tag:theconversation.com,2011:/ca-fr/topics/dermatology-10652/articlesDermatology – La Conversation2024-03-25T19:05:37Ztag:theconversation.com,2011:article/2241442024-03-25T19:05:37Z2024-03-25T19:05:37ZSummer’s over, so how much sun can (and should) I get?<figure><img src="https://images.theconversation.com/files/583381/original/file-20240321-22-89ys3l.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6016%2C3998&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/woman-sitting-on-beach-shore-during-daytime-f9HmXiFNKXM">Tamara Bellis/Unsplash</a></span></figcaption></figure><p>As we slide of out summer, you might be wondering how careful you need to be about sun exposure. Excessive exposure causes <a href="https://www.cancer.org.au/about-us/policy-and-advocacy/prevention-policy/national-cancer-prevention-policy/skin-cancer-statistics-and-issues/uv-radiation">skin cancer</a>, but sun exposure also has <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9976694/">benefits</a>. How do you balance the two? </p>
<p>A new <a href="https://www.sciencedirect.com/science/article/pii/S1326020023052949?via%3Dihub">position statement</a> from cancer, bone health and other experts <a href="https://www.assc.org.au/wp-content/uploads/2023/01/Sun-Exposure-Summit-PositionStatement_V1.9.pdf">aims to help</a> Australians balance the good and bad effects of sun exposure by taking into account their skin colour, risk of skin cancer, and where they live.</p>
<h2>What are the benefits of sunlight?</h2>
<p>Ultraviolet (UV) radiation (the wavelengths in sunlight that cause skin cancer) also leads to vitamin D production. <a href="https://dermnetnz.org/topics/vitamin-d">Vitamin D</a> is very important for maintaining strong bones, and is likely to have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9976694/">multiple other health benefits</a>. </p>
<p>But vitamin D probably isn’t the whole story. Sunshine, including UV radiation, is thought to affect health in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9976694/">other ways</a> such as improving our mood and reducing the risk of autoimmune diseases and infections. So for many people, avoiding the sun and taking a vitamin D supplement may not be the best approach.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/vitamin-d-supplements-can-keep-bones-strong-but-they-may-also-have-other-benefits-to-your-health-219521">Vitamin D supplements can keep bones strong – but they may also have other benefits to your health</a>
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</em>
</p>
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<h2>How much time does it take to make vitamin D?</h2>
<p>It’s complicated, but for most people and most of the year across most of Australia, it’s a lot less than you think.</p>
<p>The <a href="https://onlinelibrary.wiley.com/doi/10.1111/php.13854">amount of time needed</a> depends on the amount of skin covered by clothing and the intensity of UV radiation (indicated by the UV index). More skin exposed and higher UV index equate to less time needed. </p>
<p>Both the UV index and the amount of the year that UV radiation is high increase as you get closer to the equator. In summer, all of Australia is bathed in sunshine. But in winter, opposite ends of the country have <a href="https://onlinelibrary.wiley.com/doi/10.1111/php.13854">very different exposures</a>. </p>
<p>In summer, everybody except those with deeply pigmented skin can make enough vitamin D in <a href="https://www.sciencedirect.com/science/article/pii/S1326020023052949?via%3Dihub">just five minutes</a> between 9am and 3pm, anywhere in Australia, provided they are wearing shorts and a T-shirt. </p>
<p>In winter it’s a different story. In <a href="https://www.sciencedirect.com/science/article/pii/S1326020023052949?via%3Dihub">Darwin and Brisbane</a>, 5–10 minutes between 10am and 3pm will do the trick, but in <a href="https://www.sciencedirect.com/science/article/pii/S1326020023052949?via%3Dihub">Hobart</a>, factoring in winter clothing, it will take nearly an hour in the middle of the day.</p>
<p>Hover your mouse over the lines below to see the length of exposure needed at specific times of day.</p>
<p><iframe id="X5szQ" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/X5szQ/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>Staying out for longer than needed doesn’t necessarily make more vitamin D, but it <a href="https://www.sciencedirect.com/science/article/pii/S1326020023052949?via%3Dihub#bib25">does cause skin damage</a>. </p>
<h2>Hang on, what about those with darker skin?</h2>
<p>People with deeply pigmented, brown to black skin accumulate both vitamin D and DNA damage at a much slower rate than people with lighter skin tones. </p>
<p>When UV radiation hits a DNA strand, it causes the DNA to become distorted. If the distortion isn’t fixed, it will cause a mistake when the DNA is copied for a new cell, causing a permanent mutation that sometimes leads to cancer. </p>
<p>Melanin, the brown pigment in the skin, absorbs UV photons before that can happen, and the high melanin content in the darkest skin tones provides <a href="https://faseb.onlinelibrary.wiley.com/doi/full/10.1096/fj.201701472R">60 times</a> as much UV protection as the small amount in very fair skin. </p>
<p>The flip side is the risk of vitamin D deficiency is much higher than the risk of skin cancer. </p>
<p>The new statement accounts for this by putting people into <a href="https://www.sciencedirect.com/science/article/pii/S1326020023052949?via%3Dihub">three groups</a> based on their risk of skin cancer, with specialised advice for each group.</p>
<h2>Highest skin cancer risk</h2>
<figure class="align-center ">
<img alt="Red-headed woman" src="https://images.theconversation.com/files/583354/original/file-20240321-22-qfrbj0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/583354/original/file-20240321-22-qfrbj0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/583354/original/file-20240321-22-qfrbj0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/583354/original/file-20240321-22-qfrbj0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/583354/original/file-20240321-22-qfrbj0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/583354/original/file-20240321-22-qfrbj0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/583354/original/file-20240321-22-qfrbj0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">People with pale skin that burns easily are in the high-risk group.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/close-up-photo-of-person-with-nose-ring-2146042/">Luriko Yamaguchi/Pexels</a></span>
</figcaption>
</figure>
<p>This includes people with very pale skin that burns easily and tans minimally, but also people with darker white or olive skin who can tan easily but have extra skin cancer risk factors because they: </p>
<ul>
<li>have had <strong>skin cancer</strong> before</li>
<li>have a <strong>family history</strong> of melanomas</li>
<li>have many <strong>moles</strong></li>
<li>are taking <strong>immunosuppressant</strong> medications.</li>
</ul>
<p>For these people, the harms of sun exposure almost certainly <a href="https://www.sciencedirect.com/science/article/pii/S1326020023052949?via%3Dihub">outweigh the benefits</a>.</p>
<p>These people should wear sunscreen every day the <a href="https://www.arpansa.gov.au/our-services/monitoring/ultraviolet-radiation-monitoring/ultraviolet-radiation-index">UV index</a> is forecast to get to <a href="https://www.assc.org.au/peak-health-bodies-recommend-new-approach-to-sunscreen-use/">three or more</a>, and use the <a href="https://www.cancer.org.au/cancer-information/causes-and-prevention/sun-safety/be-sunsmart">five sunsmart steps</a> whenever the UV index is above three: </p>
<ul>
<li><strong>slip</strong> on clothing covering as much of the body as possible</li>
<li><strong>slop</strong> on SPF30+ sunscreen on areas that can’t be covered up</li>
<li><strong>slap</strong> on a hat</li>
<li><strong>seek</strong> shade</li>
<li><strong>slide</strong> on sunglasses.</li>
</ul>
<p>They shouldn’t spend time outdoors deliberately to make vitamin D, but should discuss vitamin D supplements with their doctor. </p>
<h2>Intermediate skin cancer risk</h2>
<figure class="align-center ">
<img alt="Man drinks soda from a cup" src="https://images.theconversation.com/files/583358/original/file-20240321-20-42mfoy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/583358/original/file-20240321-20-42mfoy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/583358/original/file-20240321-20-42mfoy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/583358/original/file-20240321-20-42mfoy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/583358/original/file-20240321-20-42mfoy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/583358/original/file-20240321-20-42mfoy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/583358/original/file-20240321-20-42mfoy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">People with skin that tans easily are at intermediate risk.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/man-in-gray-shirt-drinking-from-white-ceramic-mug-TfqM6Kg2Rh4">Jarritos/Unsplash</a></span>
</figcaption>
</figure>
<p>This means people with dark white/olive skin that sometimes burns but tans easily, and who don’t have other skin cancer risk factors. </p>
<p>These people should still apply sunscreen as part of their usual routine on all days when the UV index is forecast to get to <a href="https://www.assc.org.au/peak-health-bodies-recommend-new-approach-to-sunscreen-use/">three or more</a>, but they can spend enough time outdoors to get a “dose” of vitamin D on most days of the week. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-how-does-the-sun-help-your-body-make-vitamin-d-139670">Curious Kids: how does the Sun help your body make vitamin D?</a>
</strong>
</em>
</p>
<hr>
<p>Once the time needed for their vitamin D dose is up, they should also use the <a href="https://www.cancer.org.au/cancer-information/causes-and-prevention/sun-safety/be-sunsmart">slip-slop-slap-seek-slide</a> steps to avoid accumulating DNA damage. </p>
<p>If they’re unable to do this because of health or lifestyle factors, like being housebound, working night shifts, or always covering up with clothing, they should see their doctor about whether they need vitamin D supplements.</p>
<h2>Lowest skin cancer risk</h2>
<figure class="align-center ">
<img alt="Family members sit outside, laughing" src="https://images.theconversation.com/files/583359/original/file-20240321-16-fk5ehb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/583359/original/file-20240321-16-fk5ehb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/583359/original/file-20240321-16-fk5ehb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/583359/original/file-20240321-16-fk5ehb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/583359/original/file-20240321-16-fk5ehb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/583359/original/file-20240321-16-fk5ehb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/583359/original/file-20240321-16-fk5ehb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">People with skin that rarely burns have the lowest risk of cancer.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/two-persons-staring-at-each-other-jg_t3PBq5Jo">Eye for Ebony/Unsplash</a></span>
</figcaption>
</figure>
<p>This covers people with deeply pigmented brown to black skin that rarely or never burns. </p>
<p>These people can <a href="https://www.sciencedirect.com/science/article/pii/S1326020023052949?via%3Dihub#bib14">safely spend enough time outdoors</a> to make vitamin D and get the other benefits of sunshine. But because more time is needed, it can be difficult, particularly when the weather is cold. Vitamin D supplements might be needed. </p>
<p>They don’t need to routinely protect their skin, but might need to <a href="https://www.cancer.org.au/cancer-information/causes-and-prevention/sun-safety/be-sunsmart">slip-slop-slap-seek-slide</a> if they are outdoors for more than two hours.</p>
<h2>How do I get the feel-good effects of sunshine?</h2>
<p>Spending time outdoors in the early morning is the best way to get the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9976694/">feel-good effects</a> of sunshine. An early morning walk is a great idea for all of us, but it won’t make vitamin D.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/should-i-be-getting-my-vitamin-d-levels-checked-211268">Should I be getting my vitamin D levels checked?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/224144/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katie Lee receives funding from the National Health and Medical Research Council for a student stipend. </span></em></p><p class="fine-print"><em><span>Rachel Neale receives funding from the National Health and Medical Research Council for grants related to vitamin D and sunscreen. She was the lead author of the manuscript describing the revised position statement and chaired the Summit that led to the revised recommendations.</span></em></p>Excessive exposure causes skin cancer, but sun exposure also has benefits. How do you balance the two?Katie Lee, PhD Candidate, Dermatology Research Centre, The University of QueenslandRachel Neale, Principal research fellow, QIMR Berghofer Medical Research InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2225952024-03-08T05:41:05Z2024-03-08T05:41:05ZTattoo regret? How to choose a removal service<figure><img src="https://images.theconversation.com/files/577250/original/file-20240222-30-6z69d0.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C998%2C666&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-blonde-woman-tattoo-wearing-summer-1891174123">Krakenimages.com/Shutterstock</a></span></figcaption></figure><p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10043702/">About one in four</a> people regret at least one of their tattoos. Almost half of those go on to have their unwanted tattoo removed or camouflaged with a new one.</p>
<p>So it’s no wonder people are <a href="https://trends.google.com/trends/explore?geo=AU&q=%2Fg%2F11sx2710yh&hl=en">searching for</a> laser tattoo removal services.</p>
<p>Here’s what to consider when choosing the best clinic and what to expect when you get there.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/thinking-of-a-nother-tattoo-this-summer-what-you-need-to-know-about-sunburn-sweating-and-fading-216078">Thinking of a(nother) tattoo this summer? What you need to know about sunburn, sweating and fading</a>
</strong>
</em>
</p>
<hr>
<h2>Why are tattoos permanent?</h2>
<p>You can still see tattoos on the 5,300-year-old ice mummy <a href="https://www.sciencedirect.com/science/article/abs/pii/S1296207415000023#bib0200">Ötzi</a>. That’s because tattoo artists use needles to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10485912/">deposit ink in the dermis</a>, the <a href="https://dermnetnz.org/topics/the-structure-of-normal-skin">layer of skin</a> under the outer layer (or epidermis).</p>
<p>When this happens, the body recognises ink particles as “foreign”. So <a href="https://onlinelibrary.wiley.com/doi/10.1111/cup.12023">immune cells</a> in the dermis, such as <a href="https://link.springer.com/content/pdf/10.1007/s10103-022-03576-2.pdf">macrophages</a>, take them up. </p>
<p>But the particles are too large for these specialised cells to break down and remove via the lymphatic system. Instead, the particles remain “locked” permanently in macrophages in the dermis.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/563548/original/file-20231205-29-8elmtu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Cross-section of human skin showing epidermis and dermis" src="https://images.theconversation.com/files/563548/original/file-20231205-29-8elmtu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/563548/original/file-20231205-29-8elmtu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=300&fit=crop&dpr=1 600w, https://images.theconversation.com/files/563548/original/file-20231205-29-8elmtu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=300&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/563548/original/file-20231205-29-8elmtu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=300&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/563548/original/file-20231205-29-8elmtu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=377&fit=crop&dpr=1 754w, https://images.theconversation.com/files/563548/original/file-20231205-29-8elmtu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=377&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/563548/original/file-20231205-29-8elmtu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=377&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Tattoo inks are inserted into the dermis, and tend to stay there.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/normal-skin-layers-crosssection-human-structure-2339540305">zonn hong/Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-otzi-the-prehistoric-iceman-can-teach-us-about-the-use-of-tattoos-in-ceremonial-healing-or-religious-rites-168058">What Ötzi the prehistoric iceman can teach us about the use of tattoos in ceremonial healing or religious rites</a>
</strong>
</em>
</p>
<hr>
<h2>How do lasers remove tattoos?</h2>
<p>To remove a tattoo, a laser device delivers high-intensity laser pulses to the ink. These incredibly short pulses are delivered in a billionth or trillionth of a second (<a href="https://pubmed.ncbi.nlm.nih.gov/25949016/">nanosecond or picosecond pulses</a>), confining the laser energy to the tiny ink particles, minimising damage to the surrounding skin. </p>
<p>Once the ink particles absorb the laser energy, a thermal reaction takes place, increasing the particles’ internal pressure and causing them to <a href="https://pubmed.ncbi.nlm.nih.gov/25949016/">expand</a>, then <a href="https://link.springer.com/content/pdf/10.1007/s10103-022-03576-2.pdf">fragment</a>.</p>
<p>The macrophages can now remove these smaller particles via the lymphatic system. That’s when your tattoo starts to fade.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/thinking-of-laser-hair-removal-heres-what-you-need-to-know-113561">Thinking of laser hair removal? Here's what you need to know</a>
</strong>
</em>
</p>
<hr>
<h2>Can all inks be removed?</h2>
<p>Most inks can be removed, but several factors affect the result.</p>
<p><strong>Colours</strong></p>
<p>Each colour absorbs a <a href="https://link.springer.com/content/pdf/10.1007/s10103-022-03576-2.pdf">different wavelength of light</a>, so each colour requires a specific laser to be removed effectively. This may require using several different machines over the course of the treatment.</p>
<p>Some colours are much more challenging to remove than others. For instance, black ink is much easier to remove than yellow, which is easier to remove than <a href="https://pubmed.ncbi.nlm.nih.gov/33068020/">white</a>. This is because different pigments (such as black) are more likely to absorb the laser’s energy than others (yellow or white).</p>
<p>As a result, tattoos with white ink particles often need extra therapies. These include ablative laser treatments, which vaporise the tissue containing the tattoo ink, and tattooing over the original tattoo with a saline solution, which helps to draw the tattoo out of the skin.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/579109/original/file-20240301-30-zeap0m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Laser treatment to remove leg tattoo" src="https://images.theconversation.com/files/579109/original/file-20240301-30-zeap0m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/579109/original/file-20240301-30-zeap0m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/579109/original/file-20240301-30-zeap0m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/579109/original/file-20240301-30-zeap0m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/579109/original/file-20240301-30-zeap0m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/579109/original/file-20240301-30-zeap0m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/579109/original/file-20240301-30-zeap0m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">You may need several laser treatments to remove your tattoo.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/laser-tattoo-removal-leg-443862091">damiangretka/Shutterstock</a></span>
</figcaption>
</figure>
<p><strong>Combination of colours</strong></p>
<p>Tattoo inks can also be made up of many colours to achieve the desired shade.</p>
<p>For example, a red ink may have touches of yellow ink to create a poppy red. As the red particles are broken down, the yellow appears and must be treated with a different wavelength, sometimes requiring a different machine and extra sessions.</p>
<p><strong>Your skin colour</strong></p>
<p>Any laser that can target and destroy an ink particle can also <a href="https://link.springer.com/content/pdf/10.1007/s10103-022-03576-2.pdf">target natural skin pigment</a> and the cells that produce them. This can result in overheating of the skin, and in severe cases, damage or destruction of the cells that produce pigment. This causes the skin to either darken or lighten in response to the injury, sometimes permanently. </p>
<p>So it’s important to choose a tattoo removalist who not only knows how to operate the laser, but how to choose the right wavelengths and modify the treatment plan as the tattoo changes.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/thinking-of-getting-a-minor-cosmetic-procedure-like-botox-or-fillers-heres-what-to-consider-first-161271">Thinking of getting a minor cosmetic procedure like botox or fillers? Here's what to consider first</a>
</strong>
</em>
</p>
<hr>
<h2>Choosing a tattoo removalist</h2>
<p>Laser tattoo removal creates a <a href="https://link.springer.com/content/pdf/10.1007/s10103-022-03576-2.pdf">controlled wound</a> in your skin, so it’s important to choose the right service to get the result you want, without increasing your risk of complications.</p>
<p>But in Australia, there is no national regulation for laser tattoo removal services, so standardising practitioners’ education and the treatments they offer is an ongoing challenge. Instead, each state and territory either licenses its own practitioners, or has no licensing at all.</p>
<p>As there are no licensing requirements in Victoria, New South Wales, Australian Capital Territory, South Australia and the Northern Territory, anyone can legally own and operate laser devices to remove tattoos there.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/579114/original/file-20240301-18-lofsm1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Young person with tattoos on arms sitting at desk using laptop" src="https://images.theconversation.com/files/579114/original/file-20240301-18-lofsm1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/579114/original/file-20240301-18-lofsm1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/579114/original/file-20240301-18-lofsm1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/579114/original/file-20240301-18-lofsm1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/579114/original/file-20240301-18-lofsm1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/579114/original/file-20240301-18-lofsm1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/579114/original/file-20240301-18-lofsm1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Not all tattoo removal services are licensed, so you’ll have to do some research before booking yourself in.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-man-tattoo-using-laptop-table-437656087">Africa Studio/Shutterstock</a></span>
</figcaption>
</figure>
<p>But in <a href="https://www.health.qld.gov.au/public-health/industry-environment/personal-appearance/laser-licensing">Queensland</a>, <a href="https://www.health.tas.gov.au/health-topics/radiation-protection/applying-new-licence-or-amending-current-radiation-licence">Tasmania</a> and <a href="https://www.radiologicalcouncil.wa.gov.au/%7E/media/RadiologicalCouncil/Documents/PDFs/Notices/lasers-cosmetic-fact-sheet.pdf">Western Australia</a>, tattoo removal providers need a licence to operate and must have studied infection control, laser safety and tattoo removal. They also need to have many hours of supervised practical experience. </p>
<p>In unregulated states and territories, look for a practitioner with similar education and extensive practical experience, such as a bachelor-qualified <a href="https://www.dermalclinicians.com.au/dermal-locator">dermal clinician</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/more-than-skin-deep-beauty-salons-are-places-of-sharing-and-caring-127006">More than skin deep, beauty salons are places of sharing and caring</a>
</strong>
</em>
</p>
<hr>
<h2>How long will it take and how much will it cost?</h2>
<p>Most tattoos require multiple sessions to be effectively removed. The <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4411587/">inks and art style</a>, as well as the tattoo size, play a big role in how many sessions it will take – and how much it will cost.</p>
<p>An experienced practitioner will use the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2923953/">Kirby-Desai</a> scale – which includes noting your skin colour, body site, scarring, ink colour and density, and layering of ink – to estimate how many sessions your specific tattoo will need. </p>
<p>Typically, black fine-line tattoos are easier to remove than coloured high-density tattoos, such as a portrait or sleeve.</p>
<p>You’ll also need to allow time between sessions for your tattoo to recover, since the wound needs to heal before the next treatment. </p>
<p>After your laser treatment, your practitioner will advise you on how to manage the health of your skin. In many circumstances you will be asked to <a href="https://www.researchgate.net/publication/287123713_Laser_Treatment_of_Tattoos">keep the area cool</a>, and depending on the tissue response, you may need topical aftercare products (such as emollient creams and a protective hydrogel dressing) to keep the area clean and hydrated. </p>
<p>There are many variables that influence how quickly your tattoo will heal after treatment. This includes where the tattoo is (for instance, a chest tattoo heals faster than an ankle tattoo), the devices used, and your general health. The more compromised your health, the longer it will take to heal. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/tattoos-have-a-long-history-going-back-to-the-ancient-world-and-also-to-colonialism-165584">Tattoos have a long history going back to the ancient world – and also to colonialism</a>
</strong>
</em>
</p>
<hr>
<h2>Watch out for allergies</h2>
<p>Depositing tattoo ink in the dermis can cause <a href="https://link.springer.com/content/pdf/10.1007/s10103-022-03576-2.pdf">acute and chronic skin reactions</a>, including allergic or inflammatory reactions, infections, and hypersensitivity responses. So it’s important to tell your practitioner how your skin responded to the initial tattoo. That’s because you might be at risk of the same response again when the laser breaks down the tattoo ink. </p>
<p>An experienced practitioner will conduct a <a href="https://link.springer.com/content/pdf/10.1007/s10103-022-03576-2.pdf">thorough consultation</a> to ensure they identify any treatment risks. If necessary, they will work with your GP or dermatologist to ensure the safe removal of your tattoo.</p><img src="https://counter.theconversation.com/content/222595/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katie Lee receives funding from the National Health and Medical Research Council. </span></em></p><p class="fine-print"><em><span>Claire Coulstock and Samantha Reeve do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Not all tattoo removal services are licensed, so you’ll have to do some research before booking yourself in. Here’s what to look out for.Katie Lee, PhD Candidate, Dermatology Research Centre, The University of QueenslandClaire Coulstock, Lecturer in dermal science, Victoria UniversitySamantha Reeve, Course Chair and Lecturer, Bachelor of Dermal Sciences, Victoria UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2211552024-03-07T13:03:45Z2024-03-07T13:03:45ZWhy schools need to take sun safety more seriously – expert explains<figure><img src="https://images.theconversation.com/files/577546/original/file-20240223-16-azytla.jpg?ixlib=rb-1.1.0&rect=37%2C0%2C4195%2C2788&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The World Health Organization recommends formal school programmes as the key to preventing skin cancer.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-boy-having-sunscreen-applied-339150182">Paul Higley/Shutterstock</a></span></figcaption></figure><p>Despite the UK’s rainy climate, there is a one in six <a href="https://onlinelibrary.wiley.com/doi/10.1002/ski2.61">risk</a> of developing skin cancer. Children, especially, should take extra care as severe sunburn as a youngster more than <a href="https://www.skincancer.org/risk-factors/sunburn/">doubles</a> the chance of developing skin cancer later on. </p>
<p>But <a href="https://academic.oup.com/ced/advance-article/doi/10.1093/ced/llad458/7507665">new research</a> my colleagues and I conducted shows that less than half of primary schools in Wales have a formal sun safety policy.</p>
<p>With skin cancer rates continuing to rise by <a href="https://gettingitrightfirsttime.co.uk/medical_specialties/dermatology/">8% annually</a> in England and Wales, it’s a problem that’s not going away and the disease now accounts for half of all cancers. In 2020 alone, the cost of treating skin cancer in England was <a href="https://pubmed.ncbi.nlm.nih.gov/23554510/">estimated</a> to be more than £180 million.</p>
<p>There is hope, though. It is estimated that around <a href="https://www.skincancer.org/skin-cancer-information/skin-cancer-facts">90% of skin cancers</a> are due to ultraviolet (UV) radiation exposure from the sun. This means they can be prevented through safer behaviour. </p>
<p>In the UK, though, many people still <a href="https://academic.oup.com/her/article/20/5/579/611761">underestimate</a> the link between sunburn and skin cancer. Research paints a worrying picture, revealing disparities in sun protection awareness and behaviour across different groups. Notably, <a href="https://academic.oup.com/her/article/20/5/579/611761">men</a>, people living in <a href="https://pubmed.ncbi.nlm.nih.gov/26875569/">low-income neighbourhoods</a>, those belonging to <a href="https://academic.oup.com/her/article/20/5/579/611761">lower socioeconomic groups</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/28125871/">people of colour</a> are often found to be less informed about sun safety and are more likely to put themselves at risk. </p>
<p>With childhood a crucial time for learning healthy behaviour, teaching all children from a young age about sun protection could be one way to reduce future skin cancer rates. And the <a href="https://iris.who.int/bitstream/handle/10665/42678/9241590629_v1.pdf?sequence=1">World Health Organization</a> recommends formal school programmes as the key to prevention. </p>
<p>Overall, school-based interventions have been <a href="https://www.sciencedirect.com/science/article/pii/S0091743521000438">shown</a> to positively influence sun safe knowledge and behaviour. For example, <a href="https://doi.org/10.1093/her/cyt105">schools in Australia</a> with written policies show better sun protection practices than those without.</p>
<p>But in UK schools, the situation varies. The UK government’s Department for Education has issued <a href="https://www.gov.uk/government/publications/relationships-education-relationships-and-sex-education-rse-and-health-education/physical-health-and-mental-wellbeing-primary-and-secondary#by-the-end-of-primary-school">statutory guidance</a> for England that children should leave primary school knowing about sun safety and how to reduce the risk of getting skin cancer. </p>
<p>In Scotland and Northern Ireland, it is not a legal requirement to teach sun safety in schools. And in Wales, while sun safety is recommended as part of the Welsh Network of Healthy Schools scheme, again there is no mandatory requirement to have a sun safety policy or to teach skin cancer prevention. Nor are there central UK resources provided to help schools in this area. </p>
<figure class="align-center ">
<img alt="The red, peeling sunburnt back and shoulders of a young girl." src="https://images.theconversation.com/files/578006/original/file-20240226-21-2xd3jb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/578006/original/file-20240226-21-2xd3jb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/578006/original/file-20240226-21-2xd3jb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/578006/original/file-20240226-21-2xd3jb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/578006/original/file-20240226-21-2xd3jb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/578006/original/file-20240226-21-2xd3jb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/578006/original/file-20240226-21-2xd3jb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Being severely sunburnt as a youngster more than doubles the chance of developing future skin cancer.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/dangerous-sunburn-shoulders-young-girl-601094933">Alonafoto/Shutterstock</a></span>
</figcaption>
</figure>
<p>My colleagues and I wanted to know how many schools have a sun safety policy, a formal document that sets out a school’s position with respect to the education and provision of sun safety. We also wanted to understand whether the existence of a policy varied by area or school characteristic, and what support schools need. </p>
<p>In 2022, we sent a survey to all 1,241 primary schools in Wales. In total, 471 schools responded. </p>
<h2>What we found</h2>
<p>We found that only 39% of responding schools had a formal sun safety policy. And of these, not all enforced them. Schools that had more children receiving free school meals and with lower attendance rates were less likely to have a sun safety policy.</p>
<p>We asked schools that did not have a policy to tell us the reasons why not. Thirty-five per cent of schools were “not aware of the need”, while 27% of schools had “not got around to it just yet”. Thirty schools (13%) said that a sun safety policy was not a priority at this time. Clearly, there is work to be done on raising awareness among schools and school leaders on the role they can play in this area.</p>
<p>Of course, schools are busy places. So, when asked to indicate what would encourage them to create a sun safety policy, 73% of schools said assistance with development, while 56% said resources to aid the teaching of sun safety. </p>
<p>Previously both Cancer Research UK and the Wales-based Tenovus Cancer Care charities have offered support and guidelines for schools but this support is no longer easily available. The England-based charity <a href="https://www.skcin.org/ourWork/sunSafeSchools.htm">Sckin</a> has a comprehensive and free sun-safe schools accreditation scheme. Some schools told us they based their policies on resources supplied by the local authority, but this was not consistent across Wales.</p>
<p>UV levels will soon rise in the UK and now is the time for schools to start thinking about sun protection. Having a formal sun safety school policy sets out the position of the school when it comes to sun safety. When enforced and communicated properly, this makes it clear to everyone (governors, teachers, carers and pupils) their individual responsibilities when it comes to staying safe. </p>
<p>But with fewer than half of schools in Wales having formal policies, and not all enforced, awareness of the importance of this issue and the potential role of schools is lacking. </p>
<p>It is therefore time for sun safety policies to become mandatory for primary schools across the UK. This could help to improve knowledge and behaviour for all age groups. But adequate support and guidance must be also given to schools to help them educate children about sun safety and protect them while they are at school.</p><img src="https://counter.theconversation.com/content/221155/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julie Peconi received funding for the Sunproofed Study from Health and Care Research Wales through a Health Research Grant Award. She is also a volunteer with the charity Skin Care Cymru, a charity working to raise the profile of skin health in Wales. </span></em></p>Being severely sunburnt as a child more than doubles the chance of developing future skin cancer but less than half of primary schools questioned in new research have a sun safety policy.Julie Peconi, Senior Research Officer in Health Data Science, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2160782023-12-27T20:26:50Z2023-12-27T20:26:50ZThinking of a(nother) tattoo this summer? What you need to know about sunburn, sweating and fading<p>More of us have tattoos than ever before. About <a href="https://mccrindle.com.au/article/tattoos-on-the-rise-among-aussies/">25% of Australians</a> are inked. </p>
<p>A tattoo can be a large investment in time, money and pain.</p>
<p>So how do you take care of your tattooed skin? Here’s what you need to know about sunburn, sweating and fading.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/tattoos-have-a-long-history-going-back-to-the-ancient-world-and-also-to-colonialism-165584">Tattoos have a long history going back to the ancient world – and also to colonialism</a>
</strong>
</em>
</p>
<hr>
<h2>What’s a tattoo, dermatologically speaking?</h2>
<p>Tattoo inks are deposited in the <a href="https://dermnetnz.org/topics/the-structure-of-normal-skin">layer of skin</a> called the dermis. This layer contains sweat and oil glands, a blood supply, immune cells, collagen to support the skin’s structures, and fibroblasts, which produce collagen.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/563548/original/file-20231205-29-8elmtu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Cross-section of human skin showing epidermis and dermis" src="https://images.theconversation.com/files/563548/original/file-20231205-29-8elmtu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/563548/original/file-20231205-29-8elmtu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=300&fit=crop&dpr=1 600w, https://images.theconversation.com/files/563548/original/file-20231205-29-8elmtu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=300&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/563548/original/file-20231205-29-8elmtu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=300&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/563548/original/file-20231205-29-8elmtu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=377&fit=crop&dpr=1 754w, https://images.theconversation.com/files/563548/original/file-20231205-29-8elmtu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=377&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/563548/original/file-20231205-29-8elmtu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=377&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Tattoo inks are inserted into the dermis.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/normal-skin-layers-crosssection-human-structure-2339540305">zonn hong/Shutterstock</a></span>
</figcaption>
</figure>
<p>Fibroblasts <a href="https://www.sciencedirect.com/science/article/pii/S1470204511703400?via%3Dihub#bib74">take up</a> the ink particles, as do immune cells in the dermal tissue known as <a href="https://onlinelibrary.wiley.com/doi/10.1111/cup.12023">macrophages</a>. The ink particles also stick inside bundles of collagen.</p>
<p>Between these three mechanisms, the dermis holds tattoo inks so well they can be seen even on the 5,300-year-old <a href="https://www.sciencedirect.com/science/article/pii/S1296207415000023#bib0200">ice mummy Ötzi</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-otzi-the-prehistoric-iceman-can-teach-us-about-the-use-of-tattoos-in-ceremonial-healing-or-religious-rites-168058">What Ötzi the prehistoric iceman can teach us about the use of tattoos in ceremonial healing or religious rites</a>
</strong>
</em>
</p>
<hr>
<h2>Can I get a tattoo if I’m sunburnt?</h2>
<p>No, and many tattoo artists will not do it. During sunburn, your skin calls in extra immune cells and fluid to kill off and break down cells that have too much UV damage. </p>
<p>This <a href="https://link.springer.com/article/10.1007/s40257-017-0326-5">inflammation</a> can affect the tattoo ink deposits. You might not get the look you were after, with too much ink removed by your immune cells or swelling distorting the lines.</p>
<p>It’s much better to be proactive about sun protection before a tattoo, or at least be patient and reschedule when your skin has healed.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/i-cant-get-sunburnt-through-glass-shade-or-in-water-right-5-common-sunburn-myths-busted-150640">I can't get sunburnt through glass, shade or in water, right? 5 common sunburn myths busted</a>
</strong>
</em>
</p>
<hr>
<h2>How soon after my new tattoo can I go into the sun?</h2>
<p>There’s not much research on how soon you can expose your new tattoo to the sun. However, <a href="https://karger.com/drm/article/doi/10.1159/000533489/861717/An-Analysis-of-the-Content-and-Recommendations-of">most tattooists</a> advise you to avoid sun exposure while the tattoo heals, generally about three weeks.</p>
<p>This seems sensible, as your fresh tattoo is a type of wound.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/563560/original/file-20231205-25-bjthp5.jpg?ixlib=rb-1.1.0&rect=0%2C11%2C1920%2C1267&q=45&auto=format&w=1000&fit=clip"><img alt="Woman with sleeve tattoo heading to ocean, yoga mat under arm" src="https://images.theconversation.com/files/563560/original/file-20231205-25-bjthp5.jpg?ixlib=rb-1.1.0&rect=0%2C11%2C1920%2C1267&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/563560/original/file-20231205-25-bjthp5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/563560/original/file-20231205-25-bjthp5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/563560/original/file-20231205-25-bjthp5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/563560/original/file-20231205-25-bjthp5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/563560/original/file-20231205-25-bjthp5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/563560/original/file-20231205-25-bjthp5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Wait about three weeks before heading out into the sun with your new tattoo.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/crop-tattooed-woman-with-yoga-mat-against-river-4793296/">Anete Lusina/Pexels</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>Because the skin is damaged by inserting a needle, it’s not too surprising that the most common short-term complication is local inflammation with swelling, redness and discomfort at the tattoo site. There is an influx of immune cells to deal with the damage, much like a sunburn.</p>
<p>So, in one way, you should treat your new tattoo like sunburn and <a href="https://www.aad.org/public/everyday-care/injured-skin/burns/treat-sunburn">avoid sun exposure</a> while it heals. </p>
<p>But you shouldn’t use <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7442309/">sunscreen</a> on the tattoo in that time. That’s because sunscreen can <a href="https://www.futuremedicine.com/doi/10.2217/nnm.12.196?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed">enter the dermis</a> through the puncture wounds and cause more irritation. Cover your new tattoo with loose clothing instead.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/do-beach-cabanas-actually-protect-you-from-the-sun-199102">Do beach cabanas actually protect you from the sun?</a>
</strong>
</em>
</p>
<hr>
<h2>What happens if my tattoo gets sunburnt?</h2>
<p><a href="https://onlinelibrary.wiley.com/doi/10.1111/jdv.12093">Sunlight-induced reactions</a> to both new and existing tattoos are common. There’s usually swelling, itching or stinging on the tattoo site that can start immediately or develop over the course of a day. We’re not really sure why this happens.</p>
<p>Most of the time, these reactions are unpleasant but don’t require medical treatment, much like sunburn. </p>
<p>There is also a small amount of evidence that sunburn on a tattoo temporarily suppresses the skin’s immune system, allowing an <a href="https://onlinelibrary.wiley.com/doi/10.1111/j.1468-3083.2004.01121.x">infection</a> to become established.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/common-skin-rashes-and-what-to-do-about-them-91518">Common skin rashes and what to do about them</a>
</strong>
</em>
</p>
<hr>
<h2>Do tattoos increase my risk of skin cancer?</h2>
<p>Some <a href="https://www.sciencedirect.com/science/article/pii/S1470204511703400?via%3Dihub#bib4">ink components</a>, such as mercury or carbon black, are suspected cancer-causing agents when used in other applications. However, there’s <a href="https://www.sciencedirect.com/science/article/pii/S1470204511703400?via%3Dihub">no evidence</a> skin cancers are more likely in tattooed skin.</p>
<p>Tattoos make newly-developed skin cancers <a href="https://onlinelibrary.wiley.com/doi/10.1111/ajd.12219">more difficult to detect</a>. Besides making the lesion more difficult to spot in the first place, the colours of the tattoo interfere with your doctor’s assessment of the colours in the lesion, which can be an important sign of cancer.</p>
<p>So it’s a good idea to get familiar with the moles and freckles on a patch of skin before you’re inked, and check them yourself once a month for changes. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/563561/original/file-20231205-15-fbd5ki.jpg?ixlib=rb-1.1.0&rect=2%2C2%2C995%2C663&q=45&auto=format&w=1000&fit=clip"><img alt="Man with tattoos spraying sunscreen on arms" src="https://images.theconversation.com/files/563561/original/file-20231205-15-fbd5ki.jpg?ixlib=rb-1.1.0&rect=2%2C2%2C995%2C663&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/563561/original/file-20231205-15-fbd5ki.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/563561/original/file-20231205-15-fbd5ki.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/563561/original/file-20231205-15-fbd5ki.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/563561/original/file-20231205-15-fbd5ki.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/563561/original/file-20231205-15-fbd5ki.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/563561/original/file-20231205-15-fbd5ki.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Don’t use sunscreen on new tattoos but after about three weeks, go for it.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/tattooed-man-applying-sunscreen-cream-on-2338700035">Pixel-Shot/Shutterstock</a></span>
</figcaption>
</figure>
<p>Red tattoos seem to be more prone to large but benign (non-cancerous) skin tumours called <a href="https://dermnetnz.org/topics/keratoacanthoma">keratoacanthomas</a>. These appear within a few months of tattooing, and often grow rapidly but then heal by themselves.</p>
<p>However, they can be difficult to distinguish from <a href="https://karger.com/drm/article/237/2/309/115107/Keratoacanthomas-and-Squamous-Cell-Carcinomas-on">squamous cell carcinomas</a> (a type of skin cancer). They can also damage underlying structures, such as nerves and muscles. So they often need to be removed anyway.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-do-i-need-a-skin-cancer-check-48096">Health Check: do I need a skin cancer check?</a>
</strong>
</em>
</p>
<hr>
<h2>Can sunlight fade my tattoo?</h2>
<p>As tattoos age, they can fade a bit as some of the loose ink particles filter deeper into the dermis. Sun exposure can also degrade ink particles.</p>
<p>There’s limited research on this in human skin. After all, most people don’t want to fade their tattoos for science. So most of what we know is from research <a href="https://onlinelibrary.wiley.com/doi/10.1111/j.1600-0625.2009.00925.x">in mice</a>.</p>
<p>However, modern tattoo inks give you a strong colour. So in practice, you might not notice any fading for years.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/friday-essay-power-perils-and-rites-of-passage-the-history-of-the-female-tattoo-72725">Friday essay: power, perils and rites of passage – the history of the female tattoo</a>
</strong>
</em>
</p>
<hr>
<h2>Does tattooed skin sweat differently to un-inked skin?</h2>
<p>This is an important question, because sweating is a major way our body avoids overheating in the summer. If you’ve got a full sleeve or your whole back is your canvas, that’s a significant amount of skin.</p>
<p>Since tattooing punctures the skin repeatedly, <a href="https://journals.physiology.org/doi/full/10.1152/japplphysiol.00427.2019?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org">sweat glands</a> in the dermis may be damaged.</p>
<p>But the research on tattoos’ impact on sweating is mixed and depends on what you are doing at the time.</p>
<p>In <a href="https://journals.physiology.org/doi/full/10.1152/japplphysiol.00427.2019?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org">one study</a>, researchers used a heatable suit to increase study participants’ internal body temperature by 1°C. Tattooed areas produced about 15% less sweat. It’s not clear if this is enough to increase the risk of heat stress.</p>
<p>However, when other researchers looked at sweating <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9463223/">induced by exercise</a> there was no effect in the volume of sweat between tattooed and un-tattooed skin.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-tattoos-became-fashionable-in-victorian-england-122487">How tattoos became fashionable in Victorian England</a>
</strong>
</em>
</p>
<hr>
<h2>Longer-term risks</h2>
<p>When performed under the clean conditions of a licenced tattoo parlour, tattooing is relatively safe. </p>
<p>But long term, some people develop <a href="https://link.springer.com/article/10.1007/s40257-017-0326-5">allergic reactions</a> to certain colours due to the different compounds in each, most commonly red dyes. This can cause lumps, scales, scarring or other visible changes.</p>
<p>So, what’s the most common long-term side effect of tattoos? Tattoo regret and wanting to have them <a href="https://link.springer.com/article/10.1007/s12016-016-8532-0">removed</a>.</p><img src="https://counter.theconversation.com/content/216078/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katie Lee receives funding from the National Health and Medical Research Council. </span></em></p><p class="fine-print"><em><span>Erin McMeniman does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A tattoo can be a large investment in time, money and pain. Here’s how to look after yours this summer.Katie Lee, PhD Candidate, The University of QueenslandErin McMeniman, Senior Lecturer Princess Alexandra Hospital Southside Clinical Unit and Casual Research Assistant, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2118612023-08-23T12:25:48Z2023-08-23T12:25:48ZAcne bacteria trigger cells to produce fats, oils and other lipids essential to skin health – new research<figure><img src="https://images.theconversation.com/files/543536/original/file-20230818-27-a54vaz.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2094%2C1416&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There's more to the bacterium _Cutibacterium acnes_ than meets the eye.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/cropped-shot-of-the-face-of-a-young-woman-with-royalty-free-image/1581451668">Youngoldman/iStock via Getty Images Plus</a></span></figcaption></figure><p>The skin is the <a href="https://theconversation.com/the-skin-is-a-very-important-and-our-largest-organ-what-does-it-do-91515">largest organ of the body</a>, and it plays a crucial role as the first line of defense against pathogens and insults from the external environment. It provides important functions like temperature regulation and moisture retention. And despite the misconception that lipids harm your skin by causing oiliness and acne, they actually <a href="https://doi.org/10.1126/sciadv.adg6262">play a vital role</a> in maintaining the skin barrier.</p>
<p>Lipids – organic compounds that include <a href="https://www.khanacademy.org/science/biology/macromolecules/lipids/a/lipids">fats, oils, waxes and other types of molecules</a> – are essential components of the outermost layer of skin. Changes to the skin’s lipid composition can disrupt its ability to function as a protective barrier, leading to a <a href="https://doi.org/10.1046/j.0022-202x.2001.01455.x">range of skin diseases</a>, including eczema and psoriasis.</p>
<p>Human skin is colonized by <a href="https://doi.org/10.1038/nrmicro.2017.157">thousands of species of bacteria</a>. One of the most common microbes on the skin, <a href="https://doi.org/10.3390/microorganisms9030628"><em>Cutibacterium acnes</em>, or <em>C. acnes</em></a>, is well known for its potential involvement in causing acne, but its broader effects on skin health are less understood.</p>
<p>I am a <a href="https://profiles.ucsd.edu/samia.l.almoughrabie">researcher in dermatology</a> working in the <a href="https://dermatology.ucsd.edu/research/basic-science/gallo-lab/index.html">Gallo Lab</a> at the University of California, San Diego. My colleagues and I study how the skin defends the body against infections and the environment, with a particular focus on the skin microbiome, or the microbes living on the skin. In our recently published research conducted in collaboration with SILAB, a company developing active ingredients for skincare products, we found that <em>C. acnes</em> triggers certain skin cells to <a href="https://doi.org/10.1126/sciadv.adg6262">significantly increase production of lipids</a> that are important to maintaining the skin barrier.</p>
<h2>Skin bacteria and lipid synthesis</h2>
<p>To determine the role that bacteria play in lipid production, we exposed keratinocytes, the cells that <a href="https://www.britannica.com/science/human-skin/The-epidermis#">make up the epidermis</a>, to different bacteria naturally present on the skin and analyzed changes in lipid composition. </p>
<p>Of the common skin bacteria we tested, only <em>C. acnes</em> triggered an <a href="https://doi.org/10.1126/sciadv.adg6262">increase in lipid production</a> within these cells. More specifically, we found a threefold increase in total lipids, including ceramides, cholesterol, free fatty acids and especially triglycerides. Each of these lipid types are essential to maintaining the skin barrier, locking in moisture and protecting against damage. These findings suggest that <em>C. acnes</em> plays a distinctive role in the lipid skin regulation. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/MWE3U3FItlc?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The skin microbiome contains bacteria and other microbes that help protect your body.</span></figcaption>
</figure>
<p>We found that <em>C. acnes</em> induced this increase in lipid production by producing a type of short-chain fatty acid called <a href="https://doi.org/10.1126/sciadv.adg6262">propionic acid</a>. Propionic acid creates an acidic skin environment that provides a number of benefits, including limiting pathogen growth, reducing staph infections and contributing to anti-inflammatory effects in the gut. </p>
<p>We also identified the <a href="https://doi.org/10.1126/sciadv.adg6262">specific gene and receptor</a> that regulate lipid synthesis through <em>C. acnes</em>. Blocking these components also blocked <em>C. acnes</em>-induced lipid synthesis.</p>
<p>In all, our findings highlight the substantial role that a common skin bacterium and its chemical byproducts play in shaping the composition of skin lipids.</p>
<h2>Reinforcing the skin barrier</h2>
<p>Our research suggests that propionic acid from <em>C. acnes</em> has <a href="https://doi.org/10.1126/sciadv.adg6262">multiple advantageous effects</a> on the skin barrier. For example, by increasing the lipid content in skin cells, propionic acid reduced water loss through the skin.</p>
<p>We also found that the lipids skin cells produce after exposure to <em>C. acnes</em> or propionic acid have antimicrobial effects against <em>C. acnes</em>. This suggests that the lipids <em>C. acnes</em> helps produce have a dual role: They not only control the presence of <em>C. acnes</em> on the skin but also contribute to the overall balance of the skin microbiome so one species of microbe doesn’t dominate the rest.</p>
<p>In the complex interplay between the skin and its microbial inhabitants, the ubiquitous <em>C. acnes</em> is emerging as an important player. Further research to better understand the skin microbiome may help lead to new treatments for skin conditions.</p><img src="https://counter.theconversation.com/content/211861/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Samia Almoughrabie does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Bacteria and lipids get a bad rap for causing breakouts and oily skin. But both play an essential role in helping your skin barrier stay strong against pathogens and insults from the environment.Samia Almoughrabie, Postdoctoral Researcher in Dermatology, University of California, San DiegoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2010822023-07-27T02:08:56Z2023-07-27T02:08:56ZWhat is dandruff? How do I get rid of it? Why does it keep coming back?<figure><img src="https://images.theconversation.com/files/536006/original/file-20230706-25-n7njvh.jpg?ixlib=rb-1.1.0&rect=2%2C0%2C995%2C667&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/dander-that-causes-itching-scalp-373934782">Shutterstock</a></span></figcaption></figure><p>Dandruff can be dry, like snowflakes, or greasy, with yellow clumps. <a href="https://www.ncbi.nlm.nih.gov/books/NBK551707/">Up to half</a> of all adults have had this scalp condition at one point, so you’ll no doubt know about these skin flakes and the itchiness. </p>
<p>Dandruff can be <a href="https://onlinelibrary.wiley.com/doi/10.1111/j.1439-0507.2008.01624.x">embarrassing</a>. It can affect many aspects of people’s lives, such as how they socialise, how they style their hair, and what clothes they wear.</p>
<p>Dandruff is not a modern problem. In fact, it has been around for millennia and was <a href="https://pubmed.ncbi.nlm.nih.gov/2181905/">described</a> by Greek physicians. We don’t know for sure whether our ancestors were as bothered by it as much as we are today. But they were interested in what causes it.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/big-hair-bald-how-much-difference-your-hair-really-makes-to-keep-you-cool-or-warm-201380">Big hair? Bald? How much difference your hair really makes to keep you cool or warm</a>
</strong>
</em>
</p>
<hr>
<h2>What causes dandruff?</h2>
<p>Dandruff is mainly caused by the yeast <em><a href="https://www.cell.com/cell-host-microbe/pdf/S1931-3128(19)30106-4.pdf">Malassezia</a></em>. The yeast lives on most people’s skin, either on the surface or in the opening of the hair follicle, the structure that surrounds a hair’s root and strand.</p>
<p>The yeast feeds on sebum, the natural moisturiser secreted by your sebaceous glands to stop your skin drying out. These glands are attached to every hair follicle and the hair provides a dark, sheltered micro-environment ideal for the yeast to flourish.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/536003/original/file-20230706-22-6t0yr8.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Diagram of skin cross-section showing hair follicle and other skin structures" src="https://images.theconversation.com/files/536003/original/file-20230706-22-6t0yr8.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/536003/original/file-20230706-22-6t0yr8.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=520&fit=crop&dpr=1 600w, https://images.theconversation.com/files/536003/original/file-20230706-22-6t0yr8.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=520&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/536003/original/file-20230706-22-6t0yr8.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=520&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/536003/original/file-20230706-22-6t0yr8.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=653&fit=crop&dpr=1 754w, https://images.theconversation.com/files/536003/original/file-20230706-22-6t0yr8.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=653&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/536003/original/file-20230706-22-6t0yr8.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=653&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The yeast that causes dandruff lives on the skin surface and in the opening of the hair follicle.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/medical-education-chart-biology-hair-diagram-645657787">Shutterstock</a></span>
</figcaption>
</figure>
<p>As the yeast grows, it releases molecules that irritate the skin and disrupts how the skin normally renews itself. This causes the cells to cluster together, appearing as white flakes. When there is excess sebum, this can mix with the cells and cause the dandruff to appear <a href="https://www.headandshoulders.co.in/en-in/healthy-hair-and-scalp/dandruff/yellow-dandruff">yellow</a>.</p>
<p>The link between dandruff and yeast was made nearly 150 years ago. The person who first identified and described this yeast <a href="https://www.cell.com/cell-host-microbe/pdf/S1931-3128(19)30106-4.pdf">in 1874</a> was Louis-Charles Malassez (the yeast’s namesake).</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/invisible-skin-mites-called-demodex-almost-certainly-live-on-your-face-but-what-about-your-mascara-195451">Invisible skin mites called Demodex almost certainly live on your face – but what about your mascara?</a>
</strong>
</em>
</p>
<hr>
<h2>Why do I have dandruff?</h2>
<p>As <em>Malassezia</em> is found on most people, why do some people get dandruff and others don’t? This depends on a range of factors.</p>
<p>These include the quality of your skin barrier. This may mean yeast can penetrate deeper if the skin is damaged in some way, for example, if it’s sunburnt. Other factors include your immunity, and external factors, such as which hair-care products you use.</p>
<p>How <em>Malassezia</em> grows also depends on the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4864613/">balance</a> of other microorganisms that live on your skin, such as bacteria.</p>
<h2>How do I get rid of dandruff?</h2>
<p>Dandruff is mostly treated with <a href="https://www.sciencedirect.com/science/article/abs/pii/S0939641123000292?via%3Dihub">anti-fungal</a> shampoos and scalp treatments to dampen down growth of <em>Malassezia</em>. The shampoos most commonly contain the anti-fungal agent <a href="https://pubmed.ncbi.nlm.nih.gov/34575891/">zinc pyrithione</a> (ZnPT for short). Other common anti-fungals in shampoos include selenium sulfide, ketoconazole and coal tar. </p>
<p>You can also treat dandruff with scalp masks and scrubs that help restore the scalp barrier, by reducing inflammation and irritation. But as these may not have any anti-fungal action, your dandruff is likely to return.</p>
<p>Home remedies <a href="https://www.healthline.com/nutrition/ways-to-treat-dandruff#7.-Omega-3s">include</a> tea tree oil, coconut or other oils, and honey. There is some evidence to support their use, mostly from <a href="https://pubmed.ncbi.nlm.nih.gov/35642120/">studies</a> that show extracts from botanical ingredients can reduce growth of the yeast in the lab. But there is great variation in the quality and composition of these ingredients.</p>
<p>There is also the risk of making the problem worse by providing more oils that the yeast will enjoy, causing more imbalance to the scalp micro-organisms and leading to more irritation.</p>
<p>So it’s best to stick with commercial products.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/does-the-price-of-your-shampoo-affect-how-clean-your-hair-is-heres-the-science-71597">Does the price of your shampoo affect how clean your hair is? Here's the science</a>
</strong>
</em>
</p>
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<h2>Why does my dandruff come back?</h2>
<p>Your dandruff is likely to return unless the active ingredients in your shampoo can reach the right spot, at the right concentration, for the right amount of time needed to kill the yeast. </p>
<p>Our <a href="https://pubmed.ncbi.nlm.nih.gov/36842718/">research</a> focussing on zinc pyrithione-based products showed these shampoos reached the skin surface. But they less-reliably ended up in the harder-to-reach hair follicles.</p>
<p>We found the zinc pythione seemed <a href="https://pubmed.ncbi.nlm.nih.gov/35631659/">to target</a> the top of the follicles rather than deep into the follicles. </p>
<p>So this may explain why dandruff keeps on coming back. Your shampoo’s active ingredient may not reach the yeast that causes your dandruff.</p>
<p>We don’t yet know how we can encourage existing formulations to penetrate deeper into the follicles.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-toe-jam-from-harmless-gunk-to-a-feast-for-bugs-177454">What is toe jam? From harmless gunk to a feast for bugs</a>
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</em>
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<h2>What about future treatments?</h2>
<p>We’ll likely see new formulations of dandruff shampoos and scalp treatments that better deliver the active ingredient to where it’s needed – deeper into the hair follicles.</p>
<p>We can also expect new active ingredients, such as <a href="https://pubmed.ncbi.nlm.nih.gov/28766952/">carbonic anhydrase</a> enzymes. These might target how the yeast grows in a different way to current active ingredients.</p>
<p>We are also beginning to see the development of creams and lotions that aim to boost the health balance of flora of the skin, much like we see with similar products for the gut. These include pre-biotics (supplements or food for skin flora) or pro-biotics (products that contain skin flora). However we have <a href="https://www.mdpi.com/2079-9284/8/3/90/htm">much to learn</a> about these types of formulations.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/your-bed-probably-isnt-as-clean-as-you-think-a-microbiologist-explains-163513">Your bed probably isn’t as clean as you think – a microbiologist explains</a>
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</em>
</p>
<hr>
<h2>In a nutshell</h2>
<p>Dandruff is annoying, treatment helps, but you may need to repeat it. Hopefully, we can develop improved shampoos that better deliver the active ingredient to where it’s needed.</p>
<p>But we need to strike a balance. We don’t want to eliminate all micro-organisms from our skin.</p>
<p>These are important for our immunity, including preventing more disease-causing microbes (pathogens) from moving in. They also help the skin produce antimicrobial peptides (short proteins) that protect us from pathogens.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/essays-on-health-microbes-arent-the-enemy-theyre-a-big-part-of-who-we-are-79116">Essays on health: microbes aren't the enemy, they're a big part of who we are</a>
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<img src="https://counter.theconversation.com/content/201082/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sean Mangion is also a medical student at The University of Sydney. </span></em></p><p class="fine-print"><em><span>Lorraine Mackenzie does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>We’ve known about dandruff for thousands of years. Here’s how to get rid of yours.Lorraine Mackenzie, Associate Professor, Clinical and Health Sciences, University of South AustraliaSean Mangion, PhD Candidate, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2083632023-07-12T02:17:21Z2023-07-12T02:17:21ZWhy is eczema sometimes treated with a diluted bleach bath? And what do I need to know before trying it?<figure><img src="https://images.theconversation.com/files/533621/original/file-20230623-15-xi7q7.jpg?ixlib=rb-1.1.0&rect=8%2C33%2C5621%2C3722&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Diluted bleach baths are a common treatment doctors and nurses use for patients with more severe eczema. It is important to note they may not replace other treatments and may not be suitable for everyone. </p>
<p>This treatment should only ever be used under the guidance of a dermatologist or doctor, who can advise if it’s appropriate and tailor the dilution ratio to suit the individual’s condition.</p>
<p>So why and how does it work for some eczema sufferers? And what should one know before trying it?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/ive-always-wondered-why-do-we-get-dark-circles-under-our-eyes-90172">I've always wondered: why do we get dark circles under our eyes?</a>
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</em>
</p>
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<h2>Germs can colonise damaged eczema skin</h2>
<p>Eczema is a genetic condition that causes a person’s skin to be easily inflamed by certain triggers, such as hot water or soaps. The person’s skin barrier becomes damaged and itchy, allowing germs to get established and cause even more problems.</p>
<p>The most common germ found in the damaged eczema skin is <em>staphylococcus aureus</em>. Certain toxic materials known as “membrane-bound vesicles” are released by the staph germ, which causes an even more profound reaction in the skin, <a href="https://pubmed.ncbi.nlm.nih.gov/27910159/">worsening the eczema</a>. Treating – or at least reducing – the amount of staph in the skin can help the eczema recover.</p>
<p>When eczema is very active, the skin literally bubbles with fluid and can begin to weep. Bacteria love to colonise and infect this type of eczema. This process is known as “impetiginisation”. </p>
<p>When this process occurs without eczema, it is called impetigo (also known as school sores). </p>
<p>A solution of water and sodium hypochlorite (in other words, bleach) will rapidly <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1580803/pdf/amjphnation01146-0053.pdf">kill</a> germs. And we know from <a href="https://pubmed.ncbi.nlm.nih.gov/17015593/">studies</a> on wounds that simple washing of a wound reduces the number of bacteria. </p>
<p>So it’s likely a gentle washing action is part of the effect, in some cases, and could be made more effective with subtle water jets.</p>
<p>For example, using a water squeeze toy for young children to create a gentle wash of water could help remove some of the build-up of body fluids in the broken eczema areas. </p>
<p>This would obviously need to be done very gently so it was not uncomfortable. Friction and rubbing of eczema – particularly with cloths and towels – generally makes things much worse.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/535989/original/file-20230706-1723-hte9mu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/535989/original/file-20230706-1723-hte9mu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/535989/original/file-20230706-1723-hte9mu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/535989/original/file-20230706-1723-hte9mu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/535989/original/file-20230706-1723-hte9mu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/535989/original/file-20230706-1723-hte9mu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/535989/original/file-20230706-1723-hte9mu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/535989/original/file-20230706-1723-hte9mu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Friction and rubbing can make eczema worse.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<h2>Reducing inflammation</h2>
<p>Researchers have also shown sodium hypochlorite can <a href="https://doi.org/10.1172/JCI70895">reduce inflammation</a> in the skin. This is another reason the treatment is recommended.</p>
<p>Eczema often involves a vicious cycle of inflammation, where redness and increasing itchiness leads to scratching and even more irritation. The skin breaks even more and the eczema worsens, leading to yet more inflammation. </p>
<p>A diluted bleach bath can help break this vicious cycle.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/535995/original/file-20230706-27-g7af4c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/535995/original/file-20230706-27-g7af4c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/535995/original/file-20230706-27-g7af4c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/535995/original/file-20230706-27-g7af4c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/535995/original/file-20230706-27-g7af4c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/535995/original/file-20230706-27-g7af4c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/535995/original/file-20230706-27-g7af4c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/535995/original/file-20230706-27-g7af4c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The bleach should be diluted in the bathwater to ensure it is safe for your skin.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<h2>You need to know what you’re doing</h2>
<p>Diluted bleach bath instructions need to be tailored to the eczema, so don’t try it at home unless you’ve been advised by a dermatologist or doctor. An example of how to perform a bleach bath might look like this:</p>
<p><strong>1. Dilution ratio:</strong> The bleach should be diluted in the bathwater to ensure it is safe for your skin. A typical dilution ratio may be ½ cup (120 ml) of household bleach (containing 5-6% sodium hypochlorite) per 150 litres of lukewarm water. However, the exact dilution ratio may vary based on the severity of your eczema, age and other factors. Children may need less bleach in their bath. Check with your doctor because getting the ratio wrong can cause pain and harm.</p>
<p><strong>2. Soak time:</strong> The recommended soak time in the bleach bath is usually around ten minutes. During this time, gently pat or submerge your affected skin areas in the water. Avoid scrubbing or rubbing the skin vigorously, as it may further irritate or damage the skin.</p>
<p><strong>3. Rinse thoroughly:</strong> After the designated soak time, carefully rinse off the bleach solution from your body with cool water. Make sure to remove all traces of the bleach, as residual bleach left on the skin may cause irritation.</p>
<p><strong>4. Moisturise:</strong> After the bath, promptly apply a moisturiser or emollient to your skin while it is still slightly damp. This helps lock in moisture and maintain hydration, which is crucial for eczema management.</p>
<p><strong>5. Frequency:</strong> The frequency of bleach baths can vary depending on your specific condition. Typically, they are done two to three times a week, but this may vary.</p>
<p><strong>6. Monitoring and follow-up:</strong> It is essential to monitor your skin’s response to bleach baths. If you notice any increased redness, irritation or discomfort, discontinue the baths and talk to your dermatologist.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-treat-scars-at-home-and-hopefully-make-them-disappear-193948">How to treat scars at home – and hopefully make them disappear</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/208363/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Freeman does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>When eczema is very active, the skin literally bubbles with fluid and can begin to weep. Bacteria love to colonise and infect this type of eczema.Michael Freeman, Associate Professor of Dermatology, Bond UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2065602023-06-29T12:16:40Z2023-06-29T12:16:40ZRingworm fungal infections are common in the US and are becoming increasingly resistant to treatment – 6 questions answered<figure><img src="https://images.theconversation.com/files/533284/original/file-20230621-19-utzvta.jpg?ixlib=rb-1.1.0&rect=0%2C43%2C7245%2C4772&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Ringworm is often easy to spot with its characteristic red rings on the skin.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/ringworm-illustration-royalty-free-illustration/1407269449?phrase=ringworm&adppopup=true">Kateryna Kon/Science Photo Library via Getty Images</a></span></figcaption></figure><p><em>The World Health Organization considers antimicrobial resistance to be one of the most <a href="https://www.unep.org/explore-topics/chemicals-waste/what-we-do/emerging-issues/antimicrobial-resistance-global-threat#">serious threats for global health</a>. Similar to <a href="https://www.cdc.gov/drugresistance/about.html#">the way bacteria have developed resistance to antibiotics</a>, fungal infections throughout the world are <a href="https://doi.org/10.1038/s41579-022-00720-1">becoming more drug-resistant</a> and <a href="https://theconversation.com/fungal-infections-worldwide-are-becoming-resistant-to-drugs-and-more-deadly-161975">more deadly</a>.</em> </p>
<p><em>In early 2023, the New York State Department of Health reported two cases of <a href="https://medlineplus.gov/tineainfections.html">severe tinea</a>, a contagious type of ringworm infection. The Centers for Disease Control and Prevention later reported that they were caused by a species of fungus that has been <a href="https://www.cdc.gov/mmwr/volumes/72/wr/mm7219a4.htm">spreading throughout South Asia</a> over the past decade.</em></p>
<p><em>The Conversation spoke with <a href="https://rodneyerohde.wp.txstate.edu/">Rodney Rohde</a>, a medical laboratory professional and public health microbiologist, about the prevalence of ringworm and the growing threat of antifungal resistance around the world.</em></p>
<h2>1. What is ringworm and how common is it?</h2>
<p>When one hears the term ringworm, it likely conjures images of a nasty parasitic worm infection. However, a ringworm infection is a common infection of the skin caused by a fungus. Experts state that about <a href="https://my.clevelandclinic.org/health/diseases/4560-ringworm">20%-25% of the population</a> will experience a ringworm infection at any given time.</p>
<p><a href="https://www.cdc.gov/fungal/about-fungal-diseases.html">Fungi can be found almost anywhere</a> – soil, plants, surfaces, on the skin and in our bodies, and even in the air. Research shows that there are <a href="https://www.cdc.gov/fungal/diseases/ringworm/definition.html">up to 40 types of fungus</a> that can cause these ringworm infections, with the most common types being from the genuses <em><a href="https://en.wikipedia.org/wiki/Trichophyton">Trichophyton</a></em>, <em><a href="https://en.wikipedia.org/wiki/Microsporum">Microsporum</a></em> or <em><a href="https://en.wikipedia.org/wiki/Epidermophyton">Epidermophyton</a></em>. </p>
<p><a href="https://www.cdc.gov/fungal/diseases/ringworm/definition.html">Medical terms for ringworm</a> are “tinea” and “dermatophytosis.” Tinea and dermatophytosis are synonyms for a contagious fungal infection of the skin. Other names for ringworm are based on its location on the body – for example, ringworm on the feet is commonly called <a href="https://www.mayoclinic.org/diseases-conditions/athletes-foot/symptoms-causes/syc-20353841">athlete’s foot</a>, and ringworm associated with the groin area is referred to as jock itch. These are characterized by a persistent itchy rash that can appear flaky and cracked.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/y-X_fWIGBZQ?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Ringworm is a fungal infection; it is not caused by a worm.</span></figcaption>
</figure>
<p>While anyone can be infected, ringworm is most commonly picked up in the following circumstances: </p>
<p>– A weakened immune system or an <a href="https://my.clevelandclinic.org/health/diseases/4875-lupus">autoimmune disease like lupus</a>.</p>
<p>– Playing a high-contact sport, like wrestling; this ringworm is called <a href="https://doi.org/10.3390/jcm11144066">tinea gladiatorum</a>.</p>
<p>– Profuse sweating, also known as <a href="https://my.clevelandclinic.org/health/diseases/17113-hyperhidrosis">hyperhidrosis</a>.</p>
<p>– The use of public showers or locker rooms.</p>
<p>– Handling or working with infected animals.</p>
<p>– Living in a subtropical or tropical region. </p>
<h2>2. How can you recognize ringworm?</h2>
<p>The hair, skin and nails of either fingers or toes are the likely landing spots for a ringworm infection. Signs and symptoms of an infection usually depend on which part of the body is affected, but generally may include hair loss and red, scaly, cracked skin. However, the most well-known sign that gives this infection its ironic and misplaced name – ringworm – is the hallmark ring-shaped rash.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/533286/original/file-20230621-24-ebqol9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Top view of a scalp with hair missing in the circlular shape of a ringworm infection." src="https://images.theconversation.com/files/533286/original/file-20230621-24-ebqol9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/533286/original/file-20230621-24-ebqol9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=449&fit=crop&dpr=1 600w, https://images.theconversation.com/files/533286/original/file-20230621-24-ebqol9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=449&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/533286/original/file-20230621-24-ebqol9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=449&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/533286/original/file-20230621-24-ebqol9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=564&fit=crop&dpr=1 754w, https://images.theconversation.com/files/533286/original/file-20230621-24-ebqol9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=564&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/533286/original/file-20230621-24-ebqol9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=564&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Ringworm commonly affects the scalp area and can cause hair loss.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/medical-illustration-of-ringworm-of-the-royalty-free-illustration/1293052667?phrase=ringworm">Viktoriya Kabanova/iStock via Getty Images Plus</a></span>
</figcaption>
</figure>
<h2>3. How does ringworm spread?</h2>
<p><a href="https://theconversation.com/fungal-infections-worldwide-are-becoming-resistant-to-drugs-and-more-deadly-161975">Many fungi can be seen with the naked eye</a>, such as common mushrooms or bread mold. </p>
<p>Fungi can grow in two forms: yeasts, which are single round cells, and molds, which are made up of many cells forming long, thin, hairlike threads called hyphae. Some of them can exhibit both forms of growth and thrive in decaying organic material like soil or a plant. But fungi can also grow in unexpected places, such as on wallpaper. </p>
<p>Fungi are relatively easily transmitted because of their ability to survive on a <a href="https://asm.org/Articles/2023/March/The-Role-of-Bacterial-Biofilms-in-Antimicrobial-Re">diversity of surfaces, including medical devices</a>.</p>
<p><a href="https://www.merckmanuals.com/home/infections/fungal-infections/overview-of-fungal-infections">Fungal transmission</a> occurs via <a href="https://www.cdc.gov/fungal/diseases/ringworm/sources.html">three primary routes</a>: by coming into close contact with another person who has a ringworm infection; by touching an infected animal, be it livestock, pets or wildlife; or by contacting an infected surface.</p>
<p>Some types of <a href="https://www.aad.org/public/diseases/a-z/ringworm-causes">fungi can thrive where it’s warm and humid</a>. Ringworm occurs more frequently <a href="https://doi.org/10.3390%2Fjof8010039">in tropical areas </a> and during hot, humid summers. </p>
<h2>4. How can you reduce the likelihood of getting it?</h2>
<p>Some of the best ways to <a href="https://www.cdc.gov/fungal/diseases/ringworm/risk-prevention.html">reduce or prevent a ringworm or other fungal infection</a> include:</p>
<p>– Wash hands with soap and warm water.</p>
<p>– Have your pets checked regularly for ringworm. </p>
<p>– Wear shoes and socks that are made of lightweight, breathable materials to reduce moisture. </p>
<p>– Avoid walking barefoot in wet or humid areas like locker rooms or public showers.</p>
<p>– Clip fingernails and toenails regularly to keep them short and clean.</p>
<p>– Change socks and underwear at least once a day, since bacteria and fungi like most, humid environments. </p>
<p>– Avoid sharing clothing, towels, sheets or other personal items with others.</p>
<p>– For athletes involved in close contact sports like wrestling, shower immediately after practice or a match and keep all sports gear and uniform clean. </p>
<p>– Do not share sports gear such as helmets with other players.</p>
<h2>5. What treatments are there?</h2>
<p>A dermatologist can typically diagnose a ringworm infection visually, but in some cases a small skin scraping, hair or nail sample may be needed for microscopic examination.</p>
<p>There are <a href="https://www.aad.org/public/diseases/a-z/ringworm-treatment">several treatment options</a>, including antifungal medications prescribed by a physician or dermatologist or over-the-counter products sold as a cream or ointment. A dermatologist may also prescribe an oral pill such as griseofulvin or terbinafine.</p>
<p>Popular <a href="https://www.webmd.com/skin-problems-and-treatments/what-you-should-know-about-ringworm">over-the-counter products</a> include clotrimazole, sold as Lotrimin or Mycelex, or topical miconazole. For more severe cases, a doctor might prescribe options such as <a href="https://www.mayoclinic.org/drugs-supplements/itraconazole-oral-route/side-effects/drg-20071421?p=1">itraconazole medications</a> or <a href="https://medlineplus.gov/druginfo/meds/a682617.html">tolnaftate</a>.</p>
<p>Finally, in some cases a person may need to use antifungal shampoo and soap to clean themselves and sterilize bedding and clothing.</p>
<p>But treatments don’t always work.</p>
<h2>6. Why is antifungal resistance a growing problem?</h2>
<p><a href="https://www.weforum.org/agenda/2023/03/antimicrobial-resistance-superbugs-antibiotics/">Antimicrobial resistance</a>, including <a href="https://theconversation.com/fungal-infections-worldwide-are-becoming-resistant-to-drugs-and-more-deadly-161975">antifungal resistance</a>, is an ongoing global emergency. Experts estimate that drug-resistant infections caused <a href="https://www.unep.org/explore-topics/chemicals-waste/what-we-do/emerging-issues/antimicrobial-resistance-global-threat#">roughly 1.3 million deaths around the world in 2019</a>. By 2050 that figure could rise to 10 million deaths each year.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/q2s1PPChOFs?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Rodney E. Rohde describes the seriousness of antifungal resistance.</span></figcaption>
</figure>
<p>Over the past 10 years, South Asia has been experiencing an <a href="https://www.cdc.gov/fungal/diseases/ringworm/dermatophyte-resistance.html">epidemic of antifungal-resistant ringworm</a> caused by the spread of a novel species of fungus called <em>Trichophyton indotineae</em>, which causes skin disease in both animals and humans. Experts believe that inappropriate use of topical antifungal and corticosteroid medications is likely driving its spread.</p>
<p>In February 2023, a New York City dermatologist reported to public health officials two cases in which unrelated patients with severe tinea caused by <em>Trichophyton indotineae</em> were not improving with oral antifungal treatment. A CDC report found that those were the first cases of <a href="https://www.cdc.gov/mmwr/volumes/72/wr/mm7219a4.htm">tinea from that species</a> in the U.S. One of the two patients had no recent international travel history, suggesting that it could be a case of local transmission of <em>Trichophyton indotineae</em> in the U.S.</p><img src="https://counter.theconversation.com/content/206560/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rodney E. Rohde has received funding from the American Society of Clinical Pathologists, American Society for Clinical Laboratory Science, U.S. Department of Labor (OSHA), and other public and private entities/foundations. Rohde is affiliated with ASCP, ASCLS, ASM, and serves on several scientific advisory boards. See <a href="https://rodneyerohde.wp.txstate.edu/service/">https://rodneyerohde.wp.txstate.edu/service/</a>.</span></em></p>An aggressive, antifungal-resistant form of tinea, a contagious ringworm fungal infection, has appeared in the US, likely driven by overuse and misuse of antifungal medications.Rodney E. Rohde, Regents' Professor of Clinical Laboratory Science, Texas State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2035752023-06-20T02:22:42Z2023-06-20T02:22:42ZCan I put cortisone on my face? The right advice on creams to fix irritated skin<figure><img src="https://images.theconversation.com/files/530540/original/file-20230607-17-118jjr.jpg?ixlib=rb-1.1.0&rect=49%2C32%2C5378%2C3607&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/skin-care-young-man-putting-face-1643342416">Shutterstock</a></span></figcaption></figure><p>Topical corticosteroids, also referred to as corticosteroids or cortisone, are the <a href="https://pubmed.ncbi.nlm.nih.gov/33719380/">go-to treatment</a> for many skin disorders including eczema, dermatitis and psoriasis. They can be found in <a href="https://www.ncbi.nlm.nih.gov/books/NBK532940/">various forms</a> such as creams, ointments, and solutions. </p>
<p>These medications <a href="https://ijdvl.com/topical-corticosteroids-in-dermatology/">work</a> by entering the skin cells and mimicking natural hormones, <a href="https://www.verywellhealth.com/how-topical-steroids-work-1068833#citation-1">blocking inflammation</a> and constricting blood vessels. Topical corticosteroids come in <a href="https://www1.racgp.org.au/ajgp/2021/september/selection-of-a-corticosteroid">different strengths</a>, from mild (such as 0.5% Hydrocortisone, available over the counter) to very potent prescription formulations. </p>
<p>But the way different people react to topical steroids can be unpredictable. While some people might get significant relief with short-term use, others could need continuous care.</p>
<p>So, how should you use cortisone creams and ointments? And why is there conflicting advice about their long-term use?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-why-do-we-get-dry-skin-in-winter-60849">Health Check: why do we get dry skin in winter?</a>
</strong>
</em>
</p>
<hr>
<h2>‘Use sparingly’</h2>
<p>Patients are currently recommended to use cortisone formulations “sparingly” or “thinly”. But this can increase the risk they won’t work effectively. Treatment failure can add to “<a href="https://pubmed.ncbi.nlm.nih.gov/34287768/">steroid phobia</a>” and stop people getting the medication they need. </p>
<p>Such warnings ignore the fact many patients are prescribed modest-strength topical steroids, which are <a href="https://doi.org/10.1111/j.1365-2133.2008.08479.x">safe and effective</a> when used properly. <a href="https://www.tandfonline.com/doi/full/10.1080/09546634.2019.1620502">Adverse effects</a>, such as when the formulations damage or irritate skin, are not typical. </p>
<p>From the patient’s perspective, the <a href="https://pubmed.ncbi.nlm.nih.gov/18294314/">current warnings</a> lump all steroids together regardless of their potential for side effects. Also, the advice tends to support false concerns: that topical and ingested (orally taken) corticosteroids carry the same dangers, which <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2796.2005.01467.x">they do not</a>.</p>
<h2>Mixed messages</h2>
<p>Should you use a weaker formulation for longer? Or hit the problem hard with a stronger concentration for less time?</p>
<p>At the moment, some treatment recommendations – such as for scalp <a href="https://pubmed.ncbi.nlm.nih.gov/31138038/">psoriasis</a> – say patients should use a high-dose cortisone formulation for four weeks and increase frequency of use if it’s not effective. If cortisone is extensively used, it is advised adults and children should be examined yearly for side effects.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/529006/original/file-20230530-23-2qp4o2.jpg?ixlib=rb-1.1.0&rect=46%2C46%2C5106%2C3305&q=45&auto=format&w=1000&fit=clip"><img alt="person rubs white skin cream on to hand" src="https://images.theconversation.com/files/529006/original/file-20230530-23-2qp4o2.jpg?ixlib=rb-1.1.0&rect=46%2C46%2C5106%2C3305&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/529006/original/file-20230530-23-2qp4o2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529006/original/file-20230530-23-2qp4o2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529006/original/file-20230530-23-2qp4o2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529006/original/file-20230530-23-2qp4o2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529006/original/file-20230530-23-2qp4o2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529006/original/file-20230530-23-2qp4o2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Some conditions need long-term cortisone treatment – so breaks might be needed.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/applying-emollient-dry-flaky-skin-treatment-551219659">Shutterstock</a></span>
</figcaption>
</figure>
<p>Skin atrophy (or deterioration) is the <a href="https://pubmed.ncbi.nlm.nih.gov/16384751/">most common side effect</a> of topical corticosteroids and manifests as tiny degenerative alterations within a few weeks. The patient’s age, body site, cortisone potency and the existence of any coverings, all have an impact on the extent of skin damage. </p>
<p>Reduced skin cell growth, decreased collagen development and stimulation of tiny vessels and capillaries in the skin are the <a href="https://pubmed.ncbi.nlm.nih.gov/25396122/">main features</a> of such skin atrophy. Thinner skin, more moisture, higher temperatures, and partial blockage make areas where skin folds on the body (for example, the armpits, between fingers, the groin) particularly vulnerable. These are also often the sites of skin irritation needing treatment. </p>
<h2>Skin thinning</h2>
<p>Topical steroids cause the skin to reabsorb a type of connective tissue building block, called <a href="https://www.histology.leeds.ac.uk/tissue_types/connective/connective_groundS.php#:%7E:text=The%20'ground%20substance'%20of%20extracellular,even%20larger%20molecules%20called%20proteoglycans.">mucopolysaccharide ground material</a>. Repeated use in the same spot on the body <a href="https://onlinelibrary.wiley.com/doi/book/10.1002/9780470750520">results in alterations</a> to the skin’s connective tissue and epidermal thinning. </p>
<p>That can result in lax, translucent, wrinkled skin as well as striae (stretch marks), fragility, hypo-pigmentation (fading) and the prominence of underlying veins. </p>
<p>More research is needed to help specialists choose the best corticosteroids for a given condition. High-potency cortisone formulations, long-term use and sun exposure have been <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6910795/">implicated</a> in chronic fragile skin syndrome, which is increasingly common and features the symptoms outlined above.</p>
<p>However, if best <a href="https://www.nice.org.uk/guidance/cg153/chapter/5-Other-versions-of-this-guideline-full-guideline">practice guidelines</a> are followed, these side effects can be reduced by using lowering the potency of corticosteroids and stopping treatment when the patient has fully recovered. </p>
<p>Corticosteroids should only be used for a maximum of three months. For some conditions, such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5300730/">vitiligo</a>, they need to be used for longer periods, so regularly taking several weeks’ break is advised. </p>
<p>The good news is that once topical corticosteroids are stopped, short-term atrophy from treatment <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7779293/">can be reversed</a>, although skin normalisation may take months.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/530523/original/file-20230607-23-ca22fh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="cream on scratched up skin" src="https://images.theconversation.com/files/530523/original/file-20230607-23-ca22fh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/530523/original/file-20230607-23-ca22fh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/530523/original/file-20230607-23-ca22fh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/530523/original/file-20230607-23-ca22fh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/530523/original/file-20230607-23-ca22fh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/530523/original/file-20230607-23-ca22fh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/530523/original/file-20230607-23-ca22fh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Patients need reassurance and guidance on how much cortisone cream to use and for how long.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cortisone-cream-spread-on-irritated-skin-1658002459">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/drugs-and-the-sun-your-daily-medications-could-put-you-at-greater-risk-of-sunburn-170559">Drugs and the sun – your daily medications could put you at greater risk of sunburn</a>
</strong>
</em>
</p>
<hr>
<h2>Can you use it safely on your face?</h2>
<p>Due to the substantial risk of steroid-induced skin deterioration, the guidelines recommend against using potent and very potent corticosteroids on the face, flexures (parts of the body that bend, such as elbows) or genitalia. So, mild to moderate-potency corticosteroids are the main treatment option. </p>
<p>Using strong cortisone creams or ointments on the face can lead to <a href="https://pubmed.ncbi.nlm.nih.gov/31138038/">steroid dependence</a>. Patients who are dependent on steroids and have acne, rosacea, perioral dermatitis or telangiectasia (widened blood vessels on the skin) continue to use the drug because they worry stopping the drug could worsen their condition. </p>
<p>Topical steroids on the face can cause symptoms sometimes referred to as “red face syndrome”, dermatitis rosaceaformis steroidica or <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4885178/">steroid addiction</a>. And stopping <a href="https://pubmed.ncbi.nlm.nih.gov/21393945/">steroid use on the face</a> after an extended period can have considerable rebound effects including erythema (redness), burning and scaling.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-sodium-lauryl-sulfate-and-is-it-safe-to-use-125129">What is sodium lauryl sulfate and is it safe to use?</a>
</strong>
</em>
</p>
<hr>
<h2>The bottom line</h2>
<p>When used correctly, cortisone creams, ointments and lotions can be safe and effective. </p>
<p>Clear instructions could include estimating dosage in “<a href="https://pubmed.ncbi.nlm.nih.gov/23097521/">fingertip units</a>”, with a chart showing the number of units needed for various body parts, such as <a href="https://patient.info/treatment-medication/steroids/fingertip-units-for-topical-steroids">one unit to treat skin on an adult’s hand</a> but seven units to treat skin on their back.</p>
<p>To avoid skin damage, corticosteroids should only be used on skin affected by a skin disease. Better education and information <a href="https://www.racgp.org.au/afp/2017/may/general-practitioners-knowledge-about-use-of-t-2">is needed</a> to reflect the minimal risks from topical corticosteroids that are low to moderate strength and how important it is to use enough medication to treat a condition. </p>
<p>Finally, treatment should be customised based on the person’s symptoms, the body parts affected and how long treatment might be required.</p><img src="https://counter.theconversation.com/content/203575/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Yousuf Mohammed receives funding from U.S FDA grants. This article reflects the views of the author and
should not be construed to represent views or
policies.</span></em></p><p class="fine-print"><em><span>Khadeejeh AL-Smadi does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Patients and some doctors have an inflated sense of the risks of low-to-moderate strength cortisone cream and might not use enough to be effective.Yousuf Mohammed, Dermatology researcher, The University of QueenslandKhadeejeh AL-Smadi, PhD Candidate, Frazer Institute,, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1939482023-01-16T01:41:03Z2023-01-16T01:41:03ZHow to treat scars at home – and hopefully make them disappear<figure><img src="https://images.theconversation.com/files/500345/original/file-20221212-94530-cep7lw.jpg?ixlib=rb-1.1.0&rect=60%2C80%2C6649%2C4386&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/surgery-scar-after-kidney-pyelonephritis-600w-1878295354.jpg">Shutterstock</a></span></figcaption></figure><p>Maybe you’ve had a skin cancer removed from your face or body. Perhaps you had an injury or accident and needed stitches. However you came by a cut on your skin, you probably want to make it appear as small as possible as quickly as possible and avoid a longer-lasting scar. </p>
<p>In order to minimise scar formation we need to address wound healing, which is a complex process. </p>
<p>It has <a href="https://link.springer.com/article/10.1007/s00018-016-2268-0">three major phases</a>: inflammation, proliferation and remodelling. These are orchestrated by special body signalling chemicals acting on the skin’s layers. The majority of scar formation occurs within the first six months after an injury.</p>
<p>So, what can you do to assist this process and support healing?</p>
<h2>The inflammation phase</h2>
<p>The inflammation phase occurs immediately to remove bacteria and bring in the blood supply. </p>
<p>The first goal of wound care is to avoid bacteria coming into contact with the body’s insides, because these will impair normal <a href="https://clinicalexcellence.qld.gov.au/sites/default/files/2018-02/wound-care.pdf">wound healing</a>. So keep it clean. </p>
<p>Ideally bacteria will be removed from the skin if a wound is anticipated, such as before surgery. Cleaning the wound to remove bacteria and bacterial spores is critical to good healing and should be done within two hours of any injury. </p>
<p>Don’t let any dirt remain in a wound even if that means scrubbing with soap and water after a fall on the ground. A one-off application of <a href="https://www.sciencedirect.com/science/article/pii/S1743919117305368">povidone-iodine</a> (sold in Australia as Betadine) will help lessen the chance of bacterial spore activation.</p>
<p>Your body’s natural reaction includes the formation of hydrogen peroxide. Unfortunately external application of this natural antiseptic can slow wound healing. Only weak antiseptic solutions containing silver (with proper advice from your doctor or pharmacist) can <a href="https://pubmed.ncbi.nlm.nih.gov/31904191/">improve scar formation</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/500347/original/file-20221212-99180-qh64s7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="wounds with stitches and doctors hand" src="https://images.theconversation.com/files/500347/original/file-20221212-99180-qh64s7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/500347/original/file-20221212-99180-qh64s7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500347/original/file-20221212-99180-qh64s7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500347/original/file-20221212-99180-qh64s7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500347/original/file-20221212-99180-qh64s7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500347/original/file-20221212-99180-qh64s7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500347/original/file-20221212-99180-qh64s7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Some people produce extra collagen and this can lead to raised scars.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/doctor-hands-checking-stitches-after-600w-759853537.jpg">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-do-we-have-to-clean-out-our-pores-75288">Health Check: do we have to clean out our pores?</a>
</strong>
</em>
</p>
<hr>
<h2>The proliferation phase</h2>
<p>During this phase, the blood vessel cells, the epidermal cells and the <a href="https://www.sciencedirect.com/topics/neuroscience/fibroblast">fibroblasts</a> multiply.</p>
<p>The fibroblasts (a type of cell that helps makes collagen to support connective tisues) cause <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3038392/">scar contraction</a>, which can “pucker” the skin. Scars tend to be white and a little shiny once the redness dies down. </p>
<p>Collagen, the body’s most <a href="https://www.hsph.harvard.edu/nutritionsource/collagen/">abundant protein</a> that helps makes skin strong, is continuously produced and broken down by the body. This can have an <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4055805/">ongoing effect</a> on the appearance of the mature wound for at least a further six months after scar formation.</p>
<h2>The remodelling phase</h2>
<p>The formation of hypertrophic scars (which are raised above the skin level but regress slowly) or keloid <a href="https://pubmed.ncbi.nlm.nih.gov/16012249/">scars</a> (which spread beyond the injury site and don’t regress later) is often genetically determined. It’s also partially related to the <a href="https://pubmed.ncbi.nlm.nih.gov/20927486/">type of injury and care</a> of the wound. </p>
<p>In people who develop these scars during the remodelling phase, the signal to stop the production of collagen within the wound is disrupted.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-do-older-people-heal-more-slowly-146182">Why do older people heal more slowly?</a>
</strong>
</em>
</p>
<hr>
<h2>Try a gel or dressing</h2>
<p>For clean, non-infected wounds, the application of a hydrogel (a polymer that <a href="https://www.sciencedirect.com/topics/chemistry/hydrogel">retains moisture</a> and doesn’t disolve) can actually speed healing, provided there is no infection. Use one that is suitable for application to the eye, such as Refresh Liquigel. </p>
<p>By keeping the wound moist, the proliferation of the surface skin cells is enhanced. When they grow out under a hard scab, it’s slowed down. </p>
<p>Wound gels that contain antiseptics and preservatives are best avoided in case of allergy and because antiseptics can <a href="https://pubmed.ncbi.nlm.nih.gov/19131809/">slow down healing</a>. </p>
<p>There is an intimate relationship between blood vessels and the fibroblasts. Red and itchy scars are likely to be growing, which will ultimately result in a larger scar. This is when keeping the scar covered to improve hydration can make a big difference.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/500346/original/file-20221212-94530-o19age.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="pink wound patch" src="https://images.theconversation.com/files/500346/original/file-20221212-94530-o19age.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/500346/original/file-20221212-94530-o19age.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500346/original/file-20221212-94530-o19age.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500346/original/file-20221212-94530-o19age.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500346/original/file-20221212-94530-o19age.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500346/original/file-20221212-94530-o19age.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500346/original/file-20221212-94530-o19age.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Silicone dressings help wound management and prevent scarring.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/rounded-square-silicone-gel-sheet-600w-1781693993.jpg">Shutterstock</a></span>
</figcaption>
</figure>
<p>Cover the scar with a silicone dressing and either a gel or a sheet for as many hours as possible. </p>
<p>For those prone to scarring, your pharmacist can show you an over-the-counter formulation of <a href="https://www.healthdirect.gov.au/medicines/brand/amt,40831000168104/zatamil-hydrogel">Zatamil Hydrogel</a> you can use once a day for one week on and one week off. Use this under the silicone to help further reduce the scar. They might also suggest a fading cream. </p>
<p>A dermatologist with a vascular laser (which targets abnormal blood vessels in the skin to reduce redness) can also help, especially in the early stages of a scar.</p>
<h2>Some final tips</h2>
<p>Keeping the scar moist with oils is more difficult than with the silicone, but can reduce excess scarring, sometimes called “over-scarring”.</p>
<p>Finally, avoid overexposing the scar to sunlight. Scars can become very dark in comparison to the rest of person’s skin and ultraviolet light is the major <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3495392/">preventable factor</a>.</p>
<p>Wound healing is complex. Doctors, pharmacists and dermatologists can help advise on which of these tips will help with your specific wound.</p><img src="https://counter.theconversation.com/content/193948/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Freeman does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The first six months after an injury or surgery is critical for scar prevention and treatment.Michael Freeman, Associate Professor of Dermatology, Bond UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1939472023-01-09T19:09:04Z2023-01-09T19:09:04ZAre polishes, acrylics and powders bad for my fingernails? Do I need a breather between manicures?<figure><img src="https://images.theconversation.com/files/496387/original/file-20221121-24-he3p7h.jpg?ixlib=rb-1.1.0&rect=53%2C44%2C5901%2C3943&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://images.pexels.com/photos/939836/pexels-photo-939836.jpeg?auto=compress&cs=tinysrgb&w=1260&h=750&dpr=2">Pexels/Valeria Boltneva</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>People are increasingly opting for regular manicures – with vibrant layers of polish, gel, acrylic or powder. </p>
<p>Australians spend more than <a href="https://stat.mozo.com.au/images/more-on-mozo/media-releases/twenty-two-billion--the-annual-cost-of-vanity.pdf">$22 billion</a> a year on beauty treatments. And it’s not slowing down – the beauty and personal care market is expected to grow at around <a href="https://www.statista.com/outlook/cmo/beauty-personal-care/australia?currency=AUD">2–5%</a> in the next <a href="https://www.ibisworld.com/au/industry/hairdressing-beauty-services/677/">year</a>.</p>
<p>Manicure popularity (velvet nails are among the <a href="https://www.refinery29.com/en-us/2022/11/11181874/winter-nail-art-trends">latest looks</a>) could be down to fashion, social media influencers or our desire for small luxuries. But should we hold off from treatments, and give our nails a break every now and then? </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-know-hand-dryers-can-circulate-germs-through-the-air-why-are-they-still-used-everywhere-157410">We know hand dryers can circulate germs through the air. Why are they still used everywhere?</a>
</strong>
</em>
</p>
<hr>
<h2>What are nails?</h2>
<p>Nails are a unique feature in primates, made from <a href="https://www.ncbi.nlm.nih.gov/books/NBK513133/">skin cells</a>. A special arrangement of keratin, a structural protein, allows the nails to become strong and compact. Keratin is the same protein present in hair, as well as the horns, claws and hooves of other animals.</p>
<p>Upon maturing, the cells making up the fingernail disintegrate their <a href="https://onlinelibrary.wiley.com/doi/10.1111/j.1467-2494.2007.00372.x">nucleus</a>, giving rise to a translucent and colourless appearance.</p>
<p>Nails strengthen and protect the fingertips. They enable fine motor control, such as turning the pages of a book or picking up a needle from a table. They allow us to scratch ourselves when itchy, hold a better grip on some items, and pry open nuts and foods. They also enhance some sensations due to the underlying nerves.</p>
<p>The <a href="https://www.ncbi.nlm.nih.gov/books/NBK539733/">curved shape</a> of the nail both strengthens it, as well as allows a nice snug fit to the underlying finger.</p>
<p>Fingernails grow at an average rate of 3 millimetres <a href="https://doi.org/10.1111/j.1365-2230.1994.tb02693.x">per month</a>, so it takes about 4–6 months to fully grow from the cuticle to the tip. This is much faster than toenails, which grow around <a href="https://onlinelibrary.wiley.com/doi/10.1111/j.1467-2494.2007.00372.x">three times</a> slower.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/495549/original/file-20221116-24-24a82f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/495549/original/file-20221116-24-24a82f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=469&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495549/original/file-20221116-24-24a82f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=469&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495549/original/file-20221116-24-24a82f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=469&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495549/original/file-20221116-24-24a82f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=590&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495549/original/file-20221116-24-24a82f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=590&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495549/original/file-20221116-24-24a82f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=590&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Labelled fingernail.</span>
<span class="attribution"><span class="source">Christian Moro, Author provided</span></span>
</figcaption>
</figure>
<p>Fingernails grow from the skin at the base of the nail, with the new nail slowly pushing the rest forward. This occurs the fastest up to about <a href="https://onlinelibrary.wiley.com/doi/10.1111/j.1467-2494.2007.00372.x">14 years</a> of age, with males exhibiting faster-growing nails than females. The growth rate evens out at <a href="https://pubmed.ncbi.nlm.nih.gov/13285907/">around 50</a> years of age.</p>
<p>Nails can be an insight into our health. An <a href="https://www.statpearls.com/ArticleLibrary/viewarticle/32684">abnormally shaped</a> nail bed (clubbing) may suggest anaemia, low tissue oxygenation, or cardiovascular disease. Discolouration or pitting could indicate <a href="https://www.mayoclinic.org/healthy-lifestyle/adult-health/multimedia/nails/sls-20076131">autoimmune</a> issues, infections or malnutrition.</p>
<h2>How do nails break?</h2>
<p><a href="http://www.healthycellsmagazine.com/articles/dermatology-more-than-just-skin">Dermatologists</a> see a lot of patients with <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6994568/">frail and brittle nails</a>. Such nails can be vulnerable to <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1473-2130.2004.00141.x">splitting or breaking</a>.</p>
<p>The external environment does impact our nails. Both low moisture and very high moisture can cause the nails to become <a href="https://www.aocd.org/page/BrittleSplittingNail">brittle</a>.</p>
<p><a href="https://synapse.koreamed.org/articles/1095278">Poor nutrition</a> and <a href="https://ijdvl.com/nail-changes-and-disorders-among-the-elderly/">age</a> can also affect the <a href="https://pubmed.ncbi.nlm.nih.gov/20620759/">health</a> of the nailbed and the strength and colour of the nails.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-causes-dry-lips-and-how-can-you-treat-them-does-lip-balm-actually-help-161264">What causes dry lips, and how can you treat them? Does lip balm actually help?</a>
</strong>
</em>
</p>
<hr>
<h2>Beautiful nails</h2>
<p>Healthy nails are more likely to <a href="https://onlinelibrary.wiley.com/doi/10.1111/j.1473-2130.2004.00141.x">look good</a>. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7105659/">Good habits</a> to adopt for strong fingernails include trimming the nails straight across and rounding the edges, not messing with the cuticles (which help keep out nasty bugs), and not putting anything sharp under the nails.</p>
<p>But of course, playing around with the look of nails using shades and colours can be fun and fashionable. Around <a href="https://www.goldsteinresearch.com/report/nail-care-market-global-industry-analysis">85–90%</a> of women worldwide use nail care products.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/496390/original/file-20221121-25-859nwp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="nail colour selection in salon" src="https://images.theconversation.com/files/496390/original/file-20221121-25-859nwp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/496390/original/file-20221121-25-859nwp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/496390/original/file-20221121-25-859nwp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/496390/original/file-20221121-25-859nwp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/496390/original/file-20221121-25-859nwp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/496390/original/file-20221121-25-859nwp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/496390/original/file-20221121-25-859nwp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Choices, choices, so many choices.</span>
<span class="attribution"><a class="source" href="https://images.pexels.com/photos/7755653/pexels-photo-7755653.jpeg?auto=compress&cs=tinysrgb&w=1260&h=750&dpr=2">Pexels/Rodnae</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/yes-women-might-feel-the-cold-more-than-men-heres-why-184329">Yes, women might 'feel the cold' more than men. Here's why</a>
</strong>
</em>
</p>
<hr>
<h2>Can manicures do damage?</h2>
<p>Although nail cosmetics can enhance nail appearance, they can potentially damage the underlying nails. Knowing what changes could occur is the important first step towards avoiding any permanent impact.</p>
<p>If you regularly paint your nails with traditional nail polish, be careful when using darker colours as this can stain the nail plate. Some ingredients in nail care products may also lead to <a href="https://pubmed.ncbi.nlm.nih.gov/12358556/">allergic</a> contact <a href="https://pubmed.ncbi.nlm.nih.gov/32355091/">dermatitis</a>.</p>
<p>To cure, harden, and dry each layer, the nail is often exposed to light under a fluorescent bulb. Most commonly, nail salons will use UV lamps, which requires about five minutes of exposure per hand.</p>
<p>This can cause <a href="https://pubmed.ncbi.nlm.nih.gov/29634895/">cell damage</a> and ageing to the skin. <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/phpp.12398">Current literature</a> reports low skin cancer risk from UV <a href="https://www.cancer.org.au/iheard/do-the-uv-lights-used-in-nail-salons-for-shellac-and-other-nail-polishes-cause-skin-cancer">lamp exposure</a>. However, the recommendation is to apply a <a href="https://pubmed.ncbi.nlm.nih.gov/29634895/">broad spectrum sunscreen</a> with SPF >30 <a href="https://www.jprasurg.com/article/S1748-6815(16)30001-8/fulltext">before exposure</a>.</p>
<p>The most common method of removing gel polish is using acetone. The chemical can lead to <a href="https://onlinelibrary.wiley.com/doi/10.1111/j.1473-2165.2011.00595.x">brittle, dry and rough nails</a> and cause separation of the nail from the nail bed. </p>
<p>Skin contact with acetone can also cause your skin to become dry, irritated and <a href="https://www.gov.uk/government/publications/acetone-properties-and-incident-management/acetone-general-information">cracked</a>. Some damage can also be done by peeling off acrylic or gel nails.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/495548/original/file-20221116-13642-mr0aal.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/495548/original/file-20221116-13642-mr0aal.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=447&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495548/original/file-20221116-13642-mr0aal.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=447&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495548/original/file-20221116-13642-mr0aal.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=447&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495548/original/file-20221116-13642-mr0aal.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=562&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495548/original/file-20221116-13642-mr0aal.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=562&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495548/original/file-20221116-13642-mr0aal.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=562&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Everybody’s doing it.</span>
<span class="attribution"><span class="source">Christian Moro, Author provided</span></span>
</figcaption>
</figure>
<h2>Maybe don’t try this at home</h2>
<p>Practising beauty techniques at home comes with the danger of serious harm. </p>
<p>The glue or chemical applicants used to adhere fake nails can cause serious <a href="https://www.mdpi.com/1660-4601/17/12/4283">burns</a>. The chemicals used can also be harmful to <a href="https://www.mdpi.com/1660-4601/17/12/4283">children</a> if left within reach. As such, going to a qualified and experienced nail technician is likely safer, provided they are taking infection precautions like using sterile tools and equipment.</p>
<p>Although nail cosmetics come with relatively minor risks, <a href="https://www.health.harvard.edu/blog/a-look-at-the-effects-of-nail-polish-on-nail-health-and-safety-2019112118231">dermatologists</a> often recommend sticking with your natural nails and painting them with regular polish, and allowing intermittent breaks between manicures to give your nails time to breathe.</p>
<p>We use the term “breathe” loosely here. Your nails receive their nourishment from the blood vessels under the skin, and do not need contact with the outside oxygen. But keeping the nails uncovered with product does give your body a chance to repair and regenerate the nail and its surrounding skin, keeping the region nice and healthy.</p>
<p>How long of a break is up to you, depending on your nails. However, given a full nail regrows entirely in four to six months, you won’t need to wait that long.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-position-should-i-sleep-in-and-is-there-a-right-way-to-sleep-189873">What position should I sleep in, and is there a ‘right’ way to sleep?</a>
</strong>
</em>
</p>
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<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/reel/CixlJqFpiKZ/?utm_source=ig_embed\u0026ig_rid=6fe3caa1-ed37-4d9b-bdad-ffb758d21b94","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p><img src="https://counter.theconversation.com/content/193947/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>With a huge array of nail cosmetics to choose from, people are getting manicure makeovers on a regular basis. But do your nails need a holiday?Christian Moro, Associate Professor of Science & Medicine, Bond UniversityCharlotte Phelps, PhD Candidate, Centre for Urology Research, Bond UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1800192022-05-31T02:05:18Z2022-05-31T02:05:18ZThe doctor says my mole is a melanoma. What happens next?<figure><img src="https://images.theconversation.com/files/460486/original/file-20220429-25229-mehb2j.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5751%2C3811&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>So your doctor removed a mole from your skin and now says it’s cancerous. What happens next?</p>
<p>Firstly, you’re not alone! <a href="https://wiki.cancer.org.au/skincancerstats/Skin_cancer_incidence_and_mortality">Two in three</a> Australians will have a skin cancer in their lifetime, nearly all of them basal cell carcinomas, squamous cell carcinomas, or melanomas. </p>
<p>If you have a “mole” – brown, round spots than can be flat or raised – removed and diagnosed as cancer, though, you’re probably talking about a <a href="https://dermnetnz.org/topics/melanoma">melanoma</a>. The other types are more likely to be pink, scaly lumps or sores that sometimes bleed. (See our piece about these more common types – basal cell carcinomas and squamous cell carcinomas – <a href="https://theconversation.com/the-doctor-says-i-have-skin-cancer-what-happens-next-182414">here</a>).</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/80-of-all-cancers-are-on-the-skin-what-happens-if-i-have-one-182414">80% of all cancers are on the skin. What happens if I have one?</a>
</strong>
</em>
</p>
<hr>
<p>Melanoma is the rarest of the main skin cancers, and also the most likely to spread around the body, which is called metastasis. How likely this is mostly depends on how deeply into the skin the melanoma has spread by the time it’s diagnosed. This is why earlier, and hopefully thinner, detection is so important to your outcome.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-does-australia-have-so-much-skin-cancer-hint-its-not-because-of-an-ozone-hole-91850">Why does Australia have so much skin cancer? (Hint: it's not because of an ozone hole)</a>
</strong>
</em>
</p>
<hr>
<p>In 2021, nearly <a href="https://melanoma.org.au/wp-content/uploads/2022/03/MIA-and-MPA_SoN-Report_Final-Report_28-March-2022.pdf">40,000 melanomas</a> were excised in Australia. About 23,000 are very thin “in situ” melanomas, where the cancer is confined to the very top layer of the skin and can spread locally but not around the body yet. The others are invasive melanomas, meaning they have grown into the deeper parts of the skin. “Invasive” sounds scary, but most actually only have very shallow invasion and an excellent prognosis. </p>
<h2>So it’s a melanoma, what’s next?</h2>
<p>After the initial excision of the melanoma, it’s sent to a pathologist to be <a href="https://dermnetnz.org/topics/melanoma-pathology">examined under a microscope</a>. They will generate a report describing the melanoma in detail to help your doctor know what to do next. </p>
<p>The most important detail is the thickness of the melanoma from the skin surface to its deepest edge. In situ melanomas are so thin they have no official measurement, and invasive melanomas are measured in millimetres. Over 1mm thick is where your doctor will start to be much more concerned about the risk of spread.</p>
<p>The report will also tell your doctor whether the melanoma was ulcerated, invaded by immune cells, or near a blood vessel or nerve.</p>
<figure class="align-center ">
<img alt="A hematoxylin and eosin stained section of a melanoma for microscopic inspection." src="https://images.theconversation.com/files/456267/original/file-20220405-12-lrqdiu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/456267/original/file-20220405-12-lrqdiu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=299&fit=crop&dpr=1 600w, https://images.theconversation.com/files/456267/original/file-20220405-12-lrqdiu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=299&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/456267/original/file-20220405-12-lrqdiu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=299&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/456267/original/file-20220405-12-lrqdiu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=375&fit=crop&dpr=1 754w, https://images.theconversation.com/files/456267/original/file-20220405-12-lrqdiu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=375&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/456267/original/file-20220405-12-lrqdiu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=375&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The pathologist, a doctor specialising in microscopic diagnoses, will examine sections of your melanoma for details that will shape your treatment plan.</span>
<span class="attribution"><span class="source">Author supplied</span></span>
</figcaption>
</figure>
<p>If your melanoma is less than 1mm thick, the first step is a wide local excision. This is removing more skin around the original melanoma site. How much is removed depends on how thick the melanoma was and what type it was. </p>
<p><a href="https://wiki.cancer.org.au/australia/Clinical_question:What_are_the_recommended_safety_margins_for_radical_excision_of_primary_melanoma%3F/In_situ">In-situ melanomas</a> generally need an extra 5mm of skin removed on each side of the original wound. For <a href="https://wiki.cancer.org.au/australia/Clinical_question:What_are_the_recommended_safety_margins_for_radical_excision_of_primary_melanoma%3F/Invasive_melanoma">invasive melanomas</a> under 1mm thick, it’s 1cm extra clearance. </p>
<p>The pathologist will check the re-excision under a microscope to check the edges of the melanoma are far enough away from the edge of the cut. If it’s not, more skin will need to be removed and checked again.</p>
<p>For most people with in-situ melanoma, that’s the end of their cancer treatment, although your doctor may want to set you up with ongoing regular skin checks. Melanomas less than 1mm thick (also called stage 1 melanomas) are also very unlikely to have spread and have a <a href="https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia/contents/cancer-incidence-and-survival-by-stage-data-visualisation">five year survival</a> rate of 99%. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-do-i-need-a-skin-cancer-check-48096">Health Check: do I need a skin cancer check?</a>
</strong>
</em>
</p>
<hr>
<h2>What are the chances it’s spread?</h2>
<p>The most important risk factor for spreading is again the tumour thickness. Melanomas more than 4mm thick are of the most concern. If the melanoma was ulcerated, or was touching a blood vessel or nerve, the risk of spread is also higher.</p>
<p>If your melanoma is more than 1mm thick, your doctor will discuss with you the possibility of a <a href="https://wiki.cancer.org.au/australia/Clinical_question:When_is_a_sentinel_node_biopsy_indicated%3F">sentinel lymph node biopsy</a> and refer you to a specialist surgeon. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/spot-the-difference-harmless-mole-or-potential-skin-cancer-33674">Spot the difference: harmless mole or potential skin cancer?</a>
</strong>
</em>
</p>
<hr>
<p>Your lymph nodes are part of your immune system, and are clustered in basins at your armpits, groin and neck. Melanoma cells that spread are carried there first, and the one that receives it is called the draining lymph node. </p>
<p>To find the draining lymph node, you will have an injection containing a <a href="https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwi1pOLUh4H3AhV-zjgGHVGLAM8QFnoECAYQAQ&url=https%3A%2F%2Fmelanoma.org.au%2Fwp-content%2Fuploads%2F2021%2F11%2FClinical-Brochure-Sentinal-Node-Biopsy.pdf&usg=AOvVaw1bGG-N0ebPvA0xjcEFQXAS">tiny dose of radioactive tracer dye</a> into the melanoma site, so it will travel to the lymph node and be detectable with a nuclear medicine camera. This allows a surgeon to plan where to operate. </p>
<p>Then, while you’re under a general anaesthetic, a blue dye is injected into the site of your melanoma to stain the draining lymph node, so the surgeon can remove the correct node and leave all the others. They will also perform the wide local excision of the original melanoma site at this point – 1-2cm extra clearance, depending on the original tumour thickness.</p>
<figure class="align-center ">
<img alt="A dermatologist examining the moles on a woman's back with a dermoscope" src="https://images.theconversation.com/files/456477/original/file-20220406-25-8nnmh8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/456477/original/file-20220406-25-8nnmh8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=476&fit=crop&dpr=1 600w, https://images.theconversation.com/files/456477/original/file-20220406-25-8nnmh8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=476&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/456477/original/file-20220406-25-8nnmh8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=476&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/456477/original/file-20220406-25-8nnmh8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=598&fit=crop&dpr=1 754w, https://images.theconversation.com/files/456477/original/file-20220406-25-8nnmh8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=598&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/456477/original/file-20220406-25-8nnmh8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=598&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">You will need to have regular skin examinations to catch any new melanomas early.</span>
<span class="attribution"><span class="source">Author supplied</span></span>
</figcaption>
</figure>
<p>If the node has no melanoma cells, you won’t need any further treatment besides a six-monthly or yearly follow-up <a href="https://wiki.cancer.org.au/australia/Clinical_question:What_is_the_ideal_setting,_duration_and_frequency_of_follow-up_for_melanoma_patients%3F">physical exam</a>. This checks for unexpected recurrences by checking for swelling at your lymph nodes and any concerning symptoms such as unexplained weight loss, pain or fatigue. This check will also look for new primary melanomas on the skin.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/sun-damage-and-cancer-how-uv-radiation-affects-our-skin-34538">Sun damage and cancer: how UV radiation affects our skin</a>
</strong>
</em>
</p>
<hr>
<p>If there is a positive lymph node, you might be invited to participate in clinical trials with immunotherapy drugs. There will also be <a href="https://wiki.cancer.org.au/australia/Clinical_question:What_investigations_should_be_performed_when_in_transit_and/or_regional_node_disease_(Stage_III_melanoma)_is_diagnosed%3F">further investigations</a> to check whether the melanoma has spread further, and if so, where. </p>
<p>These scale up from ultrasound checks of the rest of the lymph nodes, to PET/CT scans of the rest of the body, or even MRI scans if there are signs of spread to the brain. If there are metastases, you’ll work with an oncologist to discuss surgical removal and what drug treatment you might need. </p>
<p>Having one melanoma means you are at risk of having more in the future, so the final part of your treatment program will be regular skin checks with your doctor. Your GP might do these themselves, or refer you to a dermatologist or another GP who has specialised in skin cancer. </p>
<p>You should also <a href="https://www.cancer.org.au/cancer-information/causes-and-prevention/sun-safety/check-for-signs-of-skin-cancer">learn</a> to <a href="https://wiki.cancer.org.au/australia/Clinical_question:How_should_patients_at_each_stage_of_melanoma_be_followed_after_initial_definitive_treatment%3F">check your own skin</a> between visits, so you can bring a new or changing lesion to your doctor’s attention early.</p><img src="https://counter.theconversation.com/content/180019/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katie Lee receives funding from the NHMRC and The University of Queensland. </span></em></p><p class="fine-print"><em><span>H. Peter Soyer is a shareholder of MoleMap NZ Limited and e-derm consult GmbH, and undertakes regular teledermatological reporting for both companies. He is a Medical Consultant for Canfield Scientific Inc, MoleMap Australia Pty Ltd, Blaze Bioscience Inc, and a Medical Advisor for First Derm. He holds an NHMRC MRFF Next Generation Clinical Researchers Program Practitioner Fellowship (APP1137127) and several other NHMRC and MRFF grants. He is a Board Member of Melanoma and Skin Cancer Trials Limited and the Queensland Skin and Cancer Foundation. He is employed by The University of Queensland and works as Visiting Medical Officer at Metro South HHS. </span></em></p><p class="fine-print"><em><span>Erin McMeniman does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Two in three Australians will have a skin cancer in their lifetime, nearly all of them basal cell carcinomas, squamous cell carcinomas, or melanomas.Katie Lee, PhD Candidate, The University of QueenslandErin McMeniman, Senior Lecturer Princess Alexandra Hospital Southside Clinical Unit and Casual Research Assistant, The University of QueenslandH. Peter Soyer, Professor of Dermatology, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1811382022-04-15T18:01:27Z2022-04-15T18:01:27ZWhat is that rash? Genetic fingerprints can help doctors diagnose and treat skin conditions more effectively<figure><img src="https://images.theconversation.com/files/458016/original/file-20220413-23-kvcimv.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2121%2C1412&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Skin conditions like psoriasis and eczema can have rashes that are difficult to distinguish by eye.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/dermatitis-eczema-texture-of-ill-human-skin-royalty-free-image/1270950737">tylim/iStock via Getty Images Plus</a></span></figcaption></figure><p>Rashes can be thought of as a dysfunctional community of skin cells. Your skin harbors <a href="https://dermnetnz.org/topics/the-structure-of-normal-skin">dozens of distinct cell types</a>, including those that form blood vessels, nerves and the local immune system of the skin. For decades, clinicians have largely been <a href="https://doi.org/10.1097/01.pcr.0000117274.16187.de">diagnosing rashes by eye</a>. While examining the physical appearance of a skin sample under a microscope may work for more obvious skin conditions, many rashes can be difficult to distinguish from one another.</p>
<p>At the molecular level, however, the differences between rashes become more clear. </p>
<p>Scientists have long known that <a href="https://doi.org/10.1038/jid.2009.71">molecular abnormalities</a> in skin cells cause the redness and scaliness seen in conditions like psoriasis and eczema. While almost all the various cell types in your skin can release chemicals that worsen inflammation, which ones leads to rash formation remains a mystery and may <a href="https://doi.org/10.1016/j.immuni.2018.05.012">vary from patient to patient</a>.</p>
<p>But molecular testing of skin rashes isn’t a common practice because of technological limitations. Using a new approach, my colleagues and I were able to analyze the <a href="https://www.science.org/doi/10.1126/sciimmunol.abl9165">genetic profiles of skin rashes</a> and quantitatively diagnose their root causes.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/Orumw-PyNjw?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Skin is a complex organ that performs a wide variety of functions.</span></figcaption>
</figure>
<h2>High-res skin profiles</h2>
<p>Traditional genetic analyses work by averaging out the activity of <a href="https://doi.org/10.1038/jid.2014.28">thousands of genes across millions of cells</a>.</p>
<p>Genetically testing tissue samples is standard practice for conditions like cancer. Clinicians collect and analyze tumor biopsies from patients to determine a particular cancer’s unique molecular characteristics. This genetic fingerprint helps oncologists <a href="https://doi.org/10.1016/j.semcancer.2017.08.010">predict whether a cancer will spread or which treatments might work best</a>. Cancer cells lend themselves to this form of testing because they often grow into recognizable masses that make them easy to <a href="https://www.cancer.gov/about-cancer/treatment/types/biomarker-testing-cancer-treatment">isolate and analyze</a>.</p>
<p>But skin is a complex mixture of cells. Collapsing these unique cell communities into a single group may obscure genetic signatures essential to diagnosis.</p>
<p>Recent technological advances called <a href="https://doi.org/10.1016/j.jdin.2020.08.001?">single-cell RNA sequencing</a>, however, have enabled scientists to preserve the identity of each type of cell that lives in the skin. Instead of averaging the genetic signatures across all cell types in bulk, single-cell RNA sequencing analyses allow each cell to preserve its unique characteristics.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/k9VFNLLQP8c?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Single-cell RNA sequencing is used to analyze samples where many different types of cells are present.</span></figcaption>
</figure>
<p>Using this approach, my colleagues and I isolated over 158,000 immune cells from the skin samples of 31 patients. We measured the activity of about 1,000 genes from each of those cells to create detailed molecular fingerprints for each patient. By analyzing these fingerprints, we were able to pinpoint the genetic abnormalities unique to the immune cells residing in each rash type. This allowed us to quantitatively diagnose otherwise visually ambiguous rashes. </p>
<p>We also observed that some patients had treatment responses consistent with what we expected with our predicted diagnoses. This suggests that our concept could viably be expanded for further testing.</p>
<p>To make our approach available to clinicians and scientists, we developed an open source web database called <a href="https://rashx.ucsf.edu/">RashX</a> that contains the genetic fingerprints of different rashes. This database will allow clinicians to compare the genetic profile of their patients’ rashes to similar profiles in our database. A closely matching genetic fingerprint might yield clues as to what caused their patient’s rash and lead to potential treatment avenues.</p>
<h2>Open source diagnostics</h2>
<p>The <a href="https://www.scientificamerican.com/article/biologics-the-pricey-drugs-transforming-medicine/">rapid development of drugs that target the immune system</a> in recent years has inundated doctors with difficult treatment decisions for individual patients. For example, while certain drugs that act on the immune system are known to work well for conditions like psoriasis or eczema, many patients have atypical rashes that can’t be precisely diagnosed. </p>
<p>An <a href="https://rashx.ucsf.edu/">open source database</a> like ours could help enable clinicians to profile and diagnose these rashes, providing a stepping stone to choose a suitable treatment. </p>
<p>Furthermore, <a href="https://doi.org/10.1126/science.abf3041">chronic inflammatory diseases</a> that affect organs other than the skin share similar genetic abnormalities. Lab tests that can illuminate the root causes of skin diseases can likely be expanded to many other conditions.</p>
<p>Our <a href="https://rashx.ucsf.edu/">RashX</a> project initially focused on just two very common types of rashes, psoriasis and eczema. It is unknown whether <a href="https://www.aad.org/public/diseases/a-z">other types of rashes</a> will have similar genetic profiles to psoriasis and eczema or instead have their own unique fingerprints. It is also unclear which parts of the fingerprint would best predict drug response.</p>
<p>But <a href="https://rashx.ucsf.edu/">RashX</a> is a living web resource that will grow more useful as more scientists collaborate and contribute new data. Our lab is also working to simplify the process of developing genetic profiles of rashes to make participating in this area of research more accessible for clinics around the world. With more data, we believe that projects like RashX will make precision testing for rashes an essential next step in diagnosis and treatment.</p>
<p>[<em>Understand new developments in science, health and technology, each week.</em> <a href="https://memberservices.theconversation.com/newsletters/?nl=science&source=inline-science-understand">Subscribe to The Conversation’s science newsletter</a>.]</p><img src="https://counter.theconversation.com/content/181138/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Raymond J. Cho, MD, PhD receives funding from the LEO Foundation, the National Psoriasis Foundation, the National Eczema Assocation, Sun Pharmaceutical Industries, Sanofi, and Pfizer. </span></em></p>Many doctors currently diagnose skin conditions by eye. Advances in molecular testing could lead to more precise and accurate diagnoses for ambiguous rashes and skin lesions.Raymond J. Cho, Associate Professor of Dermatology, University of California, San FranciscoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1653562021-08-27T12:31:11Z2021-08-27T12:31:11ZPoison ivy can work itchy evil on your skin – here’s how<figure><img src="https://images.theconversation.com/files/417572/original/file-20210824-18-1i54kq2.jpg?ixlib=rb-1.1.0&rect=158%2C213%2C4442%2C3235&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Be on the lookout for poison ivy's three leaves on a reddish stem.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/wooden-sign-warning-of-poison-ivy-in-a-wooded-area-royalty-free-image/951410190">raksybH/iStock via Getty Images Plus</a></span></figcaption></figure><p>A patient recently came <a href="https://scholar.google.com/citations?user=6GAgsk0AAAAJ&hl=en&oi=ao">in to our</a> <a href="https://scholar.google.com/citations?user=dIoB7-0AAAAJ&hl=en&oi=ao">dermatology clinic</a> with a rash and a story similar to so many others. He had been out camping with friends a few days earlier and helped carry some logs to stoke the fire. Little did he know he was going to pay for lending a helping hand. A couple days later, red patches appeared on his forearms and chest, which soon began to itch miserably and form water blisters.</p>
<p>If you have ever spent any time outdoors – in the woods, working in the yard, even at the edges of a playground – maybe you’ve experienced something similar after encountering poison ivy. It’s not easy to forget.</p>
<h2>Encounters with a botanical irritant</h2>
<p>Poison ivy is found <a href="https://www.cdc.gov/niosh/topics/plants/geographic.html">everywhere in the continental U.S.</a>, mostly in Eastern and Midwestern states. Unfortunately for us humans, it is a hardy plant that can grow under many different conditions. <a href="https://ag.umass.edu/landscape/fact-sheets/poison-ivy">Its favorite places</a> are in wooded areas, gardens and roadsides with partial shade or full sunlight.</p>
<p>And despite being a nuisance to people, <a href="https://www.tallahassee.com/story/life/home-garden/2019/10/24/poison-ivy-wildlife-salad-bar-woods/4076245002/">poison ivy is an important member of the ecosystem</a>. Its leaves, stems and berries are food for animals, and its vines can be shelter for small animals like toads and mice, even helping them climb trees. Climate change is turning out to benefit poison ivy, <a href="https://www.npr.org/templates/story/story.php?storyId=128650169">allowing for larger and more irritating plants</a>.</p>
<p>You can usually spot poison ivy by its <a href="https://ag.umass.edu/landscape/fact-sheets/poison-ivy">infamous three dull or glossy green leaves</a> coming off a red stem. Sometimes there are flowers or fruits coming off the end of a branch.</p>
<p>Despite its name, poison ivy is not poisonous. It carries an oily sap on its leaves and stems called urushiol, which is irritating to most people’s skin. In fact, <a href="https://doi.org/10.1580/PR31-05.1">85% to 90% of people are allergic</a> to poison ivy’s urushiol to some degree, while the rest lack sensitivity to this oil. You can occasionally <a href="https://www.uptodate.com/contents/poison-ivy-beyond-the-basics">see the urushiol oil as black spots on poison ivy leaves</a>. Urushiol is what gives poison oak and poison sumac their evil power, too.</p>
<p>Touching poison ivy directly is obviously a bad idea. You can even get into trouble by touching clothing, pets or anything else that has brushed against the plant and picked up some of the urushiol. If a contaminated object isn’t cleaned, the urushiol will remain lying in wait – it can still cause a rash after hours, days or <a href="https://www.iwu.edu/physical-plant/tailgate/grounds-tailgate/april-poison-ivy-oak-sumac.pdf">even years</a>. Another danger is <a href="https://www.mayoclinic.org/diseases-conditions/poison-ivy/symptoms-causes/syc-20376485">smoke from burning poison ivy</a>, which can also affect your skin, as well as your nose, mouth, windpipe and lungs if you breathe it in.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/417573/original/file-20210824-13-qudowb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="pink rash with blisters on skin close up" src="https://images.theconversation.com/files/417573/original/file-20210824-13-qudowb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/417573/original/file-20210824-13-qudowb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=378&fit=crop&dpr=1 600w, https://images.theconversation.com/files/417573/original/file-20210824-13-qudowb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=378&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/417573/original/file-20210824-13-qudowb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=378&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/417573/original/file-20210824-13-qudowb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=475&fit=crop&dpr=1 754w, https://images.theconversation.com/files/417573/original/file-20210824-13-qudowb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=475&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/417573/original/file-20210824-13-qudowb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=475&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">It’s a myth that the fluid from inside a blister can spread the rash.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/poison-ivy-rash-royalty-free-image/618621168">EzumeImages/iStock via Getty Images Plus</a></span>
</figcaption>
</figure>
<h2>From oil to rash</h2>
<p>Poison ivy’s rash can come in many forms, from small, red bumps to blisters or red patches. Whichever way it shows up, it is almost always mindbogglingly itchy.</p>
<p>When you get “poisoned,” you won’t know right away. It can take anywhere from four hours to 10 days for the rash to appear, depending on how much urushiol gets on your skin, how sensitive you are to it and how many times you have been <a href="https://www.aocd.org/page/PoisonIvyDermatiti">exposed to poison ivy previously</a>.</p>
<p>Between exposure and itchy anguish, your body goes through a complex identification and reaction process. When the oil gets into your skin, your immune system’s sensor cells recognize urushiol as <a href="https://news.harvard.edu/gazette/story/2016/09/from-leaf-to-itch/">foreign to your body</a>. These sensor cells then call in protector cells to the area, warning them of the invasion. The protector cells defend your body against the intruder by attacking the urushiol in the skin. Unfortunately, some of your body’s normal <a href="https://science.howstuffworks.com/life/botany/poison-ivy2.htm">skin cells are casualties of this war</a>, which is what leads to the itchiness and swelling of a poison ivy rash.</p>
<p>Your protector cells will then sit near the skin for many years and <a href="https://news.harvard.edu/gazette/story/2016/09/from-leaf-to-itch/">stand guard for urushiol</a> if it ever shows up again. If it does, they remember having encountered this bad guy before, and their response is often <a href="https://www.cbsnews.com/news/poison-ivy-poison-oak-becoming-stronger-over-time/">faster and more powerful</a> than the first time.</p>
<p>This rash is a type of allergic contact dermatitis – in the same family as the rashes some people get from wearing jewelry or metal belt buckles or from using certain fragrances or cosmetics.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/417574/original/file-20210824-24-glhqku.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="child with smartphone pointed at plant in the woods with identifying app up" src="https://images.theconversation.com/files/417574/original/file-20210824-24-glhqku.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/417574/original/file-20210824-24-glhqku.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/417574/original/file-20210824-24-glhqku.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/417574/original/file-20210824-24-glhqku.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/417574/original/file-20210824-24-glhqku.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/417574/original/file-20210824-24-glhqku.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/417574/original/file-20210824-24-glhqku.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Learning what poison ivy looks like so you can avoid it is a crucial part of your defense.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/mother-and-son-hiking-in-the-forest-and-learning-royalty-free-image/1305955558">Onfokus/E+ via Getty Images</a></span>
</figcaption>
</figure>
<h2>What to do once the damage is done</h2>
<p>The saying “leaves of three; leave them be” highlights the best strategy to prevent poison ivy: avoidance. But <a href="https://kidshealth.org/en/parents/poison-ivy-sheet.html">if you do happen to come into contact with poison ivy</a>, the first step should always be to remove and wash any clothing that has touched the plant. Gently but thoroughly wash your skin immediately with soap and water. It can also help to clean under your fingernails and cut your nails short to prevent the urushiol from spreading if you scratch your skin.</p>
<p>Allergic contact dermatitis from poison ivy almost always results in a rash that <a href="https://www.mayoclinic.org/diseases-conditions/poison-ivy/symptoms-causes/syc-20376485#:%7E:text=The%20reaction%20usually%20develops%2012,that%20gets%20on%20your%20skin">usually lasts two to three weeks</a> before it completely goes away.</p>
<p>[<em><a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-corona-important">Get The Conversation’s most important coronavirus headlines, weekly in a science newsletter</a></em>]</p>
<p>It will eventually clear up on its own, but you can try some over-the-counter and home remedies to keep the itchiness and spread of the rash at bay. The blisters that form are not infected and do not normally require antibiotics. If you scratch though – and it can be very hard to resist – open skin can get infected.</p>
<p><a href="https://www.mayoclinic.org/diseases-conditions/poison-ivy/diagnosis-treatment/drc-20376490">To reduce itchiness</a>, cool, wet compresses can help, as can a soak in a cool bath with baking soda or oatmeal bath products. Calamine lotions or creams containing menthol can also cut the itch a bit. Over-the-counter cortisone cream or ointment can be used for the first several days after contact with poison ivy to quiet down your body’s reaction and keep the rash from getting severe. <a href="https://www.mayoclinic.org/diseases-conditions/poison-ivy/diagnosis-treatment/drc-20376490">Taking antihistamines</a> like diphenhydramine at night can slightly reduce itchiness and it has the benefit of helping you sleep better.</p>
<p><a href="https://www.mayoclinic.org/diseases-conditions/poison-ivy/symptoms-causes/syc-20376485">Seeing your doctor usually is not necessary</a> for a poison ivy rash unless it spreads over large areas, becomes infected, lasts more than three weeks or is a rare extreme case that affects your breathing.</p>
<p>The best offense is a good defense. When you’re in the great outdoors, be careful what you touch and, when in doubt, if it has leaves of three, leave them be.</p><img src="https://counter.theconversation.com/content/165356/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Two dermatologists explain the itchy and unpleasant allergic reaction this plant can cause in up to 90% of people who encounter it.Arthur Mark Samia, Postdoctoral Research Fellow in Dermatology, University of FloridaMarjorie Montanez-Wiscovich, Clinical Assistant Professor of Dermatology, University of FloridaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1285172020-09-28T12:23:30Z2020-09-28T12:23:30ZCan you have too much Botox?<figure><img src="https://images.theconversation.com/files/313162/original/file-20200201-41527-hs9e3e.jpg?ixlib=rb-1.1.0&rect=0%2C23%2C5295%2C3424&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Six million Botox procedures are performed every year.</span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Botox-Unemployment/58da9442bf8c4f1ea92f21ff93c0b175/46/0">Jacquelyn Martin/Associated Press</a></span></figcaption></figure><p>Demand for cosmetic treatments, including botox and fillers, has surged since the COVID-19 pandemic began. Dermatologists and plastic surgeons <a href="https://www.nytimes.com/2020/08/13/health/coronavirus-cosmetic-surgery.html">are attributing the boom</a> to patients wanting to put their best face forward for online Zoom meetings, as well as increased time to attend appointments and recover from treatments.</p>
<p>Botox is now the most popular non-surgical cosmetic treatment in the U.S., with a market size valued at <a href="https://www.prnewswire.com/news-releases/botulinum-toxin-market-value-to-hit-8-5-billion-by-2025-global-market-insights-inc-300872310.html">$4.7 billion</a>. Over the past 20 years, the number of cosmetic Botox procedures have increased more than <a href="https://www.plasticsurgery.org/news/press-releases/new-statistics-reflect-the-changing-face-of-plastic-surgery">700 percent</a>, with <a href="https://www.medicalnewstoday.com/articles/158647.php">over six million treatments</a> performed every year. </p>
<p>Now trending with millennials, <a href="https://www.foxnews.com/lifestyle/preventative-botox-rising-trend-among-millennials">preventative Botox</a> involves stopping wrinkles before they have a chance to form. And although women still use the most Botox, more men are trying it, a trend known as “<a href="https://www.forbes.com/sites/petertaylor/2016/05/31/three-reasons-why-botox-will-change-every-mans-job-and-online-dating-prospects/#48a23f742eb0">brotox</a>.”</p>
<p>As a <a href="https://scholar.google.com.au/citations?user=wg7hKyIAAAAJ&hl=en">board-certified dermatologist</a> who frequently administers Botox treatments, I am often asked how it works, what it achieves, how to avoid “bad Botox” and if a person can have too much. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/313164/original/file-20200202-41495-1jygo3u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/313164/original/file-20200202-41495-1jygo3u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/313164/original/file-20200202-41495-1jygo3u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/313164/original/file-20200202-41495-1jygo3u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/313164/original/file-20200202-41495-1jygo3u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/313164/original/file-20200202-41495-1jygo3u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/313164/original/file-20200202-41495-1jygo3u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">More men are using Botox.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/man-having-botox-injections-royalty-free-image/imsis618-016">Getty Images</a></span>
</figcaption>
</figure>
<h2>What is Botox?</h2>
<p><a href="https://www.botox.com/">Botox</a> is a brand name of a toxin produced by the bacterium <em>Clostridium botulinum.</em> Other brand names for similar toxins include <a href="https://www.dysportusa.com/">Dysport</a>, <a href="https://www.xeominaesthetic.com/">Xeomin</a>, and <a href="https://jeuveau.evolus.com/">Jeuveau</a>. In large amounts, these chemicals can cause <a href="https://www.mayoclinic.org/diseases-conditions/botulism/symptoms-causes/syc-20370262">botulism</a>, an illness that may produce nausea, vomiting, and in severe cases, fatal paralysis of vital muscles. </p>
<p>Using small amounts, however, doctors can safely use the toxin to reduce the appearance of fine lines and wrinkles. In the 1980s, <a href="https://www.foxnews.com/health/cosmetic-botox-the-inadvertent-discovery">Jean and Alastair Carruthers</a>, a Canadian ophthalmologist and dermatologist, accidentally discovered the toxin’s anti-aging properties when they noticed patients receiving injections for facial spasm were also losing their frown lines. Subsequent studies did not suggest long-term risk.</p>
<h2>How does it work?</h2>
<p>Botox is administered with a fine needle to the muscle under the skin. It blocks signals from nerves to muscles. This results in temporary <a href="https://www.ncbi.nlm.nih.gov/pubmed/15830090">paralysis</a> of those muscles. Because the injected muscle can no longer contract, the wrinkles soften and relax. Over time, the skin becomes smoother with improvements in quality, tone and texture.</p>
<p>Botox is most often used for horizontal forehead lines and wrinkles around the eyes – the worry lines – and between-the-eyebrow frown lines — the “11s.” It is not FDA-approved for the lips. Wrinkles on the lower face caused by gravity and sun damage don’t respond as well to Botox.</p>
<p>There is no “average” cost for Botox. Distributors and practitioners have varying rates. </p>
<p>Beyond cosmetic applications, Botox is a treatment for more than 20 medical conditions, including <a href="https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/103000s5232lbl.pdf">eye spasm</a>, <a href="https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/103000s5232lbl.pdf">Bell’s palsy</a>, <a href="https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/103000s5232lbl.pdf">headache</a>, <a href="https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/103000s5232lbl.pdf">excessive sweating</a> and <a href="https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/103000s5232lbl.pdf">urinary incontinence</a>.</p>
<p>The procedure takes only a few minutes. Some people prefer to use numbing cream, but no anesthesia is required and discomfort is minor. For four to six hours afterwards, patients must not lay down, manipulate the injected area or exercise vigorously. This keeps the Botox from migrating outside the treatment zones. But it’s OK to immediately return to work or resume normal social activities. Generally it takes <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3789632/">one to two weeks</a> for the Botox to take full effect, but some patients will notice changes after <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3789632/">two or three days</a>. </p>
<p>Typically, the effect lasts from <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3789632/">three to six months</a>. As muscle action gradually returns, lines and wrinkles begin to reappear and they can be retreated. Over time, returning lines and wrinkles often appear less severe; the muscles learn to relax and the overlying skin becomes less creased and folded.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/313165/original/file-20200202-41507-7ckfw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/313165/original/file-20200202-41507-7ckfw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=443&fit=crop&dpr=1 600w, https://images.theconversation.com/files/313165/original/file-20200202-41507-7ckfw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=443&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/313165/original/file-20200202-41507-7ckfw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=443&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/313165/original/file-20200202-41507-7ckfw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=557&fit=crop&dpr=1 754w, https://images.theconversation.com/files/313165/original/file-20200202-41507-7ckfw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=557&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/313165/original/file-20200202-41507-7ckfw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=557&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Botox is not a one-size-fits-all treatment.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Pfizer-Allergan/18b77c999d9542eeacddcfd8ad3174f8/1/0">AP Photo/Damian Dovarganes</a></span>
</figcaption>
</figure>
<h2>Things to consider before the injection</h2>
<p>The safety of Botox for <a href="https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/103000s5303lbl.pdf">pregnant or breastfeeding women</a> has not been determined, so neither group should use it. Also, people with certain neurological diseases should not use Botox. </p>
<p>When an expert performs the procedure, patients generally tolerate Botox well. A recent study found <a href="https://jamanetwork.com/journals/jamadermatology/fullarticle/1922026">less than 1%</a> of patients experience problems if a board-certified dermatologist administers the treatment. Temporary bruising is the most common side effect. Headaches sometimes occur; they stop within one to two days. A small percentage of patients may develop eyebrow or eyelid drooping, but this usually resolves in a few weeks.</p>
<p>Because day spas and other nonmedical offices do Botox treatments, many people think a Botox injection is on the same level as a manicure, facial or haircut. This is not the case. This is a medical procedure requiring specific training and expertise in order to achieve safe and aesthetically pleasing results. Many doctors and medical paraprofessionals advertise Botox treatments after taking a weekend course in injections. But those courses are teaching their students to match a template – and Botox is not a “one-size-fits-all” treatment. An individual’s unique features and muscle patterns must be taken into account. </p>
<p>It’s best to choose an experienced provider with extensive knowledge of facial anatomy, an aesthetic eye and well-developed skills. A highly trained board-certified physician is also best able to manage any complications post-treatment. </p>
<h2>Can you have too much Botox?</h2>
<p>If you go to an unqualified provider, it may not look right, no matter what the amount. That said, when it comes to Botox, less is more. You want a subtle and natural look, with plenty of movement left in the face. Too much causes that stereotypical frozen appearance. Botox isn’t noticeable if it’s injected in small doses by a skilled practitioner. And when done just right, a good Botox treatment presents a patient who appears more rested, with more defined brows, more open eyes, and skin that takes on a smoother and more youthful appearance. </p>
<p>[<em><a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=expertise">Expertise in your inbox. Sign up for The Conversation’s newsletter and get a digest of academic takes on today’s news, every day.</a></em>]</p><img src="https://counter.theconversation.com/content/128517/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Matthew J. Lin, M.D. has previously received research grants from Allergan.</span></em></p>Botox, one of the most common dermatological treatments, is now trending with millennials. But can too much Botox be bad for you?Matthew Lin, Assistant Clinical Professor, Dermatologist and Mohs Surgeon, Icahn School of Medicine at Mount SinaiLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1444832020-08-21T03:25:33Z2020-08-21T03:25:33Z8 ways the coronavirus can affect your skin, from COVID toes, to rashes and hair loss<figure><img src="https://images.theconversation.com/files/353788/original/file-20200820-18-1hz1hcb.jpg?ixlib=rb-1.1.0&rect=2%2C7%2C995%2C658&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/covid-toes-another-symptom-coronavirus-infection-1712862961">from www.shutterstock.com</a></span></figcaption></figure><p>As the pandemic progresses, we’re growing increasingly aware COVID-19 affects <a href="https://elemental.medium.com/every-covid-19-symptom-we-know-about-right-now-from-head-to-toe-bd1d47584096">multiple parts of the body</a> beyond the lungs. That includes the skin. </p>
<p>We’ve seen reports of skin symptoms ranging from “COVID toes” to hair loss, and different types of rashes.</p>
<p>Some skin symptoms appear soon after infection, while others arise later or in more severe disease. Most <a href="https://www.nature.com/articles/s41591-020-0968-3">get better</a> with time.</p>
<p>Researchers are also beginning to work out what causes these skin conditions, whether it’s the body’s immune response to infection, or whether hormones are involved.</p>
<p>Here are <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/bjd.19163">some of these symptoms</a>, from the most common to the least:</p>
<p><strong>1. widespread small red bumps and multiple flat red patches.</strong> These so-called maculopapular eruptions are associated with more severe disease</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/353996/original/file-20200821-16-v3e0l.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/353996/original/file-20200821-16-v3e0l.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/353996/original/file-20200821-16-v3e0l.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=321&fit=crop&dpr=1 600w, https://images.theconversation.com/files/353996/original/file-20200821-16-v3e0l.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=321&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/353996/original/file-20200821-16-v3e0l.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=321&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/353996/original/file-20200821-16-v3e0l.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=404&fit=crop&dpr=1 754w, https://images.theconversation.com/files/353996/original/file-20200821-16-v3e0l.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=404&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/353996/original/file-20200821-16-v3e0l.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=404&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">These maculopapular eruptions are associated with more severe disease.</span>
<span class="attribution"><a class="source" href="https://onlinelibrary.wiley.com/doi/full/10.1111/bjd.19163">British Journal of Dermatology</a></span>
</figcaption>
</figure>
<p><strong>2. redness of the whites of the eyes</strong>. This <a href="https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2764083#246398567">conjunctivitis</a> is most common later in the disease and in more severe disease</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1294699144255287298"}"></div></p>
<p><strong>3. chilblain-like symptoms, commonly called ‘COVID toes’</strong>. These can affect <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jdv.16526">hands or feet</a>, or both at the same time. The red-purple discoloured skin can be painful and itchy, and there are sometimes small blisters or pustules. These chilblain-like lesions often appear late in the disease, after other symptoms, and are most common in children</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1294554279785558017"}"></div></p>
<p><strong>4. hives</strong> or <a href="https://theconversation.com/what-are-hives-the-common-skin-condition-that-gives-you-itchy-red-bumps-121693">urticaria</a> are pink or red itchy rashes that may appear as blotches or raised red lumps (wheals). They range from the size of a pinhead to a dinner plate. Swellings usually disappear within minutes to hours in one spot, but may come and go. Mostly hives clear within ten days. They occur at the same time as other symptoms, in all ages, and are associated with more severe disease</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1248510282281844736"}"></div></p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/354000/original/file-20200821-20-1vy726c.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Vesicular eruptions, or water blisters, on the back" src="https://images.theconversation.com/files/354000/original/file-20200821-20-1vy726c.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/354000/original/file-20200821-20-1vy726c.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=424&fit=crop&dpr=1 600w, https://images.theconversation.com/files/354000/original/file-20200821-20-1vy726c.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=424&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/354000/original/file-20200821-20-1vy726c.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=424&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/354000/original/file-20200821-20-1vy726c.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=532&fit=crop&dpr=1 754w, https://images.theconversation.com/files/354000/original/file-20200821-20-1vy726c.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=532&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/354000/original/file-20200821-20-1vy726c.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=532&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">These water blisters, or vesicular eruptions, are more common in middle-aged people with COVID-19.</span>
<span class="attribution"><a class="source" href="https://onlinelibrary.wiley.com/doi/full/10.1111/bjd.19163">British Journal of Dermatology</a></span>
</figcaption>
</figure>
<p><strong>5. water blisters</strong>, or vesicular eruptions, are small fluid-filled micro-blisters that may appear early in the disease or at any time, often on the hands. Middle‐aged patients suffer more commonly. The blisters last just over ten days, and are associated with medium-severity disease</p>
<p><strong>6. ‘fishing net-like’ red-blue pattern on the skin</strong>, or livedo, sometimes with tiny bruises (purpura), is associated with more severe disease and older age groups. This pattern is thought to be due to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7158248/">blockages of the blood vessels</a> that arise as part of the body’s immune response to the virus</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1296202019091255297"}"></div></p>
<p><strong>7. rash associated with <a href="https://www.cdc.gov/mmwr/volumes/69/wr/mm6932e2.htm">multisystem inflammatory syndrome in children</a></strong> or MIS-C. This “immune system overdrive” triggers an inflammation of the heart and blood vessels, resulting in blood clots and symptoms of shock. This <a href="https://theconversation.com/4-unusual-things-weve-learned-about-the-coronavirus-since-the-start-of-the-pandemic-140168">very rare complication</a> can occur up to three months after a child has had COVID-19</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1261543698371756033"}"></div></p>
<p><strong>8. hair loss</strong> (<a href="https://dermnetnz.org/topics/telogen-effluvium/">telogen effluvium</a>) occurs in many severe illnesses, including COVID-19. This is the body shutting down unnecessary activity in times of stress. Provided people’s iron levels are normal, the hair will recover in time</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1292540903047852034"}"></div></p>
<p>COVID-19 serious enough to take people to hospital also seems to be more common in people with <a href="https://www.healthdirect.gov.au/male-pattern-baldness">male-pattern baldness</a>. One study found <a href="https://www.jaad.org/article/S0190-9622(20)30948-8/fulltext">up to 79%</a> of hospital admissions for COVID-19 were balding men.</p>
<p>An increased level of the hormone dihydrotestosterone is thought to increase the numbers of ACE2 receptors, which is how the virus enters the body. In other words, male-pattern baldness may predispose people to more severe disease.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/heres-what-we-know-so-far-about-the-long-term-symptoms-of-covid-19-142722">Here's what we know so far about the long-term symptoms of COVID-19</a>
</strong>
</em>
</p>
<hr>
<h2>What could be causing these symptoms?</h2>
<p>Some of the COVID-19 rashes are not caused by the virus itself, but by the body’s immune response to the virus.</p>
<p>For instance, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7158248/">research suggests</a> some may be caused by over-activation of a part of the immune system known as the “<a href="https://www.britannica.com/science/complement-immune-system-component">complement</a>” response. This leads to the blood vessel damage seen in the chilblain-type symptoms (point 3 above) and in livedo (point 6).</p>
<p>Complement activity is also increased in <a href="https://www.frontiersin.org/articles/10.3389/fimmu.2018.02664/full">elderly people</a> and may well explain many of the more serious COVID-19 outcomes we see in this age group.</p>
<h2>How do I know if my skin rash is COVID-19?</h2>
<p>If you’re concerned about any skin symptoms, check them against the photos in <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/bjd.19163">this article</a>. Then you can consult your GP or dermatologist via a telehealth appointment for further advice.</p>
<p>You might be infectious. Get tested and self-isolate until you receive your test results. If you feel unwell, your GP or COVID clinic will be able to coordinate your care.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/my-skins-dry-with-all-this-hand-washing-what-can-i-do-134146">My skin's dry with all this hand washing. What can I do?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/144483/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Freeman is the director of dermatology at the Gold Coast Hospital and the principal dermatologist at The Skin Centre.</span></em></p>Some skin symptoms appear soon after infection, while others arise later or in more severe disease. Most get better with time.Michael Freeman, Dermatologist, Associate Professor, Bond UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1341462020-04-13T19:48:13Z2020-04-13T19:48:13ZMy skin’s dry with all this hand washing. What can I do?<figure><img src="https://images.theconversation.com/files/324520/original/file-20200401-66125-znylpp.jpg?ixlib=rb-1.1.0&rect=0%2C8%2C1920%2C1270&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/E6fONgWV1Uo">Irina Ba/Unsplash</a></span></figcaption></figure><p>Washing your hands is one of the <a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public">crucial ways</a> <a href="https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/what-you-need-to-know-about-coronavirus-covid-19#good-hygiene">we can all help</a> limit the spread of COVID-19.</p>
<p>Regularly and thoroughly washing your hands with soap and water for at least 20 seconds, or using an alcohol-based hand sanitiser, are key steps to reducing the risk.</p>
<p>But with all this hand washing, it’s easy to get dry skin or for existing skin conditions to flare up.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/yes-washing-our-hands-really-can-help-curb-the-spread-of-coronavirus-132915">Yes, washing our hands really can help curb the spread of coronavirus</a>
</strong>
</em>
</p>
<hr>
<h2>What’s happening to our skin?</h2>
<p>The top layer of our skin (the stratum corneum) is our skin’s key protective layer. But frequent hand washing with repetitive exposure to water, soap and skin cleansers <a href="https://www.sciencedirect.com/science/article/pii/S0022202X15301676">will disrupt</a> this layer.</p>
<p>Over time, this leads to dry skin, further disruption of the skin barrier and inflammation. </p>
<p>This eventually results in hand dermatitis, or more specifically, <a href="https://www.dermcoll.edu.au/atoz/irritant-contact-dermatitis-icd/">irritant contact dermatitis</a>. </p>
<h2>Who’s more likely to have problems?</h2>
<p>Irritant contact dermatitis is <a href="https://www.sciencedirect.com/science/article/pii/S2093791114000560">more common</a> in people who perform “wet work” as they wash and dry their hands many times a day.</p>
<p>They include health-care workers (doctors, nurses, personal care assistants), hairdressers, food handlers, kitchen staff and cleaners. They may also be exposed to irritating skin cleansers and detergents.</p>
<p>But now handwashing is becoming more frequent during the COVID-19 pandemic, there may be more affected people outside these occupations.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/325148/original/file-20200403-74908-nwfm4d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/325148/original/file-20200403-74908-nwfm4d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/325148/original/file-20200403-74908-nwfm4d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/325148/original/file-20200403-74908-nwfm4d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/325148/original/file-20200403-74908-nwfm4d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/325148/original/file-20200403-74908-nwfm4d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/325148/original/file-20200403-74908-nwfm4d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/325148/original/file-20200403-74908-nwfm4d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Health-care workers, who wash their hands multiple times a day, are particularly at risk of hand dermatitis.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/couple-surgeons-washing-hands-before-operating-633363035">Shutterstock</a></span>
</figcaption>
</figure>
<p>People with eczema, asthma and hay fever are also at <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1440-0960.2007.00409.x">higher risk</a> of developing irritant contact dermatitis or experiencing a flare of underlying eczema.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/common-skin-rashes-and-what-to-do-about-them-91518">Common skin rashes and what to do about them</a>
</strong>
</em>
</p>
<hr>
<h2>How do I prevent hand dermatitis?</h2>
<p><strong>1. Soap, soap alternative or hand sanitiser?</strong></p>
<p>People with eczema or who have had contact dermatitis before will have more easily irritated skin. While they can still use hand sanitisers, it’s recommended they wash with gentler soap-free washes rather than normal soap.</p>
<p>Soap-free washes contain non-soap-based synthetic detergents (syndets). <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/jocd.12469">Syndets</a> have a nearly identical cleansing action as soap, but with the benefit of having the same pH as the skin. This means they’re less likely to remove the oils from the outer layer of the skin and are less irritating. </p>
<p>Soaps have a high pH and are <a href="https://www.egopharm.com/au/en/Hand-Hygiene-Coronavirus.html">quite alkaline</a>. This disrupts the outer layer of the skin, allowing the soap to penetrate deeper into the skin, thus causing more skin irritation and itching. </p>
<p>Other people who don’t have eczema or a history of contact dermatitis should just use soap. Liquid soaps usually contain fragrances and preservatives, which can cause another type of dermatitis (allergic contact dermatitis), so opt for a plain, unperfumed bar soap. </p>
<p><strong>2. Dry your hands thoroughly</strong></p>
<p>Dry your hands thoroughly, including the webs of your fingers and under your
rings to reduce dermatitis caused by trapped water. Skin irritation and breakdown can occur when there is excessive moisture, soap residues and water trapped between the skin and underneath rings.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/coronavirus-and-handwashing-research-shows-proper-hand-drying-is-also-vital-132905">Coronavirus and handwashing: research shows proper hand drying is also vital</a>
</strong>
</em>
</p>
<hr>
<p><strong>3. Use non-fragranced moisturiser regularly</strong></p>
<p>Moisturisers come in different formulations. While lotions are light in consistency and convenient to use during the day, they will require more frequent applications. Creams and ointments have thicker and oilier texture, are effective for dry hands and are <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/ddg.12510_1">best used overnight</a>.</p>
<p>Fragrances can cause allergic contact dermatitis and are best avoided, where possible.</p>
<p><strong>4. Use alcohol-based hand sanitiser (if you can get hold of it)</strong></p>
<p>Alcohol-based hand sanitiser will reduce your skin’s contact with water, and so lower your risk of dermatitis.</p>
<p>Research in health-care workers <a href="https://www.jstage.jst.go.jp/article/indhealth/45/5/45_5_645/_article/-char/ja/">shows</a> hand sanitisers cause less contact dermatitis than washing with soap and water.</p>
<p>Sometimes people wrongly believe that when hand sanitiser stings on a paper cut, this means that they are allergic. But this is an irritant reaction and though uncomfortable, it’s safe to keep using it.</p>
<p>Which sanitiser? This usually comes down to personal preference (and what you can get hold of).</p>
<p><strong>5. Use gloves</strong></p>
<p>Use protective gloves when doing household chores, such as washing the dishes or when gardening. </p>
<p>Use cotton gloves when doing dry work, such as sweeping or dusting, to protect your hands and <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/ddg.12510_1">minimise the need to wash them</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/325152/original/file-20200403-99325-co1vxh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/325152/original/file-20200403-99325-co1vxh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/325152/original/file-20200403-99325-co1vxh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/325152/original/file-20200403-99325-co1vxh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/325152/original/file-20200403-99325-co1vxh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/325152/original/file-20200403-99325-co1vxh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/325152/original/file-20200403-99325-co1vxh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/325152/original/file-20200403-99325-co1vxh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Use washing up gloves where possible.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-washing-dishes-kitchen-close-hand-518530291">Shutterstock</a></span>
</figcaption>
</figure>
<p>At night, moisturise your hands than wear cotton gloves. This acts like an intensive hand mask and works wonders for very dry skin. It ensures the moisturiser stays on your hands and increases its penetration into your skin.</p>
<h2>What if my hands are already damaged, dry or cracking?</h2>
<p><strong>1. Act early</strong></p>
<p>Treat hand dermatitis as soon as it occurs, otherwise it will get worse. </p>
<p><strong>2. Apply petroleum jelly</strong></p>
<p>If you think you’ve lost your nail cuticle (the protective barrier between the nail and nail fold), water will be able to seep into the nail fold, causing swelling and dermatitis. </p>
<p>Use petroleum jelly, such as Vaseline, as a sealant to prevent further water damage. Petroleum jelly can also be used on skin cracks for the same reason. </p>
<p><strong>3. Seek medical help</strong></p>
<p>If there are any red, dry and itchy areas, indicating active dermatitis, seek help from your GP or dermatologist.</p>
<p>They can start you on a short burst of an ointment that contains corticosteroids until the rash subsides.</p>
<p>Prescription ointments are likely to be more effective than over-the-counter creams because of their higher potency. </p>
<p>But you could start with buying 1% hydrocortisone ointment, not cream, from the chemist.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-can-you-use-a-telehealth-consult-for-and-when-should-you-physically-visit-your-gp-135046">What can you use a telehealth consult for and when should you physically visit your GP?</a>
</strong>
</em>
</p>
<hr>
<p>Sometimes dermatitis can become infected with skin bacteria such as <em>Staphylococcus aureus</em>. Seek medical advice if you experience symptoms such as persistent soreness or pain.</p>
<p>You should also seek medical help if you have severe hand dermatitis not responding to home treatments.</p>
<p>Most GPs and dermatologists are moving to or have started using telehealth so you can consult them using a video call, minimising face-to-face appointments.</p><img src="https://counter.theconversation.com/content/134146/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Celestine Wong is a Consultant Dermatologist working at the Patch testing Clinic at Monash Medical Centre and the Royal Melbourne Hospital.</span></em></p><p class="fine-print"><em><span>Rosemary Nixon is the Director, Occupational Dermatology Research and Education Centre, Skin Health Institute, Melbourne. The centre is a not-for-profit dermatology centre affiliated with Melbourne and Monash universities. As well as her affiliation with the University of Melbourne, Rosemary Nixon is an Adjunct Clinical Associate Professor at Monash University.</span></em></p>You can prevent your skin becoming dry and inflamed with some simple steps. And if you do develop dermatitis, it’s important to seek early medical help.Celestine Wong, Consultant Dermatologist, Monash HealthRosemary Nixon, Honorary Clinical Associate Professor, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1251292019-12-08T18:52:32Z2019-12-08T18:52:32ZWhat is sodium lauryl sulfate and is it safe to use?<figure><img src="https://images.theconversation.com/files/298865/original/file-20191028-113998-r2j8b7.jpg?ixlib=rb-1.1.0&rect=0%2C1%2C997%2C664&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">SLS is a known irritant to human skin. But if it's only in contact with your skin for a short time, it's probably OK. </span> <span class="attribution"><span class="source">from www.shutterstock.com</span></span></figcaption></figure><p>If you’ve ever Googled the causes of a skin complaint or damaged hair, chances are someone on the internet has pointed the finger at SLS, or sodium lauryl (or laureth) sulfate, a common ingredient in beauty products, washes, toothpastes and even cleaning products.</p>
<p>So what does this ingredient do, why is it in everything, and what does the evidence say about how safe it is? </p>
<h2>Why SLS?</h2>
<p>When we use a wash or beauty product on our skin, it’s probably a liquid made of a water phase and an oily phase. As we know, oil and water don’t mix, so something is required to keep the ingredients together. </p>
<p>That something is called a surfactant. A surfactant allows the oil and water molecules to bind together – it’s what’s found in soaps and detergents so we can wash our oily faces or dishes with water and get the grime to disappear.</p>
<p>Sodium lauryl sulfate is a surfactant, and its efficacy, low cost, abundance and simplicity mean it’s used in a variety of cosmetic, dermatological and consumer products.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/299627/original/file-20191031-187898-uvkcac.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/299627/original/file-20191031-187898-uvkcac.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/299627/original/file-20191031-187898-uvkcac.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/299627/original/file-20191031-187898-uvkcac.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/299627/original/file-20191031-187898-uvkcac.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/299627/original/file-20191031-187898-uvkcac.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/299627/original/file-20191031-187898-uvkcac.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/299627/original/file-20191031-187898-uvkcac.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Your toothpaste, shampoo and body wash probably all contain SLS.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-what-should-i-eat-to-improve-my-skin-94905">Health Check: what should I eat to improve my skin?</a>
</strong>
</em>
</p>
<hr>
<h2>Is it harmful?</h2>
<p>Our skin’s outermost layer is specially designed to keep harmful stuff out, and this is where a surfactant can cause problems. Using a chemical that weakens this defence mechanism can <a href="https://www.researchgate.net/publication/302244511_Sodium_Lauryl_Sulfate_Water_Soluble_Irritant_Dermatitis_Model">potentially cause our skin harm</a>. </p>
<p>And some surfactants are more irritating to our skin than others. For something to be harmful, irritant or allergenic, it has to fulfil <a href="https://espace.library.uq.edu.au/view/UQ:719752">two criteria</a>.</p>
<p>It has to have been found in studies to irritate human skin, and it has to have the ability to penetrate the skin. SLS ticks both of these boxes.</p>
<p><a href="https://onlinelibrary.wiley.com/doi/full/10.1034/j.1600-0536.2003.480209.x">Researchers from Germany tested</a> 1,600 patients for SLS irritancy and found 42% of the patients tested had an irritant reaction.</p>
<p>Another <a href="https://www.ncbi.nlm.nih.gov/pubmed/16283906">study</a>, on seven volunteers over a three and a half month period, found regular contact caused irritation, and the irritation subsided once the skin was no longer exposed to SLS.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/7758326">Another study found</a> the warmer the water used with SLS, the more irritating it will be.</p>
<p>In fact, SLS is so known to cause irritation, it’s used as a <a href="https://www.sciencedirect.com/science/article/pii/S0022202X9091287L">positive control in dermatological testing</a>. That is, new products being tested to see how irritating they might be to human skin are compared to SLS - something we know definitely to be irritating.</p>
<p>If a person is sensitive to SLS, they might find the area that has been in contact is red, dry, scaly, itchy or sore.</p>
<p>It’s also important to note there’s <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4651417/">no scientific evidence</a> SLS causes cancer, despite what you may read on the internet.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/299625/original/file-20191031-187934-17swv0k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/299625/original/file-20191031-187934-17swv0k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/299625/original/file-20191031-187934-17swv0k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/299625/original/file-20191031-187934-17swv0k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/299625/original/file-20191031-187934-17swv0k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/299625/original/file-20191031-187934-17swv0k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/299625/original/file-20191031-187934-17swv0k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/299625/original/file-20191031-187934-17swv0k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">If you suspect you are sensitive to SLS, stop using the product and consult your GP or pharmacist.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<h2>So why is it allowed?</h2>
<p>So if it’s known to be irritating to human skin, why don’t the regulatory authorities ban its use? </p>
<p>For SLS to be considered dangerous, it would have to be in contact with the skin for a long period of time. Generally, with consumer products such as washes that contain SLS, it’s assumed they won’t be on the skin for very long, meaning the chance of your skin being affected is pretty low. So authorities don’t ban its use, but instead cap the maximum percentage at which it can be used in products. </p>
<p>This cap varies based on how long the product is likely to be in contact with the skin. So products that will be on the skin for a prolonged time can contain no more than <a href="https://www.accessdata.fda.gov/scripts/cder/iig/index.cfm?event=BasicSearch.page">0.05-2.5% SLS</a> in most countries.</p>
<p>All consumer and cosmetic product manufacturers are required to conduct thorough testing and include any adverse findings in the form of warnings on their labels. So on products containing SLS, you should see something like “if this product causes any skin redness or irritation, discontinue use and consult a medical practitioner”.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-are-hives-the-common-skin-condition-that-gives-you-itchy-red-bumps-121693">What are hives, the common skin condition that gives you itchy, red bumps?</a>
</strong>
</em>
</p>
<hr>
<h2>Who should avoid SLS?</h2>
<p>People with a history of sensitive skin, hyperirritable skin and patients suffering from skin conditions such as atopic dermatitis (eczema), rosacea and psoriasis are best to avoid products containing SLS. </p>
<p>There are many safer alternatives available (look for fatty alcohol ethoxylate, alkyl phenol ethoxylate or fatty acid alkoxylate on the label). If you think it might be SLS causing a skin irritation, stop the use of the product and ask your pharmacist or GP for advice. Skin care products also have hotline numbers on the packaging that can be contacted to report adverse effects.</p><img src="https://counter.theconversation.com/content/125129/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Yousuf Mohammed receives funding from the U.S. Food and Drug Administration through grants 01FD005226,U01FD006946 and U01FD006700. The views expressed here are those of the author and do not reflect the official policies of the U.S. Food and Drug Administration. . </span></em></p>If you looked at the ingredient list on your body wash, shampoo, toothpaste and cleaning products, you’d probably find most contain sodium lauryl sulfate (SLS). It is a known irritant to human skin.Yousuf Mohammed, Dermatology researcher, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1216932019-10-09T04:44:30Z2019-10-09T04:44:30ZWhat are hives, the common skin condition that gives you itchy, red bumps?<figure><img src="https://images.theconversation.com/files/295333/original/file-20191003-49383-lmrhrt.jpg?ixlib=rb-1.1.0&rect=1%2C1%2C997%2C664&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The itchiness of hives or urticaria can severely affect people's quality of life, particularly if symptoms last or antihistamines don't work.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-woman-scratching-her-itchy-arm-1169648437?src=O7U5MHs07BCwV4fyDogiTw-1-1">from www.shutterstock.com</a></span></figcaption></figure><p>Have you ever wondered who buys those huge boxes of <a href="https://www.healthdirect.gov.au/antihistamines">antihistamines</a> prominently displayed all year round in your local pharmacy? If <a href="https://www.jacionline.org/article/S0091-6749(11)01408-4/fulltext">antihistamines</a> were just used for hay fever, you’d think sales would be good in spring, but pretty mediocre for the rest of the year.</p>
<p>Many of the antihistamines sold in Australia are actually for <a href="https://www.allergy.org.au/patients/skin-allergy/urticaria-hives">hives</a>, or what doctors call urticaria. Hives produces multiple red, raised bumps (or wheals) that are incredibly itchy. Hives occurs all year round.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/common-skin-rashes-and-what-to-do-about-them-91518">Common skin rashes and what to do about them</a>
</strong>
</em>
</p>
<hr>
<p>The condition is really <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5352572/">common</a>, with a Korean study showing around 22% of people can expect to have it at some time in their life.</p>
<p>Some people also get <a href="https://www.allergy.org.au/patients/skin-allergy/angioedema">angioedema</a>, where small blood vessels leak fluid into the tissues, causing spectacular swelling. If the swelling affects your throat and airways you can suffocate.</p>
<p>Fortunately, for the vast majority of people, hives comes and goes in a couple of weeks. While you can feel pretty miserable when you have it, antihistamines work <a href="https://www.racgp.org.au/afp/2014/september/evaluation,-diagnosis-and-management-of-chronic-urticaria/">well</a> to control the rash and itch. Suffocation is exceptionally rare.</p>
<h2>When hives won’t go away</h2>
<p>If you are unlucky enough to still have hives after six weeks, it’s <a href="https://www.racgp.org.au/afp/2014/september/evaluation,-diagnosis-and-management-of-chronic-urticaria/">likely to persist</a> six months, six years or even 26 years later. </p>
<p>This is what dermatologists call chronic urticaria, which affects <a href="https://books.google.com.au/books/about/Atlas_of_Common_Skin_Diseases_in_Austral.html?id=hgzIAAAACAAJ&redir_esc=y">about 1%</a> of the population (around 250,000 Australians). The itch, sleep disturbance, swelling and rash associated with it severely impair people’s quality of life. Of all skin diseases, chronic urticaria seems to worsen your <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2133.2005.06385.x">mood and disrupt day-to-day living</a> the most.</p>
<p>One antihistamine tablet is usually enough to control hay fever. But people with chronic urticaria may need two, three or sometimes four tablets a day to control their itch. Even that may not be enough to stop the wheals.</p>
<h2>What causes hives?</h2>
<p>So what causes hives? If your hives go away within six weeks, you probably had them because of a delayed reaction to a viral infection. Sometimes this acute condition is caused by an allergic reaction to a medication; an antibiotic allergy is a common cause. Occasionally a food allergy causes hives.</p>
<p>What about chronic urticaria, when hives last more than six weeks? Doctors don’t know the exact cause. While patients often suspect a food allergy, doctors rarely find a food trigger.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/295335/original/file-20191003-49346-4j0j6q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/295335/original/file-20191003-49346-4j0j6q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/295335/original/file-20191003-49346-4j0j6q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=456&fit=crop&dpr=1 600w, https://images.theconversation.com/files/295335/original/file-20191003-49346-4j0j6q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=456&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/295335/original/file-20191003-49346-4j0j6q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=456&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/295335/original/file-20191003-49346-4j0j6q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=573&fit=crop&dpr=1 754w, https://images.theconversation.com/files/295335/original/file-20191003-49346-4j0j6q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=573&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/295335/original/file-20191003-49346-4j0j6q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=573&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">We don’t know exactly what causes hives, seen here as raised, red bumps or wheals.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/urticaria-442616314?src=ZfCqtbFk2lL9xB1CMrWnPA-1-22">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>But we know <a href="https://www.allergy.org.au/patients/autoimmunity/autoimmune-diseases">autoimmunity</a> is involved, when the body’s immune system targets itself.</p>
<p>Most patients with chronic urticaria have <a href="https://www.nejm.org/doi/full/10.1056/NEJM199306033282204">antibodies</a> against their own immune system. In particular, these antibodies target molecules critical to a normal allergic response (immunoglobulin E, or IgE, and its receptor).</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-are-autoimmune-diseases-22577">Explainer: what are autoimmune diseases?</a>
</strong>
</em>
</p>
<hr>
<h2>When antihistamines don’t work</h2>
<p>If antihistamines don’t help, there are other options.</p>
<p>Medications that specifically target IgE and get to the root cause of urticaria autoimmunity are now available, provided you meet all the <a href="https://www.humanservices.gov.au/organisations/health-professionals/services/medicare/written-authority-required-drugs/drug-program-or-condition/urticaria-severe-chronic-spontaneous-urticaria">special criteria</a>. Only dermatologists are allowed to prescribe this medicine on the PBS.</p>
<p>To date, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4533538/">omalizumab</a> has been the most effective treatment for chronic urticaria patients who don’t respond to antihistamines. It’s given as an injection under the skin every four weeks. Unfortunately symptoms <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1215372">in fewer than 50%</a> of patients are completely controlled.</p>
<p>A new drug ligelizumab, which is still in clinical trials, is showing promise, according to international research we were involved with <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1900408?query=featured_home">published recently</a> in the New England Journal of Medicine. However, this experimental drug, which also targets IgE autoimmunity, is only available in Australia <a href="https://clinicaltrials.gov/ct2/show/study/NCT03580356?show_locs=Y#locn">as part of a clinical trial</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/randomised-control-trials-what-makes-them-the-gold-standard-in-medical-research-78913">Randomised control trials: what makes them the gold standard in medical research?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/121693/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rodney Sinclair was principal investigator in the phase 2 clinical trial dose-finding Study of QGE031 as add-on Therapy to Evaluate Efficacy and Safety in Patients With CSU (NCT03580356) and the Phase III Study of Efficacy and Safety of Ligelizumab in the Treatment of CSU in Adolescents and Adults Inadequately Controlled With H1-antihistamines (NCT03580356). These studies were funded by Novartis.
Professor Sinclair is a Dermatologist in private practice in Melbourne</span></em></p>Hives are incredibly common and most people find antihistamines help relieve this itchy skin rash. But for some, hives persist, so they have to try other treatments.Rodney Sinclair, Professor of Dermatology, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1197842019-08-09T14:41:54Z2019-08-09T14:41:54ZMedical skin creams could be a lethal fire risk when soaked into fabric – here’s what you need to know<figure><img src="https://images.theconversation.com/files/287362/original/file-20190808-144868-rwrhqu.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C3000%2C1989&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/old-women-applying-lotion-on-hand-438938872?src=r7YjXez6vBkiIIF9byXniQ-1-40">Rarin Lee/Shutterstock</a></span></figcaption></figure><p>Care providers were alerted to a house fire involving one of their patients at 4am on May 30, 2015. The fire and rescue services discovered a 74-year-old lady who had succumbed to a blaze that developed rapidly while she was still lying in bed. She had been bed bound, known to smoke in bed and was being treated for a skin condition. </p>
<p>A year later, a 61-year-old man who was also a smoker, bed bound and had emollient applied to his skin by carers was found dead in his bed after an intense fire. A year after that, an 82-year-old man died with third degree burns when his dressing gown came into contact with a lighter. He was also receiving daily applications of a cream and ointment.</p>
<p>What do all of these tragic deaths have in common? The victims were all being treated with creams for their skin conditions. While the fires were caused by smoking, the authorities reported that they were made more intense by the presence of these emollients. </p>
<h2>A hidden danger</h2>
<p>In the UK, one in five children and one in 12 adults will suffer <a href="http://www.eczema.org/about-us">from eczema</a> and <a href="http://www.bad.org.uk/for-the-public/patient-information-leaflets">2-3% of the population have psoriasis</a>. Medical creams, lotions and ointments are widely used to treat these conditions and can be prescribed or bought over the counter. They often include instructions to apply liberally, with multiple applications during the day. This results in the product soaking into clothing, dressings and bedding.</p>
<p>Several deaths from fires have been linked with the use of these skin emollients. A <a href="http://www.bbc.co.uk/news/uk-39308748">BBC freedom of information request</a> revealed that 37 fire deaths since 2010 have been linked to creams that contain paraffin. But fire reports don’t require such information to be included and not all fire services responded to questions. So the actual number of deaths and injuries may be higher.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-batteries-have-started-catching-fire-so-often-68602">Why batteries have started catching fire so often</a>
</strong>
</em>
</p>
<hr>
<p>It isn’t just products that contain lots of paraffin that pose a risk – those with a low paraffin content and even those without paraffin at all could be dangerous. <a href="https://www.uk-afi.org/seminars/annual-training-conference-2019">Our research shows</a> that all fabrics ignited quicker after contact with emollients – regardless of the paraffin level – than completely clean fabrics. </p>
<p><a href="https://www.sciencedirect.com/science/article/pii/S0379711218303400">In our initial tests</a>, we let a flame directly touch cotton sheeting that emollients had dried into for 24 hours. The fabric ignited too quickly to measure, but once we had the flame positioned 7cm from the edge of the soaked fabric, we found that ignition happened after only ten seconds, compared to over a minute with the same cotton sheeting that was completely clean.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/287222/original/file-20190807-144868-v87ih6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/287222/original/file-20190807-144868-v87ih6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=335&fit=crop&dpr=1 600w, https://images.theconversation.com/files/287222/original/file-20190807-144868-v87ih6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=335&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/287222/original/file-20190807-144868-v87ih6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=335&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/287222/original/file-20190807-144868-v87ih6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=421&fit=crop&dpr=1 754w, https://images.theconversation.com/files/287222/original/file-20190807-144868-v87ih6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=421&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/287222/original/file-20190807-144868-v87ih6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=421&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Fabric test burns after 20 seconds. The non-paraffin cream ignited at eight seconds, the 21% paraffin base cream at 11 seconds and the clean cotton at 52 seconds.</span>
<span class="attribution"><span class="source">Sarah Hall</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>The fabrics we tested included various thread counts of cotton and polyester blend sheeting and t-shirts – all are common in households and all ignite much quicker when skin creams are present. We also found that once the flame has extinguished, some of the fabrics smoulder for longer when the products are present – potentially burning for longer near the skin, causing significant burns and life-threatening injuries.</p>
<p>These findings have spurred the NHS and fire and rescue services to <a href="https://www.gov.uk/government/news/emollient-cream-build-up-in-fabric-can-lead-to-fire-deaths">reassess their safety advice</a>. Flammable residues are thought to be removed from fabrics if <a href="https://www.nationalfirechiefs.org.uk/News/latest-research-shows-hidden-fire-risk-of-emollients/220630">they’re washed at the highest temperature</a> possible, but research is still ongoing.</p>
<p>It’s important to remember that these products – on their own and in containers – aren’t a fire risk. The risk emerges when fabrics are soaked with them and allowed to dry. As the creams have soaked into fabrics, reducing the time it takes for the garments to ignite, <a href="https://www.judiciary.uk/wp-content/uploads/2015/10/Hills-2015-0317.pdf">elderly and immobile</a> victims haven’t been able to remove their clothing quickly enough to prevent injury or death. </p>
<p>People shouldn’t stop using much-needed medication, but they should know how to use the products safely. Our advice is to wash your clothes at high temperatures as often as you can to reduce the build up of the creams. Most importantly, keep any fabrics away from naked flames and cigarettes – you’re likely to have less time to react in the event of a fire than you think.</p><img src="https://counter.theconversation.com/content/119784/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Hall conducted this work with research assistant Kirsty Blackburn.
</span></em></p><p class="fine-print"><em><span>Joanne Morrissey does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Common emollients used to treat skin conditions are a hidden fire risk in most homes.Sarah Hall, Senior Lecturer and Head of the Forensic and Investigative Sciences Research Group, Anglia Ruskin UniversityJoanne Morrissey, Senior Lecturer in Crime and Investigative Studies, Anglia Ruskin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1209702019-08-02T05:14:23Z2019-08-02T05:14:23ZWant to avoid a botched beauty procedure? This is what you need to be wary of<figure><img src="https://images.theconversation.com/files/286548/original/file-20190801-169710-4jmt19.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Regulation doesn't cover procedures performed in a beauty salon in the same way it does those performed on the operating table.</span> <span class="attribution"><span class="source">From shutterstock.com</span></span></figcaption></figure><p>Recent news that more than a dozen cosmetic beauty operators <a href="https://www.theage.com.au/national/victoria/more-than-a-dozen-dodgy-beauty-salons-in-melbourne-shut-down-20190724-p52abl.html">have been shut down</a> across Victoria in the last year will give many people cause for concern.</p>
<p>One beauty therapist was allegedly found to be <a href="https://hcc.vic.gov.au/news/288-cosmetic-service-provider-under-investigation-after-allegedly-treating-clients-back">operating at the back of a jewellery store</a>, offering risky procedures including mole removal, facial fillers and skin tightening. In many cases, plastic surgeons and dermatologists have been required <a href="https://www.theage.com.au/national/victoria/plastic-surgeons-forced-to-fix-rising-tide-of-botched-cosmetic-procedures-20190730-p52c5h.html">to treat</a> the damage caused at these rogue salons, including swelling, scarring, and infection.</p>
<p>While low-cost procedures can be alluring, there are several things to keep in mind to ensure the treatments you’re getting are safe and reputable.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/injecting-regulations-into-cosmetic-medicine-41855">Injecting regulations into cosmetic medicine</a>
</strong>
</em>
</p>
<hr>
<h2>Regulation</h2>
<p>The skin is the <a href="https://www.tandfonline.com/doi/full/10.3109/17453054.2010.525439">largest</a> and most accessible organ of the body, making skin procedures like laser, dermabrasion, microneedling, skin peels, toxin injections and fillers very common among unqualified or minimally qualified people and clinics.</p>
<p>The Medical Board of Australia, supported by the Australian Health Practitioner Regulation Agency (AHPRA), are the governing bodies for medical professionals. They register practitioners, and <a href="https://www.medicalboard.gov.au/Codes-Guidelines-Policies/Cosmetic-medical-and-surgical-procedures-guidelines.aspx">enforce guidelines</a> for cosmetic medical and surgical procedures, which serve to protect the community.</p>
<p>There have been cases where registered medical practitioners, including general practitioners, have performed procedures <a href="https://www.smh.com.au/national/nsw/push-to-ban-rogue-operators-from-using-cosmetic-surgeon-title-20181120-p50h9e.html">outside their area of expertise</a> or have not conformed with codes of conduct, sometimes with tragic consequences. But in many of these cases, the regulations in place have helped to identify offending practitioners and ensure <a href="https://www.medicalboard.gov.au/News/2018-11-20-Media-release-Former-registered-practitioner-prosecuted.aspx">disciplinary action</a> is taken.</p>
<p>Yet for non-medical operators, for the most part, no training or educational requirements need to be met, no uniform national professional standards or codes of conduct exist, and there is no governing body to whom people can direct concerns. </p>
<p>Essentially, these beauty salons and non-medical clinics are simply not regulated by an external body or organisation.</p>
<h2>The importance of medical training</h2>
<p>The skin is an organ, just like the heart or lungs. Its structure and function is complex. In order to practise as a dermatologist, a person needs to first complete their medical degree, and then complete a further six years of specialist training in all matters related to the skin, hair and nails.</p>
<p><a href="https://en.wikipedia.org/wiki/Laser">Laser treatment</a> is commonly offered to treat things like redness on the skin, brown spots, and to improve skin texture and tone.</p>
<p>In order to deliver safe laser treatments, an accurate diagnosis is important. Is the brown spot on your cheek you want to remove a freckle, <a href="https://www.chromaderm.com.au/services/pigmentation/melasma/">melasma</a> (a discolouring of the skin) or a <a href="https://www.cancer.org.au/about-cancer/types-of-cancer/skin-cancer/melanoma.html">melanoma</a>? A person without a medical background could easily mistake a melanoma for a freckle, which could be deadly.</p>
<p>Even if you do have just a freckle, what laser settings will be safe and effective? An intimate understanding of the structure and function of the skin and the physics of the laser is necessary to make these important decisions.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/friday-essay-toxic-beauty-then-and-now-84267">Friday essay: toxic beauty, then and now</a>
</strong>
</em>
</p>
<hr>
<p>The regulations surrounding who can operate a laser differ from state to state. In Western Australia, unless you’re a medical doctor, nurse, or hold a diploma or certificate IV in beauty therapy (or equivalent) with a licence, you cannot operate a laser for the purpose of hair removal. Further <a href="http://www.radiologicalcouncil.wa.gov.au/Pages/FAQ/Lasers.html">restrictions apply</a> to the use of lasers for cosmetic procedures and tattoo removal. In Queensland and Tasmania, only <a href="https://www.health.qld.gov.au/public-health/industry-environment/personal-appearance/laser-licensing">those with relevant licences</a> can operate laser devices.</p>
<p>For the rest of the country, no regulation exists. This means <a href="https://www.racgp.org.au/afp/2017/september/navigating-the-disparate-australian-regulatory-minefield-of-cosmetic-therapy/">anyone can offer</a> skin treatments – a person who has done some online training or a weekend course could hang a “laser certificate” on the wall and start using lasers and other devices to treat skin.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/286568/original/file-20190801-169706-1sdzj1d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/286568/original/file-20190801-169706-1sdzj1d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/286568/original/file-20190801-169706-1sdzj1d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/286568/original/file-20190801-169706-1sdzj1d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/286568/original/file-20190801-169706-1sdzj1d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/286568/original/file-20190801-169706-1sdzj1d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/286568/original/file-20190801-169706-1sdzj1d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">In some Australian states, a person performing laser treatment doesn’t need to have had any training.</span>
<span class="attribution"><span class="source">From shutterstock.com</span></span>
</figcaption>
</figure>
<p>The same can be said for <a href="https://www.dermnetnz.org/topics/skin-needling/">microneedling</a>, the insertion of very fine, short needles into the skin for the purposes of rejuvenation or to reduce acne scarring. While some states <a href="https://ww2.health.wa.gov.au/Articles/S_T/Skin-penetration-procedures-and-the-law">regulate procedures</a> involving skin penetration, particularly around <a href="https://www2.health.vic.gov.au/-/media/health/files/collections/policies-and-guidelines/i/infection-prevention-control-guidelines---hair-beauty-tattooing-skin-penetration.pdf?la=en&hash=388465039045582AADF0B2012351C4795C82FDD7">infection control</a>, no uniform minimum training requirements exist for providers. </p>
<p>The depth of penetration of the microneedling device, the type of needle chosen, and pre- and post-treatment care are critical to maximising the benefits and minimising the risks of the procedure. </p>
<p>Similarly, for anti-wrinkle injections and fillers, an intimate understanding of facial anatomy is required to ensure safe and successful treatment. Complications can range from local injection site infection <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5840246/">through to blindness</a>. To have people performing these procedures who are not medically trained is very risky.</p>
<p>Medical professionals take precautions to minimise the risk of complications and are trained to recognise and deal with <a href="https://www.ncbi.nlm.nih.gov/pubmed/11966791">complications</a> that will inevitably occur from time to time. They can also prescribe relevant medications to help with things like infection or pain, if necessary. Non-medical providers cannot.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/will-microdermabrasion-or-skin-needling-give-me-better-skin-86619">Will microdermabrasion or skin needling give me better skin?</a>
</strong>
</em>
</p>
<hr>
<h2>Equipment and sanitation</h2>
<p>There are hundreds of different lasers, microneedling and skin care devices around. There are different brands, different models, and different safety features. So, varying outcomes can be seen with different devices.</p>
<p>Any piece of equipment that penetrates the skin needs to be sterilised in a medical-grade steriliser. Sterilising the equipment prevents the transmission of blood-borne infections like hepatitis B, hepatitis C and HIV. Failing to sterilise properly or not doing so at all places patients and the community at risk.</p>
<p>It must be said that there are many trained non-medical practitioners who adhere to infection control measures, understand what is safe and what is not, and who administer treatments in sanitary conditions. </p>
<h2>What needs to change?</h2>
<p>Regulatory bodies and the government need to work together to safeguard the community. We need to better regulate who can operate lasers and other skin devices, who can inject, cut and treat skin and in what type of environment this can take place. And we even need to regulate advertising – who can use the words “skin specialist”, “medical grade skin peels”, and so on. Because right now, anyone can. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/safety-before-profits-why-cosmetic-surgery-is-ripe-for-regulation-39365">Safety before profits: why cosmetic surgery is ripe for regulation</a>
</strong>
</em>
</p>
<hr>
<p>So how can a consumer know how to access treatment from a qualified practitioner? Given there are little or no regulations in some parts of the country, it’s very hard to be sure, but these tips can help:</p>
<ul>
<li>if you want to be treated by a medical practitioner, look up the <a href="https://www.ahpra.gov.au/Registration/Registers-of-Practitioners.aspx">APHRA website</a> to see if the practitioner you are going to consult with is registered</li>
<li>you only get what you pay for. If consultations and treatments are very cheap, you may want to look into the quality of the equipment and the experience of the provider</li>
<li>don’t believe everything you read online. Medical professionals are <a href="https://www.medicalboard.gov.au/News/2018-0516-New-tool-about-testimonials.aspx">not allowed</a> to have testimonials on their websites, so don’t decide on a provider on this basis</li>
<li>trust your gut – if something doesn’t feel right about the place or person, walk away.</li>
</ul><img src="https://counter.theconversation.com/content/120970/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michelle Rodrigues works as a dermatologist in private practice.</span></em></p>A botched beauty procedure can be more than just unsightly – it can be dangerous. Here are some things to keep in mind when seeking a skin treatment.Michelle Rodrigues, Consultant Dermatologist, St Vincent's Hospital MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1135612019-07-05T02:53:59Z2019-07-05T02:53:59ZThinking of laser hair removal? Here’s what you need to know<figure><img src="https://images.theconversation.com/files/282588/original/file-20190704-126350-erpzkn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Laser treatment may need to be repeated for permanent hair loss and isn't for everyone.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/3d-rendering-weakened-hair-concept-loss-1100682638?studio=1">from www.shutterstock.com</a></span></figcaption></figure><p><a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/hirsutism-excessive-hair-women">Unwanted facial and body hair</a> can affect the way we feel, our social interactions, what we wear and what we do.</p>
<p>Options to camouflage or remove unwanted hair include plucking, shaving, bleaching, using creams and epilation (using a device that pulls out multiple hairs at once).</p>
<p>Longer-term options include electrolysis, which uses an electrical current to destroy individual hair follicles, and laser therapy.</p>
<p>So what is <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1468-3083.2005.01327.x">laser therapy</a>? What can it achieve? And what are the side-effects?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/friday-essay-how-19th-century-ideas-influenced-todays-attitudes-to-womens-beauty-111529">Friday essay: how 19th century ideas influenced today's attitudes to women’s beauty</a>
</strong>
</em>
</p>
<hr>
<h2>How does laser treatment work?</h2>
<p><a href="https://www.sciencenewsforstudents.org/article/explainer-what-laser">Lasers</a> emit a wavelength of light with a specific single colour. When targeted to the skin, the energy from the light is transferred to the <a href="https://www.medicinenet.com/script/main/art.asp?articlekey=4340">skin and hair pigment melanin</a>. This heats up and damages the surrounding tissue.</p>
<p>But to remove hair permanently and to minimise damage to the surrounding tissue, the laser needs to be targeted to specific cells. These are the hair follicle stem cells, which sit in part of the hair known as the hair bulge.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/282590/original/file-20190704-126369-rwjj7c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/282590/original/file-20190704-126369-rwjj7c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/282590/original/file-20190704-126369-rwjj7c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=540&fit=crop&dpr=1 600w, https://images.theconversation.com/files/282590/original/file-20190704-126369-rwjj7c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=540&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/282590/original/file-20190704-126369-rwjj7c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=540&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/282590/original/file-20190704-126369-rwjj7c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=678&fit=crop&dpr=1 754w, https://images.theconversation.com/files/282590/original/file-20190704-126369-rwjj7c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=678&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/282590/original/file-20190704-126369-rwjj7c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=678&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The laser needs to be targeted to stem cells that sit in the hair bulge.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/3d-rendering-weakened-hair-concept-loss-1100682638?studio=1">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>As the skin surface also contains melanin, which we want to avoid damaging, people are carefully shaved before treatment.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/mondays-medical-myth-shaved-hair-grows-back-faster-and-thicker-6743">Monday's medical myth: shaved hair grows back faster and thicker </a>
</strong>
</em>
</p>
<hr>
<h2>Will it remove hair permanently?</h2>
<p>Laser treatment can either permanently reduce the <em>density</em> of the hair or permanently <em>remove</em> unwanted hair.</p>
<p>Permanent reduction in hair density means some hairs will regrow after a single course of therapy and patients will need ongoing laser treatment.</p>
<p>Permanent hair removal means none of the hairs in the treated area will regrow after a single course of therapy and no ongoing laser therapy is needed.</p>
<p>Whether hair is removed permanently or just reduced in density is influenced by:</p>
<ul>
<li>the colour and thickness of the hairs being treated</li>
<li>the colour of the patient’s skin</li>
<li>the type and quality of the laser used, and </li>
<li>the competence and training of the person operating the laser.</li>
</ul>
<p>However, if you have grey hairs, which have no melanin pigmentation, currently available lasers don’t work.</p>
<h2>How many treatments will I need?</h2>
<p>The number of treatments you’ll need depends on your <a href="https://www.arpansa.gov.au/sites/default/files/legacy/pubs/RadiationProtection/FitzpatrickSkinType.pdf">Fitzpatrick skin type</a>. This classifies your skin by colour, its sun sensitivity and its likelihood to tan.</p>
<p><strong>Pale or white skin, burns easily, rarely tans (Fitzpatrick types 1 and 2)</strong>
People with dark hair can usually achieve permanent hair removal with 4-6 treatments every 4-6 weeks. People with fair hair will generally only achieve permanent hair reduction and after an initial course of treatment may need 6-12 treatments a month apart.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/282586/original/file-20190704-126340-14fcucf.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/282586/original/file-20190704-126340-14fcucf.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=859&fit=crop&dpr=1 600w, https://images.theconversation.com/files/282586/original/file-20190704-126340-14fcucf.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=859&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/282586/original/file-20190704-126340-14fcucf.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=859&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/282586/original/file-20190704-126340-14fcucf.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1080&fit=crop&dpr=1 754w, https://images.theconversation.com/files/282586/original/file-20190704-126340-14fcucf.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1080&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/282586/original/file-20190704-126340-14fcucf.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1080&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Laser treatment work best in the hands of a professional.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p><strong>Light brown skin, sometimes burns, slowly tans to light brown (type 3)</strong>
People with dark hair can usually achieve permanent hair removal with 6-10 treatments every 4-6 weeks. People with fair hair will generally only achieve permanent hair reduction and after an initial course of treatment may require 3-6 repeat treatments a month apart.</p>
<p><strong>Moderate brown to dark brown skin, rarely burns, tans well or to moderate brown (type 4 and 5)</strong>
People with dark hair can usually achieve permanent hair reduction with 6-10 treatments every 4-6 weeks. Maintenance will usually be required with 3-6 monthly repeat treatments. People with fair hair are unlikely to respond.</p>
<p>Re-treatments must be long enough apart to allow new hair growth to reach the level of the bulge.</p>
<h2>What side effects or complications should I be aware of?</h2>
<p>You will be advised to wear goggles during the treatment to prevent eye injury. </p>
<p>You will also experience some pain during treatment, especially the first few. This is mainly due to not removing all hair in the area to be treated before the procedure. Hairs missed while shaving absorb laser energy and heat the skin surface. There is less pain with repeat treatments at regular intervals.</p>
<p>Your skin will feel hot for 15-30 minutes after laser treatment. There may be redness and swelling for up to 24 hours. </p>
<p>More serious side effects include blisters, too much or too little skin pigmentation, or permanent scarring.</p>
<p>These generally occur in people with a recent suntan and the laser settings have not been adjusted. Alternatively, these side-effects can occur when patients are taking <a href="http://www.webstercare.com.au/files/Continuing_Education_March_2015.pdf">medications</a> that affect their skin’s response to sunlight.</p>
<h2>Does the type of laser matter?</h2>
<p>The type of laser not only influences how well it works, it influences your chance of side-effects.</p>
<p>Lasers suitable for hair removal include: <a href="https://www.ncbi.nlm.nih.gov/pubmed/10759801">long-pulse ruby lasers</a>, <a href="https://www.sciencedirect.com/science/article/pii/S1090820X05000828">long-pulse alexandrite lasers</a>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/12766964">long pulse diode lasers</a> and <a href="https://jamanetwork.com/journals/jamadermatology/fullarticle/478428">long-pulse Nd:YAG lasers</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-how-are-tattoos-removed-19078">Explainer: how are tattoos removed?</a>
</strong>
</em>
</p>
<hr>
<p>Intense pulsed light (IPL) devices are not laser devices but flash lamps that emits multiple wavebands of light simultaneously. They work in a similar way to lasers, albeit less effectively and they are much less likely to permanently remove hair.</p>
<p>To minimise the risk of damage to melanin producing cells on the skin surface, the choice of laser and how it’s used can be matched to your skin type.</p>
<p>Fair skinned people with dark hair can use an IPL device, an alexandrite laser or a diode laser; people with dark skin and dark hair can use a Nd:YAG or diode laser; and people with blond or red hair can use a diode laser.</p>
<p>To control the spread of heat and unwanted tissue damage, short laser pulses are used. The energy of the laser is also adjusted: it needs to be high enough to damage the bulge cells but not so high to cause discomfort or burns.</p>
<h2>Can I buy a home laser device and do it myself?</h2>
<p>Home laser devices and IPL home devices are available in Australia and cost between $200 and $1,000. But they don’t tend to work as well and you need to use them repeatedly to maintain hair reduction.</p>
<p>Parameters are only set for people with fair skin (Fitzpatrick types 1 and 2) and dark hair. For safety, energy settings are capped. And in inexperienced hands, <a href="https://www.ncbi.nlm.nih.gov/pubmed/20625788">complications</a> may still arise. This includes burns, pain, blistering and changes to skin pigmentation.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/do-i-need-to-shave-my-pubic-hair-before-having-sex-114614">'Do I need to shave my pubic hair before having sex?'</a>
</strong>
</em>
</p>
<hr>
<p>By contrast, medical grade lasers must be registered with the government regulator, the <a href="https://www.tga.gov.au/can-i-import-ithttps:/www.tga.gov.au/can-i-import-it">Therapeutic Goods Administration</a>. There are also national and state-based regulations about the <a href="https://www.arpansa.gov.au/understanding-radiation/radiation-sources/more-radiation-sources/lasers">facility</a> where the laser is used, <a href="https://www.lasersafetyonline.com.au/">compulsory laser safety training requirements</a> and state-based qualifications and licensing for laser operators.</p>
<p>So, a safe and regulated laser in the hands of a skilled professional is recommended.</p>
<h2>When to see your GP</h2>
<p>Not all excess hair is cause for concern. But severe <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/hirsutism-excessive-hair-women">hirsuitism</a> (excess growth of dark and coarse hair over areas of the body where it ordinarily wouldn’t grow) or <a href="https://www.dermnetnz.org/topics/hypertrichosis/">hypertrichosis</a> (excess hair growth for someone’s age, sex or race) can be clues to underlying illness.</p>
<p>Hirsutism, especially when associated with symptoms including irregular periods or acne, can be caused by <a href="https://www.tandfonline.com/doi/full/10.1586/edm.11.45?scroll=top&needAccess=true">extra androgen hormones</a>. Hypertrichosis later in life can be a sign of malignancy. </p>
<p>Your GP can investigate these.</p>
<p><em>Consultant dermatologist Nekma Meah co-authored this article.</em></p><img src="https://counter.theconversation.com/content/113561/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rodney Sinclair is the head of Sinclair Dermatology, which performs laser hair removal.</span></em></p>How well laser therapy works depends on your type of hair and skin, the type of laser and the skill of the person operating it.Rodney Sinclair, Professor of Dermatology, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1055262018-10-25T15:36:56Z2018-10-25T15:36:56ZNo safe suntan, but research suggests there may be a way to reduce ‘old leathery’ look<figure><img src="https://images.theconversation.com/files/242255/original/file-20181025-71032-16n1mmp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/man-reddened-itchy-skin-after-sunburn-714070519?src=R5_pDNKBT77Xrfb0KX-FOQ-1-75">Focus and Blur/Shutterstock</a></span></figcaption></figure><p>Getting a tan may not depend on how much sun people get, but rather when they get it. This is the finding from a new international research project. The study, published in <a href="https://www.cell.com/molecular-cell/fulltext/S1097-2765(18)30793-7">Molecular Cell</a>, found that sun exposure every other day was more effective for tanning and caused less DNA damage than daily exposure.</p>
<p>This kind of exposure also avoided causing the <a href="http://www.who.int/uv/faq/uvhealtfac/en/index2.html">skin “thickening”</a> seen in people exposed to the sun every day. So, according to the research, those wanting a strong tan, while avoiding that “old leather” look often seen in long-term sun worshippers would be best off taking 24-hour breaks between sunbathing sessions.</p>
<p>The study also suggests it might be possible to create cosmetics that can give people a “natural” tan, as well as increasing our understanding of skin cancer, which is <a href="https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/melanoma-skin-cancer#heading-One">killing</a> an increasing number of people. However, none of this alters the risk of skin cancer from exposure to the sun – or the <a href="https://www.cancer.org/cancer/melanoma-skin-cancer.html">health advice</a> about minimising exposure.</p>
<p>The researchers looked at the impact of the ultra-violet light found in the sun’s rays on human and mouse skin and in cultured cells, and identified the importance of a protein called MITF. This acts like a clock, synchronising and coordinating two systems used to protect the body from the harmful effects of sunlight. One protective process, which starts within a few minutes of exposure, thickens our skin and tries to <a href="https://www.nature.com/scitable/topicpage/dna-damage-repair-mechanisms-for-maintaining-dna-344">repair the sun’s damage</a> to our DNA.</p>
<p>The other process starts within a few hours and produces the <a href="https://www.news-medical.net/health/What-is-Melanin.aspx">dark pigment melanin</a> in specialised skin cells <a href="http://www.jbc.org/content/282/38/27557.full.html">called melanocytes</a>. The pigment then passes to the main type of skin cells, keratinocytes. It is this melanin that absorbs some of the harmful UV energy produced by the sun and gives people a tanned appearance.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/242256/original/file-20181025-71017-1moyzt7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/242256/original/file-20181025-71017-1moyzt7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/242256/original/file-20181025-71017-1moyzt7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/242256/original/file-20181025-71017-1moyzt7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/242256/original/file-20181025-71017-1moyzt7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/242256/original/file-20181025-71017-1moyzt7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/242256/original/file-20181025-71017-1moyzt7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Without protection, the sun will always damage your skin.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/severely-burned-skin-dark-tanned-body-156996335?src=_xqvZWDyOkpDb7X4R9aSTA-1-2">Marko Marcello/Shutterstock</a></span>
</figcaption>
</figure>
<p>The importance of melanin cannot be understated, as it <a href="https://www.scienceabc.com/humans/why-some-people-fair-others-dark-skin-color-determine.html">reduces the amount of damage</a> the sun does to DNA, which can lead to cancer. The researchers were able to show that thre was less damage to DNA in skin exposed to UV light every other day, even though the DNA repair process wasn’t switched on as often. This is probably because exposure every other day produced more melanin.</p>
<p>The researchers showed that the exposing the skin to UV light increased the concentration of MITF protein in the skin. But the level of MITF doesn’t simply increase and then decrease. Instead it displays a decaying oscillation, repeatedly falling and rising again but gradually disappearing over 48 hours. But the researchers also showed that if a second period of exposure started after just 24 hours, before MITF levels have returned to their baseline level, different genes were activated and the result was less tanning and more skin thickening.</p>
<h2>No safe suntan yet</h2>
<p>Interestingly, previous work published <a href="https://www.sciencedirect.com/science/article/pii/S0140673682902148">in The Lancet</a> has also shown that the body’s vitamin D concentrations are also higher when there is a 24-hour gap between sun exposure. Vitamin D is produced in the skin using energy from UV light and is critical for a healthy immune system, heart, protection from cancer, sepsis and a whole host of <a href="https://www.webmd.com/osteoporosis/features/the-truth-about-vitamin-d-why-you-need-vitamin-d">other functions</a>.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/i-nearly-died-from-sepsis-and-ignorance-of-this-condition-is-killing-millions-99051">I nearly died from sepsis – and ignorance of this condition is killing millions</a>
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<p>The new findings will be of particular interest to the cosmetics industry. They mean it could be possible to develop products containing proteins that will stimulate the skin into developing a “natural” tan, without being exposed to the harmful effects of the sun. So a risk-free suntan may be possible in the future.</p>
<p>In the meantime, the research suggests it may be best to use a higher factor sunblock – or avoiding the sun altogether – on alternate days. But it’s important to remember that there is <a href="https://www.nhs.uk/news/cancer/new-nice-guidelines-on-sun-exposure-warn-tanning-is-unsafe/">no safe amount of tanning</a>. Any sustained exposure to the sun increases your risk of skin cancer so you should still wear appropriate protection every day.</p><img src="https://counter.theconversation.com/content/105526/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Porter does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Exposure to the sun every other day produces more skin pigment than sunbathing every day – but protection is still vital.Michael Porter, Lecturer in Molecular Genetics, University of Central LancashireLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/971832018-07-09T02:50:00Z2018-07-09T02:50:00ZHealth Check: what causes chilblains and how can I prevent them?<figure><img src="https://images.theconversation.com/files/225839/original/file-20180703-116123-1sjqrdz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Red, itchy and dry spots on your fingers and toes are caused by cold, but should resolve on their own. </span> <span class="attribution"><span class="source">from www.shutterstock.com</span></span></figcaption></figure><p>While some of us love the winter chill, this winter others will notice itchy or tender red lumps on their fingers and toes.</p>
<p>These small bumps are called chilblains (also known as pernio) and they occur with exposure to cold. While children and the elderly are most commonly affected, other age groups are not immune to this problem.</p>
<p>Several hours after exposure to cold, damp weather, the blood vessels in the fingers and toes tighten up and get smaller (called vasoconstriction) to keep the warm blood as far away from the skin as possible, as this is where heat is lost.</p>
<p>When returning to a warm environment from the cold, these blood vessels expand again, but can get inflamed (called vasculitis) if this happens too quickly.</p>
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<strong>
Read more:
<a href="https://theconversation.com/health-check-do-cold-showers-cool-you-down-71004">Health Check: do cold showers cool you down?</a>
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<p>This causes itch and burning in the affected area. Small reddish lumps can appear on the skin, which may become painful or blistered. In those with <a href="https://www.chromaderm.com.au/services/skin-of-colour/">skin of colour</a>, chilblains may look purple-ish or even present as a brown patch of skin. The most commonly affected areas include the fingers, toes, ears and nose.</p>
<p>If they’re untreated, chilblains can swell and form blisters, with a risk of ulcers, scarring and infection. But usually, if extremities are warmed, they will get better on their own in a few weeks.</p>
<p>This reaction is <a href="https://www.mayoclinic.org/diseases-conditions/chilblains/symptoms-causes/syc-20351097">more common</a> in people who have a family history of chilblains and those who have problems with their <a href="https://www.webmd.com/dvt/ss/slideshow-dvt-improve-circulation">blood circulation</a>. Smoking, diabetes and high cholesterol can lead to poorer blood circulation. People who are underweight or have diseases that affect connective tissue (such as <a href="https://theconversation.com/explainer-what-is-lupus-and-how-is-stress-implicated-92699">lupus</a>) are also at <a href="https://www.mayoclinic.org/diseases-conditions/chilblains/symptoms-causes/syc-20351097">increased risk</a> of chilblains.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/225840/original/file-20180703-116120-1tdtzkb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/225840/original/file-20180703-116120-1tdtzkb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/225840/original/file-20180703-116120-1tdtzkb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/225840/original/file-20180703-116120-1tdtzkb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/225840/original/file-20180703-116120-1tdtzkb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/225840/original/file-20180703-116120-1tdtzkb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/225840/original/file-20180703-116120-1tdtzkb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/225840/original/file-20180703-116120-1tdtzkb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Keep your extremities covered, and warm them up slowly if they get cold.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
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</figure>
<p>The diagnosis is usually straightforward and no extra tests are needed. But occasionally other conditions need to be excluded, such as lupus and <a href="https://www.mayoclinic.org/diseases-conditions/raynauds-disease/symptoms-causes/syc-20363571">Raynaud’s disease</a> (where small arteries narrow, limiting blood circulation). For this, your doctor might need to do some blood tests or even take a small piece of skin (skin biopsy) to confirm the diagnosis.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/forget-heatwaves-our-cold-houses-are-much-more-likely-to-kill-us-83030">Forget heatwaves, our cold houses are much more likely to kill us</a>
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<p>If the weather gets the better of you and chilblains do appear, your doctor is likely to suggest topical steroid creams to help with itch and inflammation. For more severe cases, medications that open (dilate) blood vessels, such as nifedipine and diltiazem, can be used.</p>
<p>But we all know prevention is better than cure, so here are some tips to avoid chilblains:</p>
<ul>
<li><p>clothing: keep your extremities warm with covered shoes, gloves and ear muffs</p></li>
<li><p>temperature control: keep your skin dry and warm, and when you’re rewarming your skin, do it slowly and gently</p></li>
<li><p>get active: staying active and keeping fit with physical activity improves circulation so will decrease the risk of developing chilblains</p></li>
<li><p>avoid smoking and eat well to optimise the health of your blood vessels.</p></li>
</ul><img src="https://counter.theconversation.com/content/97183/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michelle Rodrigues does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A “how to” on avoiding and resolving chilblains this winter.Michelle Rodrigues, Consultant Dermatologist, St Vincent's Hospital MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/901722018-06-22T02:04:45Z2018-06-22T02:04:45ZI’ve always wondered: why do we get dark circles under our eyes?<figure><img src="https://images.theconversation.com/files/204387/original/file-20180201-123862-w563md.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The skin under our eyes is thinner than elsewhere on our face, meaning our blood vessels are more visible. </span> <span class="attribution"><span class="source">from www.shutterstock.com</span></span></figcaption></figure><p><em>This is an article from I’ve Always Wondered, a series where readers send in questions they’d like an expert to answer. Send your question to alwayswondered@theconversation.edu.au</em></p>
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<p><strong>I’ve always wondered why we get dark circles under our eyes, and whether anything can be done about them - Fran, 34, Melbourne</strong></p>
<p>Thanks for the question Fran, it’s a common one. Many people have an appearance of dark circles on the lower eyelids, and they have many different causes. </p>
<p>Dark rings under the eyes are worsened by general fatigue, especially lack of sleep. The daily fluctuation is due to swelling of the skin, leading to a change in light diffusion, which looks like increased darkness of the skin.</p>
<p>For some people, all we can say is that their parents had dark circles under their eyes and therefore they do too. This trait can <a href="http://www.pigmentinternational.com/article.asp?issn=2349-5847;year=2018;volume=5;issue=1;spage=1;epage=3;aulast=Daroach">run in families</a>, and is more pronounced in certain ethnic groups.</p>
<p>Sun exposure can also create dark circles under the eyes, by increasing the melanin content. The skin in this region can pigment more than the surrounding skin because it’s more sensitive.</p>
<p>Because the skin is thinnest under the eyes, the blood vessels here will be closer to the surface, meaning they look darker. As we age, our skin gets thinner and we lose collagen (the main structural protein in skin) and elastin (a highly elastic protein in connective tissue), which is why we get wrinkles. This often makes the blood vessels (which are dark in colour) under our eyes stand out more.</p>
<p>The tear trough (the depression below the eye) also deepens with age because of movement of fat under the eye forwards, creating shadowing below it.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/204388/original/file-20180201-123826-17q1jw7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/204388/original/file-20180201-123826-17q1jw7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/204388/original/file-20180201-123826-17q1jw7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/204388/original/file-20180201-123826-17q1jw7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/204388/original/file-20180201-123826-17q1jw7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/204388/original/file-20180201-123826-17q1jw7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/204388/original/file-20180201-123826-17q1jw7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/204388/original/file-20180201-123826-17q1jw7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">It’s likely blood vessels under our eyes will become more visible as we age.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
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</figure>
<p>The dark circles could also be a mere shadow from tired, puffy eyelids, or just from the anatomical shape of someone’s eye sockets: some are hollowed more than others.</p>
<p>People with this appearance could be suffering from a skin condition of the eyelid skin such as eczema or allergic contact dermatitis. Inflammation from dry and sore skin, and also rubbing, cause melanin production.</p>
<p>Some people may not always have dark circles, but may have been rubbing their eyes from fatigue or itchiness caused by hayfever. In these cases, the dark rings will simply go away after a while.</p>
<h2>Can dark circles under the eyes be treated?</h2>
<p>Darker skin under the eyes is a perfectly normal and natural appearance. But if it bothers you, there are a few options. Treatment will depend on what causes the dark circles, and these causes need to be addressed. In some cases, only an improvement may be possible.</p>
<p>Removing the cause of inflammation of the eyelids will stop the melanin factory from overproducing. Then a fading cream can be used to reduce the colour. Be careful to use a cream without hydroquinone, which is a bleach that can harm our skin if used for too long, as it will be necessary to treat for a very long time.</p>
<p>Ideally a fading cream would contain <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3663177/">licorice root extract</a>, as there is some evidence this inhibits the melanin factory in the cells without causing toxicity to the cells. Uva-Ursi plant leaf extract and a type of nanopeptide (Nanopeptide-1) are also commonly used. But while we know they are safe to use their effectiveness hasn’t been tested.</p>
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<p><em>* Email your question to alwayswondered@theconversation.edu.au
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<p class="fine-print"><em><span>Michael Freeman is Director of Atom Labs, a cosmeceutical manufacturer.</span></em></p>Many people have an appearance of dark circles on the lower eyelids, and they have many different causes.Michael Freeman, Dermatologist, Associate Professor, Bond UniversityLicensed as Creative Commons – attribution, no derivatives.