Approximately 2% of the Irish population are estimated to suffer with hyperhidrosis – the medical term for excessive sweating. Whilst sweating is a natural response to a rise in body temperature or emotional states such as anxiety, hyperhidrosis occurs without obvious causes such as exercise or heat. The condition can affect just one area or the whole body, with symptoms including clammy palms and visible sweat that soaks through clothes.
What are the symptoms of hyperhidrosis?
Rather than affecting the apocrine sweat glands (which create the odour causing sweat you get under the arms), hyperhidrosis affects the eccrine (water-producing) sweat glands and is divided into two types:
1) Primary or localised hyperhidrosis: The most common type of hyperhidrosis (primary) which tends to start in childhood or teenage years and can improve with age. This type affects certain parts of the body only, with the palms, soles of feet, armpits, face and scalp the most likely places to experience excessive sweating. The cause is not completely clear, but hyperhidrosis has been recognised as a feature of some rare inherited conditions, with up to a third of people with hyperhidrosis thought to have a family member with the condition.
2) Secondary or generalised hyperhidrosis affects the whole body and is caused by side effects of a medication or another medical condition, although occasionally, no cause can be found.
How will hyperhidrosis be diagnosed?
As this is a medical condition, you will need to visit your GP if you suspect you have hyperhidrosis. They may suggest you have tests to rule out other possible causes including infection, diabetes or thyroid overactivity before making a diagnosis.
Can hyperhidrosis be cured?
Hyperhidrosis appears to get better with increasing age but in the meantime, there are many treatments that help reduce sweating.
Treatment options
Most people with this condition try antiperspirants as a starting point. Antiperspirants work to reduce sweating, differentiating from deodorants, which minimise odour. If this doesn’t help, ask your doctor for advice. Your GP may then suggest medication to manage your condition including anticholinergic drugs which block the nerves that trigger sweating. There are also surgical options including endoscopic thoracic sympathectomy for cases that do not respond to other forms of treatment.
Sweating can also be blocked by injecting Botulinum toxin (one brand name is “Botox”) into the skin. This is an increasingly popular treatment option and is usually considered to work well, with the effect usually lasting 2-6 months. Check back in with The Mini SKINday Times next week, where we will examine this option more closely.
Self-care
There are several ways you can help manage the condition yourself, including:
Avoiding your triggers: For example, excessive sweating triggers may be brought on by being in hot places or consuming alcohol and spicy foods.
Using adhesive absorbent underarm pads to help prevent sweat from becoming visible on clothing.
Opting for loose-fitting clothes and those made of natural fibres. Select colours wisely - black or white coloured clothes are more likely to minimise signs of sweating.
Avoiding tight-fitting shoes and invest in absorbent insoles.
Using an antiperspirant and washing regularly.
Wearing socks made from natural fibres or made from fabrics incorporating silver (which has been claimed to reduce odours).
Working to minimise anxiety – many people feel embarrassed when experiencing symptoms but as anxiety can worsen sweating, worrying about sweating can make the problem worse.
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What is eczema?
‘Eczema is a common chronic inflammatory skin condition that causes red, itchy, and inflamed skin,’ explains Nicola. ‘Eczema is often linked to allergies and affects approximately 20% of Irish children and up to 10% of Irish adults.’ Eczema comes from the Greek meaning 'to boil,' and it's used to describe itchy, red, and inflamed skin. The word is often used interchangeably with Atopic Dermatitis, where ‘atopic’ refers to an allergy or hypersensitive reaction and ‘dermatitis’ means inflammation of the skin. Eczema and dermatitis are umbrella terms used to describe a number of conditions that cause the skin to become inflamed or irritated.
Causes
Genetics: Some inflammatory skin conditions, such as eczema have a genetic component, which means that people with a family history of these conditions are more likely to develop them.
Age: Eczema is most common in children affecting 1 in 5 Irish children.
Immune system dysfunction: Many inflammatory skin conditions are caused by an overactive immune system, which can be triggered by various factors.
Environmental factors: Exposure to certain environmental triggers, such as allergens or irritants, can increase the risk of developing an inflammatory skin condition.
Lifestyle factors: Stress can trigger or exacerbate eczema. Maintaining a healthy lifestyle, including stress management techniques, may help reduce the risk of developing inflammatory skin conditions and also improve the condition.
How to manage eczema
Identify triggers: Identify and avoid triggers that may exacerbate your eczema. Common triggers include certain fabrics, harsh soaps or detergents, extreme temperatures, stress. Eczema can flare up in the wintertime and be extremely uncomfortable and itchy. In the winter, cold air and central heating can work together to dry out the skin, and the skin of those suffering from eczema can struggle to maintain moisture, as their skin barrier is compromised. Warm clothes and scratchy fabrics (like wool) can all do their bit to have the eczema-prone miserable in the winter. Keeping a journal to track your flare-ups and potential triggers can be helpful.
Keep the skin moisturised: Apply a fragrance-free, hypoallergenic moisturizer to the skin several times a day to help keep it hydrated and prevent dryness.
Use gentle skin care products: Use fragrance-free, hypoallergenic skin care products to avoid irritating the skin.
Avoid scratching: It’s crucial to resist the urge to scratch, as it can further irritate the skin and worsen flare-ups.
Take short lukewarm showers/baths rather than long hot ones to prevent further dryness of the skin and keep the bedroom temperature low to prevent scratching during the night.
Follow a healthy lifestyle: Encourage the person to follow a healthy lifestyle, including regular exercise, a balanced diet, and stress management, which can help to reduce inflammation and improve overall health.
Seek medical treatment: If the person's symptoms are severe or do not improve with self-care measures, encourage them to seek medical treatment from a healthcare professional. Treatment may include prescription topical or oral medications, light therapy, or other therapies which work by suppressing the immune system including oral therapies and new biologic therapies.
Maintain a comfortable environment: Keep the temperature and humidity levels in your home stable and comfortable. Use a humidifier during dry seasons to prevent your skin from drying out.
What is the difference between Atopic Eczema and seborrheic eczema?
Atopic dermatitis (AD), also known as atopic eczema, and seborrheic dermatitis (SD), also known as seborrheic eczema, are two distinct types of dermatitis with different causes, symptoms, and treatments.
Atopic dermatitis is a chronic inflammatory skin condition that often runs in families with a history of allergies or asthma. It typically appears as dry, itchy patches of skin that can become red, swollen, and cracked. It is usually diagnosed based on a patient's medical history, physical examination, and symptoms.
Seborrheic dermatitis, on the other hand, is a common skin condition that affects the scalp, face, and other oily areas of the body (central chest/upper back). It is caused by an overgrowth of yeast on the skin (malasezzia furfur) and is often associated with oily skin, stress, and hormonal changes. Symptoms include red, scaly patches of skin that may be itchy. Diagnosis is usually based on a patient's medical history and physical examination, as the symptoms are often distinctive and can be recognized by your doctor. The scale can sometimes be more yellow and have a greasy feel to it.
If you suspect you have eczema or are suffering with severe eczema, make sure that you are being seen by your doctor, whether that be your GP or a dermatologist to get the best medical advice. For more information, please contact instituteofdermatologists.ie
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How common is cancer of the nails?
‘While still rare, squamous cell carcinoma (SCC) is the most common skin cancer of the nail,’ explained Caitriona. ‘Typically, it presents as a slowly growing warty mass on the nail border or under the nail that may ulcerate and bleed or cause lifting of the nail. It can move to the surrounding bone but metastases to other parts of the body are rare, and patients have a 99% 5-year survival.’ Melanoma of the nail is less common, Caitriona informs us, and accounts for only 0.7–3.5% of all melanomas (but up to 75% of melanomas in dark skinned individuals). ‘Africans, Asians, and native Americans (dark-skinned races) account for up to one-third of all cases. It is much more dangerous than SCC and the 5-year survival is only approximately 15%.’
What are the signs of nail melanoma?
Just like we are encouraged to regularly check our skin for changes, the same is necessary for our nails. ‘Melanoma should be suspected when a single coloured band or streak arises in the nail in adulthood. The pigmented band is usually dark brown or black in colour, irregular and with a width of more than 3mm.’ The digit most commonly involved is the finger or thumb. ‘Extension of pigment onto the proximal or lateral nail fold (cuticle and skin surrounding the nail) is known as Hutchinson's sign and is very concerning for nail melanoma. A pigmented area under the nail that is associated with onycholysis (which is when the nail detaches from the nail bed) and/or nail destruction is another sign. As is a pink nodule that frequently ulcerates and bleeds.’
How can we protect ourselves?
‘In the same way we protect our skin. Avoid UV damage and don’t use tanning beds.
Gel/acrylic/shellac manicures can cause UV damage to the skin and nails when UV lamps are used to cure and harden the gel polish. The UVA radiation from these lamps penetrates the skin leading to premature aging and an increased risk of skin cancer. Typically, nail salons now use LED lamps, which emit less UV radiation than traditional UV lamps but there is still some cumulative UV damage over time.’ If you do choose to have a treatment, ensure that you apply broad-spectrum UV on your fingers and hands before your treatment. ‘Try and spread out your nail treatments and use longer lasting polishes –Go to see your GP or dermatologist if you develop any change in colour of your nailbed, pigmented streaks or any lumps or painful areas under your nail.’
If we have been using UV lamps, is there anything we can do to reverse the damage?
‘The simple answer is no - there is no turning back the clock. But you can certainly minimise the damage going forward (as above).’
If you are concerned about any changes to your nails or the surrounding skin, please book an appointment to discuss this with your GP.
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McDonald’s bangs
Yes, you read that right – the golden arches are Summers most unlikely hair muse – and we’re not mad about it. Taking inspiration from the fast-food chain's logo (rather than the Big Mac), ‘McDonald’s Bangs’ have become an unexpected hit in the hair world, going viral with more than 194 million views to date on TikTok! Soft, voluminous and ultra-flattering, we love the face-framing layers and 70s inspired finish a la Swedish influencer Matilda Djerf.
Great for lifting the face, it’s an easy look to follow as long as you keep your locks in a centre parting and fringe long enough to be swept either side of your face. What then follows is a refresh on the also adored curtain bang, with the main difference being that the root lift is more curved and lifted to create the infamous M-shape. Don’t worry if you haven’t got Rapunzel length locks either - this style complements all hair lengths – we love Nicola Anne Peltz Beckham’s mid-length take on the trend.
Image: @matildadjerf
Image: @nicolaannepeltzbeckham
The blunt bob
If you are looking for a versatile cut that makes your locks look thicker and healthier in a snip, look no further than the blunt bob! Currently being embraced by TikTok users, stylists and celebrities such as Gigi Hadid, the ‘grown-up’ bob is a fail-safe choice for all hair types and can be dressed up (with textured waves and volume) or polished with smoothing products in minutes!
Image: @haileybieber
Image: @kourtneykardash
Mermaidcore
Jewel toned tresses, dewy skin and cascading waves - the release of the updated Little Mermaid has influenced many beauty trends coming into play this season. If you don’t want to reach for the hair dye, the easiest way to dip your toes into the Mermaidcore trend is to try a wet ‘straight out of the water’ style. A beachy, ‘air-dried’ finish is key for this trend, so avoid anything too polished and embrace any natural movement.
Image: @toniandguygeorges
Image: @xtaramartin
Barbie Blonde
Creamy, Barbie-blonde hues are tipped to be on trend as the new Barbie movie is released this Summer. Team with darker, natural roots for a lived-in look and if you aren’t sure about investing in a brand new colour, try Babylights first. Babylights are more finely woven, delicate highlights that keep depth and dimension in the hair for a more subtle, natural look.
Image: @brycescarlett
Image: @toniandguyworld
Peachy Keen
Blonde a little too bold for your liking? How about matching your tresses to your favourite summer spritz? Peach is this season’s softer colour choice and a surprisingly flattering option. Think a dreamy blend of muted copper and golden blonde that look especially ethereal teamed with a curl or layered look.
Image: @wellanordic
Image: @roxyhorner
]]>Along with antibacterial products and video calling, the ‘Tweakment’ market profited greatly from our time in Lockdown. Over the past three years, the market for non-invasive treatments such as filler and injectables has expanded enormously and is thought by many to be fueled by increased time spent on video conferencing calls, which inadvertently led to a vast number of us paying closer attention to our physical appearance. But it’s not just demand for non-invasive treatments that has soared - the global aesthetic medicine market size was valued at USD 99.1 billion in 2021 and is expected to expand at a compound annual growth rate (CAGR) of 14.5% from 2022 to 2030.* Whilst we applaud the freedom and opportunity to take action over anything that helps them feel better inside and out, both the reasons behind the surge and growing nonchalance surrounding tweakments leave us feeling a little unsettled...
The situation is a complex one and along with the trials of remote working, there are many other factors fueling the demand to take more drastic action with the areas of ourselves we are dissatisfied with. ‘There are so many reasons why a person may choose to get tweakments,’ observed Professor Caitriona Ryan of The Institute of Dermatologists, Ireland. ‘Tweakments are minimally invasive cosmetic procedures and typically require little to no downtime, making them a convenient option for women with busy schedules. I think the most important motivator for most of us is to improve self-confidence and feel better about our appearance. Tweakments can help enhance a person's natural beauty without drastically altering their appearance. For example, dermal fillers can be used to add volume to cheeks for a more youthful, radiant look and to lift a sagging jawline. Tweakments also help maintain a more youthful appearance and slow signs of ageing by addressing fine lines and wrinkles, sagging skin and the loss of facial volume that occurs with age.’
From building self-esteem to rising social status, it’s rarely all about vanity, ‘There is enormous social pressure on young women today to look “beautiful” and “perfect,” largely due to the huge pressures of social media. Instagram and social media have had an incredible influence on recent trends in cosmetic procedures, particularly in the younger generation,’ noted Professor Ryan. ‘These young women have an unrealistic sense of reality, being bombarded daily with filtered, digitally enhanced images of flawless young girls with filled lips and there is huge pressure to conform to these idealistic, artificial portrayals of beauty.’ One area that is particularly popular is lip filler. ‘Having overfilled lips has become the new norm, almost akin to having the newest fashion accessory. Unfortunately, these are also the age-group of women who tend to be less cautious about where they go for dermal fillers, have less money to pay for high quality fillers with medical experts and often fall victim to disfiguring botched jobs by non-medical practitioners.’ Indeed, social media helps new developments gain traction fast. For example, buccal fat removal, which involves removing fat pads from the cheek, is the latest trending treatment, favoured by celebrities such as Chrissy Teigan. The treatment has received over 257.8M views on TikTok and once this popularity is built, it often remains – think the still asked-for ‘Brazilian Butt lift’ that statistics show to be the dangerous surgery in recent years, or the draw of preventative Botox despite any solid scientific backing. Although plastic surgery has been around for decades, the number of people undertaking less invasive procedures is still new. Whilst previously, people may have tried to disguise any aesthetic work, it’s now a social norm and described as part of a ‘maintenance’ routine. The more frequently you see something, the more normal it becomes but we are yet to understand the ultimate cost both physically and emotionally.
A duty of care
With almost two-thirds of Irish people (62%) stating that they would be open to trying or have tried anti-wrinkle injections such as Botox, according to new research, * the wide acceptance of aesthetic procedures is a great opportunity for Irish salons to get into the medi-aesthetic space. Education is also an opportunity, with more than half (51%) said they would be open to the treatment, with 29% saying they would like to and 22% saying they were unsure, but curious to try.
Emotional support pre and post procedure are other areas that could be further developed. Many plastic surgeons have claimed to believe in the importance of saying ‘no’ to a client as a duty of care. Not everyone is an ideal candidate, for example those with unrealistic expectations or mental health conditions such as Body Dysmorphia Disorder. In these cases, carrying out a thorough psychological assessment before any surgery is crucial. Studies suggest that people who struggle with their psychological health can feel pressured to turn to ‘quick fix’ procedures to improve their appearance, but surgery can lead to depression in patients who are not properly screened beforehand.
What is body dysmorphic disorder?
People who strongly perceive imperfections within themselves may suffer from body dysmorphic disorder (BDD). This psychological disorder is characterized by an obsessive fixation on a perceived physical flaw. It affects between 1.7% and 2.4% of the general population.
In many cases, people with BDD will seek out multiple plastic surgery procedures and are usually unhappy with the results. This has meant that sometimes plastic surgeons will not operate on people with BDD.
If you feel very negatively about your physical appearance, it is advised you consult your GP or mental health professional about body dysmorphic disorder.
The SKINday Times Verdict
At The Skin Nerd, we prioritise a 360 approach to skin health, which means taking care of the skin on the inside, outside and on-top. Plastic surgery and aesthetic tweakments are a personal choice and have the potential to have positive or negative consequences dependent factors such as your reasons for undertaking the procedure, where you go and the aftercare you receive. All we ask is that you do your research beforehand, so you can make a fully informed decision before committing to treatment.
Plastic Surgery: The Stats
The global Plastic Surgery market size is predicted to reach USD million by 2028.
The top five most popular surgical procedures are liposuction, breast augmentation, eyelid surgery, rhinoplasty, and abdominoplasty.
The top five non-surgical procedures are botulinum toxin, hyaluronic acid, hair removal, skin tightening, and fat reduction.
Breast augmentation remains the most common surgical procedure for women.
Face and head procedures increased by 14.8% with eyelid surgery being the most common procedure, and the most popular surgical procedure among men.
If you wish to seek professional advice, please contact Professor Caitriona Ryan and Professor Nicki Ralph at The Institute of Dermatologists, Ireland (instituteofdermatologists.ie) for more information.
Sources
* Phorest Salon Software
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To mark Melanoma awareness month, The SKINday Times talks to Dermatologist Professor Caitriona Ryan about the steps you can take to protect yourself from skin cancer
Melanoma and keratinocyte skin cancer are two of the most common types of cancers today – but they are also types of the disease where you can take proactive steps to protect yourself as much as possible.
‘Currently there are over 13,000 cases of skin cancer per year in Ireland, about 1300 of which are melanoma. If melanoma is recognised and treated early, approximately 90% are curable, but if it is not, the cancer can advance and spread to other parts of the body, where it becomes difficult to treat and can be fatal,’ warns Professor Caitriona Ryan. Melanoma tends to affect a younger population than most cancers, with major risk factors including white skin, sun sensitivity and family history of melanoma. Sunburn and intermittent sun exposure have also been found to increase the risk of developing melanoma.** ‘Early detection is crucial. The most common forms of non-melanoma skin cancer are basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). If left untreated, some types of non-melanoma skin cancer can spread to other parts of the body but thankfully can almost always be completely cured and treated early.’
Whilst incidence rates are rising worldwide and largely attributed to increasing exposure to ultraviolet (UV) radiation (the main causal risk factor for skin cancer) mortality rates have been stable or have decreased over the past few years – possibly due to increased awareness on the importance of sun protection.*** Being safe in the sun is still the best way to reduce your risk of developing skin cancer, with many steps you can take including wearing a high factor SPF every day (we recommend SPF50), reapplying sunscreen every 2 hours, covering your skin with clothing and wearing a hat and sunglasses. ‘Daily sunscreen use on exposed areas could greatly reduce their risk of skin cancer,’ explains Caitriona. ‘Most Irish people are great at wearing SPF when abroad on holidays but rarely wear it at home, which is where they get most of their cumulative sun damage.’
The most important signs to look out for when it comes to melanoma are changes in the size, shape or colour of a mole. Here’s a handy 5-point check, which we call the ABCDE of melanoma:
A is for Asymmetry; Is one half of the spot different to the other half?
B is for Border: Does the spot have an irregular, scalloped, or poorly defined border?
C is for Colour: Does the spot have varying colours from one area to the next, e.g as shades of brown, tan, or black, or areas of red, white or blue.
D is for Diameter: Melanomas tend to be greater than 6 millimetres but they can be smaller.
E is for Evolution: Have you noticed the spot changing shape or appearance?
‘Consult with your GP or dermatologist immediately if you have a changing or new mole, or any skin abnormality, such as a lump, ulcer, lesion or skin discolouration that has not healed after 4 weeks,’ Caitriona advises. ‘While it may not be skin cancer, it's always best to get checked.’ And how often should we examine our skin? ‘Examine yourself from head to toe every month. Learn the moles, freckles and other skin marks that are normal for you. Stand in front of a long mirror and have a hand mirror that you can use to check parts that are hard to see. Ask a relative or friend to check your back or other hard-to-see areas like your scalp or the back of your neck. It may help to take photographs of your skin and compare any changes that occur over time. If you detect something that concerns you, visit your GP.’
Skin cancer: What you need to know
Types of skin cancer
Types of skin cancer are divided into two main groups: melanoma and non-melanoma. Melanoma is the least common but most serious form.
Non-melanoma skin cancers (NMSC)
Non-melanoma skin cancers are the result of DNA damage usually due to excess exposure to UV radiation but sometimes also result from exposure to dangerous chemicals. These are the most common types of skin cancer and include basal cell and squamous cell carcinomas, with an estimated average of 12,000 non-melanoma skin cancers diagnosed in Ireland during 2018-2020. In many cases, exposure to the carcinogen has occurred years before the cancer appears.
Melanoma skin cancer
Melanoma is a rarer form of skin cancer, although larger numbers of people are being diagnosed with it each year, with on average 1,100 melanoma skin cancers diagnosed in Ireland during 2018-2020.
Melanoma skin cancer is associated with ultraviolet radiation (UV) exposure from sunbeds, and / or a history of sunburn and commonly begins with a change in a mole or new growth on the skin. Melanoma is an aggressive cancer that develops in the melanocytic cells in the epidermal layer of the skin and can quickly spread to other parts of the body if not detected early. In rarer cases, melanomas can be found in the eye, under the nails or in areas of the body not normally exposed to the sun.
Skin cancer can appear in a number of ways including:
What is the difference between UVA and UVB?
UVA: These rays have a longer wavelength and lower amount of energy than UVB rays. UVA rays account for 95% of the radiation that reaches the earth’s surface and can penetrate the skin deeper than UVB rays, with the ability to enter the dermis - the middle layer of the skin. These rays have skin cancer causing potential and can cause pigmentation and premature ageing.
UVB: These rays have slightly more energy than UVA rays but shorter wavelength, meaning that they only reach the epidermis (the outermost layer of the skin). These types of rays can cause skin burning, as well as also possessing the potential to cause skin cancer. Although they do not penetrate the skin as deeply, the majority of skin cancers are due to UVB.
What does the SPF number mean?
SPF stands for Sun Protection Factor and refers to the sunscreen’s potential to block UVB rays (not UVA). Your sunscreen will display SPF followed by a number ranging from 2 to 50+. This number tells you the time the skin will take to redden with the sunscreen compared to the amount of time it would take to redden without the sunscreen. To break it down, this means if you select and correctly apply SPF 15, it will take your skin 15 times longer to redden as compared to having no sunscreen on at all.
The higher the SPF number, the longer the protection but as SPF is a measure of the degree of protection it gives you from UVB rays, bear in mind that this should not be used to calculate the length of sun exposure.
What about UVA radiation?
If your sunscreen has a UVA seal – a logo with ‘UVA’ inside a circle - this indicates that the product conforms to EU recommendations for UVA protection which is equivalent to at least one third of the SPF. Sometimes, you will see a star rating for UVA. Select one with at least 4 stars for better protection. In the USA and Japan, a PA scale is used to indicate UVA protection, ranging from PA + (Low) to PA ++++ (High).
What are UVA star ratings?
UVA star ratings are often seen across the bottles of many forms of sun protection. Developed in 1992, Boots created this system, which became Europe’s first measurement system for UVA protection. With the rating ranging from 0 to 5, each number indicates the percentage of UVA radiation absorbed by that sun protection, compared to UVB. The higher the star rating, the better the protection against UVA rays. 4 is considered to be the lowest recommended star rating.
Truth V Myths
Sunscreens can harm the ecosystem
New research has suggested that sunscreen can cause harm to the coral ecosystem. The study found that corals absorb oxybenzone from sunscreen and convert it into phototoxins. These molecules then become harmful when exposed to sunlight. The scientists found that coral bleaching events, which can be caused by climate change and warming oceans, make the corals more susceptible to sunscreen accumulation and its damaging effects.* In the new study, environmental chemist Djordje Vuckovic of Stanford University and colleagues found that anemones exposed to fake sunlight while submersed in water containing the chemical died within 17 days.
It’s still unclear what amount of oxybenzone might be toxic to coral reefs in the wild.
Chemicals in sunscreen cause cancer
Cancer.ie revealed that two of their top queries were if chemicals in sunscreens are harmful and if they increase your risk of developing cancer. Current research on the chemicals in sunscreen (oxybenzone, retinyl palmitate and parabens) does not show that they cause cancer and none of these chemicals has been classified as a cancer-causing substance by any major scientific organisations. There have been studies that have suggested that parabens (preservatives used in many cosmetic products, including some sunscreens) act like estrogen in the body, which can speed up the growth of breast cancer tumours but more research is needed to understand this association better.
Only women who sunbathe lots get skin cancer
Skin cancer doesn’t discriminate. In 2013, research showed that almost 6,000 men were diagnosed with skin cancer compared to just under 5,000 women. Skin cancer represents 29% of all cancers in women and 31% of all cancer cases in men, so it’s an issue across genders.
The SKINday Times verdict
Skin Cancer is an insidious disease and so it is important to take precautions when it comes to protecting the skin AND regularly check your skin for any skin changes. We suggest making it a routine and checking the skin weekly whilst applying your body lotion. Encourage the loved ones in your life to do this too. Arranging for a dermatologist to check the skin once per annum may help to map out your skin and help you to recognise any changes also. The regular and consistent application of SPF is crucial. The Irish Cancer Society states that we should be applying a broad-spectrum SPF of at least factor 30 every two hours during the day, and this is necessary every single day, come rain or shine! For the average adult, it is recommended that you need 35mls of sunscreen to cover the whole body. The Irish Cancer Society recommends using a measure of half a teaspoon of sunscreen to cover each arm, the face, neck and ears. Use a measure of one teaspoon for each leg, the front and the back of the body. This is a visible cancer and whilst skin changes can be harmless if you do spot anything unusual, do not delay in getting this assessed by your GP.
Sources
*World Economic Forum, 2022
** Rager EL, Bridgeford EP, Ollila DW. Cutaneous melanoma: update on prevention, screening, diagnosis, and treatment. Am Fam Physician. 2005 Jul 15;72(2):269-76. PMID: 16050450.
*** Leiter U, Keim U, Garbe C. Epidemiology of Skin Cancer: Update 2019. Adv Exp Med Biol. 2020;1268:123-139. doi: 10.1007/978-3-030-46227-7_6. PMID: 32918216.
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What is rosacea?
Rosacea is a chronic skin condition characterised by symptoms of facial flushing, as well as erythema, telangiectasia, coarseness of skin, and an inflammatory papulopustular eruption resembling acne.* ‘Rosacea affects approximately 10% of Irish adults,’ explains Dr Nicola Ralph, a dermatologist based in Dublin. ‘Also known as “the curse of the Celts,” rosacea presents as redness, easy flushing, and visible blood vessels and broken capillaries on the face, especially the central cheeks and nose. It also includes inflammatory lesions, which are small red spots and micropustules.’ Despite being incredibly common, many sufferers experience rosacea differently, with signs and symptoms presenting in different ways.
The 4 main subtypes of rosacea
Erythematotelangiectatic rosacea (ETR): Characterized by persistent redness within the central section of the face, this subtype is often accompanied by visible blood vessels (telangiectasiae). Those with this type of rosacea may also experience flushing, burning, stinging, and dryness of the skin.
Papulopustular rosacea (PPR): This subtype is characterised by papules and pustules that resemble acne, along with redness and swelling of the central face. These symptoms may also be accompanied by burning and stinging sensations. There are no comedones (blackheads) like acne, and the skin does not scar from inflammatory rosacea.
Phymatous rosacea: This is primarily characterised by thickening of the skin and enlargement of the nose, but it can also affect the chin and forehead. Irregular surface nodules and prominent pores may also be present.
Ocular rosacea: This subtype affects the eyes and eyelids can cause uncomfortable symptoms such as inflammation, redness, dryness, tearing, and vision problems.
‘Diagnosis of rosacea is typically based on a patient's symptoms and a physical examination by your doctor,’ Nicola informs The Skin Nerd. ‘There are no specific tests or diagnostic criteria for rosacea. However, your doctor may perform tests to rule out other conditions that may cause similar symptoms, such as lupus or seborrheic dermatitis.’
What causes rosacea?
The exact cause of rosacea is not fully understood, but it is thought to be related to a combination of factors including:
Genetics: Family history of rosacea, skin type (Fitzpatrick I or II), and specific genetic mutations (ApaI G/T) have all been reported as risk factors, suggesting a genetic component of the condition, however, more research is needs to be conducted on the causative genes.
Microorganisms: ‘Demodex mites are a normal part of the skin flora and can be found in small numbers on the skin of most people. However, in people with rosacea, there is evidence that the density of Demodex mites may be slightly higher than normal and there may be more of a specific subtype of demodex mite, which may play a role in the development of rosacea,’ suggests Nicola. ‘The exact relationship between Demodex mites and rosacea is not fully understood, but one theory is that mites trigger an immune response in the skin, leading to inflammation and other symptoms of rosacea. Another theory is that the mites themselves release substances that contribute to the development of rosacea. However, the relationship between the mites and the condition is still a subject of research and debate.’
Immune system dysregulation: Much research on the immunology related to the development of rosacea has been conducted over the years, with studies suggesting that LL-37 (Cathelicidin antimicrobial peptide - which is said to play a role in immunomodulation, wound healing, and cell growth) may serve as a key contributor to the proinflammatory and proangiogenic (the process through which new blood vessels form from pre-existing vessels) effects, which are highly evident in the skin of patients with rosacea.***
Neurogenic dysregulation: There has been some evidence to suggest a pathogenesis of neurogenic dysregulation. For example, triggers such as stress or spicy food, could be aggravating factors for rosacea. Comorbidity research also suggests a close relationship between neurogenic dysregulation and rosacea, such as psychosis (e.g. depression) and neurological disorders (e.g., Parkinson's disease).
Inflammation: A high rate of inflammatory response has been found in subjects with rosacea, suggesting a response or a trigger to immune, microorganisms, and neurogenic dysregulation progression.
Abnormal barrier function: Increased TEWL and decreased stratum corneum hydration have been identified in those suffering with rosacea. This means that cleansing habits and skin care that support barrier function is key to managing the condition. However, cleansing at a high frequency or with a machine could also disrupt the delicate barrier and exuberate any problems, so care should be taken under the advice of a dermatologist.
Triggers
In 2022, the National Rosacea Society conducted a survey and collected responses from 1066 patients with rosacea. Aiming to investigate which factors can trigger or aggravate the symptoms of the disease, results revealed that the most prominent triggers were found to be sun exposure, emotional stress, and hot water. Food triggers include figs, bananas, plums, chocolate, cheese, yoghurts, soy sauce, spinach, beans, peas, and broad beans. Strong and hot coffee or tea, alcohol, and sweeteners added to drinks can act by activating transient receptor potential ion channels leading to functional impairment of the skin barrier. Although some patients with rosacea indicate that coffee has the potential to worsen symptoms, a large study provided opposite conclusions. The study by Li et al. found that 82,737 women with rosacea who consumed more caffeine had a lower risk of incident rosacea, highlighting its possible protective effect. Furthermore, the consumption of histamine-rich foods and sugary foods can also lead to rosacea exacerbations. **
If you suspect you have acne or rosacea, please visit your GP or dermatologist, who will be able to make a professional assessment of your skin.
Sources
*Aimee M Two, Wiggin Wu, Richard L Gallo, Tissa R Hata, Journal of the American Academy of Dermatology 2015 May
Xi-Min Hu,a,b Zhi-Xin Li,c Dan-Yi Zhang,c Yi-Chao Yang, c Sheng-Yuan Zheng,c Qi Zhang,b Xin-Xing Wan,d Ji Li,a,e,f,
**Li et al, Current research and clinical trends in rosacea pathogenesis (2022)
*** Pound LD, Patrick C, Eberhard CE, Mottawea W, Wang GS, Abujamel T, Vandenbeek R, Stintzi A, Scott FW. Cathelicidin Antimicrobial Peptide: A Novel Regulator of Islet Function, Islet Regeneration, and Selected Gut Bacteria. Diabetes. 2015 Dec;64(12):4135-47.
]]>Ever noticed that you get a spot just before a big date? Or that you blush when you stumble over your words during a presentation? When you think about it, it makes sense that your skin is a visual representation of what is going on within your body. But way more than just the mirror to your inner self, the skin’s two-way relationship with the brain and body has been brought into sharper focus of late. The term psychodermatology may have crossed your path recently, and we wouldn’t judge you if you rolled your eyes at what sounds like another made up skincare buzzword. However, we encourage you to bear with us nerdies, for Psychodermatology and its sister psychoendoneuroimmunology are more than just passing trends. The study of the relationship between the mind and the skin is changing the way we look at skin health and providing vital support to those experiencing mental distress due to a skin condition.
More than skin deep
Although it seems like a new buzzword, the concept of psychodermatology actually dates back to Hippocrates (460-377 BC) who was the first to suggest causality between emotional stress and skin disease, whilst reporting two cases of trichotillomania (the repetitive syndrome also called the ‘hair pulling disorder’)****** Despite the practice of psychodermatology remaining relatively niche today, awareness is growing, with almost a third of all the research mentioning the term in the National Institute of Medicine's Library of Health, being published in the last three years.
As a skincare brand and educator with a 360 approach to skin health, we welcome this holistic study of the skin, which encourages practitioners to consider the person as a whole. How we feel and think on the inside (whether we like it or not) often presents itself on the outside. And vice versa – how we look on the outside can influence how we feel inside. And science backs this up - research increasingly reveals that skin health is intrinsically linked to emotional well-being with one study revealing that 98% of skin disease patients say their condition affects their emotional wellbeing.*** With this huge statistic in mind, it is great news that its now becoming more accepted that what is going on with the skin can have an emotional, behavioural or psychosomatic aspect.
Call it skintution
Masters in non-verbal communication, the skin and brain are said to continually interact through psychoneuroimmunoendocrine mechanisms and behaviours that affect the initiation or flaring of skin disorders.****
The skin is our body’s largest organ, but the significance of skin on our inner lives is often overlooked. The skin is acknowledged as a protector against environmental aggressors but is less appreciated for the emotion it can incite. Referred to as a medium for psychosomatic expression, ‘skin to skin’ contact encouraged when a newborn baby is placed on its mother at birth. The soothing effect can encourage a restless infant to become calm and it is through this contact, through the comfort of holding and being held that sensations of smell, touch, taste, and warmth are transmitted between the two.******** This nurturing communication can signal warmth and love, yet how we feel about our skin throughout our lives can also lead to negative feelings embarrassment, fear or even shame. Physically, the mind is linked to the skin through the sensory nerves. These nerves release neuropeptides (including cortisol) into the skin that influence how the skin behaves in times of both disease and health. For example, long-term increases in cortisol can cause inflammation, leading to aging and acne. This can then become a vicious cycle as stress can worsen some skin symptoms, but skin symptoms can also raise a person's stress levels.
The skin condition psoriasis is an example of how your immune system, central nervous system, mental health, and stress levels are intertwined. Psoriasis causes the skin cells to grow too quickly. Whilst usually your body would shed these extra skin cells, with psoriasis, the extra cells build up on the skin’s surface and can cause pain and itching. The release of cytokines from the immune system is the reason for this overgrowth of skin cells and it has been found that stress can worsen or trigger psoriasis flares. Many people with psoriasis and chronic skin conditions report having depression and increased stress, particularly those with immunodermatoses such as atopic dermatitis and seborrheic eczema.***** Though many of these conditions are long term, Psychodermatology has the potential to provide support. The field can also aid those struggling with more common issues such as acne. Acne is now widely recognised for being accompanied by low self-esteem and social isolation, with acne sufferers reported to have a 63% higher risk of developing major depression within a year of diagnosis.*********
As well as skin conditions affecting the psyche, having a psychological disorder has also been seen to have an effect on the skin. The resulting stress that can accompany the disorder can then exacerbate any skin conditions, leading to more stress and a vicious circle. Skin conditions particularly influenced by stress include Inflammatory acne vulgaris; atopic dermatitis which typically flares with stress through psychoneuroimmune mechanisms and through scratching; lichen planus; pruritus and rosacea.***
What can a psychoderm do?
About 30% of patients who have skin disorders are reported to have concurrent psychiatric disorders and psychosocial impairments, while the overall prevalence of psychological disorders among patients with skin disease is about 25–30%. Psychodermatology may assist those suffering emotionally with a skin condition greatly by providing more support alongside traditional medical treatment if needed. And it appears the support is called for. The British Skin Foundation noted that around 26% of Brits are embarrassed by their disease and one third said that their skin condition affects their mental health and the lack of mental health support for skin disease patients was recently criticised in a UK Parliamentary report. The All Party Parliamentary Group on Skin revealed 98% of skin disease sufferers said their condition affects their emotional and psychological wellbeing. A worrying 5% of those surveyed reported suicidal thoughts. The survey further revealed that more than half the patients asked were unaware that specialist support was available for UK patients with skin conditions in the form of psychodermatology and only 18% had received some form of psychological support.
Addressing the area where skin conditions and mental health overlap, a psychodermatologist can empower those with chronic or long-term skin issues and recommend therapy such as Cognitive Behavioural Therapy, hypnosis, and counselling as support alongside any necessary medication. For example, a person with eczema may be advised to try habit-reversal therapy to help break an itch-scratch cycle that has been causing distress.
The link between skin and the mind: The statistics
A survey by British Association of Dermatologists revealed:
17% of dermatology patients need psychological support to help them with the psychological distress secondary to a skin condition
14% of dermatology patients have a psychological condition that exacerbates their skin disease.
8% of dermatology patients present with worsening psychiatric problems due to concomitant skin disorders
3% of dermatology patients have a primary psychiatric disorder
85% of patients have indicated that the psychosocial aspects of their skin disease are a major component of their illness.
British Association of Dermatologists, 2011
For more help...
If you want to see a psychodermatologist, we suggest you contact your GP first, but you can also visit mentalhealthireland.ie for more information on managing your mental health.
Other useful contacts include:
Dr Alia Ahmed: thepsychodermatologist.com
Irish Skin Foundation: irishskin.ie
Sources
* Journal of Investigative Dermatology (2008), vol.128
**Practical Psychodermatology, edited by Anthony Bewley, et al., John Wiley & Sons, 2014.
***Reich A, Wójcik-Maciejewicz A, Slominski AT. Stress and the skin. G Ital Dermatol Venereol. 2010 Apr;145(2):213-9. PMID: 20467395.
*** One Size Does Not Fit All: Diversifying Immune Function in the Skin (Shruti Naik)
***** From the brain-skin connection: the neuroendocrine-immune misalliance of stress and itch (Petra Arck, Ralf Paus)
******Psychodermatology: Past, present and future, Journal of the American Academy of Dermatology, Volume 81, Issue 4, Supplement 1, 2019,
******* Psychoneuroimmunologic aspects of skin diseases (Liborija Lugović-Mihić et al)
******** Koblenzer, C. Psychodermatology of women, Clinics in Dermatology (1997)
*Stress and psychoneuroimmunologic factors in dermatology (Mauro Urpe et al)
*********The Psychological and social impact of skin diseases on people’s lives, All Party Parliamentary Group on Skin.
]]>For strong hair at optimum health, you need to have a happy scalp. Whilst previously it could be considered as the ‘Cinderella’ of the anatomy, the scalp is well and truly having its time in the spotlight with scalp products and routines trending as we begin to realise what the trichologists have been trying to tell us all along – good hair begins at the roots.
But what if your hair doesn’t feel strong and resilient? You may have a problem that begins with the scalp and particularly the hair follicles. Scalp problems are often felt as much as seen and if you have been suffering with dryness, flakiness, itching and irritation, chances are you have an excess or lack of scalp oil.
There are many reasons why your scalp may become dry, including something as simple and reversable as over-washing. Shampooing daily can be necessary but if care is not taken (i.e you double cleanse too much, or use too hot water), it can strip your scalp of essential natural oils. Continuing over time, this can lead to hair breaking. So, what is a healthy number of times to wash your hair per week? This is down to your hair type. Those with fine locks may find they need to shampoo daily, whilst those with coarse hair might not need to wash their hair as frequently. As well as taking note of how your hair feels after a day of not shampooing, we also recommend checking with your hairdresser if you are unsure.
Another cause of dry scalp can be Contact Dermatitis. ‘Contact dermatitis on the scalp will often result in itching and is caused by a reaction to the chemicals in some shampoos, hair dyes or other grooming products’ explains Deborah Whelan Hair@TheSkinNerds resident trichologist. ‘It may be that the person has an allergic reaction to certain ingredients that are in the product or that the ingredients simply irritate the skin. This condition will be recognised by your Trichologist and can be treated if necessary.’ The best remedy is to strip back your regime until you discover which product caused the reaction and remove the culprit pronto.
Changes in the temperature can also be a cause of a thirsty scalp. During the winter, the humidity in the air drops and this can cause the skin across the whole body to become drier. The techniques and tools you use to wash and style your hair can also make a difference. Using a too hot setting on your hairdryer or scoldingly hot water in the shower can lead to irritation and dryness. To avoid this, stick to warm water when bathing and consider getting a humidifier to add moisture to the air in your home.
Skin conditions such as eczema and psoriasis can also affect the scalp too. Eczema is an inflammatory skin condition that can also affect the skin on your scalp, leaving it red, dry and itchy.** Types of soap, shampoos, cleansing products and intrinsic factors such as stress can lead to a flare up of symptoms and cause patches of eczema to develop on many places across your body including the scalp. It is important to identify and avoid harsh shampoos or any other products or ingredients that trigger your symptoms, such as cocamidopropyl betaine, which is used to thicken shampoos and lotions and has been identified by The National Eczema Organisation as a common trigger.** Psoriasis is said to affect 1 to 2% of the general population and can affect any part of the body. According to the National Psoriasis Foundation, as many as 45% to 56% of those with psoriasis have it on their scalp. When it comes to psoriasis, your autoimmune condition causes your skin cells to multiply faster than usual. The additional cells build up on the skin and create plaques (itchy, scaly patches) which can occur on your scalp. As psoriasis is a medical condition, your first port of call would be to discuss this with your GP or trichologist but for mild scalp psoriasis, they are likely to suggest trying a medicated shampoo that contains juniper tar, rosemary or thyme oil which can help to relieve the itch.
Ask our expert: Does your shampoo really make a difference?
‘Yes!’ says our in-house trichologist, Deborah Whelan. ‘It is important to seek professional advice on which shampoo you should use regularly as shampoos are tailored to individual hair types. The pH of hair naturally lives between 4.5-5, which is in the acidic level. The natural oil secreted from the scalp is responsible for the pH of our hair. Scalp oil is naturally more acidic as this is helpful at fighting off bacteria and the growth of fungus. When we use a hair product such as a shampoo that has a pH of 7 or higher, that high alkalinity can cause irritation to the scalp and can leave the hair feeling dry. The pH scale ranges from 0 to 14 pH. Any liquid that is between zero and 6.99 pH is acidic. Any liquids that are between 7.01 and 14 pH are basic, or alkaline. Water itself has a pH of seven, which is considered to be neutral since it is equal parts acids and alkalis. Most shampoos are between 3.5 to 9 on the pH scale, which is a wide range. If you are using a shampoo that is too high or too low on the pH scale, then you might be interfering with your scalp’s natural pH balance, causing hair damage and scalp irritation. When you use a shampoo with a very high pH, your scalp and hair will feel very clean, and your hair may appear fuller but after time your hair will become dry and dull from a lack of oil. Shampoos with a very high pH will begin to lift the follicle’s outermost layer (known as the cuticle). This is what gradually leads to split ends, frizz, and breakage over time. A very acidic shampoo can also cause scalp irritation, so to maintain healthy looking hair and avoid drying out the scalp the pH of shampoos should be less than 7. My recommendation for a shampoo would be one with a pH of around 5 -5.5.’
Always book an appointment to see your GP or trichologist if your scalp is red, swollen, painful or warm to touch, if you develop a rash or if the itchiness of your scalp is severe and unexplained.
Sources
* Saxena R, Mittal P, Clavaud C, et al. Comparison of Healthy and Dandruff Scalp Microbiome Reveals the Role of Commensals in Scalp Health. Front Cell Infect Microbiol. 2018;8:346. doi:10.3389/fcimb.2018.00346
** Eczema (atopic dermatitis): Causes, symptoms, and treatment (nationaleczema.org)
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