Monthly Archives: June 2021

Atopic dermatitis (AD) is a chronic inflammatory skin condition caused by overactivity in the immune system. Its also known as atopic eczema, or eczema for short.

AD may be linked to other inflammatory symptoms in your body. These symptoms may lead to mental health conditions, such as depression and anxiety. The good news is, both conditions can be managed with a combination of treatments and lifestyle changes.

Read on to learn more about the connection between eczema and your mental health, as well as what you can do to help treat each of them.

Research currently shows a strong link between AD and mental health conditions. This may have several potential causes.

First, the same inflammation causing AD may also potentially cause other inflammation in the body. Inflammation may impact your brain, according to 2019 research and this may potentially lead to changes that result in depression and anxiety.

Whats more, stress and anxiety are two common eczema triggers, according to the National Eczema Association (NEA).

Stress increases production of the hormone cortisol, which can increase inflammation in your skin. Then, if you have a severe flare-up, you may feel more stressed and anxious. These feelings may affect your mental health.

Severe eczema may also cause you to feel embarrassed, and its not uncommon to want to withdraw socially as a result. This can be difficult on your overall mental well-being.

The itch and overall discomfort of an AD flare-up may also make it hard to sleep at night. Long-term sleep deprivation may increase your risk for mood disorders, such as depression and anxiety, according to 2018 research.

Depression and anxiety are the most common mental health conditions in people with eczema.

A 2017 survey by the NEA estimated that 30 percent of people are affected. In addition, people with eczema were also found to experience depression at four times the rate of the general population.

A study published in 2020 confirmed an increased risk for depression and anxiety in adults with AD, at rates of 14 percent and 17 percent, respectively.

A 2018 analysis also found a significantly increased risk of suicidal thoughts and actions in people with AD than in the general population.

This analysis included 15 studies of 310,681 people with atopic dermatitis and found that 44 percent of people with the condition had increased odds of suicidal ideation, and 36 percent had an increased likelihood of suicide attempts than people without AD.

Contact a healthcare professional right away if you have any thoughts of self-harm or suicide.

If you or a loved one is experiencing a mental health crisis, call 800-273-8255, or dial 911.

Managing your eczema may help reduce your risk for developing mental health complications. If you feel your current treatment isnt working, contact your doctor for a follow-up visit to discuss alternate options.

You should also talk with your doctor if what youre experiencing is impacting your mental health. As a rule of thumb, experts recommend getting help for mental health symptoms that last for 2 or more weeks.

These may include one or more of the following:

If youre experiencing any of the above symptoms, talk with your doctor. Depending on their findings, they may refer you to a therapist or other mental health professional for support.

Aside from using doctor-recommended or prescribed moisturizers and topical steroids for severe AD, you may need to take oral medications to help treat mental health symptoms.

These may include:

For ongoing depression and anxiety, seeing a therapist may also help. Psychotherapy (also known as talk therapy) may be especially useful in helping you reframe certain thoughts or behaviors.

You should also monitor both your eczema and mental health while taking other medications. Report any changes to your doctor.

A combination of medication and therapy may go a long way to treat a mental health condition.

Plus, there are other ways you can support your mental health and possibly reduce AD triggers, too. These may include:

Research has demonstrated a strong link between moderate to severe eczema and mental health conditions, with depression and anxiety being the most common. Some people with eczema may also be at an increased risk of suicidal thoughts and actions.

Its important to stay in touch with your doctor about both your eczema and your mental health. If youre feeling anxious or depressed for longer than 2 weeks, talk with your doctor about how youre feeling.

A healthcare professional can give you information on the available treatment options. Seek immediate help if youre having thoughts of or attempting self-harm.

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Eczema and Mental Health: What's the Link - Healthline

I am going to die. That was the phrase I repeated to myself as I sat in the passenger seat of my moms car, heart pounding, chest tighter than my clenched fists. We were driving to the emergency room because I at 15 years old was convinced I was having a heart attack.

That wasnt the first time my anxiety got so bad that I became convinced there was something gravely wrong with my body. I spent high school in a hypochondria-induced haze, fixated on every little sensation in my body and assuming Id drop dead at any second.

But the constant stress and panic went beyond racing thoughts and an ever-present sense of doom. It also seemed to be directly responsible for another chronic condition Ive dealt with most of my life atopic dermatitis (aka eczema) although it would take nearly a decade before I realized what was going on.

After all, eczema seems to be all about the skin. It caused stretches of rashes across my hands. Sometimes, they were a mild annoyance, but other times, my skin oozed and bled. The swollen welts made my fingers so stiff, I could hardly bend them.

Ointments and treatments did little to ease my symptoms. It wasnt until I faced my stress and anxiety head on that my skin finally cleared up.

Heres how I discovered the connection between anxiety and atopic dermatitis, and how getting rid of stress calmed them both at the same time.

My first visit with a therapist when I was in high school was mediocre. I left the appointment feeling no better, and wondering what the point of the session was.

Fast forward a few years later, when I moved 350 miles from home to go to college. I found myself craving a space to process the big changes going on in my life, as I learned to live on my own and buried myself in new, exciting projects.

I cycled through several therapists at the school counseling office, but eventually I connected with one who helped me unpack a lot of negative experiences in childhood that likely led to the snowball effect of anxiety taking over my teens.

One session in particular sticks out in my mind: I was explaining a particularly stressful situation Id been in, when my therapist noted, Look how youre sitting. Youre holding all this tension in your shoulders.

I was shook. I had never noticed how much my anxiety manifests in my body from my stiff posture to the way I picked at my hair and bit the inside of my cheeks when I was stressed.

I knew from experience that when I was less anxious, my stomach hurt less. When my mind wasnt racing, I could sleep better at night.

And then it clicked: When my anxiety got worse, so did my physical health a pattern that had been hidden in plain sight for years.

Seeing a therapist on a regular basis helped keep me grounded in college. It didnt make my problems go away, but gave me some solace knowing I had a place where I could feel safe talking about how I felt.

I slowly worked through my hypochondria and learned how to cope with panic attacks vital skills that helped me feel in control when my world was spinning so fast.

But during my last year of school, things took a turn for the worse. My dad passed away suddenly from a heart aneurysm the summer before my senior year of college.

Crushed by grief, I could feel my hypochondria roaring with a vengeance. And with it came one of my worst eczema flares yet, just in time for the funeral.

I remember looking down at my hands, from the base of my right-hand pinky to my wrist, my skin was oozing bright yellow liquid and burning with the need to be scratched.

When I returned to school, I focused on simply surviving the next year. Stress piled on me with every class, job, and internship I took on.

Amid the eczema flare-ups, warts grew on my hands for the first time. And just like with eczema, I turned to topical treatments to get rid of the ugly lumps, which didnt help at all.

I kept going to therapy, and started taking antidepressants, which was just enough to keep me from staying in bed every day. But my skin continued to rage, and there I was, hands constantly covered in Band-Aids as I endured the slow slog to graduation.

What happened after I gathered my diploma, however, felt like a miracle.

A few months after graduation, I was standing in the bathroom, looking at the warts on my hands. I noticed theyd lost their firmness, and some smaller ones even vanished. So I did what any anxious meddler would do I picked at them.

To my surprise, the deformed lumps fell off with ease. The months of trying to chemically rid my hands of their afflictions suddenly seemed like a waste. What was different now compared to just a few months ago?

Well, a lot, actually. I had a full-time job that kept me in a steady 9-to-5 rhythm. I didnt jam-pack my already-busy schedule with a half of dozen extracurricular activities on top of my normal work week.

In the evenings, I made dinner for myself and my partner, watched TV, and strolled around the neighborhood. And on the weekends, I got to hang around the house and rest, rather than feeling guilty about neglecting assignments or skipping social events.

Life was moving at a far slower pace than it did in school. Not only did I feel less on edge, but my skin seemed to take notice, too. Before I knew it, my eczema simply disappeared. Id finally tackled my main trigger: stress.

Without the constant demands of school, I was free from the never-ending loop of anxiety. I had more time to listen to my body and take care of it.

Today, I still get eczema flares every now and then, but now that I know they come from stress, I can take care of my mind to soothe my body. And my skin thanks me for it.

Jennifer Walter is a journalist based in Wisconsin. She writes about health, psychology, tech, and history. You can follow her on Twitter or visit her website.

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How Reducing Stress and Anxiety Calmed My Eczema - Greatist

Exposure to toxins like wildfire smoke can leave you vulnerable to skin irritation.

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For 17 harrowing days in November 2018, the deadliest wildfire in the Californias history swept across the northern region of the state. Officially dubbed the Camp Fire (named after its origin point at Camp Creek Road in Butte County), the fire continued to spread for several weeks, capturing national attention. Scientists and environmental experts recognized it as a sign of the increasing impacts of climate change on the West Coast wildfire season: As global temperatures rise, Californias already fire-prone landscape becomes more susceptible to dangerous blazes with each passing year.

For locals, the Camp Fires effects have long outlasted that initial media frenzy. Three years later, and many Californians are still working to rebuild their homes and lives. But disasters like this permeate deeper than the immediate economic damagethey also have a long-term impact on human health. A new study in JAMA Dermatology has found that wildfire smoke may trigger and exacerbate eczema symptoms, even in people with no known history of chronic skin disease.

Researchers at the University of California San Francisco collected data from dermatology visits by 4,147 people who lived in San Francisco, approximately 175 miles from the source of the Camp Fire. During the weeks when wildfire-related air pollution was highest, they discovered a significant increase in doctors visits related to atopic dermatitis (a.k.a. eczema) or itch. It wasnt just people with pre-existing eczema who developed symptoms during the wildfire, but also people who had never reported these symptoms before.

These findings illustrate one of many ways that air pollution, worsened by climate change, can aggravate (or induce) skin barrier dysfunction. Generally, conversations about climate change policy, mitigation, and prevention havent considered the effects of air pollution from wildfires on skin health, says Raj Fadadu, environmental epigenetics graduate student researcher at University of California San Francisco (UCSF) and first author of this study. Perhaps these [skin] diseases should be discussed more when thinking about the many ways in which the changing climate impacts human health.

One of the challenges in studying eczema is that its an extremely complicated health condition, and the origin and risk factors vary from person to person. Eczema (or atopic dermatitis, as it is formally known) is believed to be caused by a combination of genetics and environmental factors, both of which can compound to make symptoms worse. For instance, someone might be born with an overactive immune system (genetics), which is then triggered by external irritants like cigarette smoke or household cleaners (environment), causing an eczema flare.

The skin is a wonderful barrierthats its function, explains Maria Wei, M.D., professor of dermatology at UCSF and co-author of the wildfire study. It is a barrier against physical entities, gases, liquids, infections, and temperature [changes]. But it does have its limits, and there are ways for components of pollution to breach that barrierespecially when the skin barrier is already in a compromised state.

Exposure to pollutants contributes to eczema in several ways: oxidative stress, skin barrier dysfunction, immune stimulation, and exacerbation of itching and scratching. And different types of pollutioncar exhaust, construction zones, cigarette smokelikely have somewhat different impacts on the skin. But heres what we know: They all seem to have a very strong pro-oxidative effect, explains Raj Chovatiya, M.D., a dermatologist with Northwestern Medicine in Chicago.

These pollutants cause damage to the skin and deplete its natural antioxidant mechanisms. In addition, Dr. Chovatiya says, they can mess around with the normal skin microbiome, changing the balance of healthy cells that keeps your skin barrier strong and protective against infection. All of this, combined with the stimulation of your bodys immune response, contributes to skin irritation and eczema symptoms, and it may even trigger new symptoms in people with underlying skin sensitivity.

We know that chemical-based cleaning products (especially those with harsh ingredients or fragrances) can provoke eczema symptoms, so it makes sense that outdoor pollutants would be able to do this, too. But one major challenge researchers face is trying to sort out the specific impacts of air pollution on skin health. This is a very difficult kind of study to do in isolation, Dr. Chovatiya notes.

After all, its not like you can pick out individual air pollutants and expose people to them in a laboratory setting. We know there are a lot of different environmental factors that influence eczema, he says. Even aside from pollution, youre talking about UV light, precipitation, humidity, temperature, and other environmental factors.

So, what we see in the research is more of a case for correlation, not causationtheres a link between eczema and air pollution, but its not clear exactly how strong that link is or who is most at risk. One review in Clinical Reviews in Allergy & Immunology examined the effects of man-made outdoor pollutants like vehicle exhaust, tobacco smoke, and particulate matter on atopic dermatitis. The authors found strong evidence of a connection but emphasized the need for further research to better understand the specifics.

A 2019 literature review in the British Journal of Dermatology noted that while air pollutants pose a multifaceted threat to atopic dermatitis, the specific mechanism through which this happens is not totally clear. Similarly, this wildfire study revealed an association between wildfire pollution exposure and eczema symptoms, but the authors were not able to definitively name it as the primary cause.

Still, Dr. Chovatiya notes, the growing research on this topic is becoming more and more compelling. With the wildfire study, we have yet another piece of evidence to suggest that in addition to having negative impacts on the global environment, [air pollution] actually has a negative impact on health, he says. And targeting air pollution may be one way to slow the increase in eczema cases across the world.

The estimated prevalence of eczema has more than doubled in the past 30 years, especially in urban areas and industrialized countries. The rising prevalence of atopic dermatitis in industrialized countries globally is coincident with urbanization, industrialization, and consideration of the impact of air pollution on the development and course of atopic dermatitis, says Lawrence Eichenfield, M.D., professor of dermatology and pediatrics at UC San Diego School of Medicine and chair of the National Eczema Associations Scientific and Medical Advisory Council.

Air pollution is on the decline in some affluent countries, including the United States, yet 55% of the worlds population (mostly those in mid- to low-income countries) are being exposed to increasing levels of air pollution year after year. And although the air quality is improving here, its still far from where it needs to be: the Environmental Protection Agency (EPA) estimates that 97 million Americans lived in counties with pollution levels exceeding national air quality standards in 2020.

Both short term and long-term exposure to pollutants may exacerbate symptoms of atopic dermatitis, Dr. Eichenfield notes. This could be a key factor to help explain the vast upswing in atopic dermatitis diagnoses, especially in highly industrialized places with minimal environmental regulations.

So, whats next, and how do we begin to solve this global issue? Dr. Chovatiya hopes that future research will help distinguish the causes of eczema on a more individualized levelincluding the way that air pollution may damage the skin. Maybe air pollution doesnt matter to every single person with eczema, he considers. Who is going to be that person who is most affected by a forest fire, a high industrial area, or a construction site? This information would allow doctors to help patients craft a treatment plan that targets their specific needs.

For now, people with eczema can continue to stick to the generalized prevention guidance: avoid exposure to harsh chemicals, allergens, and fragrances. Being aware of pollution levels on a day-to-day basis is important, too, Dr. Eichenfield suggests, and minimizing outside time during bad pollution days is a reasonable strategy.

If youre hoping to broaden your impact and get involved in advocacy work, environmental groups like Earthjustice and the American Lung Association have clean air campaigns with opportunities for volunteers.

This conversation will remain relevant as we continue to see the impacts of environmental devastation caused by climate change. Fadudu hopes that the UCSF wildfire study can add one more piece to the puzzle of understanding climate change and public health. Not only can there be greater public health skin-related education for communities affected by wildfires, he says, but we can also use these results to show that wildfire smoke and air pollution affect peoples and communities skin health, which can impact quality of life. We all deserve access to clean natural spaces, for ourselves, our children, and the generations ahead.

Meet Our Writer

Sarah Ellis is a wellness and culture writer who covers everything from contraceptive access to chronic health conditions to fitness trends. She is originally from Nashville, Tennessee and currently resides in NYC. She has written for Elite Daily, Greatist, mindbodygreen and others. When shes not writing, Sarah loves distance running, vegan food, and getting the most out of her library card.

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The Impact of Air Pollution on Eczema - HealthCentral.com

The entire JAK inhibitor family of medicines isfeeling the ripple effects from a safety signal flagged for Pfizers Xeljanz. Now, the first marketed drug in the class is encounteringincreased scrutiny from the FDA.

The FDA has pushed back a decision for Incytes application for Jakafi in steroid-refractory chronic graft-versus-host disease (GVHD) by three months, the company said Tuesday. The new target action date isSept. 22.

The delay came after Incyte submitted additional data in response to a recent request by the agency. The FDA views the update as a major amendment to the previous package, so it now needs more time to review it, the drugmaker said.

Despite the setback, RBC Capital Markets analyst Brian Abrahams still believes Jakafi will eventually get its approval. Feedback from experts has been positive,with physicians noting limited alternatives and clear signs of efficacy for the drug, he wrote in a Wednesday note to clients. He projects the indication could get Jakafi over $300 million in U.S. peak sales.

Jakafi is only thelatest in the JAK drug class to face an FDA delay. Previously, the FDApostponed its verdict on Eli Lillys Incyte-partnered Olumiant and Pfizers investigational abrocitinib in moderate-to-severe atopic dermatitis. The agency also held up Xeljanzs filing in ankylosing spondylitis by three months. Before that, the agencydelayed two AbbVie filings for Rinvoq in eczema and psoriatic arthritis.

The extra hurdles stemmed from a safety problem observed in a post-marketing trial of Xeljanz in rheumatoid arthritis. The study linked an increased risk of dangerous heart-related side effects to the Pfizer JAK inhibitor compared with traditional TNF blockers in patients who were at least 50 years old withat least one existing cardiovascular risk factor.

RELATED:More relief for Dupixent as FDA pushes back Lilly, Pfizer eczema decisions on safety concerns

Jakafi was the first JAK inhibitor to reach the market with an FDA go-ahead for the bone marrow disease myelofibrosis in late 2011. The drug has been allowed in patients with steroid-refractory acute GVHD since May 2019.

The company's latest application in chronic GVHD comes off positive results from the phase 3 REACH3 trial. At week 24, the drug triggered a response in 49.7% ofpatients. For patients on best available treatments, 25.6% responded.

We remain confident in the data from the REACH3 trial supporting our sNDA submission for [Jakafi] and look forward to continued dialogue with the FDA throughout the remainder of the review process, Incytes chief medical officer, Steven Stein, M.D., said in a statement.

RELATED:ASH: Incyte, Novartis eye Jakafi approval after chronic graft vs. host win

Currently, Jakafi is given at different strengths twice daily. Incyte is evaluating a once-daily formulation with a potential approval expected by the end of 2022.

In a more important regulatory decision for Incyte, the company is also awaiting a verdict for a cream product with the same ruxolitinib active ingredient as used in the oral Jakafi for the treatment of atopic dermatitis. It used a priority review voucher for that application to secure an early decision date thats scheduled for June 21.

An Incyte spokesperson confirmed that the application for the topical drug remains under review at the FDA, though RBCs Abrahams said he now seesincrementally higher risk for a clean label.Last month, when asked about the increased JAK scrutiny at the FDA, Sten said the company is very comfortable where we are with the review.

Editor's Note: The story has been updated with analysisfrom RBC Capital Markets and a response from Incyte.

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Incyte the latest to fall victim to JAK scrutiny as FDA pushes back Jakafi review in GVHD - FiercePharma

Japanese pharma giant Kyowa Kirin is set to receive $400 million in a deal that wouldnt have happened without the companys San Diego lab.

The company recently announced a partnership with Amgen to develop a drug against eczema, a skin condition that can leave painful and itchy rashes across your hands, feet and behind your knees, among other places. Those rashes break out when irritants and allergens pass through the outermost layer of skin, triggering inflammation.

Kyowa Kirins experimental treatment, developed by scientists at its La Jolla lab, targets immune cells responsible for these inflammatory signals. The drug uses an antibody, a Y-shaped protein, to target T cells, immune cells that normally play a key role in fighting off microbes but can also trigger friendly fire against the bodys own tissues. The small arms of that Y latch onto the surface of activated T cells, while scientists modified the other end to efficiently trigger other immune cells to kill T cells coated in the antibody.

In February, Kyowa Kirin reported that the drug, KHK4083, significantly reduced the size and severity of eczema rashes without causing serious side effects in a 274-person study.

If those results hold up in larger follow-up studies, Kyowa Kirin could pull in another $850 million from Amgen, plus future royalties on sales. More importantly, says Andrew McKnight, director of the companys La Jolla site, the drug could benefit up to 25 to 30 million patients across the U.S., Japan and Europe, regions where Kyowa Kirin and Amgen see the greatest market potential.

This opens up a new paradigm, a new therapy for those patients, he said.

Its just the latest example of the work done by his team of 42 scientists. The local lab is the only research facility Kyowa Kirin has outside of Japan, and its roots in San Diego site date to 1988 back when it was called Gemini Science.

During that time, the lab has worked closely with the La Jolla Institute of Immunology, founded around the same time. Kyowa Kirin helps fund the nonprofit research organizations annual budget, according to McKnight, and the company often follows up on promising initial findings from the institutes scientists. Its a long-running partnership that has led to an antibody treatment being developed against Crohns disease and now against COVID-19, too.

The local research lab has also developed its own drugs internally, including Crysvita, an antibody that helps treat patients with a genetic condition that leads to low phosphate levels in their blood, which can result in weak, soft bones.

The FDA approved Crysvita in 2018, and the drug was approved in Japan in 2019. During the first three months of 2021, Kyowa Kirin earned $162 million in sales from Crysvita, easily exceeding revenue from any of its other products, according to the companys financial reports.

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Kyowa Kirin's San Diego lab just helped the pharma company make $400M on a deal for an eczema drug with Amgen - The San Diego Union-Tribune

A woman has warned eczema sufferers against overuse of steroid medication, sharing her painful journey through Topical Steroid Withdrawal, which left her with an excruciating lizard-like rash all over her face and body.

Megan Crome, a 25-year-old digital marketing assistant from London described showering as like having acid poured over her skin at the height of her reaction, revealing the horrendous experience absolutely shattered her quality of life.

Megan, who had to move back in with her parents for the three-month withdrawal period, was diagnosed with eczema when she was six-years-old, but her condition worsened through her final year of school.

RELATED: I wanted to die: Rash ruins womans life

After years of navigating various steroid treatments for her condition, she developed a resistance known as Topical Steroid Addiction (TSA) which left her with red and swollen skin.

When she stopped using the medication, the pain only worsened, making it difficult to do everyday tasks and prompting her take to time off from her job.

I was suffering every second of the day for three months straight. I always had pain somewhere and couldnt make my own meals, go out or do simple tasks due to this, she said.

I didnt recognise myself in the mirror for months and my whole face was just damaged skin that was inflamed and falling off it was absolute hell and thinking back on it now, it is very upsetting as it was quite traumatic, she admitted.

RELATED: Awful cause of mums red face

The traumatic ordeal had a massive impact on her mental health, she revealed.

TSW absolutely shattered my quality of life. I had to take time off work, stop seeing my friends and move back home. All I could do was lay in bed and try to find a position that was somewhat comfortable without any of my open wounds touching the bed.

My friends have been very understanding, but I have missed out on a lot of time with them and I do worry about how this will affect my relationship with them going forward.

Describing her long-term struggle with eczema, Megan said she was initially prescribed hydrocortisone, followed by a stronger cream called betnovate.

When the condition worsened in her teenage years, she was prescribed more steroid creams including elocon and protopic, neither of which had much of an effect.

Megan remembers eventually developing red sleeves, a common symptom of Topical Steroid Addiction (TSA), which left her skin swollen and arms hot to the touch.

Her skin began to weep and scab over due to her whole body being scratched red raw, where her face was engulfed in thick scabs which were continuously prone to infections.

I believe the steroids given to me absolutely exacerbated my skin problems without me even realising, Megan said, going on to add she sought advice from online support groups which told her to quit cold turkey but warned of the difficult journey ahead.

The short but brutal route meant she stopped using all moisturisers and creams to push the body to create its own natural oils, noticing the reaction almost instantly.

I had burning, hot skin, but felt freezing cold inside, extreme flaking which made me feel like a lizard shedding its skin, as well as insomnia where I wasnt able to lay still or relax for any longer than five seconds, she said.

Concluding her ordeal, she revealed she is speaking out in the hopes of raising awareness for others.

I feel so strongly that doctors need to be educated on the effects of steroids and stop handing them out for anything and everything.

Megan now helps her condition by eating healthily and has cut out dairy, wheat, and gluten, as well as taking vitamins and fish oil everyday.

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Womans excruciating reaction to steroid cream withdrawal after eczema treatment - NEWS.com.au

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