Category Archives: Eczema

The covid-19 pandemic has led to a marked increase in the use of personal protective equipment (PPE) both in and out of healthcare settings. The term maskne has become increasingly popular during the pandemic, particularly in the media, where it is used to describe several facial dermatoses. Individuals often buy expensive but potentially ineffective treatments for these conditions.

In this practice pointer we summarise the most common causes of facial eruptions associated with wearing facial PPE, and highlight the key areas to cover when assessing someone with new or worsening pre-existing facial dermatoses that they attribute to the use of facial PPE.

Facial PPE in this article includes full face shields, visors, safety spectacles, surgical masks (fluid resistant surgical mask, FRSM type IIR), and respirator masks (eg, FFP3, FFP2, and N95).1

Facial dermatoses related to PPE have been well described, but data about their prevalence are limited, and often a descriptive terminology is used rather than specific diagnoses. Based on the limited available evidence, mask related acne and irritant contact dermatitis are the most common facial dermatoses associated with mask wearing.2345

During the covid-19 pandemic, a prospective cross sectional study of 833 medical school staff in Thailand, including healthcare and non-healthcare workers, showed a self-reported prevalence of 54% adverse skin reactions to surgical and cloth masks.6

Typically, a patient presents with new onset facial eruption, or exacerbation of a pre-existing dermatosis that is most pronounced in the area covered by the mask. Ideally, such an assessment would take place in person, but video consultation provides an acceptable alternative.

Relevant history and family history of skin disease and a comprehensive drug history that includes prescribed, over-the-counter, and complementary medicines

Temporal relationship with mask wearingestablish if periods without mask wearing alleviate or improve the problem, eg, allergic contact dermatitis should improve with a period of no mask wearing, while acne, once established, may not respond so readily

Symptoms of itch, soreness, and appearance of pustules or papules

Duration of PPE exposure each day

Ask if mask breaks (periods of time when facial PPE is removed entirely) are allowed or taken

Assess the impact on the patients mood, work, and social life to assess severity and decide further management. The effect of PPE related dermatoses on the life quality of healthcare workers can be substantial3

Examination should focus on the morphology of the eruption, the distribution, and whether it is present at sites other than the face.

Each condition described below may appear de novo or be exacerbated by wearing facial PPE. Exacerbation tends to result from the development of a warm, moist, occlusive environment around the face, particularly during mask use. Added to this is the frictional effect of the material held in place with elastic.

General measures to prevent PPE related facial dermatoses are outlined in the box and are advised in the treatment of all conditions listed below. Additional standard medical treatment for each dermatosis is discussed separately. When post-inflammatory hyperpigmentation or scarring occurs, a more aggressive treatment approach is required to prevent irreversible skin changes. Referral to specialist care is warranted at this stage if no improvement occurs.

Irritant contact dermatitis (ICD) is the most common occupational and mask related dermatosis.3 ICD is a form of exogenous eczema caused by direct physical or chemical injury. Pressure ICD related to facial masks is commonly described4 over the cheeks and nasal bridge.35 It is associated with prolonged mask wearing (>6 hours) and its severity depends on the irritant and chronicity of exposure.3 Presentation ranges from a discrete, dry, scaly patch to oedema and vesicles, erosions, and ulceration.35 People with atopic dermatitis, who already have a defective skin barrier, are particularly at risk of developing ICD.7

Enabling restoration of the skin barrier is key to treating ICD, and regular mask breaks (every hour for respirators) is one way to do this.8 For broken skin, a silicon backed dressing such as Mepilex Border Lite can be applied to protect the skin and ensures that the mask seal remains intact.9

Allergic contact dermatitis (ACD) (fig 1) is a delayed type IV hypersensitivity reaction to an external allergen, and is much less common than ICD.910 Typically, it occurs after exposure to preservatives such as formaldehyde11 and dibromodicyanobutane,12 but thiuram, a rubber accelerator found in the elastic straps on surgical masks,13 is also a recognised allergen. Metal wires are used to mould the mask to the face; nickel and cobalt have both been reported as causes of facial ACD.14

Allergic contact dermatitis

ICD and ACD can be clinically indistinguishable. Both usually manifest as localised dermatitis but well demarcated areas of inflammation and redness are more suggestive of ACD, while a more diffuse pattern is more commonly seen in ICD. Treatment involves a short course of a mild to moderate potency corticosteroid, such as hydrocortisone 1% ointment. Avoiding allergens prevents further episodes, and therefore identification of causative agents is key. This can be achieved by patch testing, indicated where well demarcated areas are seen clinically and in cases of severe disease.

Atopic eczema is a very common dermatitis that affects up to 20-30% of children and 2-10% of adults.15

Wearing a mask may have an irritant effect on the more delicate facial skin of a patient with eczema, plus the occlusive, moist environment favoured by mask wearing may have a deleterious effect on the skin, favouring the worsening of eczema.

This dermatosis (fig 2) affects approximately 1-3% of the adult population and usually starts in young adult life.16 On examination, a dermatitis with greasy yellow scale predominantly affecting the scalp, eyebrows, glabellar, and nasolabial folds is common. Management involves regular antifungals such as ketoconazole 2% shampoo and/or short courses of mild topical corticosteroids such as hydrocortisone 1% ointment.17 As with atopic eczema, the warm, moist, occlusive environment created by mask wearing may predispose to development of seborrhoeic dermatitis.

Periorificial dermatitis consists of a patchy erythema with tiny papulopustules, affecting the periocular and perioral skin of young women (with sparing of the vermilion border). It can be idiopathic, or is caused by the use of cosmetics or topical corticosteroids directly or indirectly (via fingers that are applying the agent elsewhere). Mask wearing may predispose to the development of periorificial dermatitis for reasons similar to those listed for atopic and seborrhoeic dermatitis. Management involves stopping the implicated cream and simplifying the skin care regimen. Topical antibiotics such as erythromycin will suffice for milder cases but often a four week course of a tetracycline, such as lymecycline 408 mg once daily, is needed.18

Both pressure and contact urticaria (fig 3) are uncommon complications of PPE.1119 Pressure urticaria is caused by the downward pressure of the mask and is characterised by the formation of wheals, immediately or delayed (4-6 hours), after a pressure stimulus. A well fitted mask that is not over tight is recommended, or alternatively a change in PPE.19

Contact urticaria is an immediate reaction to an offending allergen such as latex or formaldehyde. It typically resolves within 24 hours of removal of the contact trigger. Regular non-sedating H1 antihistamines such as loratadine are the mainstay of treatment for inducible urticaria.20

Acne vulgaris (fig 4) is a chronic inflammatory disease of the pilosebaceous unit. PPE related acne, which may be considered a subtype of acne mechanica, occurs in people with a previous history of acne vulgaris as well as in those previously unaffected. It has been associated with surgical masks and N95 respirators.2321

The pathogenesis of PPE related acne is thought to be threefold:

Creation of a humid microclimate inside the mask

Mucosa can be colonised by bacteria which could increase bacterial load on the surrounding skin

Friction effect of a close fitting mask can damage the follicular ostia causing chronic irritation, and this effect is worsened by heat and humidity.22

Retinoids such as adapalene cream alone or in combination with benzoyl peroxide cream once daily can be used for mild cases, with the addition of an oral tetracycline such as lymecycline 408 mg once daily for up to 12 weeks for moderate to severe cases.23

Rosacea (fig 5) typically affects adults aged 30-50 with fair skin.18 Commonly, patients present with facial erythema and telangiectasias of the convexities (chin, cheeks, nose, forehead). The classic area of distribution of rosacea overlaps with that covered by a mask when worn correctly. The chronicity and presence of telangiectasias usually help to distinguish rosacea from peri-orifical dermatitis. Rosacea can be induced or worsened by prolonged periods of mask wearing. Medical treatment includes topical agents such as ivermectin 1% cream once daily for mild cases. An oral tetracycline such as moderate release doxycycline 40 mg once daily for 8-12 weeks can be added for moderate to severe cases.24

Folliculitis (fig 6) on the face is more common in men because of its association with facial hair. Occlusive folliculitis, bacterial folliculitis, and pseudofolliculitis barbae (caused by ingrowing hairs) have clinically similar presentations with papules, pustules, and more rarely nodules. A swab can exclude bacterial infection. Gentle daily cleansing with a soap-free cleanser, gentle exfoliation (to release ingrown hairs), and replacing dry shaving with wet shaving can all be helpful. Antibiotic treatment is indicated where bacteria are isolated; in purely inflammatory (sterile) cases, a combination steroid/antimicrobial cream can be used.25

Cleanse skin26 with a gentle soap-free cleanser

Apply a light emollient at least 30 minutes before applying facial PPE26

Apply a silicon based barrier tapeeg, siltape (Advancis)to nasal bridge and cheeks49

Wipe skin under PPE with a silicon based barrier wipe to provide a film, protecting the skin from the harmful microenvironment26

Take time to fit the mask and ensure it is not over tight26

Take regular breaks from the mask (every one hour for respirators) to relieve the pressure and prevent moisture build up26

Stay well hydrated26

Maintain oral hygiene (teeth brushing twice daily and daily interdental flossing/brushing)27

Consider referral to secondary care in cases of severe, debilitating disease, or if the condition fails to respond to the treatments described above. Also consider a routine referral if specialist investigations, such as skin prick testing and patch testing in cases of suspected contact allergy, are indicated.

Consider how a facial dermatosis affects the patients quality of life, work, and relationships

Reflect on whether you incorporate considerations of different Fitzpatrick skin types in your treatment decisions, given the higher risk of post-inflammatory dyspigmentation and/or scarring in darker skin types

Consider the occupational implications of the diagnosis and treatment for the patient, and discuss these as part of the consultation

Signpost patients to the British Association of Dermatologists website as a useful repository of good quality reliable patient information leaflets on skin conditions (https://www.bad.org.uk)

This article was reviewed by two healthcare workers who had experienced PPE related facial dermatoses and whose experience of receiving care informed the content of this article. Specifically, they advised on the content of the box General measures to prevent PPE related facial dermatoses.

We obtained evidence using a systematic search of Medline, Embase, and Pubmed. Searches were confined to those publications written in the English language. Search terms used were facial dermatoses and mask, facial dermatoses and PPE, acne and PPE, acne and mask, eczema and mask, allergic contact dermatitis and mask, FFP3 mask and skin, N95 mask and skin.

Read the original post:
Mask related acne (maskne) and other facial dermatoses - The BMJ

Photo-Illustration: Courtesy of retailer

Editors note: Our beauty writer Rio Viera-Newton first wrote a version of this post in October 2019, when Tatcha had a very rare sitewide sale. And starting today, Wednesday, June 9, Tatcha is having another (but still fairly rare) sitewide sale. This time, its called the Summer Celebration, and many of Rios favorites are 20 percent off with the code SUMMER21. So were republishing her post to help you shop the sale smartly. But dont dillydally: It ends on Friday, June 14.

Tatcha was one of the first high-end skin-care brands I fell in love with. During some of my most brutal skin phases, Tatcha products have single-handedly saved my complexion from bad breakouts, dullness, and dryness. They also have some of the best dewiness-inducing, radiance-boosting, pre-event skin care Ive ever used. What I love about Tatcha is that while the products are incredibly effective, theyre equally gentle you get results without harsh chemicals or skin irritation.

Of course, theres a downside: Tatchas goods are horrifyingly expensive. Their Indigo Cream may have made my dry, eczema-prone skin supple and soft last winter, but paying $85 to re-up became unsustainable. And while the Silk Primer rid me of my fear of primers (they usually make me break out, and this one decidedly did not), 0.7 ounces of it will cost you a shocking $52. Are you upset? Ready for some good news? Here it is: Tatcha is having a 20 percent sitewide Summer Celebration sale from now through June 14, if you use the code SUMMER21 at checkout. (Note that sets are excluded from the sale.) If youre overwhelmed or curious where to start, Im here to help. I created a list of all my favorite products from the Tatcha sale some you may recognize from previous articles, others are new friends.

This Dewy Skin Cream from Tatcha has quickly become on my all time favorite pre-makeup skin-prep heroes. After applying this cream, youll instantly notice that your skin looks plumper, brighter, and intensely nourished. I have super-temperamental, eczema-prone skin that loves to curse me with flakey dry patches as soon as the temperature drops below 70 degrees. This cream heals any of that and gives me the glowy skin base of my dreams. Plus, makeup glides over it like a dream. This is a must-have for all dewy-skin enthusiasts or makeup lovers.

One of my all-time favorite, pre-event staples is this Violet-C Vitamin C Radiance Mask. Just to get this out of the way: This mask is the most beautiful violet color, so taking photos in it is super-fun. But apart from the aesthetic delights of this product, it has awesome skin-brightening and skin-nourishing ingredients. This mask is packed with green tea, algae, and rice for anti-aging, skin-softening, and hydrating benefits, as well as two types of vitamin C (oil soluble and water soluble), so make sure your skin is getting that antioxidant protection and serious radiance boost.

As someone with super-dry, irritable skin, I love an essence. If you havent yet incorporated an essence into your routine, its a great supplementary step to ensure your skin is getting as much moisture and nourishment as it needs after exfoliating. This essence from Tatcha I tried a little while ago and fell in love with. Much like that of the dewy-skin cream, the ingredient list includes what Tatcha deems their holy trinity: green-tea extract, algae, and rice, which, when fermented, all have amazing plumping, softening, and hydrating effects. This is great for anyone who struggles with dryness, as it doubles the skins moisture intake.

This is one of the best nighttime moisturizers I have ever used. Its very rich, but it absorbs into the skin quickly and so doesnt leave you feeling greasy or sticky. The products blend of oatmeal and Japanese indigo is calming and reparative and has helped me calm redness from breakouts and eczema. For anyone with dry, acne-prone skin, this is a must-try.

When it comes to face mists, this one is the one to try.On rushed, no-makeup mornings, I sometimes use this as the only step in my routine: A few spritzes on clean skin provide nourishment and moisture and make my face look super-bright and dewy.On full-on glam makeup days, I use this as my final, makeup-setting step. It makes everything melt into my skin and gives a perfect, flawless finish.

I wrote a full-length review of this product, so if you want the nitty-gritty, read it. But very long story short: This is one of the only primers Im willing to use. Not only does this never, ever make me break out, it also keeps my makeup looking frighteningly fresh and flawless like Ive just applied it all day long.

If youre looking for a great everyday sunscreen, this one is definitely worth buying. It absorbs super quickly into the skin and doesnt leave a white cast. Plus, after you apply, makeup glides on super easily on top of it. It also has a slight matte-ifying effect on the skin, so it wont leave you looking greasy which I think we all can agree is unique for an SPF. The sunscreen is sold out in the full-size version, so we included the travel-size here.

This lip balm is not only the perfect gift (it has pretty gold flakes in it), its also really effective. Apparently Japanese female free divers have used camellia oil (the main product in this balm) for thousands of years to protect their skin and hair from the salty ocean water. I can see why: This super-thick and creamy lip balm does a truly incredible job at soothing and healing chapped lips. It is probably my second-favorite chapstick of all time, right after my beloved Bite Agave Lip Mask.

This is a physical not a chemical exfoliant. Though it is technically a scrub, it is incredibly gentle it contains rice bran and papa enzymes and transforms into a foam when you add water to it. Tatchas ethos is, essentially, that doing small things for your skin every day will give you the best results (instead of using super-intense chemical exfoliants, in other words). This product is the definition of that: Itll never make your skin red and dry, but it will make it noticeably smoother within just one use.

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These Are My Favorite Things from Tatchas Summer Celebration - New York Magazine

If you or a loved one is living with eczema or atopic dermatitis, you probably know the importance of having a good skin care routine.

Eczema is a chronic condition that can flare when youre exposed to environmental triggers. Atopic dermatitis is a type of eczema characterized by dry skin, scaly patches, itching, and sores.

Keeping the skin moisturized can help prevent eczema flares and provide some relief when flares occur. By developing a routine that works for you, you can help ensure that you keep the skin moisturized and protected against future flares.

Keeping your skin moisturized can help to prevent itching, irritation, and thickening of the skin. In fact, in mild cases, dry skin is the primary symptom of eczema, and a good skin care routine can help keep symptoms suppressed.

In other cases, managing symptoms may require additional precautions and treatments. Whether your eczema is mild or more severe, the starting point for most routines focuses on:

One of the most important steps you can take is getting into the habit of moisturizing your skin immediately following a shower or bath.

According to the National Eczema Association, if you dont immediately apply moisturizer after bathing, the water in your skin will evaporate. This will then cause it to dry out.

During a bath or shower, you should avoid hot water. Lukewarm water helps your skin absorb some of the moisture.

You should also avoid scrubbing or using harsh soaps on your skin. Then, apply moisturizer within 3 minutes of getting out of the shower to help create a barrier to lock in the moisture, per the National Eczema Association.

The American Academy of Dermatology Association doesnt fully discourage baths, especially for children. They state that bathtime can provide an opportunity for parents and children to bond and can remove bacteria and dead skin cells.

However, you should keep baths and showers short. According to a 2018 review, researchers recommend daily bathing or showering that lasts between 5 and 10 minutes.

Eczema can get worse when you come in contact with irritants or triggers. One part of a good skin care routine should be taking active steps to avoid contact with known triggers.

If you dont know what triggers you have, you may want to keep a journal to help you determine the possible cause of your flares. This way, you can potentially avoid them in the future.

Also, keep in mind that not all triggers come from chemicals or irritants.

For example, the National Eczema Association states that cold, dry air can trigger an eczema flare. During the winter, you may need to change your routine a bit to help keep your skin protected.

No two cases of eczema are exactly alike. As a result, what works for some people may not work as well for you, and vice versa.

In an article for the National Eczema Association, dermatologist Margaret Lee notes that you may find relief with products not specifically designed for eczema care. For example, you might find that vegetable shortening or petroleum jelly helps to rehydrate and relieve the pain and itchiness associated with a flare.

Once youve established a routine with one or more products that work, you should consider writing down the routine to help keep it going.

If youre caring for a child with eczema, having the routine recorded can help in case someone else needs to take over responsibility for the routine.

Moisturizers are one of the most important parts of a skin care routine. But not all moisturizers are created the same way, and some provide better benefits than others.

According to the National Eczema Association, ointments and creams are the most effective moisturizers you can use for treating eczema. The reason is that ointments and creams have a higher oil content than lotions.

Oil has two effects on the skin. The first is that it keeps moisture in. The second is it helps keep irritants out.

Several brands, like Aveeno, offer moisturizers designed specifically for eczema. When looking for moisturizers, you should avoid ones that have added fragrances, dyes, or other ingredients that may irritate your skin.

You also want to include gentle cleansers, like CeraVe, in your routine. Keeping your skin clean will help prevent dry, cracked areas of skin from getting infected.

Finally, if youre seeing a dermatologist for treatment, you should discuss which medications may be best for you and ensure that you use them according to the prescribed instructions for the best results.

Certain substances can make eczema worse. The National Eczema Association recommends avoiding skin care products with the following ingredients:

When buying skin care products, check the labels to look out for the ingredients listed above. You can also look for a product with the National Eczema Association Seal of Acceptance on it. This will help you avoid products that contain these known irritants.

Outside of skin care, other substances you might come in contact with may make eczema worse. The National Eczema Association recommends avoiding the following common triggers:

While it helps to avoid topical substances and chemicals, remember these arent the only triggers. You may also want to avoid:

Your routine will vary based on your triggers and what youre planning to do each day. For more specific guidance, talk with your dermatologist to see what they recommend for you.

You should aim to moisturize your skin 2 to 3 times per day.

One of the most important parts of eczema care is keeping your skin moist. You should also take steps to avoid triggers, which can help you prevent flares.

Your skin care routine should consist of plans for when youll moisturize your skin as well as ways to help protect it. Your routine will likely differ from that of other people, depending on your current needs.

If you have trouble developing an effective routine, you should work with your doctor. They can provide you with more specific recommendations that may help your individual situation.

Read more:
How to Build an Eczema Skin Care Routine: Tips and More - Healthline

A WOMAN has revealed she was forced to quit her job because of extreme pain - after ditching her eczema steroids.

Andrea Cisneros, from the US, used topical steroid creams to treat her eczema but was left in agony when she came off them 18 months ago.

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She eventually had to leave her job as a dental hygienist and lost her flat, all due to topical steroid withdrawal.

At her worst, she was bed-ridden for months, with her skin oozing, her sheets covered in blood and showers making her cry from the pain.

She says: "I wished I would die because the pain and discomfort were unbearable, especially at night; when I would scream from pain."

I wished I would die because the pain and discomfort were unbearable, especially at night; when I would scream from pain

Topical steroids are commonly prescribed on the NHS and remain one of the most effective ways to treat eczema.

But they should be a short-term solution and if over-used, they can lead to horrible TSW reactions like Andrea experienced.

Now a holistic health coach, Andrea shared her story on Facebook earlier this month.

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She wrote: "For the past 18 months Ive been suffering from Topical Steroid Withdrawal (TSW), a condition that is 100% iatrogenic (meaning caused by medication; in this case topical steroids).

"I went into TSW when I stopped using steroids. TSW is not a choice; the steroids stopped working and worsened my initial condition (eczema).

"Steroids cause nerve and blood vessel damage I eventually had to stop working and move out of my apartment.

"Working with TSW was tough; it was so difficult to open my eyes in the mornings, I was weak, napping during my breaks, had swollen ankles, my clothes were sticking to my skin and showers would cause me to cry from excruciating pain I spent about 9 months limping/hunched over because the wounds on the back on my legs/body were so bad.

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"I spent several months bed ridden (not being able to sit) & oozing out of control, only getting up to use bathroom and wishing I would die because the pain and discomfort were unbearable, especially at night; when I would scream from pain.

"My mom would change my sheets and do laundry on a daily basis because my sheets would get wet from blood and ooze.

"I had to wake up to change my clothes every 2 hours; this was awful because it was difficult to move, my skin was extremely sensitive to air and I had intense chills. (During the summer I couldnt wear any clothes).

What is topical steroid withdrawal?

Topical steroid creams have been used to treat eczema for more than 50 years and, according to the National Eczema Association, remain among the most effective and widely used drugs in dermatology.

They tend to be prescribed to patients whose eczema has stopped responding to other treatments and management methods.

You're not supposed to use them continuously for more than two to four weeks, after which, patients are told to use them no more than twice a week.

TSW happens when you've used topical steroids too much and the skin then starts flaring up worse than ever the moment you stop using them.

Overuse of topical steroids can also lead to the thinning of skin.

Symptoms include:

Signs appear within days of stopping treatment

"The bed and the the floor would be covered with a disturbing amount of skin flakes everyday.

"Other symptoms included bone-deep itch, muscle twitching and hair loss.

"After 1 year of not working, I started working from home (minimum wage job - which was upsetting after having worked hard to obtain my DH degree).

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"Its been a year a half since I last worked as a dental hygienist and I miss it!

Thank you to those who have reached out for work opportunities, but Im still healing and not ready to return...

"During this process I obtained my health coaching certification and I cannot wait to work with more of you and be a part of your healing journeys".

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I had to quit my job after ditching eczema steroids my sheets were covered with blood & showers made me c... - The Irish Sun

Skin fissures are cracks in the skin that form due to intense dryness and thickened skin. Fissures can be shallow or deep, and they may bleed or be painful.

In addition to being uncomfortable, fissures can be a precursor to skin ulcers. For this reason, treating skin fissures before they worsen is important.

This article explores what causes skin fissures, how doctors can treat them, and how people can aid the healing process at home.

Skin fissures are cracked areas of skin. They can occur anywhere on the body but most commonly occur:

The visible signs of skin fissures include:

Skin fissures can cause pain because of the cut in the skin. Additionally, irritants can enter the fissure, causing more discomfort.

Skin fissures can be either superficial or deep. Superficial fissures are small cracks that do not penetrate the deeper layers of the skin, while deep fissures do penetrate the deeper layers.

Skin fissures develop as part of a progression of symptoms:

A variety of underlying conditions can contribute to this, which include the below.

The body relies on nutrients to maintain healthy skin. Inadequate food intake or nutrient levels can lead to skin disorders, including fissures.

Examples of nutrients that the body needs to maintain healthy skin include:

If a person has nutritional deficiencies, the skin may lose moisture or take longer to heal from wounds.

Skin conditions that cause inflammation, itching, and dryness can also make fissures more likely. These conditions include:

Treating or managing skin conditions can help reduce the risk of fissures. How doctors and patients approach this depends on the type and cause of the condition.

For example, if a person has eczema due to an allergen, avoiding the allergen or taking antihistamines may help. By contrast, treatment for psoriasis may involve medications or phototherapy.

Learn about the different types of eczema.

Fungal infections on the skin, such as athletes foot, can cause a dry, flaky, or itchy rash. This may increase the risk for skin cracking and fissures.

Those with diabetes are at greater risk for skin fissures on the feet, according to a 2017 study.

People with diabetes are vulnerable to nerve damage in the feet, which is known as autonomic neuropathy. This damage means the nerves are less likely to sense the need for the feet to sweat. The lack of sweating creates a very dry environment that can allow skin fissures to form.

Another potential cause of skin fissures is angiopathy, which refers to damage to blood vessels, including veins and arteries.

Doctors do not know why angiopathy increases the risk for skin fissures. However, if blood cannot reach certain parts of the skin, it may affect skin health and slow wound healing.

In addition to specific medical causes, factors in a persons lifestyle or daily routine may exacerbate dry skin, leading to fissures. These include:

Treatment for skin fissures can depend on how deep they are.

For superficial skin fissures, doctors may recommend a self-care regimen that encourages fissures to heal and prevents new fissures from forming.

This may involve:

People with athletes foot or other fungal infection may also require an antifungal cream, which they can buy over the counter.

While there are open fissures, people should use a suitable moisturizer 23 times per day.

A good moisturizer for areas of dry and cracked skin may include a number of active ingredients, such as:

For deeper skin fissures, doctors may use:

If a person has fissures on their heels, supportive insoles or heel pads may be necessary to reduce pressure on the skin.

If fissures are frequent, recurring, or do not heal on their own, a doctor may investigate whether an underlying health condition could be the cause.

Do not forcibly attempt to remove dry or thick skin at home only a qualified professional should do this. However, there are several things people can do at home to help fissures heal. These include:

In general, people can also follow these measures:

A person should seek help from a doctor if their skin fissures worsen or do not respond to home treatments. Early treatment can prevent fissures from turning into a skin ulcer, which is significantly harder to treat.

People should also speak with a doctor if they experience:

Skin fissures are cracks in the skin that typically occur in areas that get dry, thick, or calloused, such as the heels. Many factors can cause them.

It is important to treat skin fissures promptly. Deep fissures can develop infections or lead to ulcers. A doctor can provide dressings, ointments, and moisturizers to help fissures heal.

Go here to see the original:
Skin fissure: Causes, treatments, and how to heal - Medical News Today

People living with a chronic condition may feel as if it controls their lives. The discomfort, misery and pain some patients may feel both physical and psychological can keep them from living life to the fullest. Monitoring symptoms, taking medications and attending regular appointments can make managing a condition feel like a full-time job.

Many of the technologies we quickly adopted as a society to continue working and socializing during COVID-19 can make it easier for people with chronic conditions to access care and manage symptoms long-term.

The pandemic has contributed to flare-ups or a worsening in condition for many people living with chronic inflammatory conditions such as the 65 million1 around the world suffering from atopic dermatitis (also known as eczema), the 10 million2 living with an inflammatory bowel disease, and others. For this and other reasons, telehealth use in general has increased by as much as 4,000%3 in the U.S. alone since the onset of the pandemic.

Through our relationships with the patient community, we believe that many patients could find telehealth visits significantly reduce the time and disruption regular doctor appointments may cause in turn reducing the burden of managing their disease. Moving forward, we must advocate for policies that ensure continuity of care for patients that includes equal support for virtual and in-person options.

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Technology has driven patient-centric innovationwe must keep it going if we hope to improve outcomes and quality of life - Modern Healthcare

MISSISSAUGA, ON, June 1, 2021 /CNW/ - Sanofi Canada is very pleased to announce that Quebec has extended its listing of DUPIXENT (dupilumab injection) under the Rgie de l'assurance maladie du Qubec (RAMQ) to include public reimbursement for Canadians aged 12 years and older whose disease is not adequately controlled with topical prescription therapies or when those therapies are not advisable. The specific criteria for reimbursement are available on the RAMQ website.

"I would like to thank the Rgie de l'assurance maladie du Qubec for their partnership to extend its provincial listing of DUPIXENTto younger Quebec residents living with atopic dermatitis," says Marissa Poole, Country Lead, Sanofi Canada and General Manager, Sanofi Genzyme Canada. "In its moderate-to-severe form, atopic dermatitis can be a devastating condition to live with, and particularly impactful for adolescents. We support the extension of coverage and timely access to reach a younger age demographic to help them control and provide relief for this life-altering, often severely debilitating, chronic disease."

AD, the most common form of eczema, is an inflammatory disease classified by dry, itchy skin. In its moderate-to-severe form, it is characterized by rashes that can cover much of the body, and can include intense, persistent itching, skin lesions and skin dryness, cracking, redness or darkness, crusting and oozing.iInadequately controlled AD can have a physical, emotional and psychosocial impact, causing sleep disturbance, symptoms of anxiety and depression, and feelings of isolation.ii

"The signs and symptoms affecting young patients with moderate-to-severe atopic dermatitis have a strong impact on their quality of life and that of their families, which is often more difficult to bear in this age group," explains Dr. Danielle Marcoux, clinical professor at the Universit de Montral and the Centre Hospitalier Universitaire Sainte-Justine, Department of Pediatrics, Division of Dermatology. "Access to a treatment that specifically addresses the underlying cause of this disease is a positive step in helping young Quebecers affected by moderate-to-severe atopic dermatitis."

About DUPIXENT

DUPIXENT is a fully human monoclonal antibody that inhibits the signaling of the interleukin-4 (IL-4) and interleukin-13 (IL-13) proteins and is not an immunosuppressant. Data from DUPIXENT clinical trials have shown that IL-4 and IL-13 are key and central drivers of the type 2 inflammation that plays a major role in AD.iii

Since its initial approval in 2017, DUPIXENT remains the only biologic medicine approved by Health Canada for the treatment of patients six years and older with moderate-to-severe AD whose disease is not adequately controlled with topical prescription therapies or when those therapies are not advisable. DUPIXENT is also approved in Canada for the treatment of adult patients with severe chronic rhinosinusitis with nasal polyposis (CRSwNP) and for the treatment of severe asthma in patients 12 years and older.iv

DUPIXENT is jointly developed by Sanofi and Regeneron under a global collaboration agreement.

About Sanofi

Sanofi is dedicated to supporting people through their health challenges. We are a global biopharmaceutical company focused on human health. We prevent illness with vaccines, provide innovative treatments to fight pain and ease suffering. We stand by the few who suffer from rare diseases and the millions with long-term chronic conditions.

With more than 100,000 people in 100 countries, Sanofi is transforming scientific innovation into healthcare solutions around the globe.

Sanofi entities in Canada employ approximately 2,000 people. In 2018, we invested more than $127 million in R&D in Canada, creating jobs, business and opportunity throughout the country.

Follow us on Twitter @SanofiCanada and on YouTube.

Sanofi, Empowering Life

References

SOURCE Sanofi Canada

For further information: Media Relations Contact: Marissa Smith, Tel: +1 (416) 892-2158, [emailprotected]

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Quebec extends public reimbursement of DUPIXENT (dupilumab injection) for the treatment of moderate-to-severe atopic dermatitis to include adolescents...

NEW YORK (CBSNewYork) Millions of children and adults in the U.S. have to cope with the constant itching of eczema. And all that scratching can lead to bleeding and infections.

A new technology can finally measure just how much someone is scratching and help to better treat patients, CBS2s Dr. Max Gomez reported.

Jan-Kai Chang said his daughter Cynthias eczema is so bad that sometimes the five-year-old scratches until she bleeds.

We tried to ask her to stop scratching when she feels itchy. But you can imagine that its too hard, Chang said.

The itching can be unbearable for the 10 million kids and 16 million adults with atopic dermatitis (eczema). But its a challenge to actually measure how much someone is scratching.

Researchers at Northwestern University have developed a first-of-its-kind wearable sensor that can quantify itching by measuring scratching.

Its sort of an old saying. If you cant measure it, you cant manage it,' said Northwesterns Dr. Steve Xu.

The soft, flexible, wireless device measures vibrations from the hand and can capture all forms of scratching finger, wrist and elbow motion related.

An algorithm picks out just scratching and doesnt flag similar movements, like waving. A study validating its accuracy was recently published in Science Advances.

Dr. Xu said having an objective measure of scratching can lead to better care for itchy conditions.

If things look like theyre getting worse, that might require a treatment change, a treatment adaptation, Xu said. And also can reinforce that something is working right, that this child is scratching less, sleeping better.

Cynthia took part in the sensor testing and her dad said they learned a lot.

When its windy, we have to apply a lot of topical lotion, moisturizer before she went to bed, Chang said. And that can significantly reduce the scratching time.

While the sensor was tested in patients with eczema, it can be used with any condition that causes children and adults to itch.

Researchers expect the sensor to be widely available as soon as the end of this year.

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Researchers Develop Wireless Sensor That Measures Scratching To Improve Eczema And Other Anti-Itch Treatments - CBS New York

Systemic alitretinoin is safe and effective for patients with moderate to severe chronic hand eczema (CHE) that is refractory to standard therapy with potent topical corticosteroids, according to study findings published in Dermatologic Therapy.

The DECISA project (Dermatology Clinics in Italy: Survey on Alitretinoin), a retrospective cohort study conducted in 15 Italian dermatology clinics, sought to collect clinical data for patients with CHE unresponsive to potent or super-potent topical corticosteroids. All participants were treated with oral alitretinoin 30 mg daily for 6 consecutive months.

Investigators assessed patients disease severity at baseline and after 3 and 6 months of treatment with use of the 5-point Physician Global Assessment (PGA) and the modified Total Lesion Symptom Score (mTLSS).

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A total of 438 patients (mean age, 49.7113.20 years; 248 men, 56.6%) were enrolled from 2010 to 2018. Within the cohort, irritant contact dermatitis (ICD) was diagnosed in 189 cases (43.2%), allergic contact dermatitis (ACD) in 97 (22.2%), and atopic dermatitis in 79 (18.0%). Eczema was considered mixed type (ICD/ACD) in the other 73 patients (16.7%).

At baseline, 364 patients (83.1%) had a severe PGA score (4), and 74 (16.9%) had a moderate score (3). The mean mTLSS score was 12.86 (2.76). After 3 months, 420 patients were re-evaluated, and the decrease in mTLSS score was significant compared with baseline (6.293.27, P <.0000001). The PGA score was clear (0) in 33 cases (7.5%), almost clear (1) in 123 (28.1%), mild (2) in 101 (23.1%), moderate (3) in 130 (29.7%), and severe (4) in 33 (7.5%), confirming the improvement (P <.0000001 vs baseline). There were 26 nonresponders (5.9%).

After the first follow-up, 350 patients continued alitretinoin treatment, and 341 (97.4%) were re-evaluated after 6 months, at which time the PGA score was clear in 85 cases (24.9%), almost clear in 117 (34.3%), mild in 56 (16.4%), moderate in 59 (17.3%), and severe in 24 (7.0%). The mTLSS score was not assessed in 23 cases, and in the remaining 318 cases, the average score was 4.32 (3.29). The improvement of both scores was evident compared with scores at baseline and the 3-month visit (P <.0000001 in all comparisons), according to the study authors.

After 6 months of alitretinoin treatment, 125 patients had relapses and another course of treatment was prescribed for 58 of them.

Side effects during treatment were reported by 17.6% of patients (n=77), and 7.1% (n=31) discontinued treatment owing to these effects. After the study authors applied the worst case scenario criteria for the 9 patients lost at follow-up and assessed them as though they had experienced adverse effects that had forced them to discontinue treatment, the percentages were 19.6% and 9.1%, respectively.

In a majority of cases, the type of side effect was not reported in the database; headache was the most common side effect among those that were reported, occurring in 12 patients, followed by dyslipidemia in 4 patients.

These statistical trends and significant associations deserve, in our opinion, further investigation in larger and different populations, and, if confirmed, could give an important contribution to the definition of the risk profile of patients who undergo treatment with alitretinoin for CHE, the researchers commented.

Ferrucci S, Persichini P, Gola M, et al. DECISA Project (DErmatology Clinics in Italy: Survey on Alitretinoin): a real-life retrospective cohort multicenter study on 438 subjects with chronic hand eczema. Dermatol Ther. Published online February 22, 2021. doi:10.1111/dth.14911

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Alitretinoin a Treatment Option for Chronic Hand Eczema - Dermatology Advisor

BALLERUP, Denmark--(BUSINESS WIRE)--NOT FOR DISTRIBUTION IN THE UK OR IRELAND

LEO Pharma A/S, a global leader in medical dermatology, today announced it has enrolled the first adult patient in the first of two pivotal Phase 3 clinical trials with delgocitinib cream, an investigational topical pan-Janus kinase (JAK)-inhibitor, for the potential treatment of adult patients with moderate-to-severe chronic hand eczema (CHE).

Delgocitinib inhibits activation of the JAK-STAT pathway, which plays a key role in the immune system in driving the pathophysiology of chronic inflammatory skin diseases.1,2 The cream formulation of delgocitinib is an investigational therapy under clinical development and has not been approved by any regulatory authority.

The primary objective for the randomized, double-blind, vehicle-controlled, multi-center Phase 3 clinical trials (DELTA 1 and DELTA 2) is to evaluate the efficacy of twice-daily applications of delgocitinib cream 20 mg/g compared with vehicle in the treatment of adults with moderate-to-severe CHE.3,4

The primary endpoint of the trials is the Investigators Global Assessment for chronic hand eczema treatment success (IGA-CHE TS) at Week 16.3,4 Treatment success is defined as an IGA-CHE score of 0 (clear) or 1 (almost clear) with at least a two-step improvement from baseline.3,4

Key secondary endpoints at Week 16 include reduction of itch and pain scores of 4 points measured by the Hand Eczema Symptom Diary (HESD) from baseline to Week 16,3,4 as well as at least 75% improvement from baseline and at least 90% improvement from baseline on the Hand Eczema Severity Index (HECSI) at Week 16.3,4 The number of treatment-emergent adverse events per patient from baseline to Week 16 defines the key safety endpoint of the trials.3,4

"Managing moderate-to-severe CHE is challenging because of limited available treatment options for chronic use, said Dr. Sibylle Schliemann, Consultant, Department of Dermatology, University Hospital Jena, Germany and lead investigator for DELTA 2. These trials will evaluate whether delgocitinib cream can potentially offer a new treatment option for adult patients with moderate-to-severe CHE who suffer from a considerable burden of disease.

CHE is defined as hand eczema (HE) that lasts for more than three months or relapses twice or more within a year.5,6 HE is the most common skin disorder of the hands7 that affects an estimated 1 5% of the general population8 with a one-year prevalence rate of approximately 10%.9 It is an inflammatory, non-infectious skin disorder of the hands and wrists5,10 and can cause itching, blisters, swelling and pain so severe that it can impair the ability to work.5,7,11 In a substantial number of patients, HE can develop into a chronic condition.7

We have been encouraged by the positive results from the Phase 2b CHE clinical trial with delgocitinib cream and look forward to learning whether it has the potential to offer benefits to adult patients through a larger Phase 3 clinical development program, said Dr. Jrg Mller, Executive Vice President, Global Research & Development, LEO Pharma. We are committed to developing innovative therapies that may help improve the lives of patients who need more treatment options for skin diseases.

#ENDS#

About Delgocitinib

In 2014, LEO Pharma A/S and Japan Tobacco Inc. (JT) entered into a license agreement in which LEO Pharma gained exclusive rights to develop and commercialize delgocitinib for topical use in dermatological indications worldwide, excluding Japan, where JT retains rights.

In 2020, LEO Pharma completed a multi-center, randomized Phase 2b dose-finding clinical trial with twice-daily topical delgocitinib cream for the treatment of adults with mild-to-severe CHE. The company presented top-line results of the trial at the European Academy of Dermatology and Venereology (EADV) Virtual 202012 and presented the results of HECSI measurements during the trial at the American Academy of Dermatology Virtual Meeting Experience (AAD VMX) 2021.13

About LEO Pharma

LEO Pharma helps people achieve healthy skin. The company is a leader in medical dermatology with a robust R&D pipeline, a wide range of therapies and a pioneering spirit. Founded in 1908 and owned by the LEO Foundation, LEO Pharma has devoted decades of research and development to advance the science of dermatology, setting new standards of care for people with skin conditions. LEO Pharma is headquartered in Denmark with a global team of 6,000 people, serving 93 million patients in 130 countries. In 2020, the company generated net sales of DKK 10,133 million. For more information please visit http://www.LEO-Pharma.com.

References

1 Damsky W, and King BA. JAAD; 2017;76(4):736-744.

2 Virtanen AT, et al. BioDrugs. 2019;33:1532.

3 ClinicalTrials.Gov: https://clinicaltrials.gov/ct2/show/NCT04871711?term=delgocitinib&draw=1&rank=8 (Accessed May 2021).

4 ClinicalTrials.Gov: https://clinicaltrials.gov/ct2/show/NCT04872101?term=delgocitinib&draw=1&rank=7 (Accessed May 2021).

5 Lynde C, et al. J Cutan Med Surg. 2010;14:26784.

6 Diepgen TL, et al. J Dtsch Dermatol Ges. 2015 Jan;13(1):e122. doi: 10.1111/ddg.12510_1.

7 Bissonnette R, et al. JEADV. 2010;24;120.

8 Christoffers WA, et al. Cochrane Database Syst Rev. 2019;4:CD004055.

9 Thyssen, et al. Contact Dermatitis. 2010;62:75-87.

10 Menn T, et al. Contact Dermatitis. 2011;65:312.

11 Politiek K, et al. Contact Dermatitis. 2016;75:6776.

12 Worm M, et al. The topical pan-JAK inhibitor delgocitinib cream demonstrates dose response in a 16-week phase 2b trial in chronic hand eczema. Presented during the Late Breaking News session of the European Academy of Dermatology and Venereology (EADV) Virtual 2020 on 29 October 2020.

13 Soerensen P, et al. A phase 2b trial evaluating the efficacy of delgocitinib cream for the treatment of chronic hand eczema (CHE) using and validating the Hand Eczema Severity Index (HECSI). E-poster presented at the American Academy of Dermatology Virtual Meeting Experience (AAD VMX) 23-25 April 2021.

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LEO Pharma initiates the first Phase 3 clinical trial with delgocitinib cream in adult patients with moderate-to-severe chronic hand eczema (CHE) -...