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  • What's a little swelling?

    The importance of skin health and integrity for those that suffer from acute, problematic and chronic swelling shouldn't be underestimated. In Part 1 of the Oedema Series we revise what causes swelling, when it becomes a problem and what your role is in identifying problematic swelling. In following posts we will focus on some of the emerging evidence in relation to understanding more about how swelling occurs and resolves, therapies for management and what this may mean for the Dermal Clinician and Therapist. What causes swelling? Swelling or its medical term Oedema is caused by an accumulation of fluid in the interstitial spaces between cells. This can happen within the body, for example pulmonary oedema (fluid in the lungs) and cerebral oedema (swelling of the brain). However in Dermal Science and Therapy we are concerned with the more common occurrence of oedema within the skin (peripheral oedema). The regulation, balance and movement of water and solutes within different compartments in the body relies on many different systems to maintain homeostatic function. These include neurological (nervous stimuli), renal (kidney), cardiovascular (heart and blood vessels), integumentary (skin) and the lymphatic system. For most of us, swelling is something that we live with at some point or another. This may be due to an injury, medication we have been taking, pregnancy or perhaps even a surgery. Dermal Clinicians and Therapists know that swelling is an expected side effect of any treatment that causes inflammation in the skin. We even use that as a positive endpoint, as regeneration of the skin requires inflammation and associated swelling to allow much needed cells and co-factors for healing to get to the site. However any swelling that is disproportionate, persists for an extended period of time, causes considerable discomfort or affects daily activities is cause for concern and further investigation. Swelling that occurs in the elderly, with medical conditions such as diabetes, cardiovascular disease and cancer should not be ignored. When is swelling a problem? Swelling is a normal and expected function of human healing. In response to tissue damage or injury, the body will have an inflammatory response. This results in vascular hyper permeability allowing for movement of cells and fluid to the area. This process facilitates immunological functions and repair or removal of damaged cells and tissues. Normal acute inflammation and swelling will usually peak at 3-7 days after the injury and then will slowly dissipate. How long this takes varies depending on how extensive the injury was, but usually within 4-12 weeks swelling will be markedly improved or gone altogether. Problematic oedema can be defined as acute oedema that is disproportionate and causing issues such as pain or discomfort, problems with movement and activities of daily living and causing risk to skin integrity. Whilst oedema is a normal part of healing, due to many factors it can negatively impact on optimal healing. Early management and support will improve wound repair, reduce risk of or degree of scarring, improve range of movement and prevent further complication in the future. Chronic oedema is under recognised as a problem and under managed. Chronic oedema can be diagnosed medically when swelling has been present for more than three months. It is a multi-factorial condition, meaning that the condition is not often caused by one thing. It is the contribution of many factors over time. However, it is known that the lymphatic system is responsible for returning fluid from the interstitial spaces to the cardiovascular network. Therefore degeneration of this system and its ability to do this task is seen as being the resulting problem. Patients with chronic oedema will often say that there was a defining event where the problem made itself known. What they didn't realise is that they probably actually had sub-clinical oedema for many years before this. Chronic oedema may or may not be reversible depending on what is exacerbating the issue and how long it has been present. Risk factors that can result in chronic oedema at some point in a persons life include obesity, pregnancy, venous insufficiency, heart or kidney problems, medications that cause fluid retention, significant or ongoing injury and increasing age. Genetic predisposition may also play a role. Early identification of problematic and chronic oedema is important to ensure that the condition is managed to prevent further problems and degeneration. Lymphoedema is a form of chronic oedema. However lymphoedema is caused by dysfunction or failure of the lymphatic system itself. Chronic oedema if present and unmanaged can develop into lymphoedema. However lymphoedema can also occur due to malformation or genetic predisposition to lymphatic dysfunction. As the lymphatic system is responsible for returning fluid to the cardiovascular network, when it is not working the fluid will not resolve on its own and the condition is not reversible. Early identification and management can prevent the condition from worsening or causing significant health problems. It is reported that 1 in 30 people globally suffer from lymphoedema, however this may not be accurate as most people only seek diagnosis when there is already significant swelling. Therefore mild forms may not be picked up in this data. In Australia, lymphoedema is mostly associated with cancer and its treatment, though it can be the result of many factors that can damage the lymphatic system. 1 in 5 woman with breast cancer and treatment will have to manage lymphoedema afterwards. In most cases this presents within the first 12 months of treatment. However it can occur at any stage afterward. Any cancer that results in removal of lymph nodes, radiation or chemotherapy increases the risk of developing lymphoedema. This includes melanoma which reports an incidence of 6-58% cases of lymphoedema, 18% incidence rate in gynaecological cancers and 25-66% for prostrate cancer. The not so missing link: Skin, lymphatics and oedema The skin (integumentary system) and Lymphatic system are inextricably linked. Together they work to provide immune functions and protect against the outside world. When the skin is intact, it reduces the load on the lymphatic system to provide this defence. When the skin barrier is compromised this will result in inflammation and the lymphatic system having to work harder. This increase in load is due to the lymphatic system both attempting to resolve inflammation by removing the fluid but also due to working to neutralise any pathogens and other substances that could damage the body. On the other hand, when there is significant oedema in the short term, this can result in stretching or even breaking of the skin barrier and damage to the skin including wounds. When oedema has been present for a long period of time, the inflammation in the skin can result in tissue changes including fibrosis, thickening and other dermatoses such as fungal infections, xerosis (dry skin), fissures and dermatitis. Therefore we need to know that any skin that is not intact particularly for long periods of time, will result in chronic inflammation, oedema and ultimately is a risk for overloading the lymphatic system in time. Conversely providing simple management strategies to manage oedema and skin barrier can assist in improving the outcomes for those with swelling. The role of the Dermal Clinician. Skin and lymphatic wellbeing is definitely within the scope of Dermal Clinicians. They study as part of their Bachelor degree programs, anatomy and physiology of both the lymphatic and integumentary systems as well as its management in health and disease. The Dermal Clinician and Therapist also play a really important role in education of those that may be at risk of lymphatic dysfunction as well as early detection. In our clinical settings we often have clients presenting with early signs of vascular insufficiency (leg veins and capillaries), obesity, increasing age, planning surgical procedures and dermatological conditions that are associated with increasing lymphatic load. Therefore implementing assessment of lymphatic and skin health, as well as simple education and management strategies to assist with optimal lymphatic function, could play an important role in reducing the incidence and severity of lymphatic dysfunction. In following posts we will explore the tools and techniques available to assess and manage skin health and lymphatic function. #asdcassociation #dermalclinician References Al-Kofahi. M., Yun. J., Minagar. A & Alexander. J. (2017). Anatomy and roles of lymphatics in inflammatory disease. Clinical and experimental Neuroimmunology. 8(3), 199-214 Alitalo. K. (2011). The lymphatic vasculature in disease. Nature Medicine. 17, 1371–1380 Chatham. N., Thomas. L. & Molyneaux. M. (2013). Dermatologic Difficulities: Skin problems in patient with chronic insufficiency and phlebolymphoedma. Wound Care Advisor. 2(6), 30-36 Flour. M. (2013). Dermatological issues in lymphoedema and chronic odedma. Journal of Community Nursing. 27(2), 27-32 Haesler. E. (2016). Evidence Summary: Lymphoedema: Skin Care. Journal of Australian Wound Management Association. 24(4), 236-238 Huggenberger. R. & Detamar. M. (2011). The cutaneous vascular system in chronic skin inflammation. Journal of Investigative Dermatology Symposium Proceedings. 15, 24-32 Huggenberger. R., Siddiqui. S., Brander. D., Ullmann. S., Zimmermann. K., Antsiferova. M., Werner. S., Akitalo. K., & Detmar. M. (2011). An important role of lymphatic vessel activation in limiting actute inflammation. Blood. 117(17), 4667-4678 Huxley. V. & Scallan. J. (2011). Lymphatic fluid: Exchange mechanisms and regulation. Journal of Physiology. 589(12), 2935-2943 Keast. D., Despatis. M. Allen. J., Brassard. A. (2015). Chronic oedema/lymphoedema: under-recognised and under-treated. International Wound Journal. 12, 328–333 Lymphoedema Action Alliance. (2015). Submission to The Standing Committee on Health: Inquiry into Chronic Disease Prevention and Management in Primary Health Care. Submission 33 Negrini. D. & Moriondo A. (2011). Lymphatic anatomy and biomechanics. Journal of Physiology. 589(12), 2927-2934 Noowicki. J. & Siviour. A. (2013). Best practice skin care management in lymphoedema. Wound Practice and Research. 21(2), 61-65 Savetsky I. et al. (2015). Lymphatic Function Regulates Contact Hypersensitivity Dermatitis in Obesity. Journal of Investigative Dermatology, 135(11), 2742-2752 Tian. W et al. (2017).Leukotriene B4 antagonism ameliorates experimental lymphedema. Science Translational Medicine, 9(389). DOI: 10.1126/scitranslmed.aal3920 Todd. M. (2013). Chronic oedema impact and management. British Journal of Nursing. 22(11). 16-20 Varricchi. G., Loffredo. S., Genovese. A. & Marone. G. (2015). Angiogenesis and lymphangiogenesis in inflammatory skin disorders. Journal of American Academy of Dermatology. 73(1), 144-153

  • Sunscreen: Decoding evidence from misinformation

    Collaborators: Helia Haghoost, Martina Masina and Jennifer Byrne In the battle against skin cancer statistics, sunscreen use is an important pillar in sun-protective behaviours. It is also one of the most controversial subjects where misinformation and myths are often perpetuated online and on social media. Skin health professionals play an important role in dispelling fears and providing education to encourage sun-safe behaviours with evidence-based information. A sunscreen aims to prevent transmission of UVR to the deeper layers of the skin (dermis) where it can cause cellular damage resulting over time in changes and alternations to normal skin structure and function as well as skin cancer development. Studies support that sunscreen use can prevent skin cancer and the signs of photo-aging including wrinkles, pigment changes and telangiectasia. Geisler, A. (2021). Visible light. Part II: Photoprotection against visible and ultraviolet light [image] from Journal Article. What are sunscreens? Sunscreens contain a combination of chemical (organic) or physical (inorganic) ingredients that on the most basic level either will absorb high-intensity UVR or reflect and refract it. To ensure a broad-spectrum coverage most sunscreens will combine both inorganic and organic ingredients. Deciphering sunscreen labels Below is some information on ingredients that may be used in sunscreen formulations. The TGA provides education and guidance that can be useful for skin health professionals Deciphering sunscreen labels Sunscreens - most sunscreens are regulated by the TGA Safe use of sunscreens Chemical (Organic) Filters in Sunscreen Chemical Filters, also known as organic sunscreens, are comprised of an aromatic compound attached to a carbonyl group. This structure facilitates the absorption of high-energy UV rays, exciting the molecules. After returning to the ground state, the released energy is of a low magnitude and a longer and safer wavelength in the form of heat. These filters can come in both UVA and UVB blockers as well as broad-spectrum which can absorb the full spectrum of the UV radiation. Chemical (Organic) Filter Ingredients UVB Blockers Aminobenzoates: The most effective UVB filter but does not protect against UVA. Para-aminobenzoic acid (PABA) is associated with photoallergen or contact allergen responses, hence their usage in chemical sunscreen has declined. Cinnamates: come in the form of octinoxate (OMC) and cinoxate and are UVB filters. As they are not the most potent UVB absorbers, they are combined with other UVB protectors to increase their SPF. Octinoxates degrade with time under direct sunlight. Salicylates: are weak UVB filters and are used in higher concentrations or to increase the SPF of other UVB filters. They can also decrease the photodegradation of other UV filters. Octocrylene: is associated with decreased instances of photoallergen reactions and can increase the SPF of sunscreens when combined with other UV filters. Ensulizole: light, less oily and more cosmetically appealing. Only protects against UVB and is not effective against UVA. UVA Blockers Benzophenones: are mainly UVB filters, however, Oxybenzones can filter UVA as well. They are not photostable and have the highest incidence of contact dermatitis. Anthranilates: weak and rarely used UVA and UVB filter Avobenzones: A broad-spectrum, very effective UVA filter, however very photo-unstable. It can be combined with other chemical and physical sunscreens to reduce its photo-degradation. Ecamsule: Photostable, water resistant and low-systemic absorption. Physical (Inorganic) Filter Ingredients Physical filters can reflect and scatter UV light as they are deposited in the stratum corneum. The higher reflective index of the material contributes to the efficacy of the filter in photoprotection. How these filters react with UVR is also reliant on the particle size and thickness of the material. The smaller, micronized particle sizes can be more cosmetically appealing due to a lack of white cast on the skin but can behave more like a chemical filter in absorbing and converting UV rays to heat. There is also a higher risk of systemic absorption. The Thicker coating can increase the filter’s reflective index but can be less cosmetically appealing. Photoreaction can cause most physical filters to become less effective, hence they are generally coated with dimethicone and silica for stability. Physical (Inorganic) Filter Ingredients Zinc Oxide: A photostable and effective UVA filter that does not react with other UV filters. Not as Protective against UVB rays. Titanium Oxide: Is a more effective UVB filter than Zinc oxide but less effective in protecting against UVA rays. Has a smaller particle size and higher reflective index, giving it a white appearance and being less cosmetically desirable. Iron Oxide: Whilst zinc and titanium oxide filters protect against UVA and UVB wavelengths, the visible light and near-infrared part of the spectrum are usually unprotected. Visible light and NIR are culpable in many pigmentary disorders and photodermatoses such as hyperpigmentation, melasma, solar urticaria, erythema and inflammation. Dark-coloured Iron Oxide filters provide protection against UVA, and UVB, as well as visible and near-infrared parts of the spectrum. Broad-spectrum sunscreen containing Iron oxide has shown improvement in melasma lesions and reduced relapses. Nanotechnology and Sunscreens Currently, nanotechnology is being widely used in sunscreens to enhance traditional sunscreen. Due to their small particle size and providing a larger surface area, nano sunscreens have the following advantages: they do not have a white cast, are non-greasy, can penetrate the skin and not become too thick, are not associated with irritation, are photostable and have higher efficacy and longer water resistance ability. Potential new sunscreen technologies The following ingredients are being studied for their potential to assist with sun protection and skin cancer prevention. Vitamin C, vitamin E, selenium and polyphenols which are found in green tea extracts are photolyases (DNA repair enzymes) and antioxidants. These are potential agents of topical and nontopical photoprotection that are emerging. Niacinamide and Polypodium leucotomos extract which is derived from a fern native to Central and South America, are used orally as photoprotective agents. Exposure of cells to UV light from the sun causes the formation of pyrimidine dimers in DNA and has the potential to lead to mutation and cancer. The use of Nicotinamide has been shown to enhance DNA repair and decrease the formation of pyrimidine dimers in human keratocytes. When taken orally P. leucotomos extract can increase the minimal erythema dose of sun exposure without significant adverse effects. This ingredient is also helpful for dermatologic diseases induced by ultraviolet radiation, such as polymorphous light eruption and solar urticaria. Myth busting – Sunscreen For more information - Cancer Council Inorganic (physical) sunscreens are superior as they reflect UVR and do not absorb it into the skin. This is a commonly perpetuated opinion. As stated above micronised inorganic molecules have been found to behave comparably to organic compounds by absorbing UVR due to their molecular size.  To have a broad. spectrum coverage of UVR most sunscreens will combine both inorganic and organic filters. However, in some situations, sunscreens with a higher zinc oxide content may be recommended due to other benefits on the skin including reducing itch, and soothing chapped and irritated skin. You can create your natural sunscreen – Sunscreens are not easy to make and are a regulated therapeutic good in most situations to ensure that they are broad spectrum, reliable and stable during use.  A sunscreen made in your kitchen is not going to meet these requirements. SPF 30+ and SPF 50+ or higher are the same – SPF is determined by the ability of the formulation to filter out UVB radiation.   In laboratory conditions, SPF 30+ will filter out approximately 97% UVB radiation, SPF50+ 98% and SPF 100 will filter out 99%.  These tests are carried out with a 2mg/cm2 thickness.  In real use, most people don’t apply their sunscreen to this thickness and therefore are not receiving the labelled SPF.  It can be recommended to use the highest SPF rating that is available to provide the best protection possible as well as education on how much to apply to get good protection. Dark-skinned individuals do not need sunscreen – While melanin-rich skin has more natural protection for UVR, all skin types can experience photodamage and skin cancer, particularly melanoma.  Research indicates that darker skin types may have a delayed diagnosis of skin cancer compared to lighter skin types due to the higher pigment content in their skin.  Therefore, all skin types can benefit from the use of sunscreen to prevent sun damage. Sunscreen in makeup is enough sun protection – most makeup has SPF15 or lower which is below the SPF30 recommendation Staying in the shade prevents the need for sunscreen - see below If I apply sunscreen that's enough to prevent skin cancer - see blow Sunscreen is not required if I am not in direct sunlight, working indoors or it's cloudy - see below Light can be reflected, scattered, and transmitted therefore we need to use multiple sun protection strategies to effectively protect against sun damage.  Using any one method alone will not be as effective as using all five (5) slip (on protective clothing), slop (on sunscreen when UV Index is above 3), slap (on a hat), slide (on your sunglasses) and seek shade, particularly in peak UV periods Sunscreen is not safe – see facts about sunscreen Sunscreen prevents Vitamin D synthesis – see facts about sunscreen Facts about sunscreen The best sunscreen is one that has evidence-based efficacy and safety, and that you can access, afford, and use regularly. Sunlight is required for Vitamin D synthesis however it has been found that 10-15 mins on the face, arms or legs early in the morning when UV is at its lowest for the day may be enough to offset this in Australia.  Due to the strong evidence to support sunscreen in the prevention of sun damage and skin cancer development, you may seek expert medical advice about whether Vitamin D supplementation is suited to your situation rather than not wearing sunscreen at all or risking overexposure of your skin to UVR by sitting out in the sun to get your Vitamin D. Visible light and Near Infra-Red is also attributed with photo-damage and photo-aging therefore some sunscreens will incorporate filters such as iron oxide (pigment) to protect against this portion of the spectrum. Sunscreen is safe to use.  Skin reactions can occur in some people and are more common for some organic ingredients.   In most people changing their sunscreen to a different formulation can alleviate this and test patching before use is recommended.  Inorganic ingredients have not been found in studies to be systemically absorbed, and while there are studies that report systemic absorption of organic filters most studies indicate that in real-world applications people don’t apply an amount that would be needed to cause harm.  Sunscreens have been used since the 1970s and evidence generally points to the safety of sunscreens overall.  Studies that report effects as an endocrine disruptor have low-quality evidence in humans at this time.  Concerns for effects on the environment have led to some countries limiting the use of certain ingredients however coral bleaching is impacted by a variety of factors and it is still controversial as to whether this can be attributed to sunscreen use in a real-world context.  It is always important to continue research and keep up with information as further updates become available. Ingredients & Regulations For more information, you can visit the Therapeutic Goods Administration (TGA) for detailed information on permitted ingredients, concentrations and the regulatory requirements and exemptions for sunscreen. Sunscreen regulation - TGA Australian Regulatory Guidelines for Sunscreen - TGA Recommendations It is important to remember that sunscreen should be used along with other sun protection strategies including broad-brimmed hats, cover-up clothing, sunglasses and seeking shade Sunscreen is not recommended in infants below 6-12 months. Babies and toddlers should be kept out of the sun and be covered with sun-protective clothing. If it must be used it is advised to be washed off as soon as possible. Children and those with more sensitive skin or barrier impairment may be recommended to use sunscreen with a higher component of physical (inorganic) ingredients however this is not always the case, personal preference, previous history and skin response are the best gauges to use. Apply liberally and reapply if you are going to be sweating, in water or sunscreen may be rubbed off While sunscreen may have some effectiveness as soon as it's applied it is still highly recommended to apply it at least 15 minutes before sun exposure. More information Cancer Council - Sunscreen FAQ's Disclaimer The information in this document is general only and is not, and is not intended to be advice. Before making any decision or taking any action, you should consult with appropriate accounting, tax, legal or other advisors. No warranty is given as to the correctness of the information contained in this publication, or of its suitability for use by you. To the fullest extent permitted by law, the Australian Society of Dermal Clinicians Inc. (ASDC) is not liable for any statement or opinion, or for any error or omission contained in this publication and disclaims all warranties with regard to the information contained in it, including, without limitation, all implied warranties of merchantability and fitness for a particular purpose. ASDC is not liable for any direct, indirect, special, or consequential losses or damages of any kind, or loss of profit, loss or corruption of data, business interruption, or indirect costs, arising out of or in connection with the use of this publication or the information contained in it, whether such loss or damage arises in contract, negligence, tort, under statute, or otherwise References Bennett SL, Khachemoune A. Dispelling myths about sunscreen. J Dermatolog Treat. 2022 Mar;33(2):666-670. doi: 10.1080/09546634.2020.1789047. Epub 2020 Jul 7. PMID: 32633165. Chavda, V. P., Acharya, D., Hala, V., Vora, L. K., & Dawre, S. (2023). Sunscreens: A comprehensive review with the application of nanotechnology. Journal of Drug Delivery Science and Technology, 104720. https://doi.org/10.1016/j.jddst.2023.104720 Gabros, S., Nessel, T. A., & Zito, P. M. (2019). Sunscreens and photoprotection. https://europepmc.org/article/nbk/nbk537164 Geisler, A., Austin, E., Nguyen, J., Hamsavi, I., Jagdeo, J., & Lim, H. (2021). Visible light. Part II: Photoprotection against visible and ultraviolet light. Journal of the American Academy of Dermatology, 84(5), 1233-1244. https://doi.org/10.1016/j.jaad.2020.11.074 Pratt, H., Hassanin, K., Troughton, L. D., Czanner, G., Zheng, Y., McCormick, A. G., & Hamill, K. J. (2017). UV imaging reveals facial areas that are prone to skin cancer are disproportionately missed during sunscreen application. PLoS One, 12(10), e0185297. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0185297 Rodan, K., Fields, K., Majewski, G., & Falla, T. (2016). Skincare bootcamp: the evolving role of skincare. Plastic and Reconstructive Surgery Global Open, 4(12 Suppl). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5172479/ Sander, M., Sander, M., Burbidge, T., & Beecker, J. (2020). The efficacy and safety of sunscreen use for the prevention of skin cancer. Cmaj, 192(50), E1802-E1808 Sarkar, R., Arora, P., & Garg, K. V. (2013). Cosmeceuticals for hyperpigmentation: what is available?. Journal of cutaneous and aesthetic surgery, 6(1), 4 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3663177/ Tanaka, Y., Parker, R., & Aganahi, A. (2023). Photoprotective Ability of Colored Iron Oxides in Tinted Sunscreens against Ultraviolet, Visible Light and Near-Infrared Radiation. Optics and Photonics Journal, 13(8), 199-208. 10.4236/opj.2023.138018

  • UV Radiation: The Link Between Sun Exposure and Skin Damage

    Collaborators: Helia Haghoost, Martina Masina and Jennifer Byrne Skin health professionals can play an important role in providing education about sun protection and the effects of sun exposure on skin health. Skin health professionals may see their clients regularly sometimes over years and are therefore well placed to support with re-enforcing sun-safe behaviours. The sun emits Ultraviolet radiation which is the main culprit for skin damage. UV rays are invisible and cover wavelengths shorter than visible light and longer than X-rays and constitute 5% of iridescent sunlight. UV radiation covers the spectrum of wavelengths from 100 to 400 nm. Ultraviolet radiation leads to the formation of reactive oxygen species (ROS). ROS  are responsible for the creation of free radicals which leads to direct damage to cutaneous DNA, lipids, proteins, damage to membranes and it is responsible for photocarcinogenesis. Ultraviolet radiation is subcategorised as UVA, UVB and UVC rays, each with specific characteristics and tissue interaction. Sander M, Sander M, Burbidge T, Beecker J. The efficacy and safety of sunscreen use for the prevention of skin cancer. CMAJ. 2020 Dec 14;192(50):E1802-E1808. doi: 10.1503/cmaj.201085. PMID: 33318091; PMCID: PMC7759112. What are UVAs UVA covers the wavelengths of 320nm to 400nm with consistent year-round intensity. Due to possessing longer wavelengths than UVB, it can penetrate deeper into the skin and cause long-term damage with delayed manifestation. Irradiation of skin by UVA causes a cascade of cellular changes that can lead to skin cancer and premature ageing. Another UVA pathway to skin cancer is its effect on immunosuppression. A secondary effect of short-term tan by stimulating epidermal melanin is also associated with UVAs. Due to the consistency of its intensity, skin health professionals need to educate their patients on the daily application of broad-spectrum sunscreen all year round. What are UVBs UVB  covers the wavelength of 280–320 nm and its intensity peaks at around midday. UVB is also the primary cause of burns. It delivers long-lasting tan and stimulates cells to produce thicker epidermis. Its effects are typically more acute and greater than UVA, such as erythema, stimulation of melanogenesis and in extreme cases, formation of blisters. Like UVA, DNA is also a chromophore for UVB, contributing to the risk of skin cancers. The beneficial effect of UVB is converting epidermal 7-dehydrocholesterol into vitamin D, hence short-term (10-15mins) of sun exposure before 10 am or after 3 pm is recommended. What are UVCs UVCs, the shortest wavelength of UV radiation (200–280 nm) and highly mutagenic, do not reach the Earth's surface because it is absorbed by stratospheric ozone. Main effects of UV radiation on normal-appearing human skin UV-rays and skin response Chen, H., Weng, Q. Y., & Fisher, D. E. (2014). UV signaling pathways within the skin. Journal of Investigative Dermatology, 134(8), 2080-2085. https://doi.org/10.1038/jid.2014.161 UV radiation activates the cutaneous immune system and this leads to an inflammatory skin response. Melanin in our skin tissue is the first line of defence mechanism against UV radiation. It absorbs UV radiation and converts it into heat. This melanin is further stimulated by the Melanocortin 1 Receptor, causing the manifestation of unwanted pigmentation and long-term tan. Keratinocytes undergo apoptosis due to UV-induced injury to avoid malignancy. UV exposure causes the synthesis of highly reactive oxygen species that place oxidative stress on the epidermal cells and cause DNA mutations. These mutations are the main pathway to epidermal malignancy and the development of skin cancers. Intermittent UVR exposure accumulates epidermal DNA damage, increasing the risk of melanoma. It is associated with 65% of melanoma cases and 90% of keratinocyte cancers. Different skin types also respond differently to UV radiation. Fitzpatrick I-III have a higher susceptibility to the development of burns and skin cancer than Fitzpatrick IV-VI. This is due to the relative ease of UV penetration into the deeper layers of the epidermis and further damage to keratinocytes and melanocytes. Consequences of UV Signalling Pathway Deficiency Mutations to the tumour suppressor p53 are associated with human cancer as well as skin cancers. It regulates many signalling pathways that are activated in response to stimuli such as DNA damage, oxidative stress, and hypoxia and is responsible for DNA repair. Mutant p53 can be found in lesions of sun-exposed human skin. UV Index The UV Index is a tool created to communicate solar damage to the general public and help them decide the level of protection they need when leaving the house. UV Index measures the Minimal Erythemal Dose. This is the minimum required UV dose that can induce erythema and skin damage to the skin. The UV Index is the measure of the level of UV radiation. This index varies throughout the day, with the highest level being at the solar noon (between noon and 2 pm) (2023).How to prevent Melanoma[Image]. Melanoma Institute of Australia. https://melanoma.org.au/about-melanoma/how-to-prevent-melanoma/ The SunSmart app can be used to determine the UV Index throughout the day. The UV Index divides UV radiation levels into: low (1-2) moderate (3-5) high (6-7) very high (8-10) extreme (11 and above). You can access the SunSmart app here Myth busting – Skin Cancer Below are some commonly held beliefs by the public about skin cancer. Skin health professionals play an important role in dispelling myths, and fears by conveying evidence-based information to support sun-safe behaviours. Only fair-haired and light-skinned people get skin cancer Skin cancer only happens when you are older Skin cancer only happens in moles or freckles that have gone rogue A tan (fake or real) will protect from burning and skin cancer Melanotan is a safe way to tan Only people who sunbathe or use solariums get skin cancer You cannot get sunburned on cloudy or cold days You can’t get sunburned behind glass (car or office window) Facts about skin cancer risk Both sexes experience skin cancer but men experience a higher risk due to environmental and behavioural influences. Those that work or play for prolonged periods outdoors have a higher risk of skin cancer More than five (5) blistering or peeling sunburns during childhood and teen years have been associated with an increased risk of skin cancer. This is important to educate on as even if someone stays out of the sun and uses sun-safe behaviours after the age of 30 their previous history can still impact on their risk. Family history can increase your risk of skin cancer Your Fitzpatrick phototype is associated with the risk of skin cancer (but it is prolonged sun exposure that causes skin cancer) Increasing age is associated with a higher risk of skin cancer due to changes in the body's ability to detect and destroy damaged cells. The number of freckles and moles, particularly atypical moles are associated with a higher risk of skin cancer. Having received radiation therapy for cancer treatment or UV therapy for a skin condition may increase the risk of skin cancer Recommendations & Sun Protective Behaviours Disclaimer The information in this document is general only and is not, and is not intended to be advice. Before making any decision or taking any action, you should consult with appropriate accounting, tax, legal or other advisors. No warranty is given as to the correctness of the information contained in this publication, or of its suitability for use by you. To the fullest extent permitted by law, the Australian Society of Dermal Clinicians Inc. (ASDC) is not liable for any statement or opinion, or for any error or omission contained in this publication and disclaims all warranties with regard to the information contained in it, including, without limitation, all implied warranties of merchantability and fitness for a particular purpose. ASDC is not liable for any direct, indirect, special, or consequential losses or damages of any kind, or loss of profit, loss or corruption of data, business interruption, or indirect costs, arising out of or in connection with the use of this publication or the information contained in it, whether such loss or damage arises in contract, negligence, tort, under statute, or otherwise REFERENCE LIST: Amaris N. Geisler, Evan Austin, Julie Nguyen, Iltefat Hamzavi, Jared Jagdeo, Henry W. Lim, Visible light. Part II: Photoprotection against visible and ultraviolet light, Journal of the American Academy of Dermatology, Volume 84, Issue 5, 2021, Pages 1233-1244, ISSN 0190-9622, https://doi.org/10.1016/j.jaad.2020.11.074. Ansary TM, Hossain MR, Kamiya K, Komine M, Ohtsuki M. Inflammatory Molecules Associated with Ultraviolet Radiation-Mediated Skin Aging. International Journal of Molecular Sciences. 2021; 22(8):3974. https://doi.org/10.3390/ijms22083974 Cancer Council. (n.d.). UV Index. https://www.cancer.org.au/cancer-information/causes-and-prevention/sun-safety/uv-index Chen, H., Weng, Q. Y., & Fisher, D. E. (2014). UV signalling pathways within the skin. Journal of Investigative Dermatology, 134(8), 2080-2085. https://doi.org/10.1038/jid.2014.161 Heckman CJ, Liang K, Riley M. Awareness, understanding, use, and impact of the UV index: A systematic review of over two decades of international research. (2019) 123:71-83. doi: 10.1016/j.ypmed.2019.03.004. Lee, J.W., Ratnakumar, K., Hung, K.-F., Rokunohe, D. and Kawasumi, M. (2020), Deciphering UV-induced DNA Damage Responses to Prevent and Treat Skin Cancer. Photochem Photobiol, 96: 478-499. https://doi.org/10.1111/php.13245 Mohania, D., Chandel, S., Kumar, P., Verma, V., Digvijay, K., Tripathi, D., ... & Shah, D. (2017). Ultraviolet radiations: Skin defense-damage mechanism. Ultraviolet Light in Human Health, Diseases and Environment, 71-87. Moshammer, H., Simic, S., & Haluza, D. (2016). UV “Indices”—What do they indicate?. International Journal of Environmental Research and Public Health, 13(10), 1041. https://doi.org/10.3390/ijerph13101041 O'Connor C, Rafferty S, Murphy M. A qualitative review of misinformation and conspiracy theories in skin cancer. Clin Exp Dermatol. 2022 Oct;47(10):1848-1852. doi: 10.1111/ced.15249. Epub 2022 Jun 15. PMID: 35514125; PMCID: PMC9796846. Piipponen M, Riihilä P, Nissinen L, Kähäri V-M. (2021)The Role of p53 in Progression of Cutaneous Squamous Cell Carcinoma. Cancers. 13(18):4507. https://doi.org/10.3390/cancers13184507 Sander M, Sander M, Burbidge T, Beecker J. The efficacy and safety of sunscreen use for the prevention of skin cancer. CMAJ. 2020 Dec 14;192(50):E1802-E1808. doi: 10.1503/cmaj.201085. PMID: 33318091; PMCID: PMC7759112. The WHO. (2022). Radiation: The ultraviolet (UV) index. https://www.who.int/news-room/questions-and-answers/item/radiation-the-ultraviolet-(uv)-index Yao Ke, Xiao-Jing Wang (2021).TGFβ Signaling in Photoaging and UV-Induced Skin Cancer, Journal of Investigative Dermatology, 141(4) Supplement 1104-1110, https://doi.org/10.1016/j.jid.2020.11.007.

  • Movember and Mens' Skin Health

    What is Movember? Movember is a global movement to raise awareness and funds to support men's health issues to improve health outcomes for men around the world. They provide education, advocacy, and collaborative opportunities to support gaps in men's health with a focus on mental health, prostate, and testicular cancer. The Australian Society of Dermal Clinicians observes Movember by raising awareness of men's skin health issues. Since 2003, Movember has funded more than 1,250 men’s health projects around the world, challenging the status quo, shaking up men’s health research, and transforming the way health services reach and support men. (https://au.movember.com/report-cards) How are you marking Movember and raising awareness about men's skin health this November? Men's skin - how different is it? The skin is our largest organ and performs many functions to maintain our health and well-being. During Movember, we will highlight skin health concerns that may have a higher impact on male skin. The underlying causes of sex-related differences in skin diseases are mostly unknown. Factors such as differences in hormones, behaviors, and environment may all contribute. The differences presented may assist us with how we approach education in order to tailor our information and treatments to different preferences and needs. However, it is important to note that sex-related differences are not clinically significant and shouldn't drastically alter how we assess or manage the skin. Dermal health professionals always approach skin health in an inclusive and person-centered manner to achieve the best outcomes for each individual. Anatomical differences Male skin is thicker than female skin Epidermal thickness doesn't appear to differ greatly between sexes however the dermis is thicker in male skin and with greater collagen density compared to female skin. While results in studies have been conflicting generally it's accepted that there isn't a significant difference in skin elasticity overall. The subcutaneous (adipose or fat layer) is thinner in male skin with the structure of adipose tissue comprising smaller adipose lobules and a greater number of fibrous septa. This is thought to contribute to sex-related differences in cellulite Male skin doesn't thin as much as female skin with ageing. Skin Health Variables and Male Skin There have been conflicting results in studies regarding parameters of skin health such as skin pH, transepidermal water loss (TEWL), surface hydration, and sebum between the sexes. This may be due to different areas of the body being studied as well as the impact of cosmetics. Overall there were no significant differences apart from sebum between the sexes. According to a literature review by Rahrovan et al, (2018), sex-related differences are generally accepted to exert no or only minimal differences in skin pH. Sebum output is higher in male skin with the appearance of larger pores. These differences are attributed to hormonal differences. It was also noted in a review of the literature that there was a correlation between higher sebum and impaired barrier as well as less use of cosmetics (moisturisers) due to the feel on the skin (Radhrovan et al, 2018). (Radhrovan et al, 2018; Chen et al, 2010; Dao et al, 2007; Wong et al, 2016) Sex-related differences in skin disease Generally, males have a higher incidence of infectious skin diseases and skin cancers than females. However have a lower incidence of auto-immune, allergic, or pigmentary skin conditions. The most common skin diseases with a higher prevalence among males that dermal health professionals may see due to their higher incidence include: Acne Fulmicans Rosacea Rhinophyma Male Pattern Baldness There are also several rare skin diseases that have a higher prevalence in males. (Chen et al, 2010) Skin Cancer and Men - How do they fare? UV radiation exposure is the leading cause of skin cancer. According to the World Health Organisation, 1 in 3 deaths around the world resulting from skin cancer are attributed to working under the sun. Men are the hardest hit by these figures. In Australia, the workplace is identified as a setting where you can be exposed to significant amounts of UVR. In Queensland, it has been estimated that working outdoors can expose you to twice as much UV radiation over a two-day period than those who work or go to school indoors. Outdoor sports have also been attributed to UVR exposure that may contribute to skin cancer development. A 2014 study reported the outcomes of over 1000 phone interviews with men aged between 18-65 that were identified as working outdoors. This study found that 94% used at least one form of sun protection for more than half their time working outdoors. Protective clothing and hats were the most frequently used. However, only 8% were considered fully protected and used more than four methods of sun protection such as sunscreen, hats, clothing, and wrap-around glasses. In a recent media release by the Cancer Council, they report that sun-safe behaviors such as seeking shade and using sunscreen are lower among men according to more recent surveys in Australia. Less than 49% of men seek shade to protect against sun exposure and only 29% use sunscreen regularly. How dermal health professionals can improve sun awareness and early identification of skin cancer? Educate on the importance of as well as encourage sun-safe behaviors, including using more than 3 protective measures when out in the sun. Screen their skin regularly if they are coming to see you, as you can see areas they may not be able to. Educate significant others to assist with monitoring skin health in hard-to-see areas. Encourage regular medical skin checks. Resources Men and Cancer Flyer - Reducing your risk Summary This Movember we raise awareness of some of the skin health concerns and issues that impact on male skin. Anatomical, hormonal, environmental, and behavioral variation noted between the sexes can result in differences in skin care choice and use, as well as minor differences in the skin with age, healing as well as skin problems and diseases. Dermal health professionals can make a positive impact in the area of male skin health through education, particularly in basic skin awareness and care to reduce the risk of skin infections, ensure optimal skin health, and prevent skin cancer. Monitoring the skin and assisting with referrals to see the right person, at the right time to get the right care can also have a positive impact on skin health outcomes. Disclaimer The information in this document is of a general nature only and is not, and is not intended to be advice. Before making any decision or taking any action, you should consult with appropriate accounting, tax, legal or other advisors. No warranty is given as to the correctness of the information contained in this publication, or of its suitability for use by you. To the fullest extent permitted by law, the Australian Society of Dermal Clinicians Inc. (ASDC) is not liable for any statement or opinion, or for any error or omission contained in this publication and disclaims all warranties with regard to the information contained in it, including, without limitation, all implied warranties of merchantability and fitness for a particular purpose. ASDC is not liable for any direct, indirect, special, or consequential losses or damages of any kind, or loss of profit, loss or corruption of data, business interruption, or indirect costs, arising out of or in connection with the use of this publication or the information contained in it, whether such loss or damage arises in contract, negligence, tort, under statute, or otherwise References Movember https://au.movember.com/?home Skin cancer incidence and mortality, Skin Cancer Statistics and Issues Prevention Policy. Skin Cancer Council (2023), https://www.cancer.org.au/about-us/policy-and-advocacy/prevention-policy/national-cancer-prevention-policy/skin-cancer-statistics-and-issues/skin-cancer-incidence-and-mortality#gender Carey RN, Glass DC, Peters S, Reid A, Benke G, Driscoll TR, Fritschi L. Occupational exposure to solar radiation in Australia: who is exposed and what protection do they use? Aust N Z J Public Health. 2014 Feb;38(1):54-9. doi: 10.1111/1753-6405.12174. PMID: 24494947. Watts CG, Drummond M, Goumas C, Schmid H, Armstrong BK, Aitken JF, Jenkins MA, Giles GG, Hopper JL, Mann GJ, Cust AE. Sunscreen Use and Melanoma Risk Among Young Australian Adults. JAMA Dermatol. 2018 Sep 1;154(9):1001-1009. doi: 10.1001/jamadermatol.2018.1774. PMID: 30027280; PMCID: PMC6143037. Australian Institute of Health and Welfare. (2022). Cancer Data in Australia. Social Research Centre. (2022). 2022 Summer Sun Protection Survey (Life in Australia ™) - Analytical Report. Melbourne, Victoria. S. Rahrovan, F. Fanian, P. Mehryan, P. Humbert, A. Firooz, Male versus female skin: What dermatologists and cosmeticians should know, International Journal of Women's Dermatology, Volume 4, Issue 3, 2018, Pages 122-130, https://doi.org/10.1016/j.ijwd.2018.03.002 Harry Dao, Rebecca A. Kazin, Gender differences in skin: A review of the literature, Gender Medicine, Volume 4, Issue 4, 2007, Pages 308-328 https://doi.org/10.1016/S1550-8579(07)80061-1 Wong, R., Geyer, S., Weninger, W., Guimberteau, J.-C. and Wong, J.K. (2016), The dynamic anatomy and patterning of skin. Exp Dermatol, 25: 92-98. https://doi.org/10.1111/exd.12832 Chen W, Mempel M, Traidl-Hofmann C, Al Khusaei S, Ring J. Gender aspects in skin diseases. J Eur Acad Dermatol Venereol. 2010 Dec;24(12):1378-85. doi: 10.1111/j.1468-3083.2010.03668.x. PMID: 20384686. Roberts CA, Goldstein EK, Goldstein BG, Jarman KL, Paci K, Goldstein AO. Men's Attitudes and Behaviors About Skincare and Sunscreen Use Behaviors. J Drugs Dermatol. 2021 Jan 1;20(1):88-93. doi: 10.36849/JDD.5470. PMID: 33400407.

  • Research Updates : Skin Health & the Breast Cancer Journey

    People of all genders can get breast cancer but it is the most common cancer in women in Australia, with 1 in 7 women diagnosed with breast cancer in their lifetime. While not as common, men also experience breast cancer with 1 in 500 men receiving a diagnosis in their lifetime (National Breast Cancer Foundation,2023). While the specific cause is not known there are some factors that are associated with a higher risk of prevalence Increasing age - the older we get the higher the risk of cellular damage and mutations that can result in cancers Family history - those with a first-degree relative such as a parent or sibling with breast cancer have an increased risk. Mutations of a gene associated with breast cancer BRCAI and BRCA2 are also linked to a family history. Research also indicates other factors such as smoking, alcohol, and obesity have links to a higher risk of breast cancer (Australian Breast Cancer Research https://australianbreastcancer.org.au) Treatment for breast cancer can include surgery such as lumpectomy or mastectomy to remove breast cancer as well as reconstructive techniques, chemotherapy, hormone therapy, and adjuvant radiation therapy. Treatment for breast cancer can have short and long-term impacts on skin health due to medications, surgery, and radiation therapy including skin changes such as dermatitis and fibrosis, scarring, and lymphoedema. The overall 5-year survival rate according to Australian statistics for those that have breast cancer is now reported to be 92% and 86% for the 10-year survival rate. Early detection and diagnosis can make a significant impact with a 100% 5-year survival rate for those diagnosed with early stage 1 breast cancer (National Breast Cancer Foundation, 2023). In this post, we will focus on research updates in the area of managing radiation dermatitis within the scope of practice for dermal clinicians. What can happen to the skin with radiation therapy? Radiation therapy is associated with acute and early skin changes that are usually transient and reversible, resolving after treatment is completed. Acute side effects are related to the dosages used and how frequent the treatments are. Chronic and long-term side effects may not resolve and may be permanent alterations to the structure and function of the skin. Early skin response such as erythema, oedema, heat, and pain or tenderness is an inflammatory response to tissue irradiated relating to cellular damage and oxidative stress. It may feel a bit like a moderate to severe sunburn. Over a period of 1-4 weeks, symptoms can progress to include dry desquamation which can progress if not managed to wet desquamation or skin necrosis (ulceration). Image courtesy of DermNetNZ.org Acute radiation-induced skin changes are graded 1-4 according to the classification system created by the National Cancer Institute in the USA. Grade 1 – Faint erythema or desquamation. Grade 2 – Moderate to brisk erythema or patchy, moist desquamation confined to skin folds and creases. Moderate swelling. Grade 3 – Confluent, moist desquamation greater than 1.5 cm diameter, which is not confined to the skin folds. Pitting oedema (severe swelling). Grade 4 – Skin necrosis, bleeding or ulceration of full-thickness dermis (middle layer of skin). Chronic and late skin changes The skin that has been treated with radiation therapy will experience changes over a 6 -12 month period after treatment and these are usually irreversible. These changes included alterations in skin pigmentation, fibrosis in the tissues, loss of hair follicles, dysfunction of the sebaceous glands, and telangiectasia. Radiation therapy can also be associated with skin necrosis and tumour genesis such as basal cell skin cancers. Image courtesy of DermNetNZ.org Research Publication Updates - Best Practice Guidelines and Global Consensus to Manage Acute Radiation Dermatitis. Management of acute radiation dermatitis has experienced significant discrepancies around the world and within different clinical settings due to a lack of high-level evidence to support clinical practice. Recently several publications have been published to review literature and propose best practices through more definitive consensus recommendations. dermal (skin) health professionals should be aware of updates and changes in this area in order to translate and transmit accurate and current information. Two research updates were published in 2023 by the Multinational Association of Supportive Care in Cancer (MASCC). MASCC is an international, non-profit, multidisciplinary organization that is dedicated to research into and education of supportive care for cancer patients. The Oncodermatology Study Group comprises experts in dermatology, medicine, radiation, dental/oral surgery, and supportive oncology, nursing. The research and the development of evidence-based guideline recommendations for the care of cancer-related dermatologic (skin, hair, nail) toxicities. This group provided a two-part publication series on the MASCC Clinical Practice Guidelines for the Prevention and Management of ARD, including a systematic review to highlight the available evidence on the prevention and management of acute radiation dermatitis and a Delphi-based expert consensus recommendations report. Sherman and Walsh published their review titled Promoting Comfort: A Clinician Guide and Evidence-Based Skin Care Plan in the Prevention and Management of Radiation Dermatitis for Patients with Breast Cancer. This publication aimed to translate a review of current high-level evidence and assimilate findings into a protocol for clinicians. A substantial number of prevention and management strategies were evaluated including topical, oral, and complementary/alternative therapies. It was determined that in many cases there is still insufficient evidence to support their use and couldn't be recommended as current best practice. A few interventions that were of note to discuss to inform practice included: Topical corticosteroids including OTC and prescribed can be useful to prevent or manage itch and inflammation associated with radiation therapy. Most supported by consensus were Mometasone and Betamethasone. Non-steroidal agents weren't recommended based on inconclusive results. Barrier film dressings including polyurethane film and silicone-based polyurethane films can be useful to manage acute radiation dermatitis. Many moisturising and emollient agents were evaluated, those with the greatest consensus for recommendation by the experts were for the use of aqueous cream or olive oil. As this is a global working group it was flagged in their discussion that accessibility and affordability had to be a consideration for lower socioeconomic countries or groups. Products with calendula, turmeric, and silymarin-based products did not achieve consensus recommendations but were discussed to show promising results in the literature review. The use of aluminum or aluminum-free deodorants in the literature review didn't show any negative impact on acute radiation dermatitis. However, there wasn't a consensus to recommend deodorants be used. Sherman & Walsh (2022) suggest to leave it to the patient's preference. The use of photo-biomodulation or low-level light therapy was recommended by 79% of experts based on current evidence and their own experience in preventing acute radiation dermatitis with breast cancer. It is worth noting as well that use with head and neck cancer in this review did not achieve consensus and is not supported based on current evidence. There have been concerns about using PBM and cancer recurrence. A 5-year long-term follow-up study of 120 patients with breast cancer was undertaken by Robjins et al, 2022 to evaluate this question. In this study, it was reported that receiving PBM for acute radiation dermatitis during breast cancer treatment didn't have a statistically significant influence on local recurrence, development of new tumours, or overall survival. While more research is still underway, being published and evidence is still emerging these therapies should only be used when integrated with oncology specialists, and cancer management teams for risk assessment and decision-making. (Behroozian et al, 2023; Behroozian et al, 2023; Sherman & Walsh, 2022 & Robjins et al, 2022) Resources for patients receiving radiation therapy The American Academy of Dermatology Association has created a resource page for assisting those receiving radiation therapy to manage their skin. How to care for your skin during and after radiation therapy General Recommendations for Skin Health during Breast Cancer Treatment Gentle washing with a gentle soap & fragrance-free cleanser. Don't scrub or rub, splash lukewarm water gently. Gently pat the area dry. Apply emollient gently If the skin is not intact avoid situations where the skin may become further damaged or infected for example spas, pools, lakes, or even hot baths. Protect the area from damage from the sun, extremes of temperature, or friction. Covering the area with a dressing can be helpful. If on the face discuss options with your skin or health professional. Don't use cold or hot packs in the area. Avoid make-up, perfume, and adhesive products in the area. If the skin becomes irritated, itchy or the skin is broken talk to the oncology medical health professionals about options to manage it. Summary Breast cancer is one of the most common cancers affecting women and radiation therapy is a mainstay therapy in its treatment. Radiation therapy is associated with short and long-term side effects. Skin management is an area that has been challenging with many options with practices being varied around the world and in different clinical settings. Dermal Clinicians should be informed about emerging and current best practices particularly as clients may ask about therapies within the Dermal Clinicians' expertise and skill set. Working in interprofessional or integrated oncology teams is an emerging area of practice due to the importance of skin health and integrity for those receiving radiation therapy. Disclaimer The information in this document is of a general nature only and is not, and is not intended to be advice. Before making any decision or taking any action, you should consult with appropriate accounting, tax, legal or other advisors. No warranty is given as to the correctness of the information contained in this publication, or of its suitability for use by you. To the fullest extent permitted by law, the Australian Society of Dermal Clinicians Inc. (ASDC) is not liable for any statement or opinion, or for any error or omission contained in this publication and disclaims all warranties with regard to the information contained in it, including, without limitation, all implied warranties of merchantability and fitness for a particular purpose. ASDC is not liable for any direct, indirect, special, or consequential losses or damages of any kind, or loss of profit, loss or corruption of data, business interruption, or indirect costs, arising out of or in connection with the use of this publication or the information contained in it, whether such loss or damage arises in contract, negligence, tort, under statute, or otherwise References Behroozian T, Goldshtein D, Ryan Wolf J, van den Hurk C, Finkelstein S, Lam H, Patel P, Kanee L, Lee SF, Chan AW, Wong HCY, Caini S, Mahal S, Kennedy S, Chow E, Bonomo P; Multinational Association of Supportive Care in Cancer (MASCC) Oncodermatology Study Group Radiation Dermatitis Guidelines Working Group. MASCC clinical practice guidelines for the prevention and management of acute radiation dermatitis: part 1) systematic review. EClinicalMedicine. 2023 Mar 27;58:101886. doi: 10.1016/j.eclinm.2023.101886. PMID: 37181415; PMCID: PMC10166790. Behroozian T, Bonomo P, Patel P, Kanee L, Finkelstein S, van den Hurk C, Chow E, Wolf JR; Multinational Association of Supportive Care in Cancer (MASCC) Oncodermatology Study Group Radiation Dermatitis Guidelines Working Group. Multinational Association of Supportive Care in Cancer (MASCC) clinical practice guidelines for the prevention and management of acute radiation dermatitis: international Delphi consensus-based recommendations. Lancet Oncol. 2023 Apr;24(4):e172-e185. doi: 10.1016/S1470-2045(23)00067-0. PMID: 36990615. Jinlong Wei, Lingbin Meng, Xue Hou, Chao Qu, Bin Wang, Ying Xin & Xin Jiang (2019) Radiation-induced skin reactions: mechanism and treatment, Cancer Management and Research, 11:, 167-177, DOI: 10.2147/CMAR.S188655 Sherman DW, Walsh SM. Promoting Comfort: A Clinician Guide and Evidence-Based Skin Care Plan in the Prevention and Management of Radiation Dermatitis for Patients with Breast Cancer. Healthcare (Basel). 2022 Aug 9;10(8):1496. doi: 10.3390/healthcare10081496. PMID: 36011153; PMCID: PMC9408725. Ren Y, Kebede MA, Ogunleye AA, Emerson MA, Evenson KR, Carey LA, Hayes SC, Troester MA. Burden of lymphedema in long-term breast cancer survivors by race and age. Cancer. 2022 Dec 1;128(23):4119-4128. doi: 10.1002/cncr.34489. Epub 2022 Oct 12. PMID: 36223240; PMCID: PMC9879608. Robijns J, Lodewijckx J, Claes M, Lenaerts M, Van Bever L, Claes S, Pannekoeke L, Verboven K, Noé L, Maes A, Bulens P, Mebis J. A long-term follow-up of early breast cancer patients treated with photobiomodulation during conventional fractionation radiotherapy in the prevention of acute radiation dermatitis. Lasers Surg Med. 2022 Dec;54(10):1261-1268. doi: 10.1002/lsm.23608. Epub 2022 Oct 2. PMID: 36183377.

  • Breast Cancer and Skin Health: Dermal Clinicians’ Perspectives

    Talking about breast cancer can be a tough topic. All genders can experience breast cancer. It is the most common cancer in women in Australia, with 1 in 7 women diagnosed in their lifetime. While not as common, men also experience breast cancer with 1 in 500 men receiving a diagnosis in their lifetime (National Breast Cancer Foundation,2023). This means that many of us will have been touched by breast cancer in knowing someone who has received a diagnosis or having one ourselves. A diagnosis of breast cancer and then the journey of treatment can be overwhelming. Breast Cancer Awareness Month works to raise awareness and funds for research as well as support networks and organisations that can help family, friends, and health professionals to support their loved ones or clients on their individual journeys. The overall 5-year survival rate according to Australian statistics for those that have breast cancer is now reported to be 92% and 86% for the 10-year survival rate. Early detection and diagnosis can make a significant impact with a 100% 5-year survival rate for those diagnosed with early stage 1 breast cancer (National Breast Cancer Foundation, 2023). The increase in survivorship and life after a cancer diagnosis and treatment also brings new challenges. To get a better insight into how dermal health professionals can support those with breast cancer we meet two dermal clinicians who tell their stories. Dora and Diane provide inspiration for how you can use your knowledge and skills or gain further education and expertise to support those with breast cancer and make a difference in the breast cancer survivorship journey. Dora’s Story: My personal journey with breast cancer and beyond. Breast cancer awareness month strikes a personal chord with me as not only did l witness my mum navigate her experience of breast cancer 10 years ago, but l too, had my own journey when l was diagnosed with DCIS (ductal carcinoma in situ) 6 years ago. I have a strong family history of breast cancer so perhaps it wasn’t entirely surprising that my genes caught up with me but nevertheless, it was still a shock. It provided me with a sense of awareness of what many women and men potentially experience emotionally and physically upon a diagnosis of breast cancer. Mum and l were fortunate that we were diagnosed early but we both had a lumpectomy and had to undergo radiotherapy treatments. Prior to commencing a course of radiotherapy treatments, time is spent with a radiation nurse who discusses the treatment, the potential side effects and the management of these side effects including the skin changes that one can experience. As a Dermal Clinician, l was at an advantage in understanding skin but did my due diligence and researched in depth exactly what happens to the skin during and after a course of treatments to gain a greater understanding of the grading of radiation-induced skin reactions. Evidence suggests that skin reactions from radiotherapy treatments cannot be avoided, hence management of these skin reactions is vital. My journey as a Dermal Clinician during my time as a patient of breast cancer as well as for my mum was mainly focused on the management of skin changes. However, due to the complexities of breast cancer journeys that can be different from patient to patient, treatment interventions can vary considerably during or after. Diane’s Story – Providing support and closure to those with breast cancer. Breast cancer awareness month reminds me how incredibly strong these women are and what they have survived! Since 2016 I have been honoured to help these women through their breast cancer journey providing them with some closure. Offering areola and nipple tattooing to help them when they look in the mirror gives them some comfort by not constantly reminding them what they have gone through. I get tears after it’s completed, I receive gratitude and incredible messages of thanks. Some say they have only booked their tattoo because their surgeon suggested it, but after they get it done, they cry not realizing the impact it has had on them and the difference it makes. When I started my career in this field, I was fortunate to work with one of Victoria’s top surgeons specialising in breast reconstruction surgery in both public hospitals and privately. He supported creating a position at Western Health [in Melbourne] for reconstructive tattooing. This involved collaboration with the Breast Cancer Foundation which assists breast cancer patients financially to have their tattoos done. From there one of my colleagues, a theatre nurse, linked me with another surgeon who is a leading expert in Australia providing surgery for lymphoedema and lipoedema patients. (image permission provided restore_cosmetic_tattooing) What skills do dermal clinicians have that can support skin health during breast cancer treatment? According to Diane, Dermal Clinicians have a lot to offer to those diagnosed and undergoing treatment for breast cancer. She says that skin care advice and management in particular is a big one! Their skin changes so much. Whether this is from radiation and/orchemotherapy they can experience major skin changes, including pigment changes, loss of moisture, dryness, and skin texture changes. Dora provides further insight that if the management of radiation-induced skin changes is what a Dermal Clinician would like to be involved in they need to consider interprofessional collaboration. We would need to work alongside the patient’s medical team including their radiation nurse in supporting them in working towards the goals of care in skin care. These can include, maintaining the integrity of the skin, minimising treatment-induced symptoms, supporting patients with self-care interventions such as maintaining cleanliness, providing correct management for patients to prevent further trauma, pain, and possible infection as well as promoting a moist wound healing environment. Diane explains that the knowledge and skills of dermal clinicians can also be of benefit after surgery particularly as they can be left with significant scars. We offer scar management which can be as simple as recommending silicone gel or dressings after surgery or to help improve their scar. Furthermore, laser therapy may be used to improve the appearance of their scars. Lymphoedema is something that 20% or 1 in 5 people with breast cancer can experience after surgery as well as during or after radiation therapy (Australian Government, Cancer Australia, 2023). Diane explains: Educating these patients early on is key to help them with early detection and knowing the signs to look for as well as small techniques to help them. We can teach them self-manual lymphatic drainage, discuss the use of garments and compression, and what signs to look for indicating changes in the skin. We can also offer these patients manual lymphatic drainage professionally in the clinic, LED treatments and low-level laser therapy may be helpful. In Diane’s experience, she says, that when they [patients] see differences it can also have a snowball effect motivating them to recommend our services to others experiencing this journey as well. If Dermal health professionals want to work in this area what further education and training or personal attributes do, they need to consider? Dora provides this important advice: Regardless of whatever one chooses; the greatest consideration is that our approach must always be evidence-based and therefore ongoing education and training is vital. Diane expands on this to reiterate that if they want to work specifically with breast cancer patients they should get more training in lymphoedema assessment and treatment. To do this they should also consider undertaking an accreditation qualification course, recognised by the Australasian Lymphology Association (ALA). Besides the practical skills, Diane says dermal clinicians need to have a high level of emotional intelligence and empathy. We need to consider the emotions of these patients. These patients are going through a stressful time of survival, and we need to be aware of this and be very supportive. How we communicate is vital. Some [patients] have gone through multiple surgeries; their bodies have changed significantly, and it’s a major impact on their life. Diane also provides advice regarding the importance of making connections and networking. Diane recommends signing up with companies like garment and compression companies that send newsletters as they can also provide webinars and workshops to attend. Networking in our industry is so important. Attending any related conferences is such an important way for us to be recognised, and meet other professionals who work with cancer patients, for example, nurses and physiotherapists. You can get an insight of what others experience and bounce ideas amongst each other as well as learning through their experiences and troubleshooting. I also highly recommend volunteering at a plastic surgery clinic that specialize in breast cancer, that’s how I started my career in this field and they may even link with us to assist with job opportunities in the future We thank Dora and Diane for sharing their valuable insights and pearls of wisdom on this topic with all dermal health professionals. Continue to follow the Australian Society of Dermal Clinicians this month as we focus on updates in best practices, skin health advice, and management for those with breast cancer. Contributors Dora - Dermal Clinician Diane Camilleri - Dermal Clinician and owner of Restore Cosmetic Tattooing Disclaimer The information in this document is of a general nature only and is not, and is not intended to be advice. Before making any decision or taking any action, you should consult with appropriate accounting, tax, legal or other advisors. No warranty is given as to the correctness of the information contained in this publication, or of its suitability for use by you. To the fullest extent permitted by law, the Australian Society of Dermal Clinicians Inc. (ASDC) is not liable for any statement or opinion, or for any error or omission contained in this publication and disclaims all warranties with regard to the information contained in it, including, without limitation, all implied warranties of merchantability and fitness for a particular purpose. ASDC is not liable for any direct, indirect, special or consequential losses or damages of any kind, or loss of profit, loss or corruption of data, business interruption or indirect costs, arising out of or in connection with the use of this publication or the information contained in it, whether such loss or damage arises in contract, negligence, tort, under statute, or otherwise

  • SKINCON23 - Is going to the be the place to be for all things skin this August.

    We are excited to announce more about our lineup of speakers for three days that will invigorate your love of skin health and its possibilities, as well as inspire you to innovate for the future and all its opportunities. SKINCON23 is unlike any of our previous conferences, with a combination of live scientific presentations, on-demand content, and interactive demonstration workshops with our industry partners and experts. You will be inspired and informed by experts in their fields of dermal practice, dermatology and cosmetic nursing, dermatology, plastics, lymphoedema, lipoedema, melanography, skin cancer medicine health policy, clinical photography, and governance. Some of the most interesting conversations happen during breaks in the exhibitor area with time to catch up, meet and greet old and new colleagues, friends, and industry representatives to discuss challenges and ideas. We also have our complimentary welcome and social events on Saturday and Sunday evenings, which is a wonderful way to wind down after a day of learning. DATE 5-7 August 2023 LOCATION Rydges Hotel - 186 Exhibition Street Melbourne GET YOUR TICKET CONTENT PILLARS MASTER OF CEREMONIES Danielle is a member of the ASDC professional community and a lover of gaining and sharing knowledge. We look forward to the energy she will bring to the event. You will all know Danielle Hughes as a highly experienced professional in the aesthetics industry with over 17 years of expertise. Through the Behind the Scenes X education platform, Danielle has delivered over 100 hours of credibly researched aesthetics education, enabling professionals to access a wealth of knowledge and resources that relate to the industry. Her dedication to empowering fellow aesthetic professionals and sharing her knowledge has made her a respected figure in the industry, a sought-after keynote speaker, and a trusted industry partner. Danielle's qualifications include a Diploma in Beauty Therapy, a Bachelor of Health Science (Aesthetics), and an Executive Master of Business Administration, credentials that reflect her commitment to staying at the forefront of the rapidly evolving field of the aesthetics business and her passion for continuous learning and professional development. MEET SOME OF OUR SPEAKERS Keep an eye on our social media and the event website for updates and more information as it becomes available on our live and on-demand presenters and panelists. PROVISIONAL AGENDA Topics will stimulate discussion with presentations on new technologies, techniques, case management in various clinical settings, controversies, and best practices as well as what is on the horizon for the dynamic and growing sector of skin health and management. WORKSHOP SPONSORS Keep an eye on our social media and the event website for updates and more information as it becomes available. Attendees will have the opportunity to maintain clinical currency with updates on techniques, technologies, best practices, and new skills to expand their scope of practice. Exhibitors We thank our industry partners, workshop sponsors, and exhibitors for the support of the Australian Society of Dermal Clinicians and this event. Early Bird Ends June 30 We can't wait to see you there! SKINCON is a prime opportunity to invest in yourself now and into the future through making valuable connections and continuing education The ASDC Education Team

  • Do you want to study a professional certificate fully funded?

    Scholarship Opportunity with HealthCert Education We thank HealthCert Education who are offering a fully funded scholarship valued at $1995 to one of our ASDC members. The person awarded this scholarship can choose to study the professional certificate of general dermatology or the professional certificate in dermoscopy. Announcement of Scholarship Winner The scholarship will be awarded to the successful applicant on July 6th at 5 pm at the networking event during the SKINCON23 program. Eligibility Criteria Must be a member of the ASDC Must have a recognised Bachelor's Qualification (pre-requisite entry requirement) Must submit a 750 word statement as to how and why this opportunity for professional development will improve the accessibility of care as well as contribute to improved skin health outcomes in your practice and for your patients. The scholarship winner must contribute a 1500-word article for the ASDC for their editorial at the completion of their studies on the topic of study and interest. Evaluation Requirements Evaluation of submissions will be conducted by the Education Board and approved by the Executive Board based on the following criteria: 1. Validation of ASDC Membership status 2. Strategies and justification for improving accessibility of care 3. Strategies and justification for how this opportunity will improve future personal and professional growth 4. Strategies and justification for how this opportunity can be used to further the profession by the applicant. Submission and Due Date Expressions of interest statements must be submitted by the 21st of July at 5 pm to info@dermalclinicans.com.au with the subject heading HealthCert Scholarship Application. We look forward to seeing you at SKINCON for the announcement on behalf of the ASDC Education Team

  • March is Melanoma Awareness Month

    Two out of three Australians will be diagnosed with skin cancer in their lifetime, with approximately 16,000 individuals diagnosed with Melanoma each year. In this post, we will brush up on how as skin health professionals we assist to educate about the dangers of cumulative UV sun damage and the role we can potentially play in the early detection of skin problems. What is skin cancer? According to statistics, Australia has one of the highest rates of skin cancer in the world. With one in three people living with skin cancer, this is the most common cancer affecting Australians. The size of the issue to the health care system is considerable with over 700 million dollars in health care funding associated with hospitalisations due to non-melanoma skin cancer and according to medicare records more than 100 million treatments or about 100 per hour (Sunsmart Australia, 2022). Melanoma is the third most common skin cancer with 16,000 individuals diagnosed each year, it is the most common cancer affecting young people from 20-39 years of age. Skin cancer is defined as the uncontrolled growth of abnormal cells in the skin. The most common cause for the development of skin cancer is prolonged UV exposure and damage to the skin cells. Skin cancer becomes more common as we age due to the decline in the capacity of our bodies to repair that cellular damage as well as for our immune system to identify abnormal cells. There are three main types of skin cancer. These are Melanoma and the two non-melanoma skin cancers (NMSC's), basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). This post will focus on presenting a brief overview of skin cancers with information on how to identify who is at risk, what to do if you identify something that is atypical in your clients and how you can engage in further education. Basal Cell Carcinoma (BCC) BCC's are the most common form of skin cancer and present most commonly on the upper body and face. They are slow growing and because of this are associated with being less 'dangerous' or having the lowest mortality rates. These are usually associated with presenting as red, pale or pearly coloured lesions or lumps and may also appear dry and scaly. They can become ulcerative or look like a sore that does not heal or heals and breaks down again. Dermatoscopy can be used by those trained in this technique to view lesions that may assist to identify features of pigmented and non-pigmented lesions. For more information, you may want to read an overview of dermoscopy of BCC's Dermoscopy of basal cell carcinoma - DermNetnz.org Images courtesy of DermNetnz.org Squamous Cell Carcinoma (SCC) SCC's are also most associated with areas of the body with prolonged UV exposure. They grow over a period of months and if untreated can metastasise to other areas of the body. These skin cancers tend to be red, scaly, crusty, and thickened lesions that may bleed quite easily. SCC's can also be associated with or develop from actinic keratoses. Overview of dermoscopy of SCC's - DermNetnz.org Images courtesy of DermNetnz.org Melanoma This form of skin cancer is the most life-threatening. While it can occur on non-sun-exposed areas of the body, 95% of melanomas are associated with UV overexposure. If melanomas are detected early, many of these can be cured through surgery, however, if left undetected they can metastasise quite quickly to other areas of the body. Pigmented lesions are monitored for skin changes using the ABCDE rule as a guide for a skin examination. It is important to be aware that melanoma can be non-pigmented and also nodular and doesn't always follow the ABCDE rules. So for skin changes, anything that is changing quickly hasn't healed in 4-6 weeks or causes concern should be checked. Images courtesy of DermNetnz.org Role of skin checks in skin surveillance for skin changes? Population-based screening for skin cancer is not currently recommended due to a lack of evidence to support that implementation of this would reduce mortality or morbidity. A recent research review provides an overview of how early detection of skin cancer is approached in Australia currently as well as opportunities for the future particularly as technologies emerge and consumers are more aware of the risks of skin cancer. Due to the prevalence of skin cancer, it is recommended that we should all know how to monitor our own skin for changes and seek skin checks if there are concerns. This is termed opportunistic skin screening. There are also recommendations based on risk factors for skin cancer development on when we should start checking our skin, how often, and who can support us with skin checks. Risk for skin cancer development The Royal College of General Practitioners has published a stratified risk rating and protocol for skin checks in primary practice. This is a tool that can be used by skin health professionals to support educating clients as well as when making decisions regarding performing procedures that involve possible removal of markers for skin cancer monitoring. Sinclair. R. (2012) Skin Checks. Australian Family Physician. 41(7) 464-469 Arasu.A., Meah. N., & Sinclair. R. (2019). Skin checks in primary care. The Australian Journal of General Practice. 48(9), 614-619 Who can perform skin checks? Sun Smart Australia has an information sheet that is used to guide the public with advice on who can perform skin checks and questions to ask. As a skin health professional, you may also receive questions or want to know who can assist with skin checks. Dermoscopists - These are often nurses or dermal clinicians with post-graduate qualifications in the field of dermoscopy. They assist with education about skin cancer risk, performing full-body skin checks, and digital imaging of lesions for surveillance purposes. They will provide a report and referral if any lesions require medical review or follow-up. Skin Cancer GPs - Many general practitioners perform opportunistic skin cancer screenings as part of their routine practice. There are also general practitioners who have undertaken significant further education in the assessment, diagnosis and management of skin cancer. The Skin Cancer College of Australasia accredits skin cancer doctors and also provides a locator service to assist with finding an accredited skin cancer GP. Dermatologists - A dermatologist is a medical professional who has undertaken an extra four years of specialist training in the assessment, diagnosis and management of up to 3000 disorders and diseases that affect the skin, hair, and nails. Usually, you will require a referral to see a dermatologist and they work with other medical specialties such as plastic surgeons, cancer surgeons and radiation specialists when required. You can read more about when to see a health professional with advice from the Australasian College of Dermatologists HERE. As skin health professionals what role do we play? As skin health professionals that often see our clients regularly and over long periods of time we have a role to play in skin screening and observing for skin changes. Through being well educated in skin cancer risk, detecting skin cancer, and understanding the medical pathways for diagnosis and treatment we can assist with early detection of skin cancer. This may assist to reduce mortality as well as morbidity such as more significant scarring that can result from delayed diagnosis requiring more extensive surgical removal. Where can you get more education? There are a few ways to increase your knowledge and skill set in monitoring for skin cancer depending on your current qualifications and clinical setting. The Skin Cancer College of Australasia recently developed introductory training modules for anyone that works with or sees skin regularly including beauty therapists and hairdressers. As well as for medical professionals, nurses, and allied health professionals including dermal clinicians that are new to the field of skin cancer. From there depending on your background you may be able to complete further advanced training. This applies to allied health professionals including dermal clinicians, nurses, and medical professionals. There are also other training organisations such as HealthCert that provide professional education and certification in dermoscopy for dermal clinicians and dermal therapists. As ASDC members you are also eligible for discounts when undertaking these programs. More information is in your member portal. Education about reducing UV exposure Skin health professionals play an important role in educating and supporting behaviour changes to reduce the risk of skin cancer development. How to perform self-skin examinations The infographic below was developed by students and staff of Victoria University and shared with the Australian Society of Dermal Clinicians to assist skin health professionals with educating clients or assisting them with performing skin checks. Caution regarding treatments that may alter or remove markers for skin cancer diagnosis There has been concern raised by medical professionals about treatments that are performed for cosmetic purposes by skin health professionals that can remove or alter markers that may be used to monitor the skin for changes or skin cancer development. It is advised that all skin health professionals that perform these types of treatments seek further education and knowledge in order to undertake risk assessment about the patient's risk for skin cancer development in the future or underlying yet undiagnosed skin cancers and their suitability for treatment. It is important to be confident in educating clients about any risks as well as appropriate referral pathways when required. The ASDC recommends using the skin cancer development risk matrix for decision-making regarding the suitability of clients for services. As well as implementing clinic policy or recommendations to provide evidence of a medical skin cancer screening before any further treatment as well as referral pathways for clients with increased or high-risk factors. Guidelines to inform practice For more information on current best practice recommendations and guidelines for melanoma and non-melanoma skin cancer diagnosis and management, there are many resources on the Cancer Council and Sun Smart websites. Skin Cancer Guidelines - Cancer Council Health Professionals Sun Smart Australia References Cancer Council. Skin cancer incidence and mortality [Version URL: https://wiki.cancer.org.au/skincancerstats_mw/index.php?title=Skin_cancer_incidence_and_mortality&oldid=802, cited 2023 Mar 4]. Available from: https://wiki.cancer.org.au/skincancerstats/Skin_cancer_incidence_and_mortality. In: Cancer Council Australia. Skin Cancer Statistics and Issues. Sydney: Cancer Council Australia. Available from: http://wiki.cancer.org.au/skincancerstats/ Cancer Council. Skin cancer types [Version URL: https://wiki.cancer.org.au/skincancerstats_mw/index.php?title=Skin_cancer_types&oldid=806, cited 2023 Mar 4]. Available from: https://wiki.cancer.org.au/skincancerstats/Skin_cancer_types. In: Cancer Council Australia. Skin Cancer Statistics and Issues. Sydney: Cancer Council Australia. Available from: http://wiki.cancer.org.au/skincancerstats/ Disclaimer The information in this document is of a general nature only and is not, and is not intended to be advice. Before making any decision or taking any action, you should consult with appropriate accounting, tax, legal or other advisors. No warranty is given as to the correctness of the information contained in this publication, or of its suitability for use by you. To the fullest extent permitted by law, the Australian Society of Dermal Clinicians Inc. (ASDC) is not liable for any statement or opinion, or for any error or omission contained in this publication and disclaims all warranties with regard to the information contained in it, including, without limitation, all implied warranties of merchantability and fitness for a particular purpose. ASDC is not liable for any direct, indirect, special or consequential losses or damages of any kind, or loss of profit, loss or corruption of data, business interruption or indirect costs, arising out of or in connection with the use of this publication or the information contained in it, whether such loss or damage arises in contract, negligence, tort, under statute, or otherwise

  • SKINCON23 - Horizons Early Bird Available Now!

    Put August 5-7 in your diaries now. Stay up to date with SKINCON updates by following our Instagram and Facebook pages. SKINCON is the largest educational event for the Australian Society of Dermal Clinicians. This year's conference will be something special as we've taken feedback from our previous events so that there is something for everyone. We look forward to welcoming Dermal Clinicians, Dermal Therapists, Dermatology, Cosmetic Nurses, Beauty Therapists, and Allied and Medical Professionals with a special interest in skin health and management. Over the three days will have multiple networking opportunities including starting each day with a networking breakfast and speaker, before going on to keynote presentations and panels in the morning session. After lunch, we will have interactive workshops where you can learn about a variety of techniques, technologies, or products to update your clinical practice. The event will host two networking evenings which is a great opportunity to catch up with colleagues old and new. The event coincides with our AGM which is not to be missed as there are many updates from the ASDC board for our members and the sector more broadly related to our work toward self-regulation as well as other important projects designed to elevate the dermal profession. Find out more and view the provisional agenda click on the button below. Come back regularly for updates on speakers, sponsors and workshops. Get your early bird conference pass now! Early bird passes are available from Feb 28 until May 31, further member discounts apply. As a member ensure to sign into the website to activate your discount at checkout. Professional development and education may be a tax deduction and the ASDC offers options to spread repayments using our PayPal checkout options. **Terms and Conditions Apply We look forward to seeing you virtually or in person in Melbourne. The Australian Society of Dermal Clinicians Events Management Team

  • Self Representation & Advertising Tips: Code of Ethical Practice

    The Australian Society of Dermal Clinicians recently published the code of ethical practice and standards of practice for dermal clinicians and therapists. These are valuable resources for anyone providing skin health services, including dermal clinicians, dermal therapists, skin therapists, students, supervisors, educators and policymakers, and those that employ or work with dermal health professionals. One of the most common queries, concerns, or even complaints raised with the ASDC is advertising within the dermal sector. These guidance documents have been developed to clarify some of the areas you may have been struggling to navigate. This post provides some of the more common questions or concerns that can be raised and how this aligns with the ASDC guidance documents and other legislation. This information is not exhaustive and doesn't replace reading the entire document yourself. Always seek further clarification if you have further questions and investigate your own individual situation, as circumstances may vary. Generally speaking, these are some of the do's and don'ts in promoting yourself using best practices regarding ethical advertising for dermal health professionals. You should refer to these guidance documents if you are updating your bio on your website or documentation. Tips for promoting yourself in advertising. It is good practice to have your qualifications and affiliations, such as memberships, on display in the physical premises where therapy is provided and listed accurately on any promotional materials, including websites or social media. Find out from your institution the accepted abbreviation or use the full name of your qualifications. This ensures that your qualification is easily recognised and understood. Use your endorsed professional title according to your qualifications, accreditation, or professional membership categories. Not sure? Contact the professional body with oversight or governance of these. Make sure any logos you use in your bio information to demonstrate your affiliations are used within the logo's terms of use or license. For example, only current financial members can use the ASDC logo as evidence of their membership. Not reviewing your advertising may get you in hot water if any of these are used incorrectly. You should avoid language that implies that you are more qualified or 'specialised' compared to others with the same qualifications in your field. For example, instead, factually state your number of years of experience, the areas you have worked in and/or the conditions you commonly work with, etc. Why is clear, factually accurate information important? Like many self-regulated allied health professions, the professional titles dermal clinician and dermal therapist are not regulated or reportable under any legislation currently. Reports are often made to professional bodies to investigate. This usually results in an educative response from the professional body. Having said that, using a title that is recognised in the industry sector as attached to certain qualifications if you don't have those qualifications can be confusing for the public and for other professionals working with dermal health professionals. Using these titles consistently protects and elevates all dermal health professionals as each are recognised and industry protected for the expertise they have and the roles they play in patient care until more formal regulation exists. Some titles are regulated. For example, using the word 'specialist' is regulated for medical health professionals. Using these titles can be misleading and confusing for the public as they attach those names to other professions. For example, a "dermal specialist" may mislead the public into believing you have medical qualifications and should be avoided. Some aspects of your biography can be reported under Health Complaints ACTS in many states around Australia, particularly concerning misrepresentation clauses. There is a national code of conduct for unregistered health professionals. The name of this legislated code of conduct varies slightly in each state. In most states, this legislation sits with the health ombudsman or the health complaints commissioner to investigate or enforce when required. You can be reported if a person finds information about you may be fraudulent or misleading others about your qualifications. An example of where this may be a problem is when you state you have a qualification you don't actually have or didn't finish. If you are still studying, it is best practice to state this and use the title student dermal clinician or student dermal therapist for clarity. **This information is not exhaustive and should not replace reading the codes of conduct in your state and the codes of ethical practice for dermal clinicians and therapists for yourself as well as the national legislation. For more information regarding the Nationally legislated codes of behaviour for non-registered health professionals, you can find links to these in the members portal and within the Codes of Ethical Behaviours for Dermal Clinicians and Dermal Therapists document. Click on the link below to download the guidance document.

  • Exploring the Role of the Gut Microbiome in Skin Health (Part Two)

    Written by Kiera Nikolakakis Interprofessional Practice & Providing a Holistic Approach A skin condition is usually just the surface/visible evidence of an internal health issue. With inflammatory skin conditions like atopic dermatitis and acne vulgaris, which are commonly seen within our scope of practice, we are able to create patient care plans to help manage the condition. However, more and more research suggests that where skin inflammation has risen there is potentially also gut inflammation. This could be due to an imbalance between the good and bad bacteria in the gut and can either be a mixture of a normal amount of good bacteria, but an over abundance of harmful bacteria, or not enough good bacteria and a normal to high amount of harmful bacteria. The following is an analogy we can use to make it easier to help our patients understand that it is more than just what is showing on the surface of their skin: “When it comes to gut dysbiosis and inflammatory skin conditions, think about how bees make honey. The gut is like the bee. The bee needs the right nutrients from the pollen in order to make honey. Similarly, the gut needs to have a nutrient and bacterial balance for the skin to perform its functions properly.” It is always important to remember that this research is in its infantile stages, and the exact mechanisms of the gut microbiota's influence on various inflammatory skin conditions are yet to be entirely and comprehensively understood. Looking after the gut can assist our patients in achieving the most desirable results from our clinical treatments and prescribed home care routine. Dermal Clinicians are highly trained and experienced in treating the external manifestation of inflammatory skin conditions, however, it is vital that we educate our clients on internal health, including root-causes of a condition and the benefits of practising a holistic approach when treating the skin. We want our patients to understand how lifestyle factors and diet have the potential to both negatively and positively impact skin health and conditions. It is therefore important that we are able to educate our patients on why we are recommending they see other healthcare professionals, and how this will assist in further determining and fixing the root cause of their skin conditions. Implementing inter-professional collaboration and respecting other healthcare providers’ perspectives in healthcare can help improve the patient's outcome. The treatment of inflammatory skin conditions is complex due to its multifaceted nature. Dermal Clinicians can go as far as educating patients on how the diet can impact the skin, and what the gut-skin axis is. We can provide our patients with information on how the results of our clinical treatments and home care regimes can be enhanced by treating the underlying causes of a condition by referring to additional yet complementary healthcare professionals in which the gastrointestinal tract and dietary nutrition are within the scope of practice. This includes such healthcare professionals like a: ● Gastroenterologist ● Dietician ● Nutritionist ● Naturopath Generalised and Common Suggestions for Balancing the Gut Microbiome It is now understood that there are some lifestyle and nutritional factors which ultimately affect the gut microbiome. The following are some generalised and common themes that have arisen from these published studies: Sleep Recent studies have actually shown that poor sleep quality or fragmented sleep correlates with poor microbiome diversity. In contrast, good sleep patterns are positively associated with a healthy, diverse gut microbiome. Antibiotics Inappropriate or overuse of antibiotics can significantly affect the gut microbiome, causing changes in the gut microbiota composition and leading to gut dysbiosis. This can be by causing an overgrowth of harmful bacteria or can lead to antibiotic-resistant bacteria and therefore the spread of these bad bacteria. Diet Put extremely simply, there are foods that support a healthy gut microbiome and foods that can lead to (or contribute to) gut dysbiosis when consumed in mass abundance. An example of food ingredients that support a healthy gut microbiome is prebiotics & probiotics. I’m sure we have all heard of prebiotics and probiotics by now – but what do they actually do? Prebiotic-rich ingredients include (but are not limited to) legumes, whole grains, garlic and onion, which ultimately serve as food for probiotics. Probiotics naturally contain good bacteria, in which they possess multiple ways of keeping the body healthy, like aiding in removal of excessive bad bacteria to aid in balancing and re-establishing the gut microbiome colonisation. On the other hand, a diet rich in refined carbohydrates has been shown to have an effect on the gut microbiome, being a contributing factor in gut dysbiosis. This includes foods and ingredients such as white bread, sugar, white pasta, and white rice. The above are just a few of the many complex factors involved in gut dysbiosis. These are just some examples to help our clients understand and make their own connections to what might be causing their skin inflammation whilst seeking the appropriate advice and care. Reviewed by the Education Sub-Committee of the Australian Society of Dermal Clinicians. References (for both part one & part two): Barko, P. C., McMichael, M. A., Swanson, K. S., & Williams, D. A. (2018). The gastrointestinal microbiome: A review. Journal of Veterinary Interna Medicine, 32(1), 9-25. https://doi.org/10.1111/jvim.14875 De Pessemier, B., Grine, L., Debaere, M., Maes, A., Paetzold, B., & Callewaert, C. (2021). Gut-skin axis: Current knowledge of the interrelationship between microbial dysbiosis and skin conditions. Microorganisms, 9(2), 353. https://doi.org/10.3390/microorganisms9020353 Duan, H., Yu, L., Tian, F., Zhai, Q., Fan, L., & Chen, W. (2020). Antibiotic-induced gut dysbiosis and barrier disruption and the potential protective strategies. Critical Reviews in Food Science and Nutrition, 62(6), 1427-1452. https://doi.org/10.1080/10408398.2020.1843396 Ellis, S. R., Nguyen, M., Vaughn, A. R., Notay, M., Burney, W. A., Sandhu, S., & Sivamani, R. K. (2019). The skin and gut microbiome and its role in common dermatologic conditions. Microorganisms, 7(11), 550. https://doi.org/10.3390/microorganisms7110550 Faits, T., Walker, M. E., Rodriguez-Moraro, J., Meng, H., Gervis, J. E., Galluccio, J. M., Lichtenstein, A. H., Johnson, W. E., & Matthan, N. R. (2020). Exploring changes in the human gut microbiota and microbial-derived metabolites in response to diets enriched in simple, refined, or unrefined carbohydrate-containing foods: a post hoc analysis of a randomized clinical trial. American Journal of Clinical Nutrition, 112(6), 1631-1641. https://doi.org/10.1093/ajcn/nqaa254 Lee, S-Y., Lee, E., Park, Y. M., & Hong, S-J. (2018). Microbiome in the gut-skin axis in atopic dermatitis. Allergy, Asthma and Immunology Research, 10(4), 354-362. https://doi.org/10.4168/aair.2018.10.4.354 Olvera-Rosales, L-B., Cruz-Guerrero, A-E., Ramirez-Moreno, E., Quintero-Lira, A., Contreras-Lira, A., Contreras-Lopez, E., Jaimez-Ordaz, J., Castaneda-Ordaz, J., Castaneda-Ovando, A., Anorve-Morga, J., Calderon-Ramos, Z-G., Arias-Rico, J., & Gonzales-Olivares, L-G. (2021). Impact of the gut microbiota balance on the health- disease relationship: The importance of consuming probiotics and prebiotics. Foods, 10(6), 1261. https://doi.org/10.3390/foods10061261 Salem, I., Ramser, A., Isham, N., & Ghannoum, M. A. (2018). The gut microbiome as a major regulator of the gut-skin axis. Frontiers in Microbiology, 10(9), 1459. https://doi.org/10.3389/fmicb.2018.01459 Sanchez-Pellicer, P., Navarro-Moratalla, L., Nunez-Delegido, E., Ruzafa-Coztas, B., Anguera-Santos, J., & Navarro-Lopez, V. (2022). Acne, microbiome, and probiotics: The gut-skin axis. Microorganisms, 10(7), 1303. https://doi.org/10.3390/microorganisms10071303 Seo, Y, S., Lee, H-B., Kim, Y., & Park, H-Y. (2020). Dietary carbohydrate constituents related to gut dysbiosis and health. Microorganisms, 8(3), 427. https://doi.org/10.3390/microorganisms8030427 Sinha, S., Lin, G., & Ferenczi, K. (2021). The skin microbiome and the gut-skin axis. Clinics in Dermatology, 39(5), 829-839. https://doi.org/10.1016/j.clindermatol.2021.08.021 Smith, R. P., Easson, C., Lyle, S. M., Kapoor, R., Donnelly, C. P., Davidson, E. J., Parikh, E., Lopez, J. V., & Tartar, J. L. (2019). Gut microbiome diversity if associated with sleep physiology in humans. PLoS ONE, 14(10), e0222394. https://doi.org/10.1371/journal.pone.0222394 Thursby, E., & Juge, N. (2017). Introduction to the human gut microbiota. Biochemical Journal, 474(11), 1823-1836. https://doi.org/10.1042%2FBCJ20160510 Wilmanski, T., Rappaport, N., Diener, C., Gibbons, S. M., & Price, N. D. (2021). From taxonomy to metabolic output: What factors define gut microbiome health? Gut Microbes, 13(1), Article 1907270. https://doi.org/10.1080/19490976.2021.1907270

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