tag:theconversation.com,2011:/us/topics/skin-care-33432/articlesSkin care – The Conversation2024-01-08T12:09:28Ztag:theconversation.com,2011:article/2196402024-01-08T12:09:28Z2024-01-08T12:09:28ZSunscreen: why wearing it even in winter could be a good idea<figure><img src="https://images.theconversation.com/files/567833/original/file-20240104-27-a4kzki.jpg?ixlib=rb-1.1.0&rect=11%2C0%2C3854%2C2590&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The Sun's radiation can still damage our skin even in winter.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-using-sunscreen-257081962">Stanislav Nikolov/ Shutterstock</a></span></figcaption></figure><p>Sunscreen has taken centre stage in many skincare routines, especially among those hoping to prevent visible signs of ageing. But while it makes sense to wear sunscreen every day in the summer when the sun’s rays are most powerful, many may wonder whether there’s any benefit of wearing sunscreen daily in the winter months.</p>
<p>The sun’s radiation can reach us during all times of the year. This means that in both summer and winter, we are exposed to infrared radiation, as well as UVA and UVB rays.</p>
<p>UVB is mainly responsible for sunburn and DNA damage – and can also <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3709783/">cause skin cancers</a> as a result of long-term exposure. UVA radiation does contribute to these processes somewhat, but it’s less effective at doing so. UVA can penetrate deeper into the skin, however, which can damage the collagen – a key part of the skin that keeps it firm and elastic. This can cause the <a href="https://pubmed.ncbi.nlm.nih.gov/25234829/">skin to age faster</a>, leading to wrinkles, fine lines and changes in pigmentation.</p>
<p>The amount of UVA and UVB radiation that reaches the Earth’s surface changes across the seasons. This is due to the angle of the Sun in the sky, as well as other factors such as latitude and time of day.</p>
<p>For example, let’s compare how <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/php.12422">UVA and UVB radiation varies</a> at solar noon in London, UK and Kuala Lampur, Malaysia (which is near the equator).</p>
<p>In latitudes closer to the equator (such as in Kuala Lampur), the amount of UVA and UVB radiation throughout the year remains fairly consistent. But in higher latitudes, such as London, there’s almost no UVB radiation throughout the winter months – whereas there’s still some UVA radiation.</p>
<p>Not only that, but people living further from the equator may tend to spend less time exposed to the Sun in winter due to the colder temperatures and variable weather. And when they do go outside, they may cover their skin up – usually leaving only their face exposed to the Sun for much shorter periods of time.</p>
<p>But UVA radiation can still penetrate through clouds and windows. While our exposure to these rays is probably minimal, skin damage from UV exposure is <a href="https://www.sciencedirect.com/science/article/pii/S0079610706000162">accumulated over decades</a>, so anything that can be done to reduce exposure (and damage) over time may be beneficial. This is also true of UVB exposure – although it is less relevant in winter months at higher latitudes.</p>
<p>This may be where daily sunscreen use during the winter is still of benefit. Sunscreens are formulated to reduce exposure to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978633/">both UVB and UVA rays</a> – although they are usually more effective at reducing exposure to UVB radiation. They have been designed in this way to prevent the most damaging effects of the Sun, such as sunburn and DNA damage. The impact of exposure to UVA radiation has only been considered more recently.</p>
<p>Numerous studies have shown regular sunscreen use over many years is effective at <a href="https://onlinelibrary.wiley.com/doi/10.1111/phpp.12109">preventing skin damage</a>, photoaging and skin cancers. The most robust trials suggest daily sunscreen use is most effective, but this will be dependent on the factors discussed above.</p>
<h2>The effects of altitude and snow</h2>
<p>One place where winter sunscreen use is especially important is when skiing or snowboarding – or when you’re otherwise going to be outside for extended periods of time, at higher altitudes on snow-covered mountains.</p>
<p>Both altitude and snow can increase the doses of <a href="https://www.who.int/news-room/questions-and-answers/item/radiation-ultraviolet-(uv)">UVA and UVB radiation</a> a person receives. Snow can reflect up to 80% of UV radiation emitted by the Sun – effectively almost doubling the doses received. Also, for every 1,000-foot increase in altitude, there’s a 10% increase in UV exposure. This is why it’s essential to protect the skin and eyes by wearing sunscreen, protective clothing and sunglasses that block both types of UV ray. This is also true when spending time in snowy environments, such as when hiking or skating.</p>
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<img alt="A man and a woman snowshoe through a snowy field on a sunny day." src="https://images.theconversation.com/files/567835/original/file-20240104-19-ml8ihz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/567835/original/file-20240104-19-ml8ihz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/567835/original/file-20240104-19-ml8ihz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/567835/original/file-20240104-19-ml8ihz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/567835/original/file-20240104-19-ml8ihz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/567835/original/file-20240104-19-ml8ihz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/567835/original/file-20240104-19-ml8ihz.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">
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<span class="caption">Snow reflects UV radiation.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/snowshoe-walkers-running-powder-snow-beautiful-1279921384">Lukas Gojda/ Shutterstock</a></span>
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<p>Sunscreens are generally regarded as safe and tend to have few adverse effects, so you don’t need to worry too much about wearing one throughout the year. However, there are some points to consider, especially if you have skin conditions. For example, sunscreen can <a href="https://www.byrdie.com/does-sunscreen-cause-acne-or-help-it-7546147">exacerbate acne</a> and cause <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7759112/">irritation and allergic reactions</a> – although these are rare.</p>
<p>There are also emerging concerns from regulatory agencies about the <a href="https://jamanetwork.com/journals/jama/fullarticle/2759002">absorption of UV filters into the body</a>. However, the consequences of such absorption and the potential affects on health are not well defined and require more research.</p>
<p>Still, the benefits of sunscreen have been widely demonstrated – as has their safety. So if you want to prevent premature signs of ageing, it’s important to use sunscreen at all times you may be exposed to the Sun – especially in the summer months. While the benefits of wearing sunscreen in winter are less well defined, there’s probably no harm in wearing one if you want to.</p>
<p>If you decide to use sunscreen in winter, use ones that have broad spectrum five-star UVA protection. For day-to-day use, high SPF sunscreens are unlikely to provide a large benefit, particularly if spending only short periods outside. However, if skiing, a <a href="https://www.jaad.org/article/S0190-9622(17)31086-1/fulltext">high-SPF sunscreen</a> with five-star UVA protection would be beneficial.</p><img src="https://counter.theconversation.com/content/219640/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Karl Lawrence has previously received funding from the sunscreen industry and hold patents related to sunscreen ingredients.</span></em></p>Regular sunscreen use over many years is shown to be effective at preventing skin damage, photoaging and skin cancers.Karl Lawrence, Research fellow, King's College LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2160782023-12-27T20:26:50Z2023-12-27T20:26:50ZThinking of a(nother) tattoo this summer? What you need to know about sunburn, sweating and fading<p>More of us have tattoos than ever before. About <a href="https://mccrindle.com.au/article/tattoos-on-the-rise-among-aussies/">25% of Australians</a> are inked. </p>
<p>A tattoo can be a large investment in time, money and pain.</p>
<p>So how do you take care of your tattooed skin? Here’s what you need to know about sunburn, sweating and fading.</p>
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<strong>
Read more:
<a href="https://theconversation.com/tattoos-have-a-long-history-going-back-to-the-ancient-world-and-also-to-colonialism-165584">Tattoos have a long history going back to the ancient world – and also to colonialism</a>
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<h2>What’s a tattoo, dermatologically speaking?</h2>
<p>Tattoo inks are deposited in the <a href="https://dermnetnz.org/topics/the-structure-of-normal-skin">layer of skin</a> called the dermis. This layer contains sweat and oil glands, a blood supply, immune cells, collagen to support the skin’s structures, and fibroblasts, which produce collagen.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/563548/original/file-20231205-29-8elmtu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Cross-section of human skin showing epidermis and dermis" src="https://images.theconversation.com/files/563548/original/file-20231205-29-8elmtu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/563548/original/file-20231205-29-8elmtu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=300&fit=crop&dpr=1 600w, https://images.theconversation.com/files/563548/original/file-20231205-29-8elmtu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=300&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/563548/original/file-20231205-29-8elmtu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=300&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/563548/original/file-20231205-29-8elmtu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=377&fit=crop&dpr=1 754w, https://images.theconversation.com/files/563548/original/file-20231205-29-8elmtu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=377&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/563548/original/file-20231205-29-8elmtu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=377&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Tattoo inks are inserted into the dermis.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/normal-skin-layers-crosssection-human-structure-2339540305">zonn hong/Shutterstock</a></span>
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<p>Fibroblasts <a href="https://www.sciencedirect.com/science/article/pii/S1470204511703400?via%3Dihub#bib74">take up</a> the ink particles, as do immune cells in the dermal tissue known as <a href="https://onlinelibrary.wiley.com/doi/10.1111/cup.12023">macrophages</a>. The ink particles also stick inside bundles of collagen.</p>
<p>Between these three mechanisms, the dermis holds tattoo inks so well they can be seen even on the 5,300-year-old <a href="https://www.sciencedirect.com/science/article/pii/S1296207415000023#bib0200">ice mummy Ötzi</a>. </p>
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<p>
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Read more:
<a href="https://theconversation.com/what-otzi-the-prehistoric-iceman-can-teach-us-about-the-use-of-tattoos-in-ceremonial-healing-or-religious-rites-168058">What Ötzi the prehistoric iceman can teach us about the use of tattoos in ceremonial healing or religious rites</a>
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<h2>Can I get a tattoo if I’m sunburnt?</h2>
<p>No, and many tattoo artists will not do it. During sunburn, your skin calls in extra immune cells and fluid to kill off and break down cells that have too much UV damage. </p>
<p>This <a href="https://link.springer.com/article/10.1007/s40257-017-0326-5">inflammation</a> can affect the tattoo ink deposits. You might not get the look you were after, with too much ink removed by your immune cells or swelling distorting the lines.</p>
<p>It’s much better to be proactive about sun protection before a tattoo, or at least be patient and reschedule when your skin has healed.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/i-cant-get-sunburnt-through-glass-shade-or-in-water-right-5-common-sunburn-myths-busted-150640">I can't get sunburnt through glass, shade or in water, right? 5 common sunburn myths busted</a>
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</em>
</p>
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<h2>How soon after my new tattoo can I go into the sun?</h2>
<p>There’s not much research on how soon you can expose your new tattoo to the sun. However, <a href="https://karger.com/drm/article/doi/10.1159/000533489/861717/An-Analysis-of-the-Content-and-Recommendations-of">most tattooists</a> advise you to avoid sun exposure while the tattoo heals, generally about three weeks.</p>
<p>This seems sensible, as your fresh tattoo is a type of wound.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/563560/original/file-20231205-25-bjthp5.jpg?ixlib=rb-1.1.0&rect=0%2C11%2C1920%2C1267&q=45&auto=format&w=1000&fit=clip"><img alt="Woman with sleeve tattoo heading to ocean, yoga mat under arm" src="https://images.theconversation.com/files/563560/original/file-20231205-25-bjthp5.jpg?ixlib=rb-1.1.0&rect=0%2C11%2C1920%2C1267&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/563560/original/file-20231205-25-bjthp5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/563560/original/file-20231205-25-bjthp5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/563560/original/file-20231205-25-bjthp5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/563560/original/file-20231205-25-bjthp5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/563560/original/file-20231205-25-bjthp5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/563560/original/file-20231205-25-bjthp5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Wait about three weeks before heading out into the sun with your new tattoo.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/crop-tattooed-woman-with-yoga-mat-against-river-4793296/">Anete Lusina/Pexels</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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<p>Because the skin is damaged by inserting a needle, it’s not too surprising that the most common short-term complication is local inflammation with swelling, redness and discomfort at the tattoo site. There is an influx of immune cells to deal with the damage, much like a sunburn.</p>
<p>So, in one way, you should treat your new tattoo like sunburn and <a href="https://www.aad.org/public/everyday-care/injured-skin/burns/treat-sunburn">avoid sun exposure</a> while it heals. </p>
<p>But you shouldn’t use <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7442309/">sunscreen</a> on the tattoo in that time. That’s because sunscreen can <a href="https://www.futuremedicine.com/doi/10.2217/nnm.12.196?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed">enter the dermis</a> through the puncture wounds and cause more irritation. Cover your new tattoo with loose clothing instead.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/do-beach-cabanas-actually-protect-you-from-the-sun-199102">Do beach cabanas actually protect you from the sun?</a>
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</em>
</p>
<hr>
<h2>What happens if my tattoo gets sunburnt?</h2>
<p><a href="https://onlinelibrary.wiley.com/doi/10.1111/jdv.12093">Sunlight-induced reactions</a> to both new and existing tattoos are common. There’s usually swelling, itching or stinging on the tattoo site that can start immediately or develop over the course of a day. We’re not really sure why this happens.</p>
<p>Most of the time, these reactions are unpleasant but don’t require medical treatment, much like sunburn. </p>
<p>There is also a small amount of evidence that sunburn on a tattoo temporarily suppresses the skin’s immune system, allowing an <a href="https://onlinelibrary.wiley.com/doi/10.1111/j.1468-3083.2004.01121.x">infection</a> to become established.</p>
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<p>
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<strong>
Read more:
<a href="https://theconversation.com/common-skin-rashes-and-what-to-do-about-them-91518">Common skin rashes and what to do about them</a>
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<h2>Do tattoos increase my risk of skin cancer?</h2>
<p>Some <a href="https://www.sciencedirect.com/science/article/pii/S1470204511703400?via%3Dihub#bib4">ink components</a>, such as mercury or carbon black, are suspected cancer-causing agents when used in other applications. However, there’s <a href="https://www.sciencedirect.com/science/article/pii/S1470204511703400?via%3Dihub">no evidence</a> skin cancers are more likely in tattooed skin.</p>
<p>Tattoos make newly-developed skin cancers <a href="https://onlinelibrary.wiley.com/doi/10.1111/ajd.12219">more difficult to detect</a>. Besides making the lesion more difficult to spot in the first place, the colours of the tattoo interfere with your doctor’s assessment of the colours in the lesion, which can be an important sign of cancer.</p>
<p>So it’s a good idea to get familiar with the moles and freckles on a patch of skin before you’re inked, and check them yourself once a month for changes. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/563561/original/file-20231205-15-fbd5ki.jpg?ixlib=rb-1.1.0&rect=2%2C2%2C995%2C663&q=45&auto=format&w=1000&fit=clip"><img alt="Man with tattoos spraying sunscreen on arms" src="https://images.theconversation.com/files/563561/original/file-20231205-15-fbd5ki.jpg?ixlib=rb-1.1.0&rect=2%2C2%2C995%2C663&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/563561/original/file-20231205-15-fbd5ki.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/563561/original/file-20231205-15-fbd5ki.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/563561/original/file-20231205-15-fbd5ki.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/563561/original/file-20231205-15-fbd5ki.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/563561/original/file-20231205-15-fbd5ki.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/563561/original/file-20231205-15-fbd5ki.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Don’t use sunscreen on new tattoos but after about three weeks, go for it.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/tattooed-man-applying-sunscreen-cream-on-2338700035">Pixel-Shot/Shutterstock</a></span>
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<p>Red tattoos seem to be more prone to large but benign (non-cancerous) skin tumours called <a href="https://dermnetnz.org/topics/keratoacanthoma">keratoacanthomas</a>. These appear within a few months of tattooing, and often grow rapidly but then heal by themselves.</p>
<p>However, they can be difficult to distinguish from <a href="https://karger.com/drm/article/237/2/309/115107/Keratoacanthomas-and-Squamous-Cell-Carcinomas-on">squamous cell carcinomas</a> (a type of skin cancer). They can also damage underlying structures, such as nerves and muscles. So they often need to be removed anyway.</p>
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<p>
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<strong>
Read more:
<a href="https://theconversation.com/health-check-do-i-need-a-skin-cancer-check-48096">Health Check: do I need a skin cancer check?</a>
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</em>
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<hr>
<h2>Can sunlight fade my tattoo?</h2>
<p>As tattoos age, they can fade a bit as some of the loose ink particles filter deeper into the dermis. Sun exposure can also degrade ink particles.</p>
<p>There’s limited research on this in human skin. After all, most people don’t want to fade their tattoos for science. So most of what we know is from research <a href="https://onlinelibrary.wiley.com/doi/10.1111/j.1600-0625.2009.00925.x">in mice</a>.</p>
<p>However, modern tattoo inks give you a strong colour. So in practice, you might not notice any fading for years.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/friday-essay-power-perils-and-rites-of-passage-the-history-of-the-female-tattoo-72725">Friday essay: power, perils and rites of passage – the history of the female tattoo</a>
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<h2>Does tattooed skin sweat differently to un-inked skin?</h2>
<p>This is an important question, because sweating is a major way our body avoids overheating in the summer. If you’ve got a full sleeve or your whole back is your canvas, that’s a significant amount of skin.</p>
<p>Since tattooing punctures the skin repeatedly, <a href="https://journals.physiology.org/doi/full/10.1152/japplphysiol.00427.2019?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org">sweat glands</a> in the dermis may be damaged.</p>
<p>But the research on tattoos’ impact on sweating is mixed and depends on what you are doing at the time.</p>
<p>In <a href="https://journals.physiology.org/doi/full/10.1152/japplphysiol.00427.2019?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org">one study</a>, researchers used a heatable suit to increase study participants’ internal body temperature by 1°C. Tattooed areas produced about 15% less sweat. It’s not clear if this is enough to increase the risk of heat stress.</p>
<p>However, when other researchers looked at sweating <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9463223/">induced by exercise</a> there was no effect in the volume of sweat between tattooed and un-tattooed skin.</p>
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<strong>
Read more:
<a href="https://theconversation.com/how-tattoos-became-fashionable-in-victorian-england-122487">How tattoos became fashionable in Victorian England</a>
</strong>
</em>
</p>
<hr>
<h2>Longer-term risks</h2>
<p>When performed under the clean conditions of a licenced tattoo parlour, tattooing is relatively safe. </p>
<p>But long term, some people develop <a href="https://link.springer.com/article/10.1007/s40257-017-0326-5">allergic reactions</a> to certain colours due to the different compounds in each, most commonly red dyes. This can cause lumps, scales, scarring or other visible changes.</p>
<p>So, what’s the most common long-term side effect of tattoos? Tattoo regret and wanting to have them <a href="https://link.springer.com/article/10.1007/s12016-016-8532-0">removed</a>.</p><img src="https://counter.theconversation.com/content/216078/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katie Lee receives funding from the National Health and Medical Research Council. </span></em></p><p class="fine-print"><em><span>Erin McMeniman does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A tattoo can be a large investment in time, money and pain. Here’s how to look after yours this summer.Katie Lee, PhD Candidate, The University of QueenslandErin McMeniman, Senior Lecturer Princess Alexandra Hospital Southside Clinical Unit and Casual Research Assistant, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1987892023-02-01T09:26:44Z2023-02-01T09:26:44ZPeople with light skin are at higher risk of skin cancer. How to reduce sun exposure<figure><img src="https://images.theconversation.com/files/507082/original/file-20230130-18-a8gn2a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Anastasiya Parfenyuk/Shutterstock</span></span></figcaption></figure><p>Most skin cancers are caused by too much exposure to the sun – specifically solar ultraviolet (UV) radiation or rays. These can damage the cells in the skin and cause them to mutate. This causes skin cancer. Melanoma is the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7037230/">most fatal</a> kind of skin cancer. </p>
<p>The <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7037230/">risk of skin cancer</a> depends on a few things including family history, lifestyle (such as spending a lot of time outdoors), a personal history of skin cancer and skin pigment. Other factors include skin that burns easily, having a large number of moles and older age. </p>
<p>A big factor in skin cancer risk is skin pigment. This is called melanin. Melanin is like a natural sunscreen that protects us from the sun’s harmful UV rays. Exposure to the sun is the most important <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7037230/">risk factor</a> for skin cancer. People who are deeply pigmented (dark skin) have more melanin than people with light skin and are <a href="https://www.ncbi.nlm.nih.gov/books/NBK481848/">less likely</a> to get skin cancer from too much exposure to the sun. </p>
<p>People with deeply pigmented skin can also get skin cancer. But there is no evidence to suggest that this occurs because of sunburn or exposure to the sun. For people with deeply pigmented skin, skin cancer is <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/iid3.623">more likely</a> to occur on the palms of the hands and soles of the feet, and on places of <a href="http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612010000300001">previous injury or wounds</a>.</p>
<p>For their part, people with lightly pigmented skin are most at risk of skin cancer caused by the sun’s UV rays. Those who spend time outdoors, either for long times or during the middle of the day when the sun is strongest, risk getting excessive sun exposure and sunburn. </p>
<p>Many countries in Africa experience high levels of solar ultraviolet radiation almost all year round. People at risk should protect themselves from the sun to reduce their chances of getting skin cancer. Anyone wanting to protect themselves from sun damage, such as wrinkles which do not have a health risk but may be disfiguring, and pigmentation or colouring of the skin, as well as people on certain medications and people with skin conditions, should also wear sun protection.</p>
<h2>Practising sun safety</h2>
<p>Protection from the sun is important in all seasons of the year, not just summer when the sun feels hot. Solar UV rays can still be harmful in cooler seasons and when the sky is cloudy. Practising sun safety is important all year round.</p>
<p>Solar UV rays can also reflect off surfaces such as water, sand, snow, and cement. It’s important to use sun protection at places like the beach and dams to protect yourself from excessive sun exposure.</p>
<p>The simplest ways to protect yourself from getting too much sun are by wearing clothing that covers as much as your body as possible (arms, body, and legs), and wearing sunglasses and a hat. These physical barriers help to stop most of the solar UV rays from reaching your skin. It can depend on the type and colour of the fabric – light-coloured clothing offers less sun protection than darker colours, which absorb more solar UV radiation.</p>
<p>If you can, try to limit the amount of time you spend outdoors between 10h00 and 16h00 when the solar UV rays are at their strongest. If you must be outside, use sun protection.</p>
<p>Sunscreen is the next line of protection for places that cannot be easily or fully covered with clothing, including your face, ears, and the tops of the feet. Try to use a sunscreen with the highest sun protection factor (SPF) that you can afford. SPF 50 is considered to offer good sun protection, but whatever sunscreen you can afford to buy and apply is better than not using any at all. The most important thing to remember with any sunscreen is to apply the product according to the instructions on the bottle and re-apply it often, especially after swimming or sweating.</p>
<p>Avoiding direct sunlight and use shade as much as possible. Tree shade, sunshades or sails, gazebos, awnings and umbrellas offer shade. Be careful when there are spots of sun coming through between the shade – don’t get caught thinking you are safe from the sun when you are not. If you raise your hand and make a shadow, there are probably some solar UV rays shining on your hand.</p>
<p>Indoor tanning using a tanning bed, sunbed, or sunlamp to darken the skin exposes the skin to high levels of UV rays. Spending time on a sunbed can lead to serious injury through accidents or burns. But more importantly, <a href="https://www.bmj.com/content/345/bmj.e4757.long">several</a> studies <a href="https://journals.lww.com/co-oncology/Abstract/2019/03000/Sunbeds_and_melanoma_risk__time_to_close_the.4.aspx">have found</a> that using a sunbed causes melanoma skin cancer. To reduce your skin cancer risk, do not use sunbeds. A tan does not indicate good skin health.</p>
<h2>A healthy relationship with the sun</h2>
<p>Spending time outdoors doing sports, relaxing and having fun is an important part of many people’s lifestyles. </p>
<p>Being exposed to some sun can help your body make vitamin D, which helps keep bones, teeth and muscles healthy and also makes you feel good because of a hormone called serotonin. Serotonin can help improve your memory and get a good night’s sleep. </p>
<p>Too much sun exposure causes sunburn and increases your risk of skin cancer. It also leads to wrinkles, fine lines and pigmentation as a result of sun damage.</p><img src="https://counter.theconversation.com/content/198789/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Caradee Yael Wright 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>People with deeply-pigmented skin can also get skin cancer. But there is no evidence to suggest that this occurs because of sunburn or exposure to the sun.Caradee Yael Wright, Chief Specialist Scientist (Public Health), South African Medical Research CouncilLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1935092023-01-19T13:37:05Z2023-01-19T13:37:05ZCold weather brings itchy, irritated, dry and scaly skin – here’s how to treat eczema and other skin conditions and when to see a doctor<figure><img src="https://images.theconversation.com/files/498142/original/file-20221130-16-t58j7l.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5342%2C3564&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">For some skin conditions, keeping hydrated is key.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/cropped-image-of-mother-holding-kids-hands-royalty-free-image/1398092187?phrase=eczema%20child&adppopup=true">Yuliya Shevtsova/EyeEm via Getty Images</a></span></figcaption></figure><p>In many parts of the U.S., the winter months bring frigid temperatures and drier conditions that can wreak havoc on the skin.</p>
<p>The primary role of the skin, as the largest organ in the body, is to act as a physical barrier to the external environment. When your skin is healthy, it helps protect you from allergens and infections. But in winter, when the outside temperature and humidity drop, skin can become especially irritated. </p>
<p>We are a <a href="http://dermatology.pitt.edu/people/sonal-choudhary-md">dermatologist</a> and a <a href="https://dom.pitt.edu/jeffrey-chen-awarded-prep-fellowship/">medical student</a> who study a <a href="https://scholar.google.com/citations?user=OFQxFnMAAAAJ&hl=en">broad range of common skin conditions </a> and the effects of the environment on skin health. </p>
<p>Heading into the winter months, a handful of common dermatological conditions can develop or worsen in response to the cold. These include eczema, chilblains, Raynaud’s phenomenon, cold urticaria and cold panniculitis. All are conditions that can be irritating and uncomfortable, and some are harder to treat than others. So it’s helpful to know when to manage these conditions on your own and when to see a dermatologist.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/7LKDLu07KgA?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Although eczema often affects infants, one form affects people 60 and older.</span></figcaption>
</figure>
<h2>Eczema</h2>
<p>Eczema is an inflammatory skin condition that causes dry and itchy skin and may be triggered by soaps and detergents, environmental or food allergens, hormonal changes and skin infections. There are numerous types of eczema, which often have overlapping symptoms. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/504514/original/file-20230113-14-njqskz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Pinkish splotches of eczema appear on an extended right arm." src="https://images.theconversation.com/files/504514/original/file-20230113-14-njqskz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/504514/original/file-20230113-14-njqskz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/504514/original/file-20230113-14-njqskz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/504514/original/file-20230113-14-njqskz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/504514/original/file-20230113-14-njqskz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/504514/original/file-20230113-14-njqskz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/504514/original/file-20230113-14-njqskz.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">According to the Cleveland Clinic, eczema affects more then 30 million Americans.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/eczema-allergy-skin-atopic-dermatitis-royalty-free-image/1270933857?phrase=eczema&adppopup=true">tylim/iStock via Getty Images Plus</a></span>
</figcaption>
</figure>
<p><a href="https://www.ncbi.nlm.nih.gov/books/NBK549807/">Asteatotic eczema</a>, also known as winter itch, is common in older adults. During the winter months, skin can become drier and, in some instances, cracked, fissured and inflamed. </p>
<p>Severe dryness may lead to itchiness and scratching. In turn, this can create open wounds that may allow allergens and bacteria to penetrate the skin and cause a rash or an infection. </p>
<p>This type of eczema typically occurs on the lower legs, but eruptions can occur anywhere on the skin, such as the trunk, arms and hands. </p>
<p>Keeping the skin hydrated is the primary treatment. Water-based lotions may worsen skin drying, so <a href="https://nationaleczema.org/eczema/treatment/moisturizing/#:%7E">applying moisturizers with a high oil content</a> – like petroleum jelly, mineral oil or Vaseline – on wet or damp skin is recommended. Hypoallergenic and anti-itch moisturizers designed specifically for eczema are also available. </p>
<p>Other tips include replacing long hot baths with quick warm showers, switching to a milder soap, and using a room humidifier if the climate is dry. If itchiness and dryness persist, seek care from a dermatologist, who may prescribe a topical steroid.</p>
<p>Hand eczema may also worsen in the winter as your <a href="https://eczema.org/information-and-advice/types-of-eczema/hand-eczema/">hands are frequently exposed to cold, dry air</a>. Scaling, fissuring and bleeding on the hands is common. Minimizing exposure to hard or antibacterial soaps, along with using gentle cleansing products followed by applying a petroleum-based unscented moisturizer can improve symptoms. </p>
<h2>Chilblains</h2>
<p><a href="https://doi.org/10.1024/0301-1526/a000838">Chilblains</a>, also known as pernio, are small, itchy patches that can occur when the skin is exposed to cold and damp weather, resulting in swollen and painful bumps that affect the fingers, toes, ears and face. Poor circulation, <a href="https://doi.org/10.1016/j.amjmed.2009.07.011">blood vessel constriction</a>, a history of autoimmune disease and being underweight may predispose people to chilblains. </p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/504517/original/file-20230113-24-7wuq83.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Against a blue background, a woman's hand shows chilblains -- swollen, bright red markings on her middle and ring fingers just below the nails." src="https://images.theconversation.com/files/504517/original/file-20230113-24-7wuq83.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/504517/original/file-20230113-24-7wuq83.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/504517/original/file-20230113-24-7wuq83.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/504517/original/file-20230113-24-7wuq83.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/504517/original/file-20230113-24-7wuq83.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/504517/original/file-20230113-24-7wuq83.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/504517/original/file-20230113-24-7wuq83.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">Although they usually heal if protected from cold, chilblains can be painful.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/chilblains-on-the-fingers-royalty-free-image/1372816804?phrase=chilblains&adppopup=true">Elizabeth Fernandez/Moment via Getty Images</a></span>
</figcaption>
</figure>
<p>Afflicted areas are painful, itchy, swollen and usually have a blueish to purple hue. In severe cases, blisters and ulcers may occur. But for most people, the condition tends to spontaneously resolve within one to three weeks. </p>
<p>Until that happens, it’s important to keep affected areas protected from the cold. If the sensitive area starts to blister, or if fevers, muscle aches and chills develop, it’s best to see a dermatologist or physician.</p>
<p><a href="https://doi.org/10.1111/bjd.19243">Pseudo-chilblains</a>, also known as “COVID toes,” can be caused by COVID-19 infection. Chilblains associated with COVID-19 resemble the rash in chilblains – painful red to blue-colored nodules on the toes – but it is not specific to winter. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/FKRjNLqZrsU?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Dry, cracked skin can lead to infections.</span></figcaption>
</figure>
<h2>Raynaud’s phenomenon</h2>
<p>Like chilblains, <a href="https://doi.org/10.1016/S0140-6736(00)05118-7">Raynaud’s phenomenon</a> is a skin condition characterized by a significant constriction of blood vessels in the fingers and toes in response to cold exposure. The digits may turn red or blue, but they quickly flush red upon rewarming. Afflicted areas may also be numb or painful, and when severe, may develop ulcers.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/504518/original/file-20230113-15-z93hrw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Against a black background, an adult hand with a pale middle finger displays Raynaud's phenomenon." src="https://images.theconversation.com/files/504518/original/file-20230113-15-z93hrw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/504518/original/file-20230113-15-z93hrw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/504518/original/file-20230113-15-z93hrw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/504518/original/file-20230113-15-z93hrw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/504518/original/file-20230113-15-z93hrw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/504518/original/file-20230113-15-z93hrw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/504518/original/file-20230113-15-z93hrw.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">Although Raynaud’s phenomenon typically affects fingers and toes, it can also affect the nose, ears and lips.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/adult-hand-and-fingers-raynauds-phenomenon-royalty-free-image/1387926245?phrase=Raynauds%27s%20phenomenon&adppopup=true">Barb Elkin/iStock via Getty Images Plus</a></span>
</figcaption>
</figure>
<p>To treat Raynaud’s phenomenon, it’s necessary to avoid cold-weather exposure. Ideally patients with Raynaud’s should dress for the cold in layers. At a minimum, make sure to wear gloves and insulated footwear. Avoid tobacco, caffeine and decongestants; they may cause <a href="https://europepmc.org/article/med/7748770">blood vessels to constrict more</a>. If symptoms don’t improve quickly – Raynaud’s due to cold typically gets better after only a few minutes – see a dermatologist or your physician, as Raynaud’s phenomenon can also be a manifestation of <a href="https://doi.org/10.1016/S0140-6736(00)05118-7">a more serious systemic disease</a>, including cancer, infections and/or trauma.</p>
<h2>Cold urticaria</h2>
<p><a href="https://doi.org/10.1111/all.14674">Cold urticaria</a> is a skin rash believed to be triggered by an autoimmune response, which leads to the release of inflammatory molecules, including histamine. </p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/504520/original/file-20230113-20-eq8ps2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman's arm covered in the blotchy red marks known as hives." src="https://images.theconversation.com/files/504520/original/file-20230113-20-eq8ps2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/504520/original/file-20230113-20-eq8ps2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=389&fit=crop&dpr=1 600w, https://images.theconversation.com/files/504520/original/file-20230113-20-eq8ps2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=389&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/504520/original/file-20230113-20-eq8ps2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=389&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/504520/original/file-20230113-20-eq8ps2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=489&fit=crop&dpr=1 754w, https://images.theconversation.com/files/504520/original/file-20230113-20-eq8ps2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=489&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/504520/original/file-20230113-20-eq8ps2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=489&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Cold urticaria is more commonly known as hives.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/girl-with-urticaria-royalty-free-image/1389641807?phrase=hives&adppopup=true">Elk Scott/i Stock via Getty Images</a></span>
</figcaption>
</figure>
<p>Soon after the skin is exposed to sudden drops in temperature, wheals – also known as hives – may develop. These are reddish, itchy and swollen areas of skin. Such episodes can last for approximately two hours. Occasionally, other symptoms accompany the outbreak, including headache, chills, shortness of breath, abdominal pain and diarrhea. </p>
<p>People can test for cold urticaria using the <a href="https://doi.org/10.1046/j.0022-202x.2001.00028.x">ice cube test</a>. This is done simply by placing an ice cube on an area of skin for five minutes; if you have cold urticaria, the skin will raise and itch within five to 15 minutes. Treatment involves avoiding cold exposure and using over-the-counter antihistamines. </p>
<p>For those who have experienced cold urticaria, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1927430/">swimming in cold water</a> can be dangerous, as it can lead to loss of consciousness and drowning. </p>
<h2>Cold panniculitis</h2>
<p><a href="https://doi.org/10.1016/j.det.2008.05.015">Cold panniculitis</a> – which appears as enlarged, red and painful nodules on the skin – develops 12 to 72 hours after cold exposure. </p>
<p>Cases of cold panniculitis have been documented in <a href="https://www.consultant360.com/article/popsicle-panniculitis">children eating Popsicles</a> and in adults undergoing <a href="https://doi.org/10.1016/j.jdcr.2018.02.010">whole-body cryotherapy</a>, which is often used as treatment for chronic inflammatory conditions such as rheumatoid arthritis, or for improving post-exercise recovery. </p>
<p>Cold panniculitis is more common during childhood and usually resolves on its own by avoiding cold exposure and direct contact with frozen products.</p>
<p>Symptoms from winter skin conditions are often self-limiting and resolve on their own with adequate protection from the cold. But if symptoms do not resolve, you should see a licensed dermatologist, as cold-induced rashes may be a sign of a more concerning underlying health condition. </p>
<p>If visiting your dermatologist in person proves difficult, you may consider seeing a dermatologist virtually, as many academic medical centers and private practices now <a href="https://doi.org/10.1016/j.jaad.2019.11.055">offer telehealth dermatology</a>.</p><img src="https://counter.theconversation.com/content/193509/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sonal Choudhary is a speaker for Regenron Pharmaceuticals and Sanofi, a pharmaceutical and health care company. Their atopic dermatitis drug Dupixent could potentially benefit from an article which mentions worsening of eczema in winters. There is no direct mention of the drug in the article.</span></em></p><p class="fine-print"><em><span>Jeffrey Chen does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Although most skin conditions aren’t dangerous, they can be painful, irritating and frustrating to deal with.Sonal Choudhary, Assistant Professor of Dermatology and Dermatopathology, University of Pittsburgh Health SciencesJeffrey Chen, Medical Student, University of Pittsburgh Health SciencesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1341462020-04-13T19:48:13Z2020-04-13T19:48:13ZMy skin’s dry with all this hand washing. What can I do?<figure><img src="https://images.theconversation.com/files/324520/original/file-20200401-66125-znylpp.jpg?ixlib=rb-1.1.0&rect=0%2C8%2C1920%2C1270&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/E6fONgWV1Uo">Irina Ba/Unsplash</a></span></figcaption></figure><p>Washing your hands is one of the <a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public">crucial ways</a> <a href="https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/what-you-need-to-know-about-coronavirus-covid-19#good-hygiene">we can all help</a> limit the spread of COVID-19.</p>
<p>Regularly and thoroughly washing your hands with soap and water for at least 20 seconds, or using an alcohol-based hand sanitiser, are key steps to reducing the risk.</p>
<p>But with all this hand washing, it’s easy to get dry skin or for existing skin conditions to flare up.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/yes-washing-our-hands-really-can-help-curb-the-spread-of-coronavirus-132915">Yes, washing our hands really can help curb the spread of coronavirus</a>
</strong>
</em>
</p>
<hr>
<h2>What’s happening to our skin?</h2>
<p>The top layer of our skin (the stratum corneum) is our skin’s key protective layer. But frequent hand washing with repetitive exposure to water, soap and skin cleansers <a href="https://www.sciencedirect.com/science/article/pii/S0022202X15301676">will disrupt</a> this layer.</p>
<p>Over time, this leads to dry skin, further disruption of the skin barrier and inflammation. </p>
<p>This eventually results in hand dermatitis, or more specifically, <a href="https://www.dermcoll.edu.au/atoz/irritant-contact-dermatitis-icd/">irritant contact dermatitis</a>. </p>
<h2>Who’s more likely to have problems?</h2>
<p>Irritant contact dermatitis is <a href="https://www.sciencedirect.com/science/article/pii/S2093791114000560">more common</a> in people who perform “wet work” as they wash and dry their hands many times a day.</p>
<p>They include health-care workers (doctors, nurses, personal care assistants), hairdressers, food handlers, kitchen staff and cleaners. They may also be exposed to irritating skin cleansers and detergents.</p>
<p>But now handwashing is becoming more frequent during the COVID-19 pandemic, there may be more affected people outside these occupations.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/325148/original/file-20200403-74908-nwfm4d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/325148/original/file-20200403-74908-nwfm4d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/325148/original/file-20200403-74908-nwfm4d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/325148/original/file-20200403-74908-nwfm4d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/325148/original/file-20200403-74908-nwfm4d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/325148/original/file-20200403-74908-nwfm4d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/325148/original/file-20200403-74908-nwfm4d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/325148/original/file-20200403-74908-nwfm4d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Health-care workers, who wash their hands multiple times a day, are particularly at risk of hand dermatitis.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/couple-surgeons-washing-hands-before-operating-633363035">Shutterstock</a></span>
</figcaption>
</figure>
<p>People with eczema, asthma and hay fever are also at <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1440-0960.2007.00409.x">higher risk</a> of developing irritant contact dermatitis or experiencing a flare of underlying eczema.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/common-skin-rashes-and-what-to-do-about-them-91518">Common skin rashes and what to do about them</a>
</strong>
</em>
</p>
<hr>
<h2>How do I prevent hand dermatitis?</h2>
<p><strong>1. Soap, soap alternative or hand sanitiser?</strong></p>
<p>People with eczema or who have had contact dermatitis before will have more easily irritated skin. While they can still use hand sanitisers, it’s recommended they wash with gentler soap-free washes rather than normal soap.</p>
<p>Soap-free washes contain non-soap-based synthetic detergents (syndets). <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/jocd.12469">Syndets</a> have a nearly identical cleansing action as soap, but with the benefit of having the same pH as the skin. This means they’re less likely to remove the oils from the outer layer of the skin and are less irritating. </p>
<p>Soaps have a high pH and are <a href="https://www.egopharm.com/au/en/Hand-Hygiene-Coronavirus.html">quite alkaline</a>. This disrupts the outer layer of the skin, allowing the soap to penetrate deeper into the skin, thus causing more skin irritation and itching. </p>
<p>Other people who don’t have eczema or a history of contact dermatitis should just use soap. Liquid soaps usually contain fragrances and preservatives, which can cause another type of dermatitis (allergic contact dermatitis), so opt for a plain, unperfumed bar soap. </p>
<p><strong>2. Dry your hands thoroughly</strong></p>
<p>Dry your hands thoroughly, including the webs of your fingers and under your
rings to reduce dermatitis caused by trapped water. Skin irritation and breakdown can occur when there is excessive moisture, soap residues and water trapped between the skin and underneath rings.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/coronavirus-and-handwashing-research-shows-proper-hand-drying-is-also-vital-132905">Coronavirus and handwashing: research shows proper hand drying is also vital</a>
</strong>
</em>
</p>
<hr>
<p><strong>3. Use non-fragranced moisturiser regularly</strong></p>
<p>Moisturisers come in different formulations. While lotions are light in consistency and convenient to use during the day, they will require more frequent applications. Creams and ointments have thicker and oilier texture, are effective for dry hands and are <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/ddg.12510_1">best used overnight</a>.</p>
<p>Fragrances can cause allergic contact dermatitis and are best avoided, where possible.</p>
<p><strong>4. Use alcohol-based hand sanitiser (if you can get hold of it)</strong></p>
<p>Alcohol-based hand sanitiser will reduce your skin’s contact with water, and so lower your risk of dermatitis.</p>
<p>Research in health-care workers <a href="https://www.jstage.jst.go.jp/article/indhealth/45/5/45_5_645/_article/-char/ja/">shows</a> hand sanitisers cause less contact dermatitis than washing with soap and water.</p>
<p>Sometimes people wrongly believe that when hand sanitiser stings on a paper cut, this means that they are allergic. But this is an irritant reaction and though uncomfortable, it’s safe to keep using it.</p>
<p>Which sanitiser? This usually comes down to personal preference (and what you can get hold of).</p>
<p><strong>5. Use gloves</strong></p>
<p>Use protective gloves when doing household chores, such as washing the dishes or when gardening. </p>
<p>Use cotton gloves when doing dry work, such as sweeping or dusting, to protect your hands and <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/ddg.12510_1">minimise the need to wash them</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/325152/original/file-20200403-99325-co1vxh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/325152/original/file-20200403-99325-co1vxh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/325152/original/file-20200403-99325-co1vxh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/325152/original/file-20200403-99325-co1vxh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/325152/original/file-20200403-99325-co1vxh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/325152/original/file-20200403-99325-co1vxh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/325152/original/file-20200403-99325-co1vxh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/325152/original/file-20200403-99325-co1vxh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Use washing up gloves where possible.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-washing-dishes-kitchen-close-hand-518530291">Shutterstock</a></span>
</figcaption>
</figure>
<p>At night, moisturise your hands than wear cotton gloves. This acts like an intensive hand mask and works wonders for very dry skin. It ensures the moisturiser stays on your hands and increases its penetration into your skin.</p>
<h2>What if my hands are already damaged, dry or cracking?</h2>
<p><strong>1. Act early</strong></p>
<p>Treat hand dermatitis as soon as it occurs, otherwise it will get worse. </p>
<p><strong>2. Apply petroleum jelly</strong></p>
<p>If you think you’ve lost your nail cuticle (the protective barrier between the nail and nail fold), water will be able to seep into the nail fold, causing swelling and dermatitis. </p>
<p>Use petroleum jelly, such as Vaseline, as a sealant to prevent further water damage. Petroleum jelly can also be used on skin cracks for the same reason. </p>
<p><strong>3. Seek medical help</strong></p>
<p>If there are any red, dry and itchy areas, indicating active dermatitis, seek help from your GP or dermatologist.</p>
<p>They can start you on a short burst of an ointment that contains corticosteroids until the rash subsides.</p>
<p>Prescription ointments are likely to be more effective than over-the-counter creams because of their higher potency. </p>
<p>But you could start with buying 1% hydrocortisone ointment, not cream, from the chemist.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-can-you-use-a-telehealth-consult-for-and-when-should-you-physically-visit-your-gp-135046">What can you use a telehealth consult for and when should you physically visit your GP?</a>
</strong>
</em>
</p>
<hr>
<p>Sometimes dermatitis can become infected with skin bacteria such as <em>Staphylococcus aureus</em>. Seek medical advice if you experience symptoms such as persistent soreness or pain.</p>
<p>You should also seek medical help if you have severe hand dermatitis not responding to home treatments.</p>
<p>Most GPs and dermatologists are moving to or have started using telehealth so you can consult them using a video call, minimising face-to-face appointments.</p><img src="https://counter.theconversation.com/content/134146/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Celestine Wong is a Consultant Dermatologist working at the Patch testing Clinic at Monash Medical Centre and the Royal Melbourne Hospital.</span></em></p><p class="fine-print"><em><span>Rosemary Nixon is the Director, Occupational Dermatology Research and Education Centre, Skin Health Institute, Melbourne. The centre is a not-for-profit dermatology centre affiliated with Melbourne and Monash universities. As well as her affiliation with the University of Melbourne, Rosemary Nixon is an Adjunct Clinical Associate Professor at Monash University.</span></em></p>You can prevent your skin becoming dry and inflamed with some simple steps. And if you do develop dermatitis, it’s important to seek early medical help.Celestine Wong, Consultant Dermatologist, Monash HealthRosemary Nixon, Honorary Clinical Associate Professor, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1251562019-11-14T12:02:34Z2019-11-14T12:02:34ZSnail slime: the science behind molluscs as medicine<figure><img src="https://images.theconversation.com/files/301510/original/file-20191113-77331-bdof4y.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/helix-pomatia-roman-snail-burgundy-edible-1026233269?src=2f042cc6-d094-4696-86a6-33a4e03b72c1-1-12">Shutterstock/Andrey Armyagov</a></span></figcaption></figure><p>Snails are well known for their lack of speed and their ability to upset gardeners. But there is growing scientific interest in the familiar sticky trail of slime they leave behind – and the medicinal value it may contain. </p>
<p>For centuries <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1062150/">it has been thought</a> that eating snails is good for you – and not just because they are a good source of protein and considered by some to be a delicacy. </p>
<p>Both the ancient Greeks and Romans advocated eating snails to cure a wide variety of ailments. These included fainting, stomach pains and coughing up blood, as well as general pain relief. The snails could either be eaten whole after boiling or crushed (shells included) into a crunchy pulp. </p>
<p>The idea of munching on these molluscs for their medicinal properties <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1062150/">continued</a>. In the 18th century it was recommended as a treatment for anthrax, and in the 19th century for tuberculosis. “Snail broth” made from the mucus was said to encourage the regeneration of wounded skin, reduce redness and make skin smoother. </p>
<p>Since publishing <a href="https://research.brighton.ac.uk/en/publications/identification-and-characterisation-of-anti-pseudomonas-aeruginos">my own work</a> on the chemical properties of snail mucus, I have been contacted by people who reported how this natural product has been used to treat skin inflammation and wounds well into the 20th century.</p>
<p>These treatments would have mostly involved the Burgundy or edible snail, <em>Helix pomatia</em>, and its close relative the brown garden snail, <em>Helix aspera</em>, which are both found across Europe. </p>
<p>And in recent years, creams, gels and face masks containing slime collected from Helix snails have become <a href="http://nymag.com/strategist/article/best-snail-mucin-skincare-products.html">popular beauty treatments</a>. But can any of the claims be substantiated by scientific evidence? </p>
<p>Interest in snail slime as a skin treatment was <a href="https://www.prnewswire.com/news-releases/revolutionary-elicina-snail-cream-scores-cnn-money-feature-300558597.html">rekindled recently</a> from observations made by workers farming edible snails in Chile. After their skin came into contact with the slime during handling, they reported that cuts and scars tended to heal easily and rapidly. This led to the development of the creams and gels which can now be found on chemist and health food shop shelves. </p>
<p>Mucus is a very sticky and biologically complicated substance. The snail uses it to aid locomotion, stick to hard surfaces (when resting or hibernating) and to defend itself against predators by creating a viscous environment around themselves and blocking the entrance to the shell.</p>
<h2>Snail secrets</h2>
<p>It is over 90% water, but it contains a lot of other compounds. The manufacturers of snail slime creams and gels claim that the key ingredients are allantoin (which is incorporated into a range of cosmetic products as well as toothpaste and shampoo) and glycolic acid (again commonly found in skincare products). </p>
<p>A research team in Italy <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6281574/">recently investigated this</a>. They found that a preparation made from the mucus produced by the snail did indeed show significant effects in laboratory tests which would explain the observed skin healing properties. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/301559/original/file-20191113-77315-18e3cfx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/301559/original/file-20191113-77315-18e3cfx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/301559/original/file-20191113-77315-18e3cfx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/301559/original/file-20191113-77315-18e3cfx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/301559/original/file-20191113-77315-18e3cfx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/301559/original/file-20191113-77315-18e3cfx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/301559/original/file-20191113-77315-18e3cfx.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">Beauty snail.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-up-snail-streaking-towards-jar-1139881079?src=f6bc48c5-fdc0-4830-bbd7-5501cbb88f07-1-2">Shutterstock/Andy Shell</a></span>
</figcaption>
</figure>
<p>So there appears to be something in this. Yet the allantoin and glycolic acid were present in very low concentrations. This suggests that either they are not as important as previously thought in skin healing or that they are only effective when working with other components within the mucus. </p>
<p>In <a href="https://tandfonline.com/doi/abs/10.1080/09674845.2015.11665749">our work</a>,
we have found that mucus from brown garden snails kills one particular species of bacteria in laboratory experiments. This is an organism called <em>Pseudomonas aeruginosa</em>, which can cause bloodstream infections, pneumonia, chronic wound infections and respiratory infections in people with cystic fibrosis. </p>
<p>We have tried 20 different strains of this bacteria and the mucus has stopped all of them from growing. But we have not seen the mucus work convincingly against any other type of bacteria. </p>
<p>We are also trying to find the key active ingredient. The viscosity of mucus makes it hard to work with, but so far we have identified three new proteins that we want to investigate, and we hope this could lead to the creation of a new antibiotic. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/301557/original/file-20191113-77320-17z2lb6.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/301557/original/file-20191113-77320-17z2lb6.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=393&fit=crop&dpr=1 600w, https://images.theconversation.com/files/301557/original/file-20191113-77320-17z2lb6.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=393&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/301557/original/file-20191113-77320-17z2lb6.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=393&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/301557/original/file-20191113-77320-17z2lb6.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=494&fit=crop&dpr=1 754w, https://images.theconversation.com/files/301557/original/file-20191113-77320-17z2lb6.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=494&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/301557/original/file-20191113-77320-17z2lb6.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=494&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The author with her lab companions.</span>
<span class="attribution"><span class="source">University of Brighton</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>At the moment, though, we do not know whether extracting them from the snail’s mucus and making them artificially will work. It is (perhaps appropriately for a snail product) a slow process – but given time, we might be able to explain why the Romans and Greeks gave snails the credit they may well be due.</p><img src="https://counter.theconversation.com/content/125156/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Pitt has received funding from Institute of Biomedical Science Research Fund. </span></em></p>A historical trail through its medicinal properties.Sarah Pitt, Principal Lecturer, Microbiology and Biomedical Science Practice, Fellow of the Institute of Biomedical Science, University of BrightonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1197842019-08-09T14:41:54Z2019-08-09T14:41:54ZMedical skin creams could be a lethal fire risk when soaked into fabric – here’s what you need to know<figure><img src="https://images.theconversation.com/files/287362/original/file-20190808-144868-rwrhqu.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C3000%2C1989&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/old-women-applying-lotion-on-hand-438938872?src=r7YjXez6vBkiIIF9byXniQ-1-40">Rarin Lee/Shutterstock</a></span></figcaption></figure><p>Care providers were alerted to a house fire involving one of their patients at 4am on May 30, 2015. The fire and rescue services discovered a 74-year-old lady who had succumbed to a blaze that developed rapidly while she was still lying in bed. She had been bed bound, known to smoke in bed and was being treated for a skin condition. </p>
<p>A year later, a 61-year-old man who was also a smoker, bed bound and had emollient applied to his skin by carers was found dead in his bed after an intense fire. A year after that, an 82-year-old man died with third degree burns when his dressing gown came into contact with a lighter. He was also receiving daily applications of a cream and ointment.</p>
<p>What do all of these tragic deaths have in common? The victims were all being treated with creams for their skin conditions. While the fires were caused by smoking, the authorities reported that they were made more intense by the presence of these emollients. </p>
<h2>A hidden danger</h2>
<p>In the UK, one in five children and one in 12 adults will suffer <a href="http://www.eczema.org/about-us">from eczema</a> and <a href="http://www.bad.org.uk/for-the-public/patient-information-leaflets">2-3% of the population have psoriasis</a>. Medical creams, lotions and ointments are widely used to treat these conditions and can be prescribed or bought over the counter. They often include instructions to apply liberally, with multiple applications during the day. This results in the product soaking into clothing, dressings and bedding.</p>
<p>Several deaths from fires have been linked with the use of these skin emollients. A <a href="http://www.bbc.co.uk/news/uk-39308748">BBC freedom of information request</a> revealed that 37 fire deaths since 2010 have been linked to creams that contain paraffin. But fire reports don’t require such information to be included and not all fire services responded to questions. So the actual number of deaths and injuries may be higher.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-batteries-have-started-catching-fire-so-often-68602">Why batteries have started catching fire so often</a>
</strong>
</em>
</p>
<hr>
<p>It isn’t just products that contain lots of paraffin that pose a risk – those with a low paraffin content and even those without paraffin at all could be dangerous. <a href="https://www.uk-afi.org/seminars/annual-training-conference-2019">Our research shows</a> that all fabrics ignited quicker after contact with emollients – regardless of the paraffin level – than completely clean fabrics. </p>
<p><a href="https://www.sciencedirect.com/science/article/pii/S0379711218303400">In our initial tests</a>, we let a flame directly touch cotton sheeting that emollients had dried into for 24 hours. The fabric ignited too quickly to measure, but once we had the flame positioned 7cm from the edge of the soaked fabric, we found that ignition happened after only ten seconds, compared to over a minute with the same cotton sheeting that was completely clean.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/287222/original/file-20190807-144868-v87ih6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/287222/original/file-20190807-144868-v87ih6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=335&fit=crop&dpr=1 600w, https://images.theconversation.com/files/287222/original/file-20190807-144868-v87ih6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=335&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/287222/original/file-20190807-144868-v87ih6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=335&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/287222/original/file-20190807-144868-v87ih6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=421&fit=crop&dpr=1 754w, https://images.theconversation.com/files/287222/original/file-20190807-144868-v87ih6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=421&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/287222/original/file-20190807-144868-v87ih6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=421&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Fabric test burns after 20 seconds. The non-paraffin cream ignited at eight seconds, the 21% paraffin base cream at 11 seconds and the clean cotton at 52 seconds.</span>
<span class="attribution"><span class="source">Sarah Hall</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>The fabrics we tested included various thread counts of cotton and polyester blend sheeting and t-shirts – all are common in households and all ignite much quicker when skin creams are present. We also found that once the flame has extinguished, some of the fabrics smoulder for longer when the products are present – potentially burning for longer near the skin, causing significant burns and life-threatening injuries.</p>
<p>These findings have spurred the NHS and fire and rescue services to <a href="https://www.gov.uk/government/news/emollient-cream-build-up-in-fabric-can-lead-to-fire-deaths">reassess their safety advice</a>. Flammable residues are thought to be removed from fabrics if <a href="https://www.nationalfirechiefs.org.uk/News/latest-research-shows-hidden-fire-risk-of-emollients/220630">they’re washed at the highest temperature</a> possible, but research is still ongoing.</p>
<p>It’s important to remember that these products – on their own and in containers – aren’t a fire risk. The risk emerges when fabrics are soaked with them and allowed to dry. As the creams have soaked into fabrics, reducing the time it takes for the garments to ignite, <a href="https://www.judiciary.uk/wp-content/uploads/2015/10/Hills-2015-0317.pdf">elderly and immobile</a> victims haven’t been able to remove their clothing quickly enough to prevent injury or death. </p>
<p>People shouldn’t stop using much-needed medication, but they should know how to use the products safely. Our advice is to wash your clothes at high temperatures as often as you can to reduce the build up of the creams. Most importantly, keep any fabrics away from naked flames and cigarettes – you’re likely to have less time to react in the event of a fire than you think.</p><img src="https://counter.theconversation.com/content/119784/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Hall conducted this work with research assistant Kirsty Blackburn.
</span></em></p><p class="fine-print"><em><span>Joanne Morrissey does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Common emollients used to treat skin conditions are a hidden fire risk in most homes.Sarah Hall, Senior Lecturer and Head of the Forensic and Investigative Sciences Research Group, Anglia Ruskin UniversityJoanne Morrissey, Senior Lecturer in Crime and Investigative Studies, Anglia Ruskin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/792802017-06-13T08:03:13Z2017-06-13T08:03:13ZHow the media can help protect people with albinism. A Tanzanian case study<figure><img src="https://images.theconversation.com/files/173343/original/file-20170612-10242-14n6vqy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Albinism is an inherited condition that affects the pigment of the eyes, hair and skin.
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p><a href="http://www.mayoclinic.org/diseases-conditions/albinism/basics/definition/con-20029935">Albinism</a> is a rare genetic condition which affects the pigment in the eyes, hair and skin. In the US about 1 person in 17,000 has albinism. In Africa the <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-6-212">prevalence</a> is estimated to range between 1 in 1100 to 1 in 15,000. But in Tanzania the rate is much higher – about 1 in every <a href="http://www.un.org/en/events/albinismday/background.shtml">1,400</a>. </p>
<p>The most common and most severe type in sub-Saharan Africa is <a href="http://emedicine.medscape.com/article/1216066-overview">ocular</a> albinism which gives people white hair, <a href="http://disorders.eyes.arizona.edu/disorders/albinism-oculocutaneous-type-ii">pink</a> skin, low vision or blindness and a greater susceptibility to <a href="http://ul.netd.ac.za/bitstream/handle/10386/97/M.A.%20Thesis%20_Selepe%20D.M_.pdf?sequence=3&isAllowed=y">skin cancer</a>. </p>
<p>People with albinism in Africa face a <a href="http://ul.netd.ac.za/bitstream/handle/10386/97/M.A.%20Thesis%20_Selepe%20D.M_.pdf?sequence=3&isAllowed=y">range</a> of prejudices and social stigmas. They are often dismissed as belonging to another race, or as ghosts or spirits. My <a href="https://www.researchgate.net/publication/262312089_Media_Analysis_of_Albino_Killings_in_Tanzania_A_Social_Work_and_Human_Rights_Perspective">research </a> confirms this. </p>
<p>The research looked at the role of the media in protecting the human rights of people with albinism. The media has the <a href="https://www.researchgate.net/figure/261653200_fig2_Figure-2-The-Agenda-Setting-Process-Media-Public-and-Policy-Agenda-Source-Dearing">power</a> to perpetuate misconceptions on albinism. It can also break down these prejudices, and to play a positive role in protecting people with albinism against abuse.</p>
<h2>Murders</h2>
<p>In East Africa, adults and children with albinism face discrimination and human rights violations driven by <a href="http://www.tanzaniatoday.co.tz/news/trade-in-body-parts-driven-by-belief-albinos-bring-luck-and-wealth">beliefs</a> rooted in witchcraft that albino body parts bring wealth and fortune.</p>
<p>Many are <a href="http://www.bbc.com/news/world-africa-31849531">murdered</a> for body parts, including infants and babies.</p>
<p>Most of the <a href="http://www.underthesamesun.com/sites/default/files/UTSS%20report%20to%20UN%20-%20REPORT.pdf">attacks</a> have taken place in Tanzania. Murders and attempted attacks, though in smaller numbers, have also been documented in Burundi, Kenya, Swaziland, Guinea, Nigeria, South Africa, Congo, Zambia, Namibia, Ivory Coast and Burkina Faso.</p>
<p>My <a href="http://www.tandfonline.com/doi/abs/10.1080/17496535.2014.895398">research</a> looked at media reports published between 2008 and 2011 on albinism and albino murders in Tanzania. I published a <a href="http://researchbank.acu.edu.au/datasets/11/">dataset</a> of 563 media reports in both English and Swahili from Tanzanian national newspapers. </p>
<p>The data showed that the Tanzanian press portrayed and explained violent attacks against persons with albinism in <a href="http://afsaap.org.au/assets/ARAS_vol34no2_burke_57-77.pdf">four</a> ways. That they were: </p>
<ul>
<li><p>criminal activity,</p></li>
<li><p>cultural practices,</p></li>
<li><p>a socio economic phenomenon, </p></li>
<li><p>a human rights issue.</p></li>
</ul>
<p>Discussing the attacks as cultural practices and economic activities contributes to the spread of myths and stereotypes and shows how to make money out of violence, which makes life harder and more dangerous for people with albinism.</p>
<p>Media reporting on these attacks as crimes that can lead to a death sentence is important in reducing the violence. The key message should be that people with albinism are humans who have rights so the whole community should treat them well and protect them from harm.</p>
<p>The majority of the articles recognised people with albinism as rightful members of society, using phrases such as “our fellow human beings” and “our fellow countrymen and women, our own kith and kin”. They also reported strong support from political leaders for people with albinism.</p>
<p>The articles urged protection for people with albinism and advocated fighting discrimination against them by using the law to identify and prosecute their attackers. They also advocated political activism to end the discrimination. </p>
<p>Many of the articles attacked the myths surrounding albinism, emphasising that witchcraft cannot deliver wealth.</p>
<p>But not all the media coverage was helpful. Some articles contributed to the spread of the myths and rumours about albinism by irresponsibly reporting on the monetary value of various body parts.</p>
<p>In some cases, the language used by the media failed to fully highlight the challenges affecting people with albinism. For example, the Swahili term for persons with albinism, <em>watu wenye ulemavu wa ngozi</em> (people with skin-disability) was regularly used. This description fails to recognise the fact that people with albinism also need proper eye care.</p>
<h2>What can be done?</h2>
<p>There is an urgent need to address the violence faced by this vulnerable group. Public health <a href="http://www.underthesamesun.com/">awareness</a> is an important first step. And adequate health services for skin and vision disabilities should be prioritised.</p>
<p>Putting out messages that counter the stigma against people living with albinism is also important, as is access to education.</p>
<p>But interventions must take into account their <a href="http://news.bbc.co.uk/2/hi/africa/7523796.stm">human rights</a>. For example, putting children with albinism in camps may protect their right to life and security, but it restricts their rights to freedom of movement, and family life.</p><img src="https://counter.theconversation.com/content/79280/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jean Burke is affiliated with the Albinism Fellowship of Australia. </span></em></p>Tanzania has one of the highest rates of albinism in the world. The media in the country has an important role to play in protecting them from harm.Jean Burke, Senior Lecturer in Social Work, Australian Catholic UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/765272017-05-17T20:13:51Z2017-05-17T20:13:51ZScience or Snake Oil: do Band-Aids really ‘heal cuts twice as fast’?<figure><img src="https://images.theconversation.com/files/167793/original/file-20170503-21637-1etoyw.png?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Don't believe the hype. Band-Aids might protect minor cuts but there's no publicly available evidence they speed up healing.</span> <span class="attribution"><span class="source">Johnson & Johnson Pacific Pty Ltd/The Conversation</span></span></figcaption></figure><p>Everyone wants wounds to heal quickly, whether it’s a paper cut or a grazed knee. So it’s easy to be swayed by marketing claims on packs of adhesive bandages, and on signs in your local pharmacy, that promise faster healing.</p>
<p>Band-Aid’s pack of 50 plastic adhesive bandages, for instance, displays the <a href="https://www.band-aid.com.au/products/plastic/PlasticStrips50">claim</a> the product:</p>
<blockquote>
<p>Heals cuts twice as fast.</p>
</blockquote>
<p>And Band-Aid’s pack of ten so-called “Advanced Healing” adhesive bandages has the <a href="https://www.band-aid.com.au/products/AdvancedHealing/AdvancedHealingRegular10">claim</a> they promote “faster healing”.</p>
<p>In store, you might see promotional displays that promise Band-Aids are:</p>
<blockquote>
<p>Clinically proven to heal wounds faster.</p>
</blockquote>
<p>But twice as fast as, or faster than what? And if this is clinically proven, who’s proved it?</p>
<h2>How do wounds heal?</h2>
<p>Wounds <a href="https://www.ausmed.com.au/guides/wound-care">heal themselves</a> because of a <a href="http://emedicine.medscape.com/article/884594-overview">complex process</a> at the site of the injury. There are three main phases: inflammation, proliferation and maturation.</p>
<p>Think of cutting your finger. The first thing that happens is the wound bleeds and eventually a blood clot forms and the bleeding stops. The area of injury is swollen and tender to touch. This is the inflammation phase.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/167829/original/file-20170504-21608-3rwvbj.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/167829/original/file-20170504-21608-3rwvbj.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/167829/original/file-20170504-21608-3rwvbj.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/167829/original/file-20170504-21608-3rwvbj.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/167829/original/file-20170504-21608-3rwvbj.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/167829/original/file-20170504-21608-3rwvbj.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/167829/original/file-20170504-21608-3rwvbj.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/167829/original/file-20170504-21608-3rwvbj.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Where’s the evidence Band-Aids pack of ten ‘Advanced Healing’ adhesive bandages ‘promote faster healing’?</span>
<span class="attribution"><a class="source" href="https://www.band-aid.com.au/products/AdvancedHealing/AdvancedHealingRegular10">Johnson & Johnson</a></span>
</figcaption>
</figure>
<p>Then it’s the proliferation phase. Over the next few hours, the blood clot becomes harder and a scab forms at the surface. </p>
<p>Below this scab, your body starts the process of healing the injury by sending in cells to fight infection. </p>
<p>That’s when your body begins to lay down collagen fibres (fibres of structural protein). These act like a simple scaffold to stabilise the damage and pull together the sides of the wound. This phase is also when new blood vessels grow in the wound.</p>
<p>The third phase of healing, maturation, takes around four to seven days after the injury for a small, uncomplicated cut. This involves a continual strengthening of the previously damaged area and new tissue replacing areas that have been damaged.</p>
<p>The final outcome is the wound is repaired, the scab falls off and there is usually little to no scarring. </p>
<p>This final phase can be more than a year for extensive wounds because our body continues to remodel the wound by breaking down the initially deposited collagen and replacing it with a structure that more closely resembles the original tissue. </p>
<p>This is why you often see a scar reduce over a period of time from one that’s raised and hard to one that’s less obvious.</p>
<h2>Can Band-Aids speed up this process?</h2>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/167423/original/file-20170502-17287-134xibf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/167423/original/file-20170502-17287-134xibf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=337&fit=crop&dpr=1 600w, https://images.theconversation.com/files/167423/original/file-20170502-17287-134xibf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=337&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/167423/original/file-20170502-17287-134xibf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=337&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/167423/original/file-20170502-17287-134xibf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/167423/original/file-20170502-17287-134xibf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/167423/original/file-20170502-17287-134xibf.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">Band-Aid’s recent in-store display at Chemist Warehouse says its products are ‘clinically proven to heal wounds faster’.</span>
<span class="attribution"><span class="source">Courtesy Prof Ken Harvey</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>This takes us back to the original question of whether Band-Aids can speed up the process of wound healing.</p>
<p>Is there something about these adhesive plasters that can speed up the processes of inflammation, proliferation and maturation that we’ve described? </p>
<p>And where are the trials to back they are “clinically proven” to do so?</p>
<p>The answer is we don’t know.</p>
<p>In correspondence from the supplier, Johnson & Johnson Pacific Pty Ltd, seen by the author, the company says:</p>
<blockquote>
<p>With regards to the “heals two times faster” claim, we stand by our position that evidence does exist to support the claim.</p>
</blockquote>
<p>The supplier does not clarify what its evidence relates to, namely whether it’s comparing Band-Aids to other adhesive bandages or to using no bandage at all.</p>
<p>But the company describes the evidence as “ageing” so it says it’s phasing out this claim. Until it does so, it’s likely to remain on old stock on pharmacy and supermarket shelves.</p>
<p>What about the “clinically proven” claim? </p>
<blockquote>
<p>We stand by our decision that our ‘clinically proven’ claims are supported with robustly designed clinical trials.</p>
</blockquote>
<p>But the company says these trials are unpublished and again, the company says it’s phasing out this claim.</p>
<p>The company continues by saying such studies are “commercial in confidence”, meaning we don’t have access to them, so none can be independently verified.</p>
<h2>What should you do with a minor cut?</h2>
<p>There are simple things you can do to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4121107/">help a minor cut heal</a>.</p>
<ul>
<li>Wash the wound with clean water</li>
<li>apply a little pressure initially to help stop the bleeding</li>
<li>cover the injury with a clean dressing, and </li>
<li>protect the wound from additional trauma or mechanical force. </li>
</ul>
<p>This is where Band-Aids and other brands of adhesive bandage might be appropriate. They protect the area from additional injury and limit exposure to dirt and other potential contaminants.</p>
<p>But as “clinically proven” to help cuts “heal twice as fast”, in the absence of any peer reviewed evidence, at best this is an unsubstantiated claim and probably just marketing hype. Science or snake oil? Verdict: snake oil.</p>
<hr>
<p><em>Correspondence mentioned in this article relates to a letter between Johnson & Johnson Pacific Pty Ltd and Professor Ken Harvey, from Monash University, on a related matter. Excerpts are used with his permission.</em></p><img src="https://counter.theconversation.com/content/76527/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nick Santamaria receives funding from Australian Commonwealth Government Coperative Research Centre for Wound Management Innovation and Molnlycke Health Care AB. He is affiliated with the World Union of Wound Healing Societies. </span></em></p>Where’s the evidence behind claims Band-Aids speed up wound healing? Here’s why we’ll never know.Nick Santamaria, Professor of Nursing Research, Skin Integrity and Wound Care, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/760782017-04-24T05:54:54Z2017-04-24T05:54:54ZResearch Check: are Aussie women ageing up to 20 years faster than US women?<figure><img src="https://images.theconversation.com/files/166043/original/file-20170420-2426-1by24ce.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There's more to ageing than wrinkles and crow's feet.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p>Across the developed world, looking older than your chronological age is considered a drawback. Western societies value physical beauty and vitality while science is actively trying to find a <a href="https://theconversation.com/the-search-to-extend-lifespan-is-gaining-ground-but-can-we-truly-reverse-the-biology-of-ageing-75127">way to reverse the ageing process</a> altogether.</p>
<p>This is probably why a study published in the latest issue of <a href="http://onlinelibrary.wiley.com/doi/10.1111/ajd.12637/abstract">The Australasian Journal of Dermatology</a>, that concluded Australian women report more severe signs of facial ageing sooner than other women, received a <a href="https://news.google.com/news/story?ncl=dwL1pRkK3Ut25EM6GZL7v8C_U2hRM&q=ageing+australian+women+us+women&lr=English&hl=en&sa=X&ved=0ahUKEwi8yrbcr7LTAhUCtJQKHWvuBCIQqgIIIjAA">fair amount of media coverage</a>.</p>
<p>It generated alarming <a href="http://www.smh.com.au/lifestyle/health-and-wellbeing/wellbeing/why-aussie-women-are-ageing-up-to-20-years-faster-than-us-women-20170410-gvho9k.html">headlines such as</a>:</p>
<blockquote>
<p>Why Aussie women are ageing up to 20 years faster than US women</p>
</blockquote>
<p>Like the research paper itself, these articles focused on photoageing – the damage done to our skin by exposure to high UV levels. But there is quite a bit more to the ageing process than wrinkles and crow’s feet. And the “20 years faster” claim also deserves scrutiny.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/166388/original/file-20170424-12658-19cxur.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/166388/original/file-20170424-12658-19cxur.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=831&fit=crop&dpr=1 600w, https://images.theconversation.com/files/166388/original/file-20170424-12658-19cxur.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=831&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/166388/original/file-20170424-12658-19cxur.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=831&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/166388/original/file-20170424-12658-19cxur.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1045&fit=crop&dpr=1 754w, https://images.theconversation.com/files/166388/original/file-20170424-12658-19cxur.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1045&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/166388/original/file-20170424-12658-19cxur.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1045&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"><span class="source">The Conversation</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<h2>How was the study done?</h2>
<p>The paper was published in a reputable, peer-reviewed outlet – the official journal of the Australasian College of Dermatologists and the New Zealand Dermatological Society.</p>
<p>The sample was 1,472 women aged 18-75 (averaging late 40s) from Australia, the UK, Canada and the US. They were recruited between December 2013 and February 2014 from an internet-based polling panel. </p>
<p>The women were asked to use a mirror to compare their own facial features to photographs illustrating increasing signs of ageing (from none to severe) for eight different characteristics.</p>
<p>These were static forehead lines, crow’s feet, glabellar (frown) lines, tear troughs (groove between lower eyelid and cheek), mid-face volume loss, nasolabial folds (the two skin folds that run from the nose to the corner of the mouth), oral commissures (the corners of the mouth) and perioral lines (wrinkles around the lips). </p>
<p>They were asked to choose one image – out of four to six (depending on the feature) – that most represented their current facial features in the absence of facial expression.</p>
<p>People were excluded if they had significant facial trauma or burns, or if they’d had any form of plastic surgery, including Botox, fillers or laser treatments. </p>
<p>Skin colour can be categorised by its typical response to UV light: from type one, which is very fair skin that always burns and never tans, to type six, which is dark brown skin that never burns and always tans. In this study, only women with skin types one to three were included. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/166046/original/file-20170420-2418-kilq9x.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/166046/original/file-20170420-2418-kilq9x.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/166046/original/file-20170420-2418-kilq9x.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=506&fit=crop&dpr=1 600w, https://images.theconversation.com/files/166046/original/file-20170420-2418-kilq9x.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=506&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/166046/original/file-20170420-2418-kilq9x.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=506&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/166046/original/file-20170420-2418-kilq9x.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=636&fit=crop&dpr=1 754w, https://images.theconversation.com/files/166046/original/file-20170420-2418-kilq9x.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=636&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/166046/original/file-20170420-2418-kilq9x.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=636&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The women were asked to use a mirror to compare their own facial features to photographs illustrating increasing signs of ageing.</span>
<span class="attribution"><a class="source" href="http://onlinelibrary.wiley.com/doi/10.1111/ajd.12637/full">Screenshot/Australasian Journal of Dermatology</a></span>
</figcaption>
</figure>
<h2>What were the results?</h2>
<p>Australian women reported more severe facial lines and higher rates of facial change with age than women from the other countries, particularly those from the US. Though, interestingly, for women in their 70s, the average severity of facial lines was generally similar from country to country.</p>
<p>The researchers then looked at the 30% or more of women who reported moderate or severe ageing for all features. They found that in Australia, this occurred:</p>
<blockquote>
<p>from the ages of 30-59 years […] but this proportion of US women did not report this level of severity until the ages of 40–69 years. </p>
</blockquote>
<p>This seems to be the crux of the paper, and the finding that underpins the conclusion that we’re ageing 20 years faster than we should be.</p>
<p>The study has many strengths. It is elegantly written and some aspects of the methodology are robust. For example, Asian women experience skin wrinkling later than Caucasian women, and smoking is associated with more skin ageing. So the researchers made sure these factors were not responsible for the results by adjusting their analyses for age, race and smoking status. </p>
<p>The results are certainly plausible and consistent with other studies. People living in Australia are exposed to higher levels of UV radiation, which is responsible for most age-associated cosmetic skin problems in fair-skinned people. </p>
<p>A <a href="https://www.ncbi.nlm.nih.gov/pubmed/21196710">study</a> of 1,400 randomly selected residents of a Queensland community used casts of the back of the hand and dermatological assessment to show that premature ageing of the skin was associated with high sun exposure during leisure or work.</p>
<h2>What is the problem?</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/166434/original/file-20170424-12640-1wrfeks.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/166434/original/file-20170424-12640-1wrfeks.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/166434/original/file-20170424-12640-1wrfeks.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/166434/original/file-20170424-12640-1wrfeks.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/166434/original/file-20170424-12640-1wrfeks.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/166434/original/file-20170424-12640-1wrfeks.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/166434/original/file-20170424-12640-1wrfeks.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/166434/original/file-20170424-12640-1wrfeks.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&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 living in Australia are exposed to higher levels of UV radiation.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>There are two main limitations of the study. First, the differences in self-reported facial lines may be statistically significant across countries, but this does not mean they are clinically significant. </p>
<p>Figures in the research plot the average severity of each line against age, with different colours representing each of the four countries. </p>
<p>Participants had up to six photographs to choose from, so the severity scale could range from 0 to 6. In the figures, the colours follow very similar trajectories and often overlap. Even the biggest gap between the countries looks like it represents a difference of 0.3 or 0.5. This is relatively small and may not be something anyone could observe.</p>
<p>Second, it is not clear why the researchers decided to focus on the 30% or more of women who reported moderate or severe ageing for all features. No other studies have used this cut-off.</p>
<p>The authors said that:</p>
<blockquote>
<p>this cut-off was chosen to yield the best sensitivity in detecting differences in facial ageing severity among countries.</p>
</blockquote>
<p>This suggests fewer differences were found than if another cut-off was considered. For example, would there have been significant differences when 20% of women rated each feature as having moderate or severe signs of ageing? Or 50%? Or 90%? Choosing a cut-off which is not based on a clinically meaningful or validated proportion raises questions about the true significance of the reported changes.</p>
<h2>What else should we consider?</h2>
<p>The title of the study is an accurate reflection of its content, stating that it is a comparison of self-reported signs of facial ageing. But the accompanying media coverage implies Australian women are ageing prematurely.</p>
<p>There is no evidence this is true. Robust studies of many tens of thousands of women show Australians are very similar to women in Europe and North America, through middle age to the extremes of old age. The <a href="http://www.alswh.org.au/">Australian Longitudinal Study on Women’s Health</a> provides a wealth of data in this field.</p>
<p>More important markers of health status in older people – disability, self-rated health, depression and anxiety, dementia – are all comparable. Life expectancy at birth (84.4 years for women) is slightly <a href="http://www.aihw.gov.au/deaths/life-expectancy/">higher in Australia</a> than in the other countries studied in this paper. </p>
<h2>What is the take-home message?</h2>
<p>Despite the methodological limitations of the study, in some ways it is good for it to be widely publicised. </p>
<p>Just like public health campaigns about premature ageing were used to decrease smoking rates in women (and thus reduced multiple smoking-related disease), the message Aussies may be looking older because of UV radiation may encourage us to limit our sun exposure. This would then reduce melanoma and other skin cancers. </p>
<p>As a type one redhead living in Brisbane, I shall certainly continue to wear my hat. <strong>– Ruth Hubbard</strong></p>
<hr>
<h2>Peer Review</h2>
<p>This Research Check fairly outlines the strengths (number of participants, accounting for age and other factors like smoking) and limitations (self-reporting and limitations in adjusting for confounding variables).</p>
<p>It also addresses the issue that caused the alarmist headlines – the graph showing when more than 30% of women rated a facial feature as reflecting moderate or severe signs of ageing. The author correctly points out there is no justification in choosing the 30% cutoff, that no other study uses it and that it is unlikely to be of any clinical significance.</p>
<p>More importantly, the Research Check analyses the figure that presents data for women across the various age groups. It points out most of the curves overlap, and that differences between groups of women are actually hard to see.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/166422/original/file-20170424-27254-4s22ze.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/166422/original/file-20170424-27254-4s22ze.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/166422/original/file-20170424-27254-4s22ze.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=508&fit=crop&dpr=1 600w, https://images.theconversation.com/files/166422/original/file-20170424-27254-4s22ze.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=508&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/166422/original/file-20170424-27254-4s22ze.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=508&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/166422/original/file-20170424-27254-4s22ze.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=639&fit=crop&dpr=1 754w, https://images.theconversation.com/files/166422/original/file-20170424-27254-4s22ze.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=639&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/166422/original/file-20170424-27254-4s22ze.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=639&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">It’s difficult to see the variations between countries in the graphs.</span>
<span class="attribution"><a class="source" href="http://onlinelibrary.wiley.com/doi/10.1111/ajd.12637/full">Screenshot/Australasian Journal of Dermatology</a></span>
</figcaption>
</figure>
<p>I would go even further and say that while the 95% confidence interval - an important estimate of variation - is presented in the tables, it is not applied to the graphs. If you show the 95% confidence intervals reported in the tables to the graphs, you would see most of the values for the women in other countries would not be significantly different to those in Australia. </p>
<p>For example, in the graph showing nasolabial folds, women in the light-poor UK have the same (age 18-29, 40-49) or marginally worse (age 70-79) nasolabial folds than in Australia. </p>
<p>This Research Check gives a clear, detailed and easily understandable background to the paper made visible by somewhat frenetic media reports. <strong>– Ian Musgrave</strong></p><img src="https://counter.theconversation.com/content/76078/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ian Musgrave receives funding from the National Health and Medical Research Council to study adverse reactions to herbal medicines and has previously been funded by the Australian Research Council to study potential natural product treatments for Alzheimer's disease. He is co-investigator of a grant to explore the metabolism of rodenticides. He lectures in biostatistics and the toxicology of retinoids, which have been used in "anti-aging" creams</span></em></p><p class="fine-print"><em><span>Ruth Hubbard 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 recent study suggests Australian women are ageing 20 years earlier than their US counterparts. But this claim deserves some close scrutiny.Ruth Hubbard, Associate Professor, Centre for Research in Geriatric Medicine, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/675802016-11-24T07:22:57Z2016-11-24T07:22:57ZTall, pale and handsome: why more Asian men are using skin-whitening products<p>Jose, 19, is a college student in Puerto Princesa City, Philippines. </p>
<p>On a regular school day, after he wakes up, he takes a shower, scrubbing his body using soap made of papaya (<em>Carica papaya</em>), a fruit that’s said to have skin-whitening properties. Afterwards, he applies a facial whitening lotion, and before finally going to school he uses SPF 30 sunscreen, again with whitening properties, on his face and arms. </p>
<p>Jose was one of many young people I met in my ethnographic work as part of the <a href="http://chemicalyouth.org">Chemical Youth Project</a>, a research programme that sought to document and make sense of the different chemicals that young people use in their everyday lives, from cosmetics to cigarettes. </p>
<p>Skin whitening among women <a href="http://pcij.org/stories/the-business-of-beauty/">has long been commonplace in the Philippines</a> and other parts of Asia and the world but, while working on this project, I was struck by the fact that young men too, are using a plethora of whitening products. And that these products have proliferated in various retail outlets, from shopping malls to small <em>sari-sari</em>, or neighbourhood, stores. </p>
<p>But this development is not unique to the Philippines either. A <a href="http://onlinelibrary.wiley.com/doi/10.1111/ijd.12860/full">2015 study</a> found that the prevalence of skin-whitening product use among male university students in 26 low and middle-income countries was 16.7%. The figure was higher in many Asian countries: 17.4% in India, 25.4% in the Philippines, and 69.5% in Thailand. </p>
<p>In the Asia-Pacific region alone, the male cosmetics industry was <a href="http://www.wsj.com/articles/in-asia-mens-skin-care-takes-off-1401320768">estimated at $2.1 billion in 2016</a>. Whiteners are likely to be a significant component of this figure; a <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1365-4632.2010.04330.x/abstract">2010 study</a> reported that 61% of all cosmetics in India had a whitening effect.</p>
<h2>Views of whiteness</h2>
<p>How do we make sense of this phenomenon? First, it must be pointed that the preference for white skin, even among men, has existed in many parts of Asia since ancient times. </p>
<p>In <a href="http://www.metmuseum.org/toah/hd/heia/hd_heia.htm">Heian Japan</a> (794 to 1185 AD) and <a href="http://www.chinahighlights.com/travelguide/china-history/the-ming-dynasty.htm">Ming China</a> (1368–1644), handsome men were described as having <a href="https://books.google.nl/books?id=BQcl4aCkY5MC">white or pale skin</a>. In <a href="https://books.google.nl/books?id=VPj2HIYXjYgC">one undated Philippine epic</a>, the hero covers his face with a shield so that the sun’s rays will not “lessen his handsome looks”.</p>
<p>Researchers have suggested that, in many societies, fair skin was a mark of class distinction. In her <a href="https://books.google.nl/books?id=4jHD4IN-N64C">2012 book Living Color</a>, American anthropologist Nina Jablonski explains: </p>
<blockquote>
<p>Untanned skin was a symbol of the privileged class that was spared from outdoor labor … Dark-skinned people were deprecated because they were of the labouring class that worked out in the sun.</p>
</blockquote>
<p><a href="https://books.google.nl/books?id=Dg4_FCU3OEgC">Others have suggested</a> that the association of whiteness with purity became conflated with the idea that white skin signifies spiritual and physical superiority. </p>
<p>Arguably, the colonial encounter lent another meaning to white skin, making it a marker of racial - not just class - distinction. Filipinos, for instance, were commonly referred to by the Americans as their “<a href="https://books.google.nl/books?id=hHzvx94oiUgC">little brown brothers</a>”, signifying an unequal fraternity based on height and skin colour. </p>
<p>But some scholars have also pointed out that many Asian people don’t necessarily aspire for a “Caucasian whiteness”, but a “<a href="https://muse.jhu.edu/article/410194">cosmopolitan whiteness</a>” that transcends race and signifies mobility across national borders.</p>
<p>Like the emergence of the “<a href="https://books.google.nl/books?id=esgaBgAAQBAJ">metrosexual</a>” (urban men who enjoy interests traditionally associated with women and homosexual men), the rise of male-specific whitening products may be explained by the demographic and social changes that have given rise to the view of the body as, in the <a href="https://books.google.nl/books?id=dfh9mI499IoC">words of UK sociologist Chris Shilling</a>, “a project that should be worked at and accomplished as part of an individual’s self-identity.”</p>
<p>It can also be attributed to <a href="https://www.sugataresearch.com/jp/news/blog/2015/02/16/%E8%8D%89%E9%A3%9F-soushoku-men-and-the-changing-definition-of-masculinity-in-japan/">changing notions of masculinity</a> that are no longer incompatible with the use of cosmetics or beauty products. </p>
<h2>Promises with side effects</h2>
<p>Today, cosmetics companies, through mass-mediated, star-studded advertising, build on these conditions. In India, Bollywood superstar Sharukh Khan <a href="http://news.bbc.co.uk/2/hi/7010885.stm">made headlines</a> by endorsing “Fair and Handsome” skin whitening cream in 2008. </p>
<p>In South Korea, K-pop superstars <a href="http://blog.euromonitor.com/2013/06/south-korea-largest-market-for-mens-skin-care-globally.html">promote homegrown brands</a> such as <a href="http://www.straitstimes.com/lifestyle/the-rise-of-k-beauty-in-singapore-and-globally">The Face Shop and Etude House</a>, and serve as ambassadors of a Korean male aesthetic: slim, youthful-looking, and fair-skinned.</p>
<p>While it is insightful to look at these historical and global trends, it’s also important to look at the individual users themselves, and the role whitening products play in their lives. </p>
<p>In my fieldwork, I met many young men who were motivated by perceived social and economic gain: 20-year-old call centre agent Edwin wanted to be more attractive to girls. </p>
<p>Jose, for his part, wanted to someday be a flight attendant. He told me, “If you’re fair-skinned, you’re noticeable, and that gives you a advantage.” </p>
<p>Their assumptions find empirical support in studies that suggest men with lighter skin <a href="http://www.nytimes.com/2007/01/28/us/28immig.html">are more likely to get higher paying jobs</a>. In environments where young people only have their <a href="http://gas.sagepub.com/content/16/2/175.short">bodies as “capital”</a>, resorting to modification is understandable. </p>
<p>But from a public health perspective, the proliferation of whitening products raises questions of efficacy and safety, particularly in Asian countries without strong regulation. </p>
<p>For all their promised effects, there’s actually <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1529-8019.2007.00144.x/full">no proof that many products actually work</a>, and many of them have potentially grave side effects. Mercury, for instance, is a known toxin but it’s <a href="http://indianexpress.com/article/india/india-news-india/tests-show-mercury-in-loreal-products-maharashtra-fda-3048779/">still found in skin whitening products in India</a>, even when it has long been <a href="http://www.who.int/ipcs/assessment/public_health/mercury_flyer.pdf">banned in many other countries</a>.</p>
<h2>Is it right?</h2>
<p>Alongside these health concerns, the moral debate continues. By shaping the way people people view their skin – and that of others – will its colour, which is determined by genes, occupation and lifestyle, become another layer of inequality?</p>
<p>And as with any other social issue, there has been dissent. Across Asia, a growing number of voices challenging the “<a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1751-9020.2007.00006.x/full">colourism</a>” they have to live with. Blogger Aswasthi Thomas, for instance, <a href="http://www.huffingtonpost.com/entry/im-indian-im-dark-and-i-dont-care_us_5813829be4b096e8706964e9">recently declared</a>: </p>
<blockquote>
<p>I’m Indian, I’m dark, and I don’t care.</p>
</blockquote>
<p>But what these campaigns sometimes forget is that the quest for distinction through physical appearance is probably as old as humanity itself. And it’s unlikely to go away, especially when it is useful for people in their everyday lives. </p>
<p>Even so, as desires for dermatological perfection become increasingly commodified – and as skin becomes subjected to a host of chemicals – the point about restraint and reflection is well taken.</p>
<p>Indeed, as more and more men and women embrace the idea that “fair is handsome”, we need a deeper conversation about the motivations that underwrite the phenomenon of skin whitening, and the meaning of (un)fair skin.</p><img src="https://counter.theconversation.com/content/67580/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gideon Lasco 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>Skin whitening among women has long been commonplace, but now young Asian men too, are using a plethora of whitening products.Gideon Lasco, PhD candidate in Medical Anthropology, Amsterdam Institute for Social Science Research (AISSR), University of AmsterdamLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/638102016-11-21T02:23:05Z2016-11-21T02:23:05ZHealth Check: are cosmetics containing Vitamin A safe during pregnancy?<figure><img src="https://images.theconversation.com/files/145118/original/image-20161109-16721-1o1q1ct.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Pregnant women are told to avoid vitamin A due to the risk of birth defects, but does anti-ageing cream count?</span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p>Cosmetics promise us many things, but could certain types of skin-care products containing vitamin A be harmful to unborn children? </p>
<p><a href="https://en.wikipedia.org/wiki/Vitamin_A">Vitamin A</a> is one of the most recognisable vitamins. It’s essential for tissue development and plays an important role in vision. In many developing countries, <a href="http://www.who.int/nutrition/topics/vad/en/">childhood vision problems</a> are due to vitamin A deficiency. </p>
<p>Too much vitamin A can be harmful too, as <a href="https://www.theguardian.com/science/antarctica-live/2013/dec/04/douglas-mawson-antarctic-trek">Antarctic trekkers discovered</a>. When starving, they ate their dogs (including their livers, which are high in Vitamin A) and suffered illness and eventually death. </p>
<p>Vitamin A is also important for skin integrity and function. Vitamin A is actually a group of related unsaturated fatty compounds that includes <a href="https://en.wikipedia.org/wiki/Retinol">retinol</a>, retinal and retinoic acid. Vitamin A and synthetic analogues of vitamin A are used to treat a variety of skin conditions, as well as some forms of cancer. </p>
<p>As well as dermatological uses of vitamin A, it may be found in some “anti-ageing” cosmetics and sunscreens because of its effect on the skin. </p>
<p>However, because vitamin A plays a role in foetal development, using pharmaceutical levels of vitamin A during pregnancy may interfere with the development of the foetus and cause deformities, especially of the face and palate. Is there a risk of this occurring with cosmetics?</p>
<h2>What vitamin A is used for</h2>
<p>Acne is a complex long-term inflammatory disease of the skin that centres on the hair follicle. There are excessive secretions in the follicle, too much protein is made and bacteria infect the site. Acne can range from mild to moderate to severe disease with the potential for disfiguring scarring.</p>
<p>Acne is resistant to many of the treatments that would usually be used in an inflammatory disease. Therapy for acne can be complex, but vitamin A in the form of “<a href="https://en.wikipedia.org/wiki/Tretinoin">tretinoin</a>” or “isotretinoin” plays a significant role in treating acne. Synthetic vitamin A is also used.</p>
<p>While most of these products are rubbed on the skin, oral isotretinoin is the treatment of choice for severe adult acne. Typical concentrations of trentinoin cream range from 0.01% to 0.1%.</p>
<p>Both Tretinoin and retinol have been incorporated into a variety of cosmetics and sunscreens. Tretinoin stimulates supporting cells in the skin to make more of the <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699641/">supporting structure of the skin</a>, which reduces wrinkling and some of the damaging effects of sunlight on skin. </p>
<p>Tretinoin can also normalise some of the pigment changes in skin with ageing and sun exposure. While the <a href="http://www.ncbi.nlm.nih.gov/pubmed/23839179">initial research</a> was done on tretinoin, retinol has been shown to be <a href="http://www.ncbi.nlm.nih.gov/pubmed/25607905">effective in cosmetic applications</a> as well (although around ten times less potent than tretinoin). Cosmetics available in Australia appear to have retinol in them, rather than any other form of vitamin A.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/145119/original/image-20161109-16691-ut2o7j.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/145119/original/image-20161109-16691-ut2o7j.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/145119/original/image-20161109-16691-ut2o7j.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=636&fit=crop&dpr=1 600w, https://images.theconversation.com/files/145119/original/image-20161109-16691-ut2o7j.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=636&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/145119/original/image-20161109-16691-ut2o7j.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=636&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/145119/original/image-20161109-16691-ut2o7j.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=799&fit=crop&dpr=1 754w, https://images.theconversation.com/files/145119/original/image-20161109-16691-ut2o7j.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=799&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/145119/original/image-20161109-16691-ut2o7j.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=799&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 anti-ageing creams contain Vitamin A.</span>
<span class="attribution"><a class="source" href="http://www.biovea.net/au/product_detail.aspx?PID=4287&TI=GGLAU&C=N&gclid=CJnnwqzFmtACFYmSvQodDAALZA">Screenshot, Biovea</a></span>
</figcaption>
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<p>While it’s generally accepted the ranges of tretinoin or retinol in cosmetics are similar to those found in pharmaceutically active products, this information can be very difficult to find. It’s also hard to find which “anti-ageing” products these compounds are actually in. </p>
<p>While some internet-based sales sites prominently feature their retinol content and one group claims to have a high 1% retinol content product (compared to 0.1% for tretinoin), another prominent anti-ageing product lists retinol under “inactive ingredients” with no actual concentration given.</p>
<p>Finding health warnings on cosmetics is variable as well. Aside from the risks of birth defects, tretinoin and retinol are both associated with adverse effects, ranging from <a href="http://www.nps.org.au/medicines/skin/acne-medicines/tretinoin-acne-medicines/retrieve-cream">rash and dry skin to irritation and burning</a>. </p>
<p>Some cosmetics sites and products mention this, some don’t. None of the products I surveyed mention issues with birth defects in any easy-to-find place.</p>
<h2>Vitamin A compounds and birth defects</h2>
<p><a href="http://www.medscape.com/viewarticle/492119">Oral consumption of isotretinoin</a> has been clearly shown to produce birth defects. However, tretonin and retinol applied to the skin are less likely to be associated with birth defects. </p>
<p>Tretonin is poorly absorbed from the skin and rapidly broken down. In animal studies tretinoin applied to the skin at levels higher than used in humans produced no birth defects. For example in rats, concentrations of 0.5 milligrams per kilogram per day were applied to the skin without effect. </p>
<p>Fewer studies have been done with retinol, but it too is <a href="http://www.ncbi.nlm.nih.gov/pubmed/18511092">poorly absorbed</a> through the skin.</p>
<p>Overall, poor absorption and the small surface area the retinoids were applied to would suggest the levels achieved in the blood would be too low to harm the developing child. </p>
<p>There were early <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3114665/">case reports</a> (isolated reports after use of the product) of birth defects following skin application of tretinoin in humans. Since then there have been four relatively large studies in humans where pregnant women who were or were not exposed to tretinoin were followed for birth defects. No differences in birth defects were found between the groups (for recent reviews see <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3114665/">here</a> and <a href="http://www.ncbi.nlm.nih.gov/pubmed/24528911">here</a>).</p>
<p>In the most <a href="http://onlinelibrary.wiley.com/doi/10.1177/0091270011429566/abstract">recent and largest study</a> reported in 2012, 235 pregnant women exposed to a variety of retinoids applied to the skin from the beginning of pregnancy were compared with 444 controls. No differences were seen between groups in rates of spontaneous abortion, minor birth defects or major birth defects. No child showed features of retinoid embryopathy (birth defects caused by Vitamin A).</p>
<h2>The bottom line</h2>
<p>Despite the low risk suggested by these studies, experts still suggest pregnant women avoid applying vitamin A-based formulations to their skin during early pregnancy.</p>
<p>On the other hand, if you have used a cosmetic containing a retinol or a similar vitamin A-like compound during pregnancy, there’s no need to panic. Stop using the product and consult with your health care professional. </p>
<p>If you are planning to becoming pregnant, it would be wise to check any “anti-ageing” cosmetics or sunscreens to determine which ones have retinol or other forms of vitamin A in them (you may have to do some sleuthing) and, as always, have a conversation with your health care professional.</p><img src="https://counter.theconversation.com/content/63810/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ian Musgrave receives funding from the National Health and Medical Research Council to study adulterants and contaminants in herbal medicines. He has previously received funding from both the Australian Research Council and the NHMRC for Alzhiemer's related research. </span></em></p>Anti-ageing cosmetics are common and many contain forms of vitamin A, but are there any risks using vitamin A on your skin during pregnancy?Ian Musgrave, Senior lecturer in Pharmacology, University of AdelaideLicensed as Creative Commons – attribution, no derivatives.