tag:theconversation.com,2011:/uk/topics/psoriasis-14069/articlesPsoriasis – The Conversation2023-07-26T19:17:50Ztag:theconversation.com,2011:article/2065542023-07-26T19:17:50Z2023-07-26T19:17:50ZPlants of the boreal forest: Using traditional Indigenous medicine to create modern treatments<figure><img src="https://images.theconversation.com/files/528931/original/file-20230529-29-adcxy0.jpg?ixlib=rb-1.1.0&rect=14%2C0%2C1902%2C1414&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Indigenous cultures possess ancestral knowledge and an in-depth understanding of plants that deserves to be recognized, preserved and promoted for the benefit of society as a whole.
</span> <span class="attribution"><span class="source">(Olivier Fradette)</span>, <span class="license">Author provided</span></span></figcaption></figure><p>Natural health products and phytomedicines (plant-based medicines) are used in many countries as the first choice of treatment. This market represents a significant proportion of the total market for health products, particularly in developing countries where a large proportion of the population depends on these products for treatment.</p>
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<p><strong>This article is part of <em>La Conversation Canada’s</em> series <a href="https://theconversation.com/ca-fr/topics/foret-boreale-138017">The boreal forest: A thousand secrets, a thousand dangers</a></strong></p>
<p><br><em>La Conversation Canada invites you to take a virtual walk in the heart of the boreal forest. In this series, our experts focus on management and sustainable development issues, natural disturbances, the ecology of terrestrial wildlife and aquatic ecosystems, northern agriculture and the cultural and economic importance of the boreal forest for Indigenous peoples. We hope you have a pleasant — and informative — walk through the forest!</em></p>
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<p>These products are deeply rooted in ancestral knowledge and traditions and are passed down from generation to generation in Indigenous communities. This knowledge represents an invaluable source of information for scientific research.</p>
<p>By exploring this knowledge, researchers can discover new medicinal molecules. Some molecules isolated from plants have become major therapeutic agents in modern medicine. One example is <em>paclitaxel</em>, an anti-cancer agent used in chemotherapy that was isolated from ground hemlock (<em>Taxus canadensis</em>), a shrub used by Indigenous peoples to treat a variety of health problems.</p>
<p>For several years, the <a href="https://creb-uqac.ca/en/recherches/laboratoire-danalyse-et-de-separation-des-essences-vegetales-laseve/">LASEVE laboratory</a>, located at the Université du Québec à Chicoutimi, has been using its expertise in phytochemical, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4204033/">pharmacognostic</a> and pharmacological research to explore the active compounds of plants endemic to Canada, based on the ancestral knowledge of Indigenous peoples. The laboratory’s expertise ranges from identifying plants with high therapeutic potential, to determining their chemical composition, developing extraction methods, isolating compounds and assessing their biological activity.</p>
<h2>The boreal forest: a source of natural medicines</h2>
<p>The LASEVE team has studied a number of plant species from the boreal forest that are used in traditional Indigenous medicine.</p>
<p>The bunchberry (<em>Cornus canadensis</em>), for example, is traditionally used as an antiviral remedy by First Nations peoples. Our research on this species has shown that the leaf extract has <a href="https://bmccomplementmedtherapies.biomedcentral.com/articles/10.1186/s12906-017-1618-2">therapeutic activity against herpes simplex type 1 (HSV-1)</a>, a virus responsible for cold sores. Thanks to an in-depth chemical analysis, we isolated around ten molecules from this extract. These molecules, which belong to the polyphenol family, are natural substances with antioxidant properties that are found in many foods and help to protect the body against damage caused by <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3249911/">free radicals</a>. Among them, the tannin named Tellimagrandin 1 has been identified as the most active polyphenolic molecule in the extract for inhibiting the HSV-1 virus.</p>
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<img alt="" src="https://images.theconversation.com/files/514307/original/file-20230308-14-rpxzth.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/514307/original/file-20230308-14-rpxzth.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/514307/original/file-20230308-14-rpxzth.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/514307/original/file-20230308-14-rpxzth.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/514307/original/file-20230308-14-rpxzth.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/514307/original/file-20230308-14-rpxzth.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/514307/original/file-20230308-14-rpxzth.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Four-count is traditionally used as an antiviral remedy by First Nations people.</span>
<span class="attribution"><span class="source">(Jacques Ibarzabal), Provided by author</span></span>
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<p>Other studies in our laboratory have looked at the traditional use of balsam poplar (<em>Populus balsamifera</em>) buds to combat inflammatory problems and infections. Several molecules found in the buds have been identified, and some belonging to the chemical family of <a href="https://www.sciencedirect.com/science/article/pii/S0040403912021338?via%3Dihub">balsacones</a> have shown interesting <a href="https://pubmed.ncbi.nlm.nih.gov/31681206/">antibacterial properties</a>, particularly against methicillin-resistant Staphylococcus aureus, also known as <em>SARM</em>. This bacterium can cause very serious infections that are difficult to treat because of their resistance to several antibiotics, including methicillin. Other molecules in this same family have shown promising effects in the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6981943/">treatment of psoriasis</a>, due to their ability to reduce inflammation and oxidative damage.</p>
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<a href="https://images.theconversation.com/files/514305/original/file-20230308-18-5c07sc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/514305/original/file-20230308-18-5c07sc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/514305/original/file-20230308-18-5c07sc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/514305/original/file-20230308-18-5c07sc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/514305/original/file-20230308-18-5c07sc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/514305/original/file-20230308-18-5c07sc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/514305/original/file-20230308-18-5c07sc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/514305/original/file-20230308-18-5c07sc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&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">Balsam poplar buds are used to combat inflammatory problems and infections.</span>
<span class="attribution"><span class="source">(Jacques Ibarzabal), Provided by the author</span></span>
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<p>A number of compounds with anti-inflammatory properties, including <a href="https://www.sciencedirect.com/science/article/abs/pii/S187439002100077X">new molecules known as nudicaulosides</a>, have been isolated from the sarsaparilla plant (<em>Aralia nudicaulis</em>), known to Indigenous people for its many benefits. The extract obtained from the underground stem (or rhizome) showed promising antioxidant and anti-inflammatory activities. These indicate potential protective effects against sun-induced oxidative stress on skin cells. This activity is due to the <a href="https://pubmed.ncbi.nlm.nih.gov/34361611/">high content of phenolic compounds</a> in the extract.</p>
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<img alt="" src="https://images.theconversation.com/files/514306/original/file-20230308-24-1zojpm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/514306/original/file-20230308-24-1zojpm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/514306/original/file-20230308-24-1zojpm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/514306/original/file-20230308-24-1zojpm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/514306/original/file-20230308-24-1zojpm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/514306/original/file-20230308-24-1zojpm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/514306/original/file-20230308-24-1zojpm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Sarsaparilla is a plant known by Indigenous people for its multiple benefits.</span>
<span class="attribution"><span class="source">(Jacques Ibarzabal), Provided by the author</span></span>
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<h2>Adaptogenic plants from the boreal forest</h2>
<p>In today’s fast-paced society, stress has become a scourge that can have serious repercussions on health. Faced with this public health problem, it has become crucial to find ways of strengthening our ability to resist stress and preserve our well-being. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8398443/">Adaptogenic plants</a> are attracting attention from researchers as a response to this challenge.</p>
<p>These plants have a regulating effect, particularly on our immune system, which improves the body’s ability to adapt to environmental stress. Echinacea, astragalus and the famous ginseng are just a few examples of adaptogenic plants.</p>
<p>As the demand for these plants is constantly increasing, we have chosen to explore the adaptogenic potential of two species of arali native to North America, <em>Aralia nudicaulis</em> and <em>Aralia hispida</em>. These two plants, which are in the same family as ginseng, have been little studied until now, even though they are frequently used in traditional medicine. We have begun chemical and biological characterization of these plants in our laboratories and have already identified several bioactive molecules.</p>
<p>In conclusion, our research group has been working for several years to explore the therapeutic potential hidden in boreal forest plants. In this context, the traditional medicine of the First Nations is a precious asset. </p>
<p>These cultures possess ancestral knowledge and an in-depth understanding of plants that deserves to be recognized, preserved and promoted for the benefit of society as a whole.</p>
<p>It is important to remember that caution is the watchword when it comes to natural products. These products are not always safe, since they contain a mixture of compounds, only some of which have beneficial properties, while others may cause undesirable effects or interfere with other medicines. </p>
<p>It is therefore important to consult a health professional before taking any natural remedy.</p><img src="https://counter.theconversation.com/content/206554/count.gif" alt="La Conversation" width="1" height="1" />
<p class="fine-print"><em><span>André Pichette is a member of the Ordre des chimistes du Québec (OCQ). He has received funding from Fonds de recherche du Québec - Santé (FRQS), Natural Sciences and Engineering Research Council of Canada (NSERC) - Alliance - Mathematics of Information Technology and Complex Systems (MITACS), Canadian Institutes of Health Research (CIHR).</span></em></p><p class="fine-print"><em><span>Jean Legault is a member of the Ordre des chimistes du Québec. He has received funding from the FQRNT, FRQS, NSERC and Mitacs.</span></em></p><p class="fine-print"><em><span>Marianne Piochon et Vakhtang Mshvildadze ne travaillent pas, ne conseillent pas, ne possèdent pas de parts, ne reçoivent pas de fonds d'une organisation qui pourrait tirer profit de cet article, et n'ont déclaré aucune autre affiliation que leur poste universitaire.</span></em></p>New scientific discoveries are being made by drawing on Indigenous peoples’ ancestral knowledge about medicinal plants.Marianne Piochon, Assistante de recherche, MSc, Université du Québec à Chicoutimi (UQAC)Andre Pichette, Professeur en chimie des produits naturels, Université du Québec à Chicoutimi (UQAC)Jean Legault, Professeur-chercheur en biochimie et pharmacologie, Université du Québec à Chicoutimi (UQAC)Vakhtang Mshvildadze, Professeur de Pharmacognosie, Université du Québec à Chicoutimi (UQAC)Licensed 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>
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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>
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<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>
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<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>
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<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>
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<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>
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<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/1985372023-02-08T14:28:15Z2023-02-08T14:28:15ZHow do I improve my immunity? Expert shares tips on what to do - and what to avoid<figure><img src="https://images.theconversation.com/files/507107/original/file-20230130-7241-9z07f6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Exercising regularly, and spending time outdoors can improve your health. </span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>The human immune system is arguably the most complex system in the human body. But scientists have made a lot of progress in understanding how it functions.</p>
<p>That’s important for understanding illnesses and how to manage them. For instance, it’s important to understand that an immune response takes several days to fully develop. This knowledge would hopefully prevent people from getting impatient and seeking inappropriate care. </p>
<p>The immune system is made up of an intricate network of cells, tissues and molecules. These control the delicate balance between eliminating cancerous or infected cells, and not harming the body in the process. </p>
<p>A poorly functioning immune system can cause a variety of health problems. </p>
<p>It could lead to a person getting recurrent infections. Depending on the nature of the immune deficiency, the infections can range from viral (such as colds, flu, shingles and fever blisters) to bacterial (such as tuberculosis) or fungal (such as thrush). </p>
<p>Immune system dysfunction can also present as excessive inflammation or even auto-immunity. In this case the body starts seeing its own tissues as foreign and attacks them. Some examples of these conditions are rheumatoid arthritis, lupus and psoriasis.</p>
<p>The factors that affect our immune system range from things we can’t change, such as our genetic make-up and exposure to past pathogens, to things we may be able to control or modify.</p>
<p>I am an immunologist, and in this article I unpack the changes you can make today to help your immune system function better. They include diet, managing stress levels, and limiting exposure to environmental factors, such as germs, pollution and toxins. </p>
<p>Optimal immune function plays an important role in maintaining health. Given the immense complexity of the immune system, simplistic solutions are not effective. It’s important to understand some of the things you should – and shouldn’t – do. </p>
<h2>What not to do</h2>
<p>Many products claim to “boost” the immune system. But given the complex interplay between the cells in our bodies, it’s not really possible to “boost” just one part of the immune system. </p>
<p>And even if it was possible, “boosting” one aspect of your immune system can set off bad reactions by upsetting the delicate balance that makes up our bodies. For instance, “boosting” the immune system’s ability to fight infection could also “boost” other aspects, such as inflammation, that could harm normal tissue. </p>
<p>It is true that the immune system relies on vitamins and minerals to perform its tasks. But there is no solid evidence that taking vitamins and mineral supplements will improve its functioning. </p>
<p>The exception is when a person has a known deficiency, such as vitamin D deficiency. Most people with vitamin D deficiency do not have any symptoms or only have vague, non-specific symptoms, such as tiredness or lower back ache. People living with osteoporosis, diabetes, kidney disease, obesity, or depression, or those with limited sun exposure, especially the elderly, are at increased risk of having a deficiency. It’s important to address the problem because it can increase the risk of fractures, as well as infection from various pathogens, especially those affecting the lungs, such as flu and SARS-CoV-2. </p>
<p>If you think you’ve got a nutrient deficiency you should consult a healthcare practitioner for an accurate diagnosis. They can set out an evidence-based management strategy for you. </p>
<p>The reason for seeking professional help is that dosing up on supplements can be bad for you. </p>
<p>Firstly, some vitamins, such as vitamin A, D, E and K, are fat-soluble and are stored in the body. It is therefore possible to have levels that are too high, which can cause its own problems. For instance, too-high levels of vitamin D can cause kidney stones, constipation and high blood pressure. Too much vitamin A or iron can cause damage to the liver and other organs. </p>
<p>Secondly, nutrients should not be seen as independent components. Rather they should be seen as parts of a whole. Many supplements can interact negatively with other supplements and even with medication. For instance, vitamin K can reduce the ability of the blood thinner warfarin to prevent blood clots.</p>
<p>Combining different supplements can also lead to excessive or inadequate amounts of certain nutrients, with potentially detrimental effects. For example, prolonged zinc supplementation can cause copper deficiency, which has been linked to anaemia and impaired brain function. </p>
<h2>What to do</h2>
<p>The best way to ensure that your immune system gets what it needs is through a healthy and balanced lifestyle. </p>
<p>Diet is critical. Eat food that is unprocessed, preservative-free, and rich in a variety of vitamins, minerals and antioxidants. Your diet should include green and yellow vegetables, fruit and berries, whole grains, seeds and nuts. </p>
<p>And it’s not just the individual components of food that are important. The interplay between them matters too. This is something that cannot be reproduced in a tablet. </p>
<p>Lifestyle factors are also key. Stress is a normal and essential part of life, but it must be switched off to protect the body. Finding effective ways to control stress, such as breathing exercises, yoga and meditation, is important. </p>
<p>Activities that have been shown to improve health include getting enough rest, exercising regularly, spending time outdoors, and staying connected socially. Smoking and excessive alcohol use are clearly harmful. </p>
<p>Finally, we often forget to be kind to ourselves. When you are ill, take time to recover. When you are going through an especially stressful time, make an extra effort to de-stress. </p>
<p>Most importantly, don’t regard these as emergency measures. Make them part of your lifestyle. As tempting as it may be, it is not possible to “supplement” yourself out of a bad lifestyle.</p><img src="https://counter.theconversation.com/content/198537/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Theresa Rossouw 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>As tempting as it is, it is not possible to “supplement” oneself out of a bad lifestyle.Theresa Rossouw, Professor, University of PretoriaLicensed 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/1298992020-04-28T19:52:35Z2020-04-28T19:52:35ZWhat is psoriatic arthritis, the condition Kim Kardashian West lives with?<p>You may have heard about psoriatic arthritis after Kim Kardashian West <a href="https://www.independent.co.uk/life-style/health-and-families/kim-kardashian-west-psioriasis-lupus-psioriatic-arthritis-skin-condition-essay-a9113611.html">said</a> last year she was diagnosed with this illness.</p>
<p>Psoriasis is a relatively common chronic skin condition that causes rapid build-up of skin cells, resulting in a rash. <a href="https://www.nature.com/articles/s41584-019-0285-8">Around 20% of sufferers</a> will develop psoriatic arthritis where a person’s joints become inflamed and sore, in addition to the skin symptoms.</p>
<p>Recent evidence suggests that psoriatic arthritis is an autoimmune disease, meaning the body’s immune system mistakenly attacks its own skin and joints.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1174748671470030849"}"></div></p>
<h2>How common is it?</h2>
<p>Around <a href="https://www.nejm.org/doi/full/10.1056/NEJMra1505557?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed">1% of people</a> in the United States have psoriatic arthritis, and it affects <a href="https://www.nejm.org/doi/full/10.1056/NEJMra1505557?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed">men and women roughly equally</a>. </p>
<p>Symptoms usually begin between the ages of 40 and 50, though they can also begin in childhood or older age.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6297592/">In around 85-90% of patients</a>, psoriasis symptoms start first.</p>
<h2>What causes it?</h2>
<p>Psoriatic arthritis is caused by <a href="https://pubmed.ncbi.nlm.nih.gov/29893226/?from_term=psoriatic+arthritis+etiology&from_pos=2">a combination of genetic and environmental or lifestyle factors</a>. Infection, stress, obesity, and smoking have been suggested to increase the risk of developing the condition. </p>
<p>Researchers have also investigated a possible link with gut microbiota, the bacteria that live in the digestive tract. Some think <a href="https://pubmed.ncbi.nlm.nih.gov/25319745/?from_term=scher+J+and+psoriatic+arthritis&from_pos=9">changes in gut microbiota diversity</a> may be involved. However, it’s not clear whether this is a cause or a consequence of chronic inflammation. </p>
<h2>What are the symptoms?</h2>
<p>Psoriasis causes a skin rash of scaly red patches or plaques that can spread all over the body. Typically it affects the knees, elbows, hairline, ears, <a href="https://www.theguardian.com/lifeandstyle/2011/dec/12/mapping-body-natal-cleft">natal cleft</a> (the groove that runs between the two buttocks), belly button and nails. </p>
<p>It might be painful and itchy. It usually evolves with a period of flare, where the illness gets worse, followed by a period of improvement.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/329658/original/file-20200422-39184-cmqk7b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/329658/original/file-20200422-39184-cmqk7b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/329658/original/file-20200422-39184-cmqk7b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/329658/original/file-20200422-39184-cmqk7b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/329658/original/file-20200422-39184-cmqk7b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/329658/original/file-20200422-39184-cmqk7b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/329658/original/file-20200422-39184-cmqk7b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&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 psoriasis experience a skin rash with scaly red patches.</span>
<span class="attribution"><span class="source">www.shutterstock.com</span></span>
</figcaption>
</figure>
<p>Psoriatic arthritis occurs in one or more joints. It can affect peripheral joints, such as the hands and feet, the spine, and the entheses, where ligaments and tendons attach to bones (such as where the Achilles tendon connects to the heel). <a href="https://www.nejm.org/doi/full/10.1056/NEJMra1505557?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed">In around 40-50% of patients</a>, the entire toe or finger can swell like a small sausage, known as dactylitis. It particularly affects the tips of the fingers and toes, known as the distal joints, as well as the buttocks and lower back.</p>
<p>Arthritis symptoms include pain, redness, swelling, and tenderness of the affected joints. It usually presents with morning stiffness, and joint pain increases while resting and improves while moving. Joint pain can also wake people up at night.</p>
<p>General symptoms can include fatigue, unexplained fever, unintentional weight loss, and loss of appetite. Early diagnosis can be challenging because these symptoms are non-specific and can be mistaken for other illnesses.</p>
<p>Patients can also suffer from eye inflammation and <a href="https://theconversation.com/explainer-crohns-disease-and-intestinal-immune-balance-6596">inflammatory bowel disease</a>, where the digestive tract becomes inflamed.</p>
<h2>How is it diagnosed?</h2>
<p>There is no single blood or imaging test for diagnosing psoriatic arthritis. Patients with symptoms should be referred to a rheumatologist, where they will be examined. </p>
<p>If psoriatic arthritis is suspected, a doctor will investigate the skin, nails, joints, spine, and entheses, the junctions where ligaments and tendons attach to the bones. They’ll also check for any dactylitis, the sausage-like swelling in the hands and toes.</p>
<p>They will request X-rays of affected peripheral joints and the spine to look for cartilage and bone damage, as well as new bone formations. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6758836/pdf/f1000research-8-20979.pdf">MRI and ultrasound scans may also help</a>. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-rheumatoid-arthritis-the-condition-tennis-champion-caroline-wozniacki-lives-with-119537">What is rheumatoid arthritis, the condition tennis champion Caroline Wozniacki lives with?</a>
</strong>
</em>
</p>
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<p>Patients will have routine blood tests looking for signs of inflammation, as well as a marker named HLA B27, <a href="https://www.nejm.org/doi/full/10.1056/NEJMra1505557?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed">present in approximately 25% of affected people</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/329992/original/file-20200423-47820-1bxmw93.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/329992/original/file-20200423-47820-1bxmw93.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=349&fit=crop&dpr=1 600w, https://images.theconversation.com/files/329992/original/file-20200423-47820-1bxmw93.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=349&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/329992/original/file-20200423-47820-1bxmw93.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=349&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/329992/original/file-20200423-47820-1bxmw93.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=439&fit=crop&dpr=1 754w, https://images.theconversation.com/files/329992/original/file-20200423-47820-1bxmw93.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=439&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/329992/original/file-20200423-47820-1bxmw93.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=439&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Psoriatic arthritis symptoms often appear in the hands, feet, buttocks and lower back, but other peripheral joints and other part of the spine can also be affected.</span>
<span class="attribution"><span class="source">www.shutterstock.com</span></span>
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</figure>
<h2>Potential complications</h2>
<p>Left untreated, patients can suffer joint deformity and damage to bones, cartilage and organs, potentially leading to permanent disability. Early diagnosis and optimal treatment are key to preventing this.</p>
<p>Patients are at increased risk of heart and blood vessel disease due to <a href="http://www.jrheum.org/content/41/7/1357.long">metabolic syndrome</a>, <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/metabolic-syndrome">a cluster of conditions including high blood pressure</a>. </p>
<p>Psychological consequences can also impact patients’ well-being and quality of life. The condition is also linked to an <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/imj.14046">increased risk of depression</a>.</p>
<h2>How is it treated?</h2>
<p>There is no cure for psoriatic arthritis, but treatment can be very effective in controlling symptoms. The challenge is to diagnose early so treatment can begin as soon as possible.</p>
<p>Painful symptoms are treated with <a href="https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Treatments/NSAIDs">non-steroidal anti-inflammatory drugs</a> such as ibuprofen, but these are generally insufficient to control the arthritis alone. </p>
<p>The clinician may then add a disease modifying anti-rheumatic drug (DMARD). These immunosuppressant drugs aim to control the inflammatory flare ups. <a href="https://www.arthritis.org/health-wellness/treatment/treatment-plan/disease-management/methotrexate-managing-side-effects">Methotrexate</a> is usually used first, while <a href="https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Treatments/Apremilast-Otezla">apremilast</a> is an alternative for milder cases.</p>
<p>If these are not sufficient, so-called <a href="https://arthritisaustralia.com.au/managing-arthritis/medical-management/medicines/bdmards/">biological treatments</a> must be used. These target certain inflammation proteins and are often administered via injection using an easy-to-use pen, as diabetics do with insulin. They are generally very effective, well tolerated and have the advantage of easing <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6297592/pdf/clinmed-17-1-65.pdf">both joint and skin symptoms</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/329914/original/file-20200423-47815-u0ncfx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/329914/original/file-20200423-47815-u0ncfx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/329914/original/file-20200423-47815-u0ncfx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/329914/original/file-20200423-47815-u0ncfx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/329914/original/file-20200423-47815-u0ncfx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/329914/original/file-20200423-47815-u0ncfx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/329914/original/file-20200423-47815-u0ncfx.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">
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<span class="caption">Biological treatments target inflammatory proteins, and can be administered via an autoinjector.</span>
<span class="attribution"><span class="source">www.shutterstock.com</span></span>
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</figure>
<p>More recently, innovative treatments have been developed that patients take as a tablet, <a href="https://www.nejm.org/doi/full/10.1056/NEJMe1709907?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubmed">known as JAK inhibitors</a>. These drugs work by blocking a key pathway involved in inflammation.</p>
<p>There is a risk of side effects when using drugs that suppress the immune system. Primarily, they can leave patients more vulnerable to infections.</p>
<hr>
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<strong>
Read more:
<a href="https://theconversation.com/what-does-it-mean-to-be-immunocompromised-and-why-does-this-increase-your-risk-of-coronavirus-135200">What does it mean to be immunocompromised? And why does this increase your risk of coronavirus?</a>
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<p>In addition to medication, it’s important for patients to maintain regular physical activity and a balanced diet. </p>
<p>Given the effectiveness of these treatments, the goals of caregivers have also changed. Clinicians are no longer targeting improvement, <a href="https://academic.oup.com/rheumatology/article/57/8/1321/4554480">but remission, where the signs and symptoms are completely resolved</a>.</p>
<p><em>This article is supported by the <a href="https://theconversation.com/au/partners/judith-neilson-institute">Judith Neilson Institute for Journalism and Ideas</a>.</em></p><img src="https://counter.theconversation.com/content/129899/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Fabien B. Vincent receives funding from Monash University, the Rebecca L. Cooper Medical Research Foundation, Arthritis Australia, and Janssen-Cilag Pty Ltd. </span></em></p><p class="fine-print"><em><span>MICELI-RICHARD Corinne a reçu des financements de Abbvie, Pfizer, MSD Avenir, Biogen, and Novartis.</span></em></p>Kim Kardashian West suffers from psoriatic arthritis. About 1% of people have the autoimmune condition which primarily affects the skin and joints.Fabien B. Vincent, Research Fellow; Rheumatology Research Group, Centre for Inflammatory Diseases, Monash UniversityCorinne Miceli-Richard, Professor (MD PhD en Rhumatologie), AP-HPLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1319572020-02-19T11:26:45Z2020-02-19T11:26:45ZDiscovery of gene associated with 20 autoimmune diseases leads to promising drug trials<figure><img src="https://images.theconversation.com/files/316134/original/file-20200219-11005-1fautxq.jpg?ixlib=rb-1.1.0&rect=15%2C0%2C5160%2C3445&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Psoriasis is an autoimmune condition.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/problem-many-people-eczema-on-hand-580580401">Ternavskaia Olga Alibec/Shutterstock</a></span></figcaption></figure><p>No matter how many times a day we wash our hands, clean our house or wash our dishes, we’re still surrounded by bacteria and viruses which can cause <a href="https://www.reactgroup.org/toolbox/understand/bacteria/bacteria-and-disease/">illness and disease</a>. So we <a href="https://www.livescience.com/26579-immune-system.html">rely on our immune system</a> to fight off these potential threats constantly. In most people, the immune system operates as an effective –- even if not perfect – defensive mechanism. </p>
<p>But in some people the immune system may go awry, causing it to perceive parts of the body itself as a threat and <a href="https://www.immunology.org/sites/default/files/autoimmunity-briefing.pdf">attack the body’s own tissues and cells</a>. This is what happens in <a href="https://www.diabetes.org.uk/type-1-diabetes">type 1 diabetes</a>, where the immune system targets cells in the pancreas that make insulin. It also happens in <a href="https://www.arthritisaction.org.uk/living-with-arthritis/what-is-arthritis/rheumatoid-arthritis/">rheumatoid arthritis</a>, when the immune system attacks the lining of the joints. Both of these are examples of <a href="https://www.diabetes.co.uk/autoimmune-diseases.html">autoimmune diseases</a>. </p>
<p>There are more than 80 different autoimmune conditions that affect more than <a href="https://www.immunology.org/sites/default/files/connect-immune-research-are-you-autoimmune-report.pdf">4 million people in the UK alone</a>. While treatments that reduce autoimmune attacks have been developed, there is still <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4061980/">no cure for these diseases</a>. Existing drugs might also not be effective in all patients, and can cause severe side effects. In order to develop better treatments, we need to have a better understanding of how these diseases develop.</p>
<p>Over the past decade, many studies investigating the genetics of autoimmunity have found a common feature: a particular gene, called <a href="https://ghr.nlm.nih.gov/gene/TYK2">TYK2</a>. This gene has been associated with <a href="https://www.nature.com/articles/s41588-019-0550-4">at least 20 autoimmune diseases</a>, including multiple sclerosis, type 1 diabetes, rheumatoid arthritis, lupus, and psoriasis. </p>
<p>Since the discovery of this gene, a drug that targets TYK2 has been developed and is <a href="https://news.bms.com/press-release/bristolmyers/bristol-myers-squibbs-novel-oral-selective-tyk2-inhibitor-delivered-signi">showing promise</a> for the treatment of psoriasis, a disease that causes <a href="https://www.psoriasis.org/about-psoriasis;">raised, red, scaly patches</a> on the skin. Based on the results, this clinical trial gives hope not only for treating psoriasis, but for the treatment of other autoimmune conditions as well. </p>
<h2>From gene to drug</h2>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/26304966">TYK2 plays an integral role</a> in regulating <a href="https://immunology.sciencemag.org/content/3/30/eaau8714">how active the immune system is</a>. But key to the effect of TYK2 on autoimmunity is what scientists call “<a href="http://stm.sciencemag.org/cgi/pmidlookup?view=short&pmid=27807284">gene variants</a>”. Every person will have one of several possible variants of the TYK2 gene. These variants are essentially slightly different versions of the gene, which might make the immune system more or less active depending on what variant a person has.</p>
<p>Certain variants that increase activity in the immune system have been found to increase the likelihood that a person will develop an autoimmune disease, while other variants can actually <a href="http://stm.sciencemag.org/cgi/pmidlookup?view=short&pmid=27807284">protect</a> against <a href="https://www.nature.com/articles/s41588-019-0550-4">more than 20 different autoimmune diseases</a>. While genetics is only one of many factors which influence whether a person develops autoimmunity, this discovery may be a major help in improving treatments of many autoimmune diseases.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/316135/original/file-20200219-11017-1989rq6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/316135/original/file-20200219-11017-1989rq6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=375&fit=crop&dpr=1 600w, https://images.theconversation.com/files/316135/original/file-20200219-11017-1989rq6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=375&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/316135/original/file-20200219-11017-1989rq6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=375&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/316135/original/file-20200219-11017-1989rq6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=471&fit=crop&dpr=1 754w, https://images.theconversation.com/files/316135/original/file-20200219-11017-1989rq6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=471&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/316135/original/file-20200219-11017-1989rq6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=471&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">This gene has been linked with more than 20 autoimmune diseases.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/dna-molecules-structure-genetic-code-3d-1353967346">Blue Andy/Shutterstock</a></span>
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<p>Since a higher level of TYK2 activity results in autoimmunity, a <a href="https://stm.sciencemag.org/content/11/502/eaaw1736?rss=1">team of researchers tested</a> the use of a drug, called BMS-986165, which inhibits TYK2 function in treating autoimmune conditions. The drug works by reducing the gene’s activity in the immune system. Promising results were reported when testing the drug both in pre-clinical and clinical settings.</p>
<p>The team first studied the effects of the drug in human blood cells. After having observed the effect of the drug on the cells, they then moved on to animal models to test the effect it had on a whole organism. The drug was <a href="https://stm.sciencemag.org/content/11/502/eaaw1736?rss=1">shown to protect mice</a> from several different autoimmune diseases, including <a href="https://www.nhs.uk/conditions/lupus/">lupus</a>, which causes long-term inflammation to the skin, joints, and organs. Treatment with the drug reduced the number of attacking immune cells by 50% in some cases. </p>
<p>These promising results follow on from a <a href="https://news.bms.com/press-release/bristolmyers/bristol-myers-squibbs-novel-oral-selective-tyk2-inhibitor-delivered-signi">2018 study</a>, which successfully trialled the drug for the treatment of psoriasis. The study found 75% of patients showed a reduction in the size of skin lesions and severity by 75%. Of these patients, 25% had complete clearance of lesions. </p>
<p>These studies, in conjunction with the evidence of the role of TYK2 in another 20 autoimmune diseases, suggest a potential for the use of this drug in the treatment of the other conditions as well. Currently, BMS-986165 is under evaluation in clinical trials in patients with Crohn’s disease, lupus and further trials for psoriasis. </p>
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<img alt="" src="https://images.theconversation.com/files/315932/original/file-20200218-11040-p9wweg.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/315932/original/file-20200218-11040-p9wweg.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=112&fit=crop&dpr=1 600w, https://images.theconversation.com/files/315932/original/file-20200218-11040-p9wweg.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=112&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/315932/original/file-20200218-11040-p9wweg.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=112&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/315932/original/file-20200218-11040-p9wweg.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=140&fit=crop&dpr=1 754w, https://images.theconversation.com/files/315932/original/file-20200218-11040-p9wweg.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=140&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/315932/original/file-20200218-11040-p9wweg.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=140&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><em>This article is part of a series tied to Medicine made for you, a series by The Anthill podcast on the future of healthcare and how it could soon get a lot more personal. <a href="https://theconversation.com/uk/topics/medicine-made-for-you-82269">Read more here</a>.</em></p><img src="https://counter.theconversation.com/content/131957/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Calliope Athina Dendrou receives funding from the Wellcome Trust and Rosetrees Trust. </span></em></p><p class="fine-print"><em><span>Melissa Grant-Peters 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 drug created to target this gene was found to be effective in treating autoimmune conditions like lupus and psoriasis.Melissa Grant-Peters, DPhil student, University of OxfordLicensed 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>
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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>
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<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>
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<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">
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<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>
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<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/1117062019-02-19T16:07:22Z2019-02-19T16:07:22ZSeven myths and truths about healthy skin<figure><img src="https://images.theconversation.com/files/259717/original/file-20190219-43258-1yb5wkv.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/close-african-woman-wearing-ear-rings-740139493">Shutterstock</a></span></figcaption></figure><p>Skin is <a href="https://theconversation.com/the-skin-is-a-very-important-and-our-largest-organ-what-does-it-do-91515">our largest organ</a> and something we may take for granted when it’s healthy. As an academic dermatologist I frequently hear misleading “facts” that seem to be stubbornly enduring. Here are some of the most commonly shared myths that can be cleared up immediately, and some truths you can rely on.</p>
<h2>Skin constantly renews itself</h2>
<p><strong>TRUE</strong> The skin provides a dynamic barrier between your body’s internal environment and the outside world. Cells called keratinocytes in <a href="https://www.dermnetnz.org/topics/the-structure-of-normal-skin">the epidermis</a> (the outer layer of skin) are constantly dividing to produce a supply of cells that move up through this layer and are shed from its surface. Skin is a rich source of <a href="https://www.eurostemcell.org/skin-stem-cells-where-do-they-live-and-what-can-they-do">stem cells</a> with the capacity to divide and renew themselves. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/259730/original/file-20190219-43252-3rpjer.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/259730/original/file-20190219-43252-3rpjer.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/259730/original/file-20190219-43252-3rpjer.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/259730/original/file-20190219-43252-3rpjer.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/259730/original/file-20190219-43252-3rpjer.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/259730/original/file-20190219-43252-3rpjer.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/259730/original/file-20190219-43252-3rpjer.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">A good skincare regime starts with removing dirt from skin.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/side-view-handsome-afro-american-man-582848200">Shutterstock</a></span>
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</figure>
<h2>Drink two litres of water a day for healthy skin</h2>
<p><strong>FALSE</strong> The amount of water you drink does not directly affect your skin. Water is supplied to the skin by blood flowing through <a href="https://www.dermnetnz.org/topics/the-structure-of-normal-skin">the dermis</a>, the inner layer of skin; water is lost from the epidermis, especially in a dry environment.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/259719/original/file-20190219-43291-kmri3j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/259719/original/file-20190219-43291-kmri3j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=558&fit=crop&dpr=1 600w, https://images.theconversation.com/files/259719/original/file-20190219-43291-kmri3j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=558&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/259719/original/file-20190219-43291-kmri3j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=558&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/259719/original/file-20190219-43291-kmri3j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=701&fit=crop&dpr=1 754w, https://images.theconversation.com/files/259719/original/file-20190219-43291-kmri3j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=701&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/259719/original/file-20190219-43291-kmri3j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=701&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/success?u=http%3A%2F%2Fdownload.shutterstock.com%2Fgatekeeper%2FW3siZSI6MTU1MDYwODk1OCwiYyI6Il9waG90b19zZXNzaW9uX2lkIiwiZGMiOiJpZGxfMTI4NjI0ODYwMCIsImsiOiJwaG90by8xMjg2MjQ4NjAwL2h1Z2UuanBnIiwibSI6MSwiZCI6InNodXR0ZXJzdG9jay1tZWRpYSJ9LCJpQWVwL1hHa0ViY1NvNUx1TWJicmF1WFBCaDQiXQ%2Fshutterstock_1286248600.jpg&pi=33421636&m=1286248600&src=u1CBEbNYSfJuR53ejxoklA-1-2">Shutterstock</a></span>
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<p>Water is needed to maintain skin hydration and when you become seriously dehydrated your skin appears dull and is less elastic. In a healthy person the internal organs – kidneys, heart and blood vessels – control the amount of water reaching the skin. There is no fixed volume of water that you need to drink, it simply depends on the amounts you are using and losing.</p>
<h2>Stress can make skin unhealthy</h2>
<p><strong>TRUE</strong> There are many health issues in modern life that we blame on stress, but several skin conditions have been shown in scientific studies (see below), to be worsened by life events, possibly via stress hormones including <a href="http://www.yourhormones.info/hormones/cortisol/">cortisol</a> (a steroid hormone made in the adrenal glands). Notable examples are <a href="https://www.dermnetnz.org/topics/alopecia-areata/">alopecia areata</a>, an auto-immune condition where the body’s immunity begins to attack the hair follicles, causing hair to fall out; <a href="https://www.ncbi.nlm.nih.gov/pubmed/29729012">psoriasis</a>, another auto-immune condition that causes skin thickening, scaling and inflammation; and <a href="https://www.ncbi.nlm.nih.gov/pubmed/29023418">eczema</a>, itchy red skin inflammation often occurring alongside asthma, hay fever and other allergies. Unfortunately a flare up of these skin conditions is exactly what you don’t need when you are feeling stressed or under pressure.</p>
<h2>Eating chocolate causes acne</h2>
<p><strong>FALSE</strong> Acne vulgaris, the common “teenage” <a href="https://www.dermnetnz.org/topics/acne-vulgaris">acne</a> which can actually persist into your 30s and 40s, occurs as a result of the interaction between hormonal effects on grease glands in the skin, plus the skin’s immune response to blocked pores and microbes living on the skin.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/259724/original/file-20190219-43288-1p7sbld.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/259724/original/file-20190219-43288-1p7sbld.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=378&fit=crop&dpr=1 600w, https://images.theconversation.com/files/259724/original/file-20190219-43288-1p7sbld.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=378&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/259724/original/file-20190219-43288-1p7sbld.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=378&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/259724/original/file-20190219-43288-1p7sbld.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=475&fit=crop&dpr=1 754w, https://images.theconversation.com/files/259724/original/file-20190219-43288-1p7sbld.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=475&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/259724/original/file-20190219-43288-1p7sbld.png?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">
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<p>Eating a high fat diet is unhealthy for many reasons, but it doesn’t cause acne. In fact some tablets prescribed for severe acne such as <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Food+increases+the+bioavailability+of+isotretinoin">oral isotretinoin</a> are better absorbed when pills are swallowed with a fatty meal – and that could include chocolate.</p>
<h2>Washing powder causes eczema</h2>
<p><strong>FALSE</strong> Eczema is a condition where the skin is dry, itchy and red. It is caused by a combination of genetic factors (how your skin is made) and environmental effects, leading to inflammation. Soap, detergents and washing powders can irritate the skin and contribute to dryness because they remove oil from the skin (just as washing-up liquid removes grease from your dishes). Biological washing powders contain enzymes – proteins that break down fats and other proteins to remove stains – and these can irritate sensitive skin, so they may worsen eczema. It is important that any washing power is thoroughly rinsed out of clothing before it is worn, to avoid skin irritation.</p>
<h2>White marks on nails = calcium deficiency</h2>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/259768/original/file-20190219-43267-ppulbs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/259768/original/file-20190219-43267-ppulbs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=690&fit=crop&dpr=1 600w, https://images.theconversation.com/files/259768/original/file-20190219-43267-ppulbs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=690&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/259768/original/file-20190219-43267-ppulbs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=690&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/259768/original/file-20190219-43267-ppulbs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=867&fit=crop&dpr=1 754w, https://images.theconversation.com/files/259768/original/file-20190219-43267-ppulbs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=867&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/259768/original/file-20190219-43267-ppulbs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=867&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><strong>FALSE</strong> Nails are manufactured in the nail matrix, an area under the skin at the top edge of your nail. If the matrix is traumatised, bumped or bitten, an irregularity in the developing nail occurs and air can become trapped. This appears as a white mark as the nail grows out. Calcium is important for healthy nails (as well as bones and teeth) but these white marks are not a sign of deficiency.</p>
<h2>Sunshine is good for you</h2>
<p><strong>TRUE & FALSE</strong> Many people have experienced the feel-good factor of a sunny day, but there are good and bad effects of sunlight. Light from the sun includes a mixture of <a href="https://www.britannica.com/science/sunlight-solar-radiation">different wavelengths of light</a>: some are visible to the human eye, some are shorter than the colours we can see – these are called <a href="https://uihc.org/health-topics/what-difference-between-uva-and-uvb-rays">ultraviolet</a> (UV) – and some are longer, the infrared. Different wavelengths have different effects on skin.</p>
<p>UVB is used by skin to manufacture <a href="https://www.nhs.uk/live-well/healthy-body/how-to-get-vitamin-d-from-sunlight/">vitamin D</a> which is essential for bone health. Without sun exposure this vitamin must be obtained from the diet. Dermatologists use specific wavelengths of UVA and UVB in carefully controlled doses to reduce skin inflammation, a valuable treatment for some skin conditions. </p>
<p>But when the skin is exposed to too much UV it can damage the skin cells’ DNA, leading to uncontrolled growth – the basis of cancer. As a simple rule, unless you have a disease or treatment that suppresses your immune system, sunshine is good for you in moderation, but always avoid getting sunburned.</p>
<h2>Keep it simple</h2>
<p>The basic principles of keeping skin healthy are mainly common sense. You should wash your skin regularly to remove dirt, but not so much that you remove the essential moisture and water-proofing substances. Use a moisturiser if your skin feels tight or dry – a greasy ointment works best unless you have acne-prone skin, in which case you should use a non-greasy water-based cream. Avoid stress if possible, eat a healthy diet and drink water when you feel thirsty. And finally, protect your skin from too much sun with a hat and clothing or sunscreen.</p><img src="https://counter.theconversation.com/content/111706/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sara J Brown receives research funding from the Wellcome Trust, the Tayside Dermatological Research Charity and the British Skin Foundation and is a medical adviser for Eczema Outreach Support.</span></em></p>When it comes to looking after your skin, some stubborn “facts” endure, so a dermatologist sets the record straight.Sara Brown, Professor of Molecular & Genetic Dermatology, Wellcome Trust Senior Research Fellow, University of DundeeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/949482018-04-20T11:40:06Z2018-04-20T11:40:06ZPsoriasis and arthritis can increase heart attack and stroke risk – new research<figure><img src="https://images.theconversation.com/files/215737/original/file-20180420-75126-1q2byjy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Rheumatoid arthritis</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hand-woman-deformed-rheumatoid-arthritis-197319983?src=suXUAbfeVnxAx4fDqL6FtA-1-12">Hriana/Shutterstock</a></span></figcaption></figure><p>Arthritis is the <a href="https://www.arthritisresearchuk.org/jointproblem.aspx?gclid=EAIaIQobChMI2KKZjbbG2gIVB6QYCh2negHBEAAYASAAEgL-sPD_BwE">leading cause</a> of pain and disability in the UK. The disorder typically causes pain and inflammation in the joints, and can affect people of all ages. It is an extremely debilitating condition that can force people to give up work or favourite hobbies. </p>
<p>There are several kinds of arthritis, including the commonly known osteoarthritis. This type is related to wear and tear of the joints due to older age, or damage from sports and other activities. But other kinds of arthritis – known as <a href="https://www.arthritis.org/about-arthritis/types/inflammatory-arthritis/">inflammatory arthritis</a> – can affect the organs and skin, too.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/215736/original/file-20180420-75093-1h1sacc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/215736/original/file-20180420-75093-1h1sacc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/215736/original/file-20180420-75093-1h1sacc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=265&fit=crop&dpr=1 600w, https://images.theconversation.com/files/215736/original/file-20180420-75093-1h1sacc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=265&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/215736/original/file-20180420-75093-1h1sacc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=265&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/215736/original/file-20180420-75093-1h1sacc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=333&fit=crop&dpr=1 754w, https://images.theconversation.com/files/215736/original/file-20180420-75093-1h1sacc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=333&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/215736/original/file-20180420-75093-1h1sacc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=333&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">Types of arthritis.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/normal-knee-joint-changes-due-osteoarthritis-482996131?src=suXUAbfeVnxAx4fDqL6FtA-1-34">Blamb/Shutterstock</a></span>
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<p>In our newly published research, we wanted to find out the associated cardiovascular risks that come with types of inflammatory arthritis – particularly rheumatoid arthritis and psoriatic arthritis. Researchers have <a href="https://academic.oup.com/rheumatology/article/48/10/1309/1787685">already found</a> that people with rheumatoid arthritis (which occurs when the body’s immune system targets affected joints, leading to swelling and pain) have higher rates of cardiovascular disease. And those with rheumatoid and psoriatic arthritis also have <a href="http://ard.bmj.com/content/early/2013/10/04/annrheumdis-2013-204223">an increased risk</a> of developing other conditions, such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5298365/pdf/rmmj-8-1-e0004.pdf">skin and heart</a> disorders. </p>
<p>However, it is not entirely clear whether those with psoriatic arthritis – a joint condition that <a href="https://www.arthritis.org/about-arthritis/types/psoriatic-arthritis/">affects around 30%</a> of people with the skin condition psoriasis – are subject to a higher risk of cardiovascular disease, too.</p>
<h2>Additional risks</h2>
<p>We cannot simply say arthritis causes heart problems, as there are numerous factors at play. There are several things that can affect everyone’s heart health whether they have inflammatory arthritis or not. Obesity and smoking are just two examples. However, as the disease process of rheumatoid and psoriatic arthritis involves inflammation, this can cause an additional risk of developing heart problems. Add to this that treatments used to control arthritis symptoms can <a href="https://ac.els-cdn.com/S0002914911022466/1-s2.0-S0002914911022466-main.pdf?_tid=e79201e5-2ef2-4903-a58f-5b308b7bd7b8&acdnat=1524146387_3cba08433dc792eed5e63ec770ddbfd9">also affect cardiovascular health</a> and the situation becomes even more complex to understand. </p>
<p>So, to understand the true cardiovascular risk in individuals with inflammatory arthritis, we decided to look at the health records of patients with rheumatoid arthritis, psoriatic arthritis and psoriasis. </p>
<p>Using information from an anonymised databank, we looked at GP, hospital and death records of arthritis and psoriasis patients. 8,650 had been diagnosed with rheumatoid arthritis, 2,128 with psoriatic arthritis, and 24,630 with psoriasis. We then compared these to 1,187,706 individuals without these conditions, looking at rates of heart attack, stroke and deaths related to these.</p>
<p>When the data was analysed, <a href="http://www.semarthritisrheumatism.com/article/S0049-0172(17)30621-2/abstract">we found that</a> cardiovascular risk factors were higher for those who had rheumatoid arthritis, psoriatic arthritis, and psoriasis, compared to people who did not have these conditions.</p>
<p>When we controlled for known cardiovascular risk factors (such as obesity and high blood pressure) there was still a higher risk of heart attack and stroke in women with rheumatoid arthritis, and in men and women with psoriasis. This increased risk of heart attack and stroke can be explained by the inflammation in rheumatoid arthritis causing inflammation in the heart. However, we are not yet sure why this occurs only in women. In addition, we know the level of inflammation in psoriasis is low so this does not explain the higher risk of heart attack and stroke in this group.</p>
<p>Though we have found evidence of increased risks, more medical research will need to be done to work out what the best cause of action is for those with inflammatory arthritis. In the meantime, people with inflammatory arthritis and psoriasis should be closely monitored and given extra support to help prevent heart attack and strokes.</p><img src="https://counter.theconversation.com/content/94948/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Roxanne Cooksey receives funding from Pfizer. </span></em></p>The risk of heart attack and stroke is increased for women with rheumatoid arthritis and psoriasis, and for men with psoriasis.Roxanne Cooksey, Research Fellow, National Centre for Population Health & Well-being Research, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/915182018-03-20T19:04:37Z2018-03-20T19:04:37ZCommon skin rashes and what to do about them<figure><img src="https://images.theconversation.com/files/209558/original/file-20180308-30983-e4u830.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">What's that rash? Here's what to look for to diagnose a common skin complaint. </span> <span class="attribution"><span class="source">from www.shutterstock.com</span></span></figcaption></figure><p><em>This article is part of our <a href="https://theconversation.com/au/topics/skin-series-50414">series about skin</a>: why we have it, what it does, and what can go wrong. Read other articles in the series <a href="https://theconversation.com/au/topics/skin-series-50414">here</a>.</em></p>
<hr>
<p>Everyone has had the unpleasant experience of a rash on the skin – pink, red or purple, flat or bumpy, itchy, scaly, pus-filled, or just plain unsightly. This variety isn’t surprising, because the skin is a complicated organ. </p>
<p>Infections, allergic reactions, immune system problems and even bad reactions to medication can all manifest as a rash. </p>
<p>Here are a few of the most common types.</p>
<h2>Drug allergy</h2>
<p><a href="http://www.nejm.org/doi/full/10.1056/NEJMcp1104080">Almost every prescription medication</a> available can cause a rash as a side effect, and more than 80% of those are “<a href="https://www.dermnetnz.org/topics/morbilliform-drug-reaction/">exanthematous drug eruptions</a>”, meaning a widespread rash accompanied by other symptoms such as headache, fever and feeling generally unwell. </p>
<p>This rash usually appears within two weeks of starting a new medication, as a widespread, symmetrical rash with pink-to-red spots that are flat or elevated and firm, and that might join together in patches. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/common-lumps-and-bumps-on-and-under-the-skin-what-are-they-59313">Common lumps and bumps on and under the skin: what are they?</a>
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</em>
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<p>This type of rash is a hypersensitivity reaction, in which the attacking soldiers of the immune system (called “T-cells”) detect the drug and try to clear it from the body by releasing inflammatory proteins. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/206734/original/file-20180216-131003-1a7s5jg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/206734/original/file-20180216-131003-1a7s5jg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/206734/original/file-20180216-131003-1a7s5jg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/206734/original/file-20180216-131003-1a7s5jg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/206734/original/file-20180216-131003-1a7s5jg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/206734/original/file-20180216-131003-1a7s5jg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/206734/original/file-20180216-131003-1a7s5jg.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">Exanthematous drug eruption.</span>
<span class="attribution"><span class="source">DermNet New Zealand.</span></span>
</figcaption>
</figure>
<p>Very rarely, a drug can cause a severe and life-threatening rash called “toxic epidermal necrolysis” where the skin begins to peel off in sheets. It’s more common in Han Chinese people with a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2586963/">specific genetic variant</a>, and requires intensive care or burn unit treatment. </p>
<p>Most drug eruptions <a href="http://www.nejm.org/doi/full/10.1056/NEJMcp1104080">go away within a week</a> once the patient stops taking the problem medication, or within several weeks in protracted cases. In the meantime, or if the drug is essential, steroid creams (which reduce inflammation) and emollient (softening) moisturisers can bring some relief. </p>
<h2>Allergic contact dermatitis</h2>
<p><a href="https://www.dermnetnz.org/topics/allergic-contact-dermatitis/">Allergic contact dermatitis</a> is caused by direct skin contact with a substance to which the person is allergic. The immune system’s T-cells overreact to the allergen and release proteins that call more immune cells to the area, making it red and swollen. </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>
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<p>It’s often itchy and can be blistered or dry but bumpy. The reaction is often delayed by 48-72 hours, so it can be difficult to determine exactly what caused the reaction. It should also die down by itself over a few days, as long as the allergen is no longer on the skin. </p>
<p>Contact allergies <a href="https://www.dermcoll.edu.au/atoz/allergic-contact-dermatitis-acd/">can develop suddenly</a> after years of exposure to an allergen. Jewellery containing nickel, fragrances in lotions, household cleaners, preservatives in hair products, and latex in gloves or condoms are common sources. A dermatologist can carry out a patch test to determine whether a substance is the allergen, by applying it to a small patch of skin.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/206735/original/file-20180216-131006-fpfxkj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/206735/original/file-20180216-131006-fpfxkj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=686&fit=crop&dpr=1 600w, https://images.theconversation.com/files/206735/original/file-20180216-131006-fpfxkj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=686&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/206735/original/file-20180216-131006-fpfxkj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=686&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/206735/original/file-20180216-131006-fpfxkj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=862&fit=crop&dpr=1 754w, https://images.theconversation.com/files/206735/original/file-20180216-131006-fpfxkj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=862&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/206735/original/file-20180216-131006-fpfxkj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=862&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Severe contact dermatitis from a drug patch.</span>
<span class="attribution"><span class="source">Dr. Khatmando</span></span>
</figcaption>
</figure>
<p>Active dermatitis is treated with emollient moisturisers and steroid creams, or with oral steroids or drugs to suppress the immune system if very severe. Further episodes can be prevented by becoming aware of the sources of the allergen, reading labels carefully, and using gloves to handle allergen-containing products. </p>
<h2>Eczema</h2>
<p><a href="https://www.dermcoll.edu.au/atoz/atopic-dermatitis/">Atopic dermatitis</a> or atopic eczema (often just called eczema) is very common in children from three months old onwards, but appears in adults too, often with hay fever and asthma. </p>
<p>Atopic dermatitis features patches of intensely itchy red skin, sometimes with blisters and weeping patches. Children often have open sores and scabs, because it’s so itchy that it’s hard to refrain from scratching. </p>
<p>Over time the skin becomes thickened and rough from frequent scratching and rubbing. Childhood atopic dermatitis tends to improve as the child grows up, but may continue. Far less commonly, atopic dermatitis can also appear first in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5122283/">adulthood</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/206736/original/file-20180216-131003-ts387q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/206736/original/file-20180216-131003-ts387q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/206736/original/file-20180216-131003-ts387q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/206736/original/file-20180216-131003-ts387q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/206736/original/file-20180216-131003-ts387q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/206736/original/file-20180216-131003-ts387q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/206736/original/file-20180216-131003-ts387q.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">Atopic dermatitis is very common in children, but often improves as they get older.</span>
<span class="attribution"><span class="source">DermNet New Zealand</span></span>
</figcaption>
</figure>
<p>Atopic dermatitis is a <a href="https://www.dermnetnz.org/topics/causes-of-atopic-dermatitis/">disease of the immune system</a>, in which
structural defects in the skin barrier make it easier for irritants to penetrate into the skin. This throws the delicate balance of the microbial community on our skin out of whack, causing the immune system to go into overdrive. Triggers include stress, sweating, coarse fibres in clothing, inhalation of allergens such as pollen, irritants such as soap or perfumes, and eating food we’re allergic to.</p>
<p>Steroid creams can help treat a bad flare of atopic dermatitis, but shouldn’t be used constantly. In very severe cases, immunosuppressant drugs are prescribed. Ongoing control of atopic dermatitis often includes using emollient moisturisers to combat dry skin, keeping cool, avoiding hot water or irritants, and reducing allergens such as dust mites in the home. </p>
<p>For severe cases that don’t respond to these methods, the drug <a href="https://www.tga.gov.au/prescription-medicines-registration-new-chemical-entities-australia">dupilumab</a> has just been approved for use in Australia. This drug blocks a specific cell receptor to prevent immune cells from detecting two overactive inflammatory proteins.</p>
<p>Atopic dermatitis can have a big impact on quality of life, due to insomnia from the constant itchiness, and restrictions on clothing, body products, pets or activities. Its presence on prominent parts of the body like the face and hands can also reduce self-esteem. Evening sedatives to improve sleep and psychotherapy can help reduce the impact on everyday life. </p>
<h2>Psoriasis</h2>
<p>Psoriasis is another chronic immune disorder. It can start at any age and can be lifelong, and is usually present as red plaques (raised or thickened skin) with well-defined edges and silvery-white scales, ranging from a few millimetres to several centimetres across. The overactive inflammation can also damage the joints and lead to <a href="https://www.dermnetnz.org/topics/psoriatic-arthritis">psoriatic arthritis</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-skin-is-a-very-important-and-our-largest-organ-what-does-it-do-91515">The skin is a very important (and our largest) organ: what does it do?</a>
</strong>
</em>
</p>
<hr>
<p>Often the plaques feel <a href="https://www.dermcoll.edu.au/atoz/psoriasis/">itchy or sore</a>, and because psoriasis is long-lasting and can appear prominently on highly visible parts of the body, it often comes with <a href="https://www.dermnetnz.org/topics/psychological-effects-of-psoriasis">severe psychological effects</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/206737/original/file-20180216-131010-1sqaufr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/206737/original/file-20180216-131010-1sqaufr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/206737/original/file-20180216-131010-1sqaufr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/206737/original/file-20180216-131010-1sqaufr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/206737/original/file-20180216-131010-1sqaufr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/206737/original/file-20180216-131010-1sqaufr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/206737/original/file-20180216-131010-1sqaufr.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">Psoriasis lesions are raised, red and often have white scales.</span>
<span class="attribution"><span class="source">DermNet New Zealand</span></span>
</figcaption>
</figure>
<p>Psoriasis is caused by too many new skin cells being produced and moving up to the surface of the skin <a href="https://www.nhs.uk/conditions/psoriasis/causes/">too quickly</a>. It’s not known exactly why, but there’s usually an overabundance of inflammatory messenger proteins in the skin. </p>
<p>It can be triggered or aggravated by a streptococcal infection such as tonsillitis, smoking, hormonal changes such as menopause, and some medications. Genetics play an important role in susceptibility to psoriasis and also in what treatments are effective.</p>
<p><a href="https://www.dermnetnz.org/topics/plaque-psoriasis/">Chronic plaque psoriasis</a>, the most common form, can be very resistant to treatment. Small areas can be treated with creams containing steroids, coal tar, or vitamin D. If a lot of the body is covered by plaques, oral immunosuppressant drugs are used, or <a href="https://www.ncbi.nlm.nih.gov/pubmed/29369396">phototherapy</a>, which uses targeted UV light to destroy over-active immune cells. Moderate sun exposure sometimes improves psoriasis, but sunburn can worsen it – a tricky balance in Australia’s high-UV environment. </p>
<p>These treatments can usually improve the plaques, but it can be very difficult to clear it completely. There are several <a href="https://www.psoriasis.org/about-psoriasis/treatments/biologics">new drugs</a> coming onto the market for severe psoriasis that hasn’t responded to other treatment.</p>
<h2>Tinea</h2>
<p>Tinea, or ringworm, is not caused by worms at all but a fungal infection. Tinea is usually named according to the body site it’s on, but the same few kinds of fungus can cause tinea in many parts of the body and it can be spread from one part of the body to another, such as by scratching or using a contaminated towel.</p>
<p><a href="https://www.dermnetnz.org/topics/tinea-pedis/">Tinea pedis</a>, on the foot, is an important type because spores can live for weeks in communal showers and changing rooms, making it a common source of infection that can then spread to the trunk, arms and legs (<a href="https://www.dermnetnz.org/topics/tinea-corporis/">tinea corporis</a>) or groin (<a href="https://www.dermnetnz.org/topics/tinea-cruris/">tinea cruris</a>, or jock itch). Cats, dogs and other animals are a common source of ringworm fungus, but many types can be spread between people too.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/206738/original/file-20180216-131006-142aznr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/206738/original/file-20180216-131006-142aznr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/206738/original/file-20180216-131006-142aznr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/206738/original/file-20180216-131006-142aznr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/206738/original/file-20180216-131006-142aznr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/206738/original/file-20180216-131006-142aznr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/206738/original/file-20180216-131006-142aznr.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">The fungus continues to spread further out while the inner area heals, forming a distinctive ring shape.</span>
<span class="attribution"><span class="source">Grook Da Oger</span></span>
</figcaption>
</figure>
<p>Typically, tinea spreads in a circular or oval patch, often healing in the middle so that it appears to be a red scaly ring of infection. Sometimes it can also become a fungal abscess that looks like a boil, feels boggy, and has pustules. </p>
<p>On the feet it can look like ringworm circles, patchy fine dry scales on the sole, blisters on the instep or a moist, red peeling area between the toes (athlete’s foot). </p>
<p>In the groin, it can have a scaly, red raised border and be extremely itchy.</p>
<p>Tinea is diagnosed by microscopic examination and laboratory culture of skin scrapings. It’s usually treated with antifungal creams, or oral antifungal drugs if it persists. It can become chronic in the warm, moist folds of the body.</p>
<h2>Shingles</h2>
<p>Shingles is a famously painful, blistering rash caused by the reactivation of chicken pox virus, <a href="http://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/health+topics/health+conditions+prevention+and+treatment/infectious+diseases/chickenpox+and+shingles">varicella-zoster virus</a>, usually years or decades after the original infection. </p>
<p>The virus lies dormant in nerves near the spine and migrates down the sensory nerve to the skin when it is reactivated, but it’s not known why the virus is reactivated. Some possible triggers are radiotherapy, spinal surgery, other infections, or cancers.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/206740/original/file-20180216-130997-1yurw17.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/206740/original/file-20180216-130997-1yurw17.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=378&fit=crop&dpr=1 600w, https://images.theconversation.com/files/206740/original/file-20180216-130997-1yurw17.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=378&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/206740/original/file-20180216-130997-1yurw17.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=378&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/206740/original/file-20180216-130997-1yurw17.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=474&fit=crop&dpr=1 754w, https://images.theconversation.com/files/206740/original/file-20180216-130997-1yurw17.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=474&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/206740/original/file-20180216-130997-1yurw17.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=474&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Shingles forms a painful, blistered red rash along the line of a sensory nerve.</span>
<span class="attribution"><span class="source">Fisle</span></span>
</figcaption>
</figure>
<p>Shingles <a href="https://www.mja.com.au/journal/2008/188/3/prevention-and-management-herpes-zoster">starts with pain in the skin</a> that is often described as burning or stabbing, followed in one to three days by a rash of raised red bumps that become blisters and then crust over. The rash is usually confined to a narrow arc of skin, along the sensory nerve that was harbouring the virus. </p>
<p>Patients often have a fever, headache and swollen lymph nodes. Recovery takes two to four weeks but the pain can persist after the rash has healed, called <a href="https://www.dermnetnz.org/topics/post-herpetic-neuralgia">post-herpetic neuralgia</a>. </p>
<p>If it’s caught within three days of onset, antiviral medication can reduce the severity of symptoms and length of the infection. Otherwise, treatment consists of powders or solutions to dry out the rash, as well as pain relief and rest. </p>
<p>Australians aged over 70 are eligible for a <a href="https://beta.health.gov.au/services/shingles-herpes-zoster-immunisation-service">free zoster vaccine</a>, which reduces the risk of shingles by half.</p><img src="https://counter.theconversation.com/content/91518/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>H. Peter Soyer receives funding from NHMRC and ARC.</span></em></p><p class="fine-print"><em><span>Katie Lee 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>Here’s a list of the most common rashes and what you need to look for.H. Peter Soyer, Professor of Dermatology, The University of QueenslandKatie Lee, Research assistant, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/828202017-09-04T02:27:58Z2017-09-04T02:27:58ZHealth Check: is makeup bad for your skin?<figure><img src="https://images.theconversation.com/files/183915/original/file-20170830-5619-9vgg3s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many people cover their face with makeup every day, potentially causing irritation. </span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p>Makeup is an everyday item for many people and non-negotiable for some. Is it bad for our skin? As always, the answer is not clear-cut and depends on the individual, their skin type, and the products they use.</p>
<p>With an overwhelming choice of cosmetic products available, most people don’t even know where to start with makeup. Organic? Natural? Fragrance free? Hypoallergenic? Non-comedogenic? Paraben free? What does this all mean, and are they any better?</p>
<p>The term makeup generally describes the group of cosmetics that are used for beautification. Other cosmetics include products that are used to cleanse, treat or protect the skin and hair. These days, though, we commonly see all-in-one products, such as BB or CC creams, which combine makeup for coverage together with other ingredients to provide sun protection and skin benefits. Reducing the total number of products can be helpful for those with problematic skin, but may complicate things for some. </p>
<h2>What does makeup do to our skin?</h2>
<p>While in most cases makeup is harmless, certain products may cause problems for some individuals. It’s very important to use makeup and cosmetics that are suitable for your skin type or skin condition. </p>
<p>Skin types are broadly classified into four groups:</p>
<p>• oily - excess oil production, large pores, blackheads and acne prone</p>
<p>• sensitive - tight, stinging, intolerant to many products and prone to redness</p>
<p>• dry - dull, rough or flaky and prone to itchiness</p>
<p>• normal/combination - may be oily in the T-zone (forehead, nose and chin) but problem-free elsewhere</p>
<p>Although most people have a good idea of their basic skin type, they may fail to recognise the existence of an underlying skin disorder. Conditions such as eczema, contact dermatitis, rosacea and sun damage may cause inflammation and disruption of the skin barrier.</p>
<p>Inflammation causes itchiness or tenderness, redness, lumps and bumps, while barrier disruption results in tight, sensitive, dry and easily-irritated skin. These symptoms can be identical to those caused by reactions to cosmetics, and therefore should be considered before assuming makeup to be the cause. Conversely, an ongoing reaction to products being applied to the skin may explain why the skin is not responding to regular treatment.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/183917/original/file-20170830-5619-1sltzla.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/183917/original/file-20170830-5619-1sltzla.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/183917/original/file-20170830-5619-1sltzla.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/183917/original/file-20170830-5619-1sltzla.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/183917/original/file-20170830-5619-1sltzla.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/183917/original/file-20170830-5619-1sltzla.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/183917/original/file-20170830-5619-1sltzla.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/183917/original/file-20170830-5619-1sltzla.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Skin irritations can cause itchy, scaly red rashes.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<h2>Skin problems caused by cosmetics</h2>
<p>Acne cosmetica is a form of acne triggered by the use of certain cosmetic products. It is linked to certain ingredients that cause comedone formation (a blockage in the pore) and typically presents as small rash-like bumpy pimples. A common misconception is that the makeup physically blocks the pore, whereas actually the block is made of dead skin cells. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-why-do-i-still-get-zits-29143">Health Check: why do I still get zits?</a>
</strong>
</em>
</p>
<hr>
<p>Mild inflammation results in excess skin turnover and clogging of the pore, with mineral oils being the most common culprit. It’s not always possible to determine makeup is the cause simply from the ingredient list, as it may be influenced by formulation, quantity and delivery methods.</p>
<p>Irritant dermatitis accounts for the majority of reactions to makeup and other cosmetic products. It can occur in anyone but is more likely in those with pre-existing sensitive skin or in those with underlying barrier disruption caused by a condition like eczema or rosacea. It typically causes an itchy, scaly red rash but can even blister or weep. Symptoms can occur immediately but may take weeks or even months to develop with weaker irritants, making it difficult to identify the cause. </p>
<p>Allergic contact dermatitis occurs when a person has become sensitised to an ingredient that has been applied to the skin. A red, itchy rash sometimes associated with swelling or blisters develops 12-48 hours after exposure, and may become chronic with ongoing use. The allergen can be very difficult to identify, because in some cases the product is used for months or years before sensitisation occurs.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/183916/original/file-20170830-5593-fowcya.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/183916/original/file-20170830-5593-fowcya.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/183916/original/file-20170830-5593-fowcya.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/183916/original/file-20170830-5593-fowcya.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/183916/original/file-20170830-5593-fowcya.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/183916/original/file-20170830-5593-fowcya.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/183916/original/file-20170830-5593-fowcya.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/183916/original/file-20170830-5593-fowcya.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">People put many different products on their face, isolating a cause of irritation can be tricky.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<h2>Are there ingredients we should avoid?</h2>
<p>Fragrances and preservatives are the most common cause of contact allergy resulting from cosmetics. There are over 5,000 different fragrances used in skin care products, many of which are natural plant extracts and essential oils. </p>
<p>Other common allergens include preservatives, lanolin, coconut diethanolamide (a foaming agent) and sunscreen agents. Preservatives, such as parabens, formaldehyde and Quaternium-15 are required in all liquid products to stabilise them and prevent the growth of microbes. A common misconception is that natural and organic ingredients will not cause allergy or irritation, but in prone individuals these can in fact be quite problematic.</p>
<p>Unless you have a known allergy or sensitivity, there are no specific ingredients that everyone should avoid. But looking for hypoallergenic, fragrance-free and non-comedogenic products is wise. Those with an oily skin type or a history of acne should also limit oil-based cosmetics. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-eczema-and-what-can-you-do-about-it-45318">Explainer: what is eczema and what can you do about it?</a>
</strong>
</em>
</p>
<hr>
<p>Those with a sensitive or dry skin type, an underlying inflammatory skin condition or history of contact allergy should try to avoid irritants and potential allergens. Foaming agents, astringent products (such as toners that remove oils), scrubs and acids (such as alpha hydroxy acids used in acne and anti-ageing) tend to be irritating. Hypoallergenic formulations and those targeting sensitive skin are a good choice. </p>
<h2>What should I do if I think I might have a reaction?</h2>
<p>If you develop a new rash or skin irritation, the first thing to do is to try to confirm the diagnosis. If you suspect you are reacting to one of your cosmetics but not sure which, then ideally you need to stop using all your current products in the problem area. You should try to simplify your daily routine, choosing products that have been specifically formulated for sensitive and allergic skin. </p>
<p>If the problem settles, you can reintroduce your cosmetics one at a time to see whether you can identify the culprit. It’s a good idea to test each one in a small localised area on the neck or face for a week or two before using it all over the face. This process is known as a “repeat open application test”. </p>
<p>If you can’t get to the bottom of it or find cosmetics that don’t irritate your skin, you may need to seek professional help to rule out other skin conditions and formally test for allergies if warranted.</p><img src="https://counter.theconversation.com/content/82820/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Cara McDonald consults to La Roche Posay. </span></em></p>Many of us cover our faces with foundation and other beauty products every day. Here’s what we know about whether they are doing us damage.Cara McDonald, Consultant Dermatologist, St Vincent's Hospital MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/818932017-08-03T02:48:37Z2017-08-03T02:48:37ZWeekly Dose: methylprednisolone, a drug for treating inflammation but not rare kidney disease<figure><img src="https://images.theconversation.com/files/180649/original/file-20170802-11374-1dpcm62.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Methylprednisolone, the corticosteroid that's used to treat serious asthma attacks, works by reducing inflammation.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/518348707?size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>Methylprednisolone is a prescription drug used to treat conditions involving inflammation, like asthma, arthritis, gout, tendinitis, transplant rejection, allergic reactions, and the skin conditions eczema and psoriasis.</p>
<p>It’s in the news because doctors have been trialling the drug to see if it helped treat a rare kidney condition called IgA nephropathy, also known as <a href="http://kidney.org.au/cms_uploads/docs/rrc-iga-nephropathy.pdf">Berger’s disease</a>.</p>
<p>A study <a href="http://dx.doi.org/10.1001/jama.2017.9362">published this week</a> reported an international trial of oral methylprednisolone involving 262 patients (including Australians) was stopped early due to safety concerns. Although the drug resulted in an almost three fold lower risk of kidney failure, there was an almost five fold higher risk of serious infection. The researchers reported two patients had died from these trial-related infections.</p>
<p><a href="http://www.nejm.org/doi/full/10.1056/NEJMoa1415463#t=article">Other clinical trials</a> have also reported higher rates of adverse effects, like serious infections, from oral use of methylprednisolone when treating IgA nephropathy.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/kidneys-are-amazing-for-all-they-do-be-sure-to-look-after-yours-30966">Kidneys are amazing for all they do, be sure to look after yours</a>
</strong>
</em>
</p>
<hr>
<p>However, for people prescribed the drug for other reasons side effects are rare. And methylprednisolone should not to be confused with similarly sounding medicines in the same drug family, like prednisolone or prednisone.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/180658/original/file-20170802-7559-8dnmh2.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/180658/original/file-20170802-7559-8dnmh2.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=812&fit=crop&dpr=1 600w, https://images.theconversation.com/files/180658/original/file-20170802-7559-8dnmh2.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=812&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/180658/original/file-20170802-7559-8dnmh2.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=812&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/180658/original/file-20170802-7559-8dnmh2.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1021&fit=crop&dpr=1 754w, https://images.theconversation.com/files/180658/original/file-20170802-7559-8dnmh2.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1021&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/180658/original/file-20170802-7559-8dnmh2.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1021&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<h2>Use and formulations</h2>
<p>Methylprednisolone is a type of <a href="http://www.medicinenet.com/corticosteroids-oral/article.htm">corticosteroid</a>, the same drug family containing hydrocortisone, dexamethasone, prednisone, prednisolone and triamcinolone.</p>
<p>Corticosteroids are not the same as <a href="https://www.drugabuse.gov/publications/drugfacts/anabolic-steroids">anabolic steroids</a>, which some athletes and body builders use illegally to build muscle and help performance.</p>
<p>Corticosteroids suppress inflammation and the immune system by <a href="https://www.yourgenome.org/facts/what-is-gene-expression">regulating how genes are expressed</a>.</p>
<p>In Australia, methylprednisolone is indicated for acute severe asthma, arthritis (including both rheumatoid and osteoarthritis), <a href="http://www.move.org.au/Conditions-and-Symptoms/Gout?gclid=CjwKCAjwzYDMBRA1EiwAwCv6JrreALKZbjLvlHyyzXDXWtCMQOCcowEcp8TXDGQdja2F9fdUaZrfMBoCAxMQAvD_BwE">gout</a> (an arthritis-like condition due to the build up of uric acid in the bloodstream), <a href="http://www.webmd.com/fitness-exercise/arthritis-tendinitis#1">tendinitis</a>, acute transplant rejection, and some autoimmune diseases, like allergies, <a href="https://www.allergy.org.au/patients/skin-allergy/eczema">eczema</a> and <a href="http://www.psoriasisxplained.com.au/psoriasis-app-page/?utm_source=Adwords&utm_medium=Advert&utm_campaign=launch&gclid=CjwKCAjwzYDMBRA1EiwAwCv6JjRBx5XwiFqZA1GsBO0BCy0UJxbKAu9WRRk1c54r0Dl0u6lQgUAp0hoCTS0QAvD_BwE">psoriasis</a>.</p>
<p>Methylprednisolone is also on the <a href="http://www.who.int/topics/essential_medicines/en/">World Health Organisation’s list of essential medicines</a> that:</p>
<blockquote>
<p>… satisfy the priority health care needs of the population. They are selected with due regard to public health relevance, evidence on efficacy and safety, and comparative cost-effectiveness.</p>
</blockquote>
<p>The most <a href="http://www.who.int/medicines/publications/essentialmedicines/20th_EML2017.pdf?ua=1">up-to-date list</a> published in March 2017 includes methylprednisolone for the treatment of acute lymphoblastic leukaemia. The list also includes the related drug, <a href="https://beta.nhs.uk/medicines/prednisolone/">prednisolone</a>, to treat different types of leukaemia and lymphoma.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-can-go-wrong-in-the-blood-a-brief-overview-of-bleeding-clotting-and-cancer-76400">What can go wrong in the blood? A brief overview of bleeding, clotting and cancer</a>
</strong>
</em>
</p>
<hr>
<p>While methylpredisolone is available in other countries in tablet form, in Australia it is only available by prescription as an injection or as skin cream or ointment. As an <a href="http://www.pharmexec.com/what-happens-when-product-loses-its-patent">off-patent</a> medicine, it is available from a variety of companies in different brands. </p>
<h2>Safety and side effects</h2>
<p>The <a href="https://amhonline.amh.net.au/">Australian Medicines Handbook</a> (subscription required) says side effects should be rare (have a rate less than 0.1%), the most common of which is liver toxicity. It is safe for women to use immediately after breastfeeding, but they should avoid using it within four hours before breastfeeding. This is because very small amounts of the drug can be transferred into the milk.</p>
<p><a href="https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2014-CMI-02603-1">Other side-effects</a> depend on the dose and the formulation used. When used on the skin, side effects can include: thinning of the skin, appearance of fine blood vessels, acne, infection of hair follicles, excessive or unwanted hair growth, redness around the mouth, skin discolouration and allergic skin reactions.</p>
<h2>In a nutshell</h2>
<p>Methylprednisolone is an effective and safe medicine for treating inflammatory and autoimmune conditions. Recent studies into its use for IgA nephropathy have indicated an unacceptably high risk of serious infection. </p>
<p>Despite this, you should not be at risk if you use the medication as directed and prescribed by your doctor. However, if you have any concerns, you should speak to your local pharmacist.</p><img src="https://counter.theconversation.com/content/81893/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Wheate in the past has received funding from the ACT Cancer Council, Tenovus Scotland, Medical Research Scotland, Scottish Crucible, and the Scottish Universities Life Sciences Alliance. He is affiliated with the Royal Australian Chemical Institute.</span></em></p>A trial of methylprednisolone in kidney patients was halted recently because of safety concerns. But this doesn’t affect people taking the drug for asthma, arthritis or other inflammatory conditions.Nial Wheate, BPharm Coordinator and Senior Lecturer, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/685832016-12-25T20:41:33Z2016-12-25T20:41:33ZHealth Check: why swimming in the sea is good for you<figure><img src="https://images.theconversation.com/files/148990/original/image-20161207-25753-83md7g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Bathing in the Dead Sea has long been used to treat psoriasis.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/60584010@N00/23932671816/in/photolist-CsRcwG-RDwB-5smym4-8BNdv2-ksJ1KP-8BNbvP-8BR3h3-cGmfK-7ASfpK-7AW4cJ-5DMQqa-9m711y-qFUNWS-7DXhCj-9m6ZZE-4f5vJq-eYY2H-eYYdK-eYY8j-8BRiM1-3fHwvx-fMgBzw-eYYax-9m3Wez-hd1bJw-4f5ffj-8BRiCN-7ASfNp-8BR3qh-qUe8SN-eYYcv-eYYhr-CnS3KM-gEMVY-8BNcti-daHumF-8BNbPe-7ASfVV-8BRiTJ-ftZjN6-4hqeHz-8BNcZR-34vFX-9m3Wfi-bZ3Hp-eYXX2-fTdDAF-8BMVV8-8BRjh9-3ZWkwx">leiris202/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>If you live near the sea, make frequent trips to the beach, or are planning an island holiday this summer, chances are you’re getting more out of it than just enjoyment. It has long been thought sea frolicking has many health benefits.</p>
<p>Historically, doctors would <a href="https://www.washingtonpost.com/news/wonk/wp/2016/07/03/the-weird-origins-of-going-to-the-beach/?utm_term=.c57b0fb7c182">recommend their patients go to the seaside</a> to improve various ills. They would actually issue prescriptions detailing exactly how long, how often and under what conditions their patients were to be in the water. </p>
<p>Using <a href="https://en.wikipedia.org/wiki/Thalassotherapy">seawater</a> for medical purposes even has a name: thalassotherapy. </p>
<p>In 1769, a popular British doctor <a href="https://en.wikipedia.org/wiki/Richard_Russell_(doctor)">Richard Russell</a> published a dissertation arguing for using seawater in “diseases of the glands”, in which he included scurvy, jaundice, leprosy and glandular consumption, which was the name for glandular fever at the time. He <a href="http://www.theatlantic.com/health/archive/2013/08/the-historic-healing-power-of-the-beach/279175/">advocated drinking seawater</a> as well as swimming in it.</p>
<p>To this day, <a href="http://www.nextavenue.org/top-9-places-healing-waters/">healing and spa resorts</a> by the seaside abound. They are thought of as places where people can not only let go of their troubles but, in some cases, <a href="https://www.spadreams.com/dead-sea-hotels/">even cure arthritis</a>.</p>
<p>But does the evidence actually stack up? Does seawater cure skin conditions and improve mental health symptoms? </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/149146/original/image-20161207-18036-5bwgdx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/149146/original/image-20161207-18036-5bwgdx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/149146/original/image-20161207-18036-5bwgdx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/149146/original/image-20161207-18036-5bwgdx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/149146/original/image-20161207-18036-5bwgdx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/149146/original/image-20161207-18036-5bwgdx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/149146/original/image-20161207-18036-5bwgdx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/149146/original/image-20161207-18036-5bwgdx.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">Doctors used to prescribe patients go to the seaside to improve health.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/search/sea-side?photo=WbBTlOk-CRY">Johnny Chau/Unsplash</a></span>
</figcaption>
</figure>
<h2>Skin conditions and wounds</h2>
<p>Ocean water differs from river water in that it has <a href="https://web.stanford.edu/group/Urchin/mineral.html">significantly higher amounts</a> of minerals, including sodium, chloride, sulphate, magnesium and calcium. This is why it’s highly useful for skin conditions such as psoriasis.</p>
<p>Psoriasis is a chronic, autoimmune (where the immune system attacks healthy cells) skin condition. People with prosiasis suffer often debilitating skin rashes made of itchy, scaly plaques.</p>
<p>Bathing in natural mineral-rich water, including in mineral springs, is called balneotherapy and has long been used to treat psoriasis. There is also evidence for climatotherapy (where a patient is relocated to a specific location for treatment) in the Dead Sea being an <a href="http://www.jaad.org/article/S0190-9622(03)00916-2/abstract">effective remedy</a> for the condition.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/149013/original/image-20161207-15197-nakoss.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/149013/original/image-20161207-15197-nakoss.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/149013/original/image-20161207-15197-nakoss.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=797&fit=crop&dpr=1 600w, https://images.theconversation.com/files/149013/original/image-20161207-15197-nakoss.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=797&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/149013/original/image-20161207-15197-nakoss.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=797&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/149013/original/image-20161207-15197-nakoss.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1001&fit=crop&dpr=1 754w, https://images.theconversation.com/files/149013/original/image-20161207-15197-nakoss.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1001&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/149013/original/image-20161207-15197-nakoss.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1001&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">People with prosiasis suffer often debilitating rashes made up of itchy, scaly plaques on their skin.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
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</figure>
<p>Patients suffering from psoriasis have themselves reported feeling better <a href="https://blog.23andme.com/23andme-research/what-patients-say-works-for-psoriasis/">after swimming in the ocean</a>, but this may also have to do with sun exposure, which has been found to <a href="http://www.tandfonline.com/doi/abs/10.3109/09546639609089534">improve psoriasis</a> symptoms.</p>
<p>Ocean swimming also has benefits for eczema, another immune-mediated condition. Swimming in the sea can be a good exercise option for those with severe eczema as they often struggle to exercise in the heat and chlorinated pools.</p>
<p>But the <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1468-3083.2012.04636.x/full">response of eczema sufferers</a> to saltwater is variable: some find it soothing, others uncomfortable.</p>
<p>There is some evidence to support the idea <a href="http://www.mgwater.com/transdermal.shtml">magnesium absorption</a> is <a href="http://www.progressivehealth.com/learn-how-to-treat-eczema-with-epsom-salt.htm">beneficial for the skin</a> of eczema sufferers – presumably because it makes it less dry – as those using Epsom salt baths will attest. This may happen because <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1365-4632.2005.02079.x/full">magnesium-rich seawater</a> may improve moisture retention in the skin, making it stronger and more rigid. </p>
<p>Because it is rich in other mineral salts such as sodium and iodine, ocean water can be <a href="http://www.abc.net.au/health/talkinghealth/factbuster/stories/2010/03/18/2849271.htm">considered an antiseptic</a>, meaning it may have wound-healing properties. On the other hand, swimming in the ocean with open wounds may expose you to potential bacterial infections.</p>
<h2>Hay fever and sinus issues</h2>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/149021/original/image-20161207-25727-fky0w6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/149021/original/image-20161207-25727-fky0w6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/149021/original/image-20161207-25727-fky0w6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/149021/original/image-20161207-25727-fky0w6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/149021/original/image-20161207-25727-fky0w6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/149021/original/image-20161207-25727-fky0w6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1130&fit=crop&dpr=1 754w, https://images.theconversation.com/files/149021/original/image-20161207-25727-fky0w6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1130&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/149021/original/image-20161207-25727-fky0w6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1130&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">Many people with sinus conditions and hay fever find nasal irrigation with salt-containing solutions helpful.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
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</figure>
<p>Nasal irrigation, or flushing of the nasal cavity, with salty solutions is used as a complementary therapy by <a href="https://www.ncbi.nlm.nih.gov/pubmed/14712112?dopt=Abstract">many people suffering from hay fever</a> as well as inflammation and infection of the sinuses.</p>
<p>Ocean swimming and exposure to the salt environment are possibly associated with reduced symptoms of hay fever and sinusitis, as well as other respiratory symptoms. </p>
<p>This is because the <a href="http://www.aafp.org/afp/2009/1115/p1117.html">saline effect on the lining of sinuses</a> may reduce inflammation, although scientific evidence for this is less robust.</p>
<p>The director of clinical services at the medical charity Allergy UK claims people who live by, and swim in, the sea tend to have <a href="http://www.dailymail.co.uk/health/article-2385191/Sea-swimming-add-years-life.html">healthier respiratory systems</a>. </p>
<p>She says because seawater is cleansing and mimics the body’s own fluids in the lining of the airways, it doesn’t irritate them.</p>
<h2>Meditation and relaxation</h2>
<p>Exercising in natural environments has been shown to have <a href="http://www.sciencedirect.com/science/article/pii/S0277953612003565">greater benefits for mental health</a> than exercising elsewhere. This is because it combines the benefits of exercise with the restorative effects of being in nature. Swimming in the ocean is no less the case.</p>
<p>It can be relaxing, meditative and reduce stress. In his 2014 book <a href="https://www.washingtonpost.com/national/health-science/blue-mind-explores-the-calming-effect-that-water-has-on-people/2014/07/28/471d7a5a-11bb-11e4-9285-4243a40ddc97_story.html?utm_term=.1309b168eeb9">Blue Mind</a>, marine biologist Wallace J. Nichols brought together evidence for why people find themselves in a meditative and relaxed state when they are in, on or under water. </p>
<p>One reason is the <a href="http://www.sciencedirect.com/science/article/pii/S0149763405802106">breathing patterns used during swimming</a> and diving. These stimulate the parasympathetic nervous system (the system that controls organ function and quietens the brain) and have effects on brain waves and hormones that influence the brain positively. </p>
<p>The weightlessness of water can also have a <a href="http://bmhmag.com/what-swimming-can-do-for-mental-health/">calming effect on the mind</a>, <a href="http://www.sciencedirect.com/science/article/pii/S105381190800757X">even changing</a> or slowing down brain waves. </p>
<p>It can help provide a distraction from life, giving a sense of mindfulness, which is a state in which one is aware of one’s surroundings in a meditative sort of fashion.</p>
<p>Hydrotherapy (water therapy) and swimming have also been <a href="http://psychcentral.com/blog/archives/2010/08/04/how-swimming-reduces-depression/">shown to decrease symptoms</a> of <a href="https://www.psychologytoday.com/blog/inner-source/201407/cold-splash-hydrotherapy-depression-and-anxiety">depression and anxiety</a>. <a href="https://www.ncbi.nlm.nih.gov/pubmed/20178872">One study showed</a> the effects of balneotherapy were comparable to a commonly used anti-depressant drug called paroxetine.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/149022/original/image-20161207-13648-bdnm79.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/149022/original/image-20161207-13648-bdnm79.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/149022/original/image-20161207-13648-bdnm79.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/149022/original/image-20161207-13648-bdnm79.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/149022/original/image-20161207-13648-bdnm79.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/149022/original/image-20161207-13648-bdnm79.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/149022/original/image-20161207-13648-bdnm79.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/149022/original/image-20161207-13648-bdnm79.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">Being in the sea can be a meditative experience.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/search/swimming?photo=g0n0FLM3UTg">Jonny Clow/Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<h2>Cold water therapy</h2>
<p>Hydrotherapy has been <a href="http://www.sciencedirect.com/science/article/pii/S1934148209005516">extensively used in rehabilitation</a>, but here I will focus on the health benefits of swimming in cooler ocean water. </p>
<p>Cold-water swimming <a href="http://journals.co-action.net/index.php/ijch/article/viewFile/17700/20171">activates temperature receptors</a> under the skin that release hormones such as endorphins, adrenalin and cortisol. These have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4049052/">therapeutic benefits</a> for musculoskeletal conditions – <a href="https://theconversation.com/hidden-and-unexplained-feeling-the-pain-of-fibromyalgia-48319">such as fibromyalgia</a>, which is a condition with chronic pain and tenderness all over the body – and skin discomfort. </p>
<p>Recurrent cold water exposure may also lead to enhanced function of the parasympathetic nervous system, which helps with organ function. This has been linked to an increase in the <a href="https://www.ncbi.nlm.nih.gov/pubmed/12546194">release of dopamine</a> and serotonin.</p>
<p>Depending on the temperature, swimming in colder waters will <a href="https://www.ncbi.nlm.nih.gov/pubmed/7068314">use up more calories</a> to preserve body temperature – although the overall effect on fat mass is controversial.</p>
<p>Frequent <a href="http://link.springer.com/article/10.1007/BF00242274">exposure to cold water</a> has also been shown to <a href="http://www.circumpolarhealthjournal.net/index.php/ijch/article/download/17474/19822">increase the body’s immunity</a>.</p>
<p>Overall, you would be wise to make ocean swimming a health habit.</p><img src="https://counter.theconversation.com/content/68583/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sergio Diez Alvarez 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>Seawater has been used to treat skin problems, sinuses and mental health issues for centuries. And the evidence largely stacks up.Sergio Diez Alvarez, Director Of Medicine, The Maitland and Kurri Kurri Hospital, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/249552014-12-16T04:07:49Z2014-12-16T04:07:49ZExplainer: what is psoriasis?<figure><img src="https://images.theconversation.com/files/67308/original/image-20141216-24285-1ve0ese.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Psoriasis produces angry red scaly plaques on the elbows, knees and elsewhere.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/mysiann/489536302">Mysi Ann/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Psoriasis is an inflammatory disease of the skin that <a href="http://www.nature.com/jid/journal/v133/n2/full/jid2012339a.html">affects around 2%</a> of the Australian population. That’s enough people to fill the Melbourne Cricket Ground each of the five days of Boxing day test match. </p>
<p>Psoriasis produces angry red scaly plaques on the elbows, knees and elsewhere; severe dandruff on the scalp; nail discoloration and soreness; and inflammatory arthritis of the joints. </p>
<p>The <a href="http://www.ncbi.nlm.nih.gov/pubmed/3519699">biblical description of “lepra”</a> is now thought to actually be psoriasis rather than leprosy. At that time, affected individuals were stigmatised and cast out from their communities. Some would argue this remains unchanged today as many <a href="http://www.jaad.org/article/S0190-9622(89)70007-4/abstract">affected people feel like lepers</a>. </p>
<h2>Causes and symptoms</h2>
<p><a href="http://genepi.qimr.edu.au/staff/davidD/psor.html">Psoriasis is hereditary</a>; over 30% of affected people can identify a first-degree relative with psoriasis. Research has also identified <a href="http://www.nature.com/ejhg/journal/vaop/ncurrent/full/ejhg2014172a.html">a number of susceptibility genes</a>, which, when mutated, increase the risk of psoriasis. </p>
<p>Known triggers <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921739/">include certain drugs</a> such as lithium, and antimalarial and antihypertensive medication, but there is no recognised dietary trigger. The mechanism by which these agents trigger psoriasis is not yet understood.</p>
<p>Skin trauma and surgery can cause psoriasis to seed into the wound; when someone with psoriasis has their appendix removed, for instance, and a new patch of psoriasis appears in their appendix scar, this is known as the Koebner phenomenon. </p>
<p>Stress has <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1365-4362.1991.tb05870.x/abstract">long been thought to aggravate</a> psoriasis. And itchiness is variable, with some people driven to distraction while others live in harmony with their condition. </p>
<p>Psoriasis causes the skin to renew too rapidly, with insufficient time for the individual cells to fully mature. Normally, it takes six weeks for cells that divide at the base of the epidermis – the uppermost layer of the skin – to differentiate, die, and shed off the skin surface. In psoriasis, this process occurs ten times faster and only takes four to five days. </p>
<p>This rapid cell proliferation causes the skin to thicken. It also requires increased blood flow and nutrients to support this rapid cell proliferation. Increased nutritional requirements stimulate new growth of blood vessels into the skin (angiogenesis), which makes the skin red. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/67309/original/image-20141216-24288-1uxdtqm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/67309/original/image-20141216-24288-1uxdtqm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/67309/original/image-20141216-24288-1uxdtqm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/67309/original/image-20141216-24288-1uxdtqm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/67309/original/image-20141216-24288-1uxdtqm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=565&fit=crop&dpr=1 754w, https://images.theconversation.com/files/67309/original/image-20141216-24288-1uxdtqm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=565&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/67309/original/image-20141216-24288-1uxdtqm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=565&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">In psoriasis, new cells are stuck together so they appear scaly and flaky.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/mediawench/432835214">Maggie Osterberg/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span>
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</figure>
<p>The new cells pushed to the surface are not fully mature and rather than shedding one by one, as mature skin cells do, they are still stuck together, producing skin scaliness and flaking.</p>
<h2>Treatment options</h2>
<p>Traditional treatments apart from tar and dithranol ointments include steroid creams, calcipitriol cream or ointment (a synthetic derivative of vitamin D), sunlight, artificial ultraviolet B treatment, and tablets such as acitretin (an oral retinoid), cyclosporine (a drug to prevent organ transplant rejection), and methotrexate (a chemotherapy agent). </p>
<p>Each of these treatments work well for some people but not all. And cumulative side effects often limit their continued use even among responders.</p>
<p>Recent years have seen a quiet revolution in the treatment of psoriasis. Gone are the messy and smelly tar and dithranol ointments. Molecular biology research has delivered a host of new therapies called biologics. </p>
<p>Biologics are a class of treatments where monoclonal antibodies are manufactured synthetically to target a specific molecule in the chain reaction that produces the skin inflammation seen in psoriasis. </p>
<p>Depending on the biologic agent used, a single injection into the skin repeated either fortnightly, monthly or quarterly can produce complete clearance of even the worst psoriasis within weeks. It can also keep the skin disease at bay.</p>
<p>The first biologic therapies for psoriasis targeted the tumour necrosis factor alpha molecule, a master cytokine. Cytokines are cell signalling molecules involved in the regulation of inflammation. These biologics are also used to treat rheumatoid arthritis, Crohn’s gastrointestinal disease, and other inflammatory diseases of the body. </p>
<p>The next generation of agents targeted interlukin 12 and 23. Interlukins are a class of cytokines initially found in white blood cells, but now known to be produced by and act on a broad range of cells in the body. Newer agents are directed at the interleukin 17 molecule.</p>
<p>The cost of these agents is in the range of A$5,000 to A$30,000 per year. The government subsidises the cost of these medications through the Pharmaceutical Benefits Scheme for only the most severely affected. This creates a unusual paradox for dermatologists: treating mild disease is now more complex than treating severe disease.</p><img src="https://counter.theconversation.com/content/24955/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rodney Sinclair has been principal investigator in sponsored clinical trials for biologic therapies for psoriasis and has received funding from Merck, Novartis, CelGene and Amgen</span></em></p>Psoriasis is an inflammatory disease of the skin that affects around 2% of the Australian population. That’s enough people to fill the Melbourne Cricket Ground each of the five days of Boxing day test…Rodney Sinclair, Professor of Dermatology, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.