INTERVIEW WITH Dr David Caballero-Lima Head of Research & Development, Labskin WRITTEN BY Linda Whitney

o you know your skin type? Of course you do – but think again. Research shows that nearly two in three women (63%) do not know their correct skin type. That means many are wasting money on unsuitable skincare products – and may even be inadvertently damaging their skin. David Caballero-Lima, who carried out this research, is Head of Research & Development at Labskin, a company which makes human skin to provide animal-free testing for cosmetics and pharmaceuticals. CaballeroLima says: “After 15 years of research we know that each one of us has a different collection of microbes living on our skin. That’s your skin microbiome and it’s unique to you.”

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It varies according to many factors, including your ethnic origins, age, hormone status, the season and your environment. Your skin microbiome at puberty will differ from the one you have as an adult and in later life. It changes across your menstrual cycle and will differ according to whether you take HRT or not. It all means that there’s a lot more to skin analysis than patting your face with a tissue to see if it’s dry, oily or combination. Therefore, knowing your skin microbiome helps when it comes to choosing a skin care routine. Bespoke skin analysis How do you get to know your skin microbiome and what kind of products will suit you?

Radioactive particles Dr Nicola Mulholland, clinical lead for nuclear medicine at King’s College Hospital, explains that people come into hospital as outpatients for the treatment and have the product painted on to the affected area. Over a period usually between 30 minutes and three hours, the radioactive particles target the lesion and the patient can then go home. The safety and effectiveness of the treatment will be further assessed under the EPIC Skin study at King’s College Hospital as part of a multicentre study. Availability of treatment Rhenium-SCT has already been through clinical trials and is used in routine practice in other countries. It is expected that this Phase IV trial will also help with the introduction of the therapy into the UK healthcare system, initially for self-pay patients. It is hoped this will be by followed by reimbursement from health insurers and then be more widely available on the NHS.

Caballero-Lima says: “Using our expertise in analysing ingredients and formulations for pharmaceutical and cosmeceutical uses, we can analyse your skin microbiome to determine which kinds of products would suit your skin, based on our testing of their ingredients.” Labskin has launched a skin health tracking app called Skin Trust Club. A self-administered skin swab, combined with environmental data such as levels of pollution and the average UV index in your location is used to create a report about your skin. This includes personalised skincare recommendations for a morning and evening skincare routine. Applications for dermatologists Dermatologists can also use the app as a medical diagnostic tool to enhance diagnosis of skin conditions such as psoriasis. Caballero-Lima says: “At a first visit the patient could take our test, alongside the dermatologist’s observations, and at a second visit the results could be used to monitor the progress of their treatment, with only a few days delay.” The app will be released to dermatologists soon, once it has been validated by the EU as a medical device.

INTERVIEW WITH Dr Saqib Bashir Consultant Dermatologist & Dermatological Surgeon Lead Clinician for Skin Cancer, King’s College Hospital

INTERVIEW WITH Dr Nicola Mulholland FRCR FRCP MA MSc Consultant Radiologist and Nuclear Medicine Physician, King’s College Hospital London WRITTEN BY Mark Nicholls

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To celebrate World Microbiome Day on June 27th, we’re giving away 5,000 skin microbiome tests for free. T&C's apply. Scan the QR code to find out more

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Increasing awareness and education of actinic keratosis change in the genetic profile of cells and over a 10-year period there is a 17% risk of developing a certain type of skin cancer. That is not negligible,” states Dr Koscielny.

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Biggest risk factors Due to the recurrent and unpredictable nature of the disease, early detection and treatment is essential to reduce the consequences for patients. The potentially precancerous condition of the disease means that lesions can progress to squamous cell carcinoma (SCC) if not adequately monitored. In the same vein, Dr Koscielny points out that “as the impetus to go to a doctor and be checked out and diagnosed is not always there, awareness is absolutely crucial. This is a chronic condition that you cannot cure, so people must take it seriously. Doctors need to be clear to patients that this is not an aesthetic condition, it is one that has potentially serious consequences.”

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Doctors need to be clear to patients that this is not an aesthetic condition, it is one that has potentially serious consequences.

Actinic keratosis is one of the most common diagnoses made by dermatologists in Europe and its prevalence can be calculated to be around 18% of the population in this continent

INTERVIEW WITH Dr Koscielny Chief Medical Officer, Almirall WRITTEN BY Mark Nicholls

ctinic keratosis (AK) is a common skin condition caused by sun damage occurring mainly in skin areas chronically exposed to ultraviolet (UV) radiation. Despite being among the five most common diagnoses in dermatological consultations, it is still an underdiagnosed pathology.1 During the last years, an ageing population increased exposure to UV radiation and changes in UV-seeking behaviour2 have increased its prevalence to approximately 18% of the population in Europe.3,4 A precancerous condition As the most common precancerous dermatological condition,5 it is estimated that 40% to 80% of squamous cell carcinomas (SCC), the second most common form of skin cancer, evolve from simple AK lesions.6,7 Awareness is therefore

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key, as early diagnosis can stop the progression of the disease. To help further increase knowledge of AK, Almirall, a global biopharmaceutical company focused on skin health, launched the first AK Global Day on May 24 in collaboration with Euromelanoma and AEDV Piel Sana. The global event, which will be held every year, aims to raise awareness of the importance of monitoring the appearance and evolution of AK skin lesions. Dr Volker Koscielny, Almirall’s Chief Medical Officer, explains that “actinic keratosis is an underestimated condition. “It is where cells in some exposed areas develop over time into cancerous cells. While we see morphological changes in the skin, people often dismiss it and do not take it seriously.” The high prevalence of AK means the disease burden is substantial, especially in middle-aged and elderly populations. “People are stoic, they dismiss it just as spots they get when they are older, but the sun exposes

Potential consequences While the core lesion is visible and can be removed, the ‘field’ around these lesions should be treated as the cells may be disturbed and could become cancerous. AK can also affect patients’ quality of life, as lesions can cause cosmetic discomfort and interfere with the patient’s daily activities. “Doctors must be very clear with patients about what to expect and educate them about the potential consequences, emphasises Dr Koscielny.” References 1. Ferrándiz C, Plazas MJ, Sabaté M, Palomino R; EPIQA Study Group. Prevalence of actinic keratosis among dermatology outpatients in Spain. Actas Dermosifiliogr.2016 Oct;107(8):674-80. 2. Chetty P, Choi F, Mitchell T. Primary care review of actinic keratosis and its therapeutic options: a global perspective. Dermatol Ther (Heidelb) 2015; 5(1): 19-35 3. Lucas R, McMichael T, Smith W, Armstrong B. Solar ultraviolet radiation: Global burden of disease from solar ultraviolet radiation: World Health Organization, 2006. 4. Worldometer. Population of Europe. 2020. Available at: https:// www.worldometers.info/world-population/europe-population/ Accessed: October 2020. 5. Skin Cancer Foundation. Actinic Keratosis Overview. Available at: https://www.skincancer.org/skin-cancer-information/actinickeratosis/#:~:text=Actinic%20keratosis%20(AK)%20is%20 the,to%20ultraviolet%20(UV)%20radiation January 2021 6. Stockfleth, E., et al. (2015). Physician perceptions and experience of current treatment in actinic keratosis. Journal of the European Academy of Dermatology and Venereology : JEADV, 29(2), 298–306. https://doi.org/10.1111/jdv.12530 7. Fernández-Figueras, M. T., et al. (2015). Actinic keratosis with atypical basal cells (AK I) is the most common lesion associated with invasive squamous cell carcinoma of the skin. Journal of the European Academy of Dermatology and Venereology : JEADV, 29(5), 991–997. https://doi.org/10.1111/jdv.12848

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