Plain Language Summaries
Predicted increased risk of squamous cell carcinoma induction associated with sunbed exposure habits
P. Tierney, F.R. de Gruijl, S. Ibbotson and H. Moseley
Summary
Ultraviolet (UV) radiation, which is given out by the sun and also by sunbeds, is known to be a major cause of skin cancer, in particular one type called squamous cell carcinoma (SCC). In 2013, researchers from Scotland and the Netherlands measured ultraviolet (UV) radiation levels emitted by 402 sunbeds across England. In this later study, they used this data and then factored in the average length of sunbed sessions, and the number of sessions each year, as well as a person's cumulative UV exposure from the sun. They then applied an equation that links UV exposure and SCC incidence, to predict risk to people who use sunbeds. The researchers found that by 55 years of age, people who used a sunbed were 90% (1·9-fold) more likely to develop SCC than those who did not. Sunbed use was defined as having a 12 min session about every eight days (or a 6 min session every 4 days), over a 15 year period from age 20 to 35 years, using a sunbed with a median UV dose. For high dose sunbeds the risk is increased by 180%. Even the sunbeds previously found to give the lowest UV dose were linked to a 40% increased risk of developing SCC. The authors conclude that it is important that the public understands the risks of UV exposure and that there is considerable variation in the UV output of sunbeds. The results of their study show that the additional UV dose from sunbed use compared to normal day-to-day sun exposure can increase the risk of developing SCC.
This summary relates to DOI 10.1111/bjd.13714
British Journal of Dermatology, 173, 201–208, July 2015
The impact of national-level interventions to improve hygiene on the incidence of irritant contact dermatitis in healthcare workers: changes in incidence from 1996 to 2012 and interrupted times series analysis
S.J. Stocks, R. McNamee, S. Turner, M. Carder and R.M. Agius
Summary
The last three decades of the 20th century saw a rise in healthcare associated infections (HCAI) in the UK, meaning infections that occur in places of healthcare, such as hospitals. Prevention of HCAI became a National Health Service (NHS) priority, and recommendations were developed to improve hygiene related to hands, equipment and the hospital environment. A campaign called ‘Cleanyourhands’ started in 2004, which promoted hand hygiene in various NHS settings by providing alcohol hand rub as well as posters aimed at healthcare workers and patients. This campaign has been effective at reducing certain infections. Occupational irritant contact dermatitis (ICD) is a type of eczema caused in the workplace, and is frequently associated with jobs that require regular hand washing. In healthcare workers, irritation caused by ICD may discourage hand washing. This study looked at numbers of ICD in healthcare workers, attributed to hygiene, before and after interventions (campaigns) to reduce HCAI and compared these figures with trends during the same periods in control groups (other, non-healthcare workers with ICD). They found that hygiene-related ICD in healthcare workers has increased steadily from 1996 to 2012 whereas the incidence in other workers is declining. The authors conclude that more effort is needed to identify products and to implement practices that pose the least risk of ICD.
This summary relates to DOI 10.1111/bjd.13719
British Journal of Dermatology, 173, 165–171, July 2015
‘We had to change to single beds because I itch in the night’: a qualitative study of the experiences, attitudes and approaches to coping of patients with cutaneous T-cell lymphoma
T. Beynon, L. Selman, E. Radcliffe, S. Whittaker, F. Child, D. Orlowska, C. Morgans, S. Morris and R. Harding
Summary
The term ‘primary cutaneous T-cell lymphoma’, or CTCL, is used to describe a group of diseases called non-Hodgkin lymphomas affecting the skin, of which types called Mycosis Fungoides (MF) and Sezary Syndrome (SS) are the most common. The aim of this study, from the UK, was to understand in greater depth patients’ experiences of living and coping with CTCL. Semi-structured interviews were conducted with 19 CTCL patients by a medical sociologist, an experienced interviewer with an interest in long term conditions. Many participants described the psychological stress of living with an often highly visible skin condition and its impact on self-image, which had an impact on employment, finances, leisure, travel and relationships. Participants also described a considerable burden caused by the disease's physical symptoms, including severe skin discomfort and itching. However, the interviews revealed how patients find ways to cope with the disease, such as drawing on social support, maintaining normal lives and becoming well-informed about CTCL. The study suggests that CTCL does impact on relationships, and further exploration of this from the perspective of family members is needed. The authors conclude that their findings show the many different effects of CTCL on patients’ lives. While the physical symptoms associated with the disease are a significant burden, psychological and social problems appear to be at least as troubling.
This summary relates to DOI 10.1111/bjd.13732
British Journal of Dermatology, 173, 83–92, July 2015
Intellectual disability and cognitive ability in Darier disease: Swedish nation-wide study
M. Cederlöf, R. Karlsson, H. Larsson, C. Almqvist, P.K.E. Magnusson, K. Nordlind, M. Landén and P. Lichtenstein
Summary
Darier's disease is a rare skin condition caused by an abnormality in a gene which means that the sticky junctions that hold the skin cells together are not made properly, and the skin may become inflamed and weeping. Since the 1950's, Darier disease has been linked to several mental health disorders, such as bipolar disorder and schizophrenia. Cognitive ability means the brain-based skills, involving how we learn, remember, problem-solve, and pay attention (rather than knowledge that we have learnt or wisdom). As there are reports that Darier's disease may be linked to intellectual disability (reduced cognitive ability), this Swedish study aimed to estimate risks of being diagnosed with intellectual disability in people with Darier's disease. They found that individuals with Darier's disease had a six times higher risk of being diagnosed with intellectual disability than individuals without the disease. To see if individuals with Darier's disease but without diagnosed intellectual disability would have impairments in cognitive ability that are subclinical (i.e. mild, so not at a level that would be detected as a clinical diagnosis), the authors looked at data from an IQ test (which measures a person's mental agility, rather than knowledge) used for the Swedish conscript examination. In this group of Darier's patients without diagnosed intellectual disability, the researchers found that mean IQ scores were significantly lower than in non Darier's patients. The authors suggest that their findings should lead to molecular genetic research on the subject.
This summary relates to DOI 10.1111/bjd.13740
British Journal of Dermatology, 173, 155–158, July 2015
4-Hexyl-1,3-phenylenediol, a nulclear factor-κB inhibitor, improves photodamaged skin and clinical signs of ageing in a double-blinded, randomized controlled trial
S. Kaur, M. Kizoulis, J. Fantasia, T. Oddos, N. Bigot, P. Galera, S. Tucker-Samaras, J.J. Leyden and M.D. Southall
Summary
Many studies have shown that levels of elastin and collagen, known as ECM proteins, in the skin go down as we age. As it is these proteins which help to give the skin its structure and support, this reduction leads to lines and wrinkles. This is a natural process within the body, but exposure to some external factors can contribute to this breakdown, making skin appear aged faster. One such factor is exposure to ultraviolet (UV) light from the sun or sunbeds. The process by which UV damages the skin is complex, but a pathway (a group of molecules) called NF-κB plays a role in converting ‘attackers’ from the environment such as UV, into skin damage. This study investigated NF-κB activity in cells called fibroblasts taken from donors aged between 17 and 78, finding that fibroblasts obtained from donors older than 50 years had higher NF-κB activity than cells from younger donors. The researchers, from France and the US, also looked at the effects of a chemical called 4-hexyl-1,3-phenylenediol, which reduces NF-kB, on elastin and collagen, using samples in the lab. They found that the chemical did reduce NF-κB activity and enhanced ECM genes which are beneficial to skin structure. Finally, they tested their lab-based findings on the appearance of photodamaged skin (skin damaged by UV) by applying a lotion to the skin of volunteers over eight weeks and comparing the results to volunteers who used a lotion without the chemical. Those treated with 4-hexyl-1,3-phenylenediol showed significantly improved crow's feet, fine lines, cheek wrinkles, age spots, mottled pigmentation and radiance, compared with those who did not receive the treatment, and compared to their results at the start of the study.
This summary relates to DOI 10.1111/bjd.13747
British Journal of Dermatology, 173, 218–226, July 2015
Methylisothiazolinone in rinse-off products causes allergic contact dermatitis: a repeated open-application study
K. Yazar, M.D. Lundov, A. Faurschou, M. Matura, A. Boman, J.D. Johansen and C. Lidén
Summary
Methylisothiazolinone (MI) is a preservative that is widely used in cosmetic products and toiletries. The maximum concentration (strength) at which it is allowed to be used, in products that are designed to be either left on the skin (such as creams) or rinsed off the skin (such as liquid hand soap, shampoo and showel gel) is 100 parts per million (100 ppm, or 0·01%). In recent years, allergy in response to skin contact with MI (called contact allergy) has increased dramatically. Several studies have found that MI at the legal limit in leave-on products causes reactions in large proportions of people who are allergic to the chemical. This study, from Sweden and Denmark, is the first to examine reactions to MI from rinse-off exposure. The study used a rinse-off liquid hand soap containing the allowed concentrations of MI (100 ppm) in 10 people with MI allergy, and half that concentration (50 ppm) in 9 people with MI allergy, as well as 19 controls with no MI allergy, to see if these concentrations have the potential to trigger allergic contact dermatitis (eczema caused by allergy). The authors found that all MI-allergic subjects had reactions to the rinse-off product preserved with 100 ppm MI. When reducing the concentration to 50 ppm, 78% (7 out of the 9) MI-allergic subjects reacted. None of the control group, meaning people without MI allergy, suffered a reaction, and none of the MI patients suffered a reaction to a control product that did not contain MI. The authors conclude that the current levels of MI in rinse-off cosmetics are not safe for people with MI allergy.
This summary relates to DOI 10.1111/bjd.13751
British Journal of Dermatology, 173, 115–122, July 2015
The role of BRAF mutations in primary melanoma growth rate and survival
V.J. Mar, W. Liu, B. Devitt, S.Q. Wong, A. Dobrovic, G.A. McArthur, R. Wolfe and J.W. Kelly
Summary
Mutations in a gene called BRAF are common in a number of cancers, including melanoma skin cancer. There is some evidence that the presence of a BRAF mutation in melanoma is associated with a poor prognosis, though these studies are mostly based on patients with metastatic disease (meaning that the cancer has spread to other parts of the body). The impact of BRAF on earlier disease progression and survival remains unclear. This study, from Australia, therefore looked at 196 patients with stage 1–3 melanoma (less advanced than stages 4–5) to calculate the melanoma growth rate and the rates of survival from the disease (known as melanoma specific survival). Overall, BRAF mutant melanomas were associated with poorer melanoma specific survival than other melanomas once thickness and other known prognostic factors were taken into account. The authors conclude that the presence of a BRAF mutation does not necessarily lead to more rapid tumour growth, however it does increase the risk of melanoma death in patients with stage 1–3 disease. Evidence is growing that looking at a patient's BRAF mutation status is important in assessing the risk of their disease becoming more advanced, particularly as new therapies emerge that target BRAF mutations.
This summary relates to DOI 10.1111/bjd.13756
British Journal of Dermatology, 173, 76–82, July 2015
