melanoma patients

Dr. Edwards has recently completed a retrospective review of our melanoma patients at The Royal Marsden developing cutaneous toxicity while receiving checkpoint inhibitor therapy. ‘Cutaneous toxicities in patients with melanoma receiving checkpoint inhibitor therapy: a retrospective review. The experience of a single large specialist institution.’

Checkpoint inhibitors have significantly improved the overall survival for several cancers and have also gained recent approval for adjuvant use in melanoma patients.

Modulating the immune system however is associated with potential side effects the most common of these being cutaneous side effects. We conducted a retrospective review of our adult patients with melanoma who between 2006 and 2018 received nivolumab, pembrolizumab or ipilimumab. This study which covers 12 years is the largest study of cutaneous side effects of checkpoint inhibitors in melanoma patients. Our results show that cutaneous toxicity occurs in at least 24% of patients, some developing more than 1 episode of toxicity. Grade 3 and 4 severity skin toxicities occurred in over 13% of patients with less than 5% of patients requiring treatment discontinuation.

Our study confirms that overall most cases are mild but severe reactions do occur. Prompt recognition and treatment can control the impact on quality of life and potentially allow urgent treatment to be administered when needed. It is important that these patients are managed both by an oncologist and dermatologist.

Read more here – https://doi.org/10.1111/ced.14469

To arrange an appointment with Dermatologist Dr Kara Heelan, at Chelsea Outpatient Centre or Sydney Street Outpatients & Diagnostic Centre call us on 0203 494 4024.

lockdown skin

The COVID-19 pandemic has led to unprecedented lockdowns across the world. For almost a year, UK residents have been living under some form of lockdown, restricted mostly to their homes. Not only is this having a significant impact on our mental health, but it’s also contributing to a number of skin issues too.

Here, we’ll look at how lockdown could be stressing out our skin and more importantly, what you can do about it.

How is lockdown impacting the skin?

During lockdown, the two most common skin conditions being reported are dry skin and ‘Maskne’.
Occlusive masks have contributed to acneiform eruptions. The term ‘Maskne’ has been coined for this during the pandemic. It is an acne variant associated with an occlusive environment exacerbated by heat and moisture. As we have also been limited to spending a lot of our time indoors at home dry skin is also an issue.

The lockdown has caused many of us to relax our skin care routines. With nowhere to go, spending time cleansing and moisturising the skin can feel pointless. However, it is just as important to look after the skin now as it was before the lockdown.

Another reason many people may be experiencing issues with their skin is because of a lack of sleep. The stress caused by the lockdowns and pandemic has had a negative impact on many people’s sleep routine. When you don’t get enough sleep, it will really start to show on the skin.

These are some of the common reasons thought to be behind an increase in skin issues during lockdown. However, it isn’t all bad news.

The lockdown has also helped the skin in other ways. Air pollution has been significantly reduced due to fewer people travelling. Some people have also ironically spent more time outdoors than they usually do as outdoor exercise has become more popular with the closure of gyms.

How to improve your skin during lockdown

If you are experiencing skin related troubles during lockdown, there are some things you can try. Ensuring you get plenty of sleep, maintain a healthy diet and keep on top of your skincare routine, are some of the most effective tips you can follow.

Eating a healthy diet will provide the skin with the nutrients it needs to repair itself. Meanwhile, skin care products such as a gentle cleaner and a lightweight moisturiser can also help.

For those with oily or breakout-prone skin there are cleansing products available with extra calming properties. And if you are spending more time outside, remember to wear a sunscreen with a high SPF to protect your skin from harmful UV rays.

While lockdown has presented many challenges for the skin, the above are some of the best ways to keep it healthy. With a date for the end of lockdown announced, now is the time to start focusing on getting the skin back to its best.

To arrange an appointment with Dr Kara Heelan, at Chelsea Outpatient Centre or Sydney Street Outpatients & Diagnostic Centre call us on 020 3494 4024.

Systemic treatment

Well done to Dr Ferguson and Dr Ho. Our case ‘Extensive mucocutaneous, oesophageal and otic lichen planus secondary to Nivolumab therapy’ has recently been published in Skin Health and Disease.

Anti-PD-1 therapy is a type of immunotherapy and an area in increasing development for its efficacy and advantages in the treatment of advanced metastatic melanoma.

Lichenoid reactions are well recognised within the context of anti-PD-1 therapy. We report a rare case of lichen planus occurring in the mucous membranes, oesophagus and otic canal. This case highlights the importance of considering systemic involvement in these patients. These cases can be difficult to treat especially within the context of malignancy.

Read more here – https://doi.org/10.1002/ski2.8

To arrange an appointment with Dr Kara Heelan, at Chelsea Outpatient Centre or Sydney Street Outpatients & Diagnostic Centre call us on 0203 494 4024.

skin in the sun

If you are being treated for cancer, whether this is with chemotherapy, immunotherapy, targeted therapy or radiation keeping your skin protected all year around is essential. Cancer treatments can make your skin more susceptible to sun damage. Even on overcast days, UV rays can still penetrate the skin. Under the right conditions, patients can still burn in the sun on a winter’s day. This makes it essential for patients to keep themselves protected.

Here, we will look at the dangers of sun for cancer patients, alongside what you can do to minimise the risks.

How can the sun damage our skin?

Sun damage is caused by UVB and UVA radiation. While UVB radiation is most harmful in the summer, it can still be present in winter. UVA radiation is associated with skin damage, ageing and specifically in patients being treated for cancer with drug photosensitivity.

UVA radiation tends to stay consistent all year round and can even penetrate through glass. It means that even if you are spending time indoors, you can still suffer skin damage from the sun.

The rays of the sun are strong enough to penetrate through clouds and fog. So, whether it is an overcast day or a bright sunny day; you remain at risk from sun damage if you don’t protect the skin.

When you are undergoing cancer treatment, sun damage can be severe. Depending on what drug you are on, this can happen very quickly, making it crucial to take preventative measures.

How can you protect skin from the sun?

Now that you know how damaging the sun can be, the question is how can you protect yourself?

Protective clothing including hats, sunglasses, and long sleeves are really important for sun protection. Wearing a hat is a good way to protect your scalp, especially for those with thinning hair. Sunglasses with wide frames are also a good idea to protect your eyes and sensitive skin around them. Regular sunscreen is a crucial way to protect the skin throughout the seasons. Ideally, you will want to choose a product which contains a minimum SPF 30 with both UVA and UVB protection.

For those with acne prone skin conditions oil-free SPF formulations are helpful. Look out for ones that contain additional antioxidants and DNA repair enzymes.
A good choice for men is a fragrance-free sunscreen that dries completely clear.

Alongside ensuring you have the right products; you should also avoid being out in the sun for long periods of time.

Cancer patients do need to be extra careful when it comes to keeping the skin safe from winter sun. The above are some of the best ways to keep yourself protected.

For more advice on how best to care for your skin while undergoing cancer treatment, call us on 0208 661 3372 to arrange a consultation with Dr Heelan.

HER2-Positive Breast Cancer

Congratulations to Dr Chawla who has recently written a case report entitled ‘Annular atrophic lichen planus induced by anti-HER2 antibodies’. This has been published in the Australasian Journal of Dermatology.

Monoclonal inhibitors Pertuzumab and Trastuzumab inhibit human epidermal growth factors receptor 2 (HER-2). These are used to treat HER-2 positive breast cancer. Our case highlights a rare variant of a lichenoid drug eruption in a 35 year old female. Recognising rare potential side effects can ensure patients do not require treatment interruption.

Read the article by visiting here.

To arrange an appointment with Dr Kara Heelan, at Chelsea Outpatient Centre or Sydney Street Outpatients & Diagnostic Centre call us on 02034944024.

oncodermatology

Dermatologist Dr Kara Heelan recently shared her expert advice with Vogue on how to care for your skin while undergoing treatment for cancer.

Dr Heelan is a specialist in oncodermatology and explained that “approximately half of people treated for cancer will develop a dermatologic issue during treatment affecting hair, skin or nails. Chemotherapy, radiotherapy or targeted treatments work by killing cancer cells, while immunotherapy treatments boost the body’s own immune system,” she says. “These effects can have repercussions, not just on the target organ, but also on other organ systems including the skin.”

Your skin can be affected in different ways, depending on the treatment you receive:

  • itchy, dry skin
  • extra sensitivity
  • increased sun sensitivity
  • pigment changes
  • skin can be more susceptible to infection

The first step is to look at your current skincare routine and eradicate any products that will irritate the skin. Dr Heelan recommends avoiding “harsh toners, and any facial treatments that contain alcohol, BHAs (beta-hydroxy acids), irritant anti-acne products such as salicylic acid or benzoyl peroxide and scrubs, harsh exfoliants or bead containing products.

“Patients often ask me about continuing their ‘active’ topical skin treatments, like vitamin C or tretinoins. However, this often needs to be dealt with on a case-by-case basis, depending on the individual’s cancer treatment and the specific topical product constitution.”

Dr Heelan also advised which products you should be using. “Exchange soaps for mild, gentle fragrance-free soap substitutes or washes, and take short, warm – not hot – showers and baths,” suggests Dr Heelan. When it comes to the skin on your face, Dr Heelan advised gently patting or dabbing your skin dry after washing and applying moisturisers or other products at this stage. “When the skin is damp, there is increased absorption of topical agents.”

Moisturising is also extremely important for treating dry skin and even before you start your cancer treatment, start building up your skin barrier. “Creams and ointments are usually better at hydrating the skin than lotions or gels, and ceramides can also be quite soothing.”

And, most importantly of all, do not neglect sun protection. “Sun-sensitivity can be particularly severe depending on the drug you are on, and can occur quite quickly. Protect your skin with clothing and SPF and use lip balms with a high SPF, as lips can be particularly sensitive. You don’t have to avoid sunshine holidays, but be very careful and wear protective clothing, and regularly apply sun cream with a high SPF of at least 30. Look for mineral or physical sunscreens, which can be less irritating on very sensitive skin, particularly for acne type skins.”

For more advice on how best to care for your skin while undergoing cancer treatment, Dr Kara Heelan recommends that patients should consider consulting a dermatologist with a special interest in oncodermatolgy. Call us on 020 8661 3372 to arrange a consultation with Dr Heelan.

skin cancer risk

May is Skin Cancer Awareness month! Everyone is at risk of developing skin cancer, but some people are at an increased risk.

If you include yourself in any of the below-listed groups, please be extra vigilant to check your skin.

  • Fair skin and get sunburnt easily
  • Previous history of lots of sun exposure and especially blistering sunburns
  • Lots of moles (>50)
  • Unusual looking moles
  • Family history of skin cancer
  • Personal history of skin cancer
  • Previous sunbed use
  • Immunosuppressed people
  • Outdoor workers

If you are worried about a skin lesion, mole or spot please consult your GP or Consultant Dermatologist immediately

London mole check

May is Melanoma Awareness Month and all this lovely weather means it’s time to check your moles! The ABCDEs of melanoma is a guide to help you check your moles. Early detection of melanoma is key.

Mole Check: A is for asymmetry

Check that both halves of your moles are the same and match each other

Mole Check: B is for border

Are the borders or outlines of your moles irregular?

Mole Check: C is for colour

Is the colour pattern regular or are there varying shades of browns, tans, white, red or blue visible?

Mole Check: D is for diameter

Melanomas are usually greater than 6mm in diameter –  bigger than a pencil eraser

Mole Check: E is for evolution

Is your mole or spot changing over time?

If any of your moles are showing any of these signs please consult your GP or Consultant Dermatologist immediately

physical vs chemical sunscreen

What is a mineral or physical sunscreen?

Physical sunscreens consist of mineral ingredients namely, zinc oxide and titanium dioxide. They work by sitting on top of the skin and they reflect and scatter light in a similar way to clothing.

Zinc oxide protects against a wide range of UVA including UVA 1 (340 to 400 nm). It is very photo-stable and does not react with other UV filters. It is more effective than titanium dioxide in regards to UVA protection however, it is less efficient against UVB radiation. Titanium dioxide protects against UVA 2 (315-340 nm) and UVB, but does not protect against UVA 1 as does zinc oxide.

What are the pros and cons of physical sunscreens?

Physical sunscreens work as soon as they are applied on the skin. They are unlikely to irritate the skin so they are good for sensitive skin types. They can also be good for rosacea skin types or patients with redness as they deflect heat from the skin. They are less likely to be pore-clogging so they are good for acne-prone skin.

They also last longer when in direct UV light, however, they can be rubbed off much more easily than chemical sunscreens especially if in contact with sweat or water. They can often leave white streaks or a white chalkiness on the skin so they are not ideal for under make-up and can be difficult to use for darker skin tones. They tend to be thicker requiring more effort to rub in.  They also tend to have a longer shelf life.

What is chemical or organic sunscreen?

Chemical sunscreens contain organic (carbon-based) compounds e.g. oxybenzone, octinoxate, octisalate and avobenzone. They create a chemical reaction and work by changing UV rays into heat and then release that heat from the skin. They consist of UVA and UVB blockers. Their structure allows for light to be absorbed.

What are the pros and cons of a chemical sunscreen?

They are usually thinner formulations which makes application easy, they do not cause much white streaking and spread easily. They are much more resistant to sweat or water compared to a physical sunscreen. They only start to be effective about 20 minutes after application to the skin and they require frequent reapplication as its protections get used up more quickly in direct sunlight. They are more likely to be irritating and the higher the SPF, the higher the risk of irritation. They can increase redness in rosacea-prone skin types and they can also clog pores causing an acne flare.

Physical vs chemical sunscreen, which is best for you?

The simple answer is… the one that feels the most comfortable on your skin. If you’re an oilier skin type you will want to choose one that is lightweight and not greasy. If you have sensitive skin that gets red easily you’ll want to find one that doesn’t irritate. If you have a darker skin tone you will want to choose one that doesn’t look chalky on the skin.

Both chemical and physical sunscreens do a great job of protecting your skin from the sun. The most important thing is to find a sunscreen that you like the look and feel of so that you are inclined to use it frequently and reapply regularly.

If you are concerned about the compatibility of your skin and a new sunscreen performing a simple patch test on your inner arm is a good idea, before using it all over your face.

For more advice, arrange a consultation with Dr Kara Heelan at either the Chelsea Outpatient Centre (020 3494 4024) or Sydney Street Outpatients & Diagnostic Centre (020 3733 9029).

photoprotection

Photoprotection – or the use of regular sunscreen – is encouraged by doctors and dermatologists because they are aware that our outdoor work and lifestyles mean that complete sun avoidance is not possible.

What is photoprotection?

  1. Why do we need photoprotection? Photoprotection is required to reduce ultraviolet (UV) radiation-induced skin damage, photo-ageing and skin cancers. Photoprotection includes sunscreens, clothing, hats and sunglasses.
  2. What is UV radiation? UV radiation affects the skin by causing ageing, sunburns, precancerous lesions, cancerous lesions and immunosuppression. There are 3 types of UVA radiation: UVC, UVB and UVA. UVA is associated with ageing and pigmentation, it produces free radical oxygen species, indirectly damaging DNA. UVB causes sunburn and DNA damage associated with non-melanoma skin cancers.
  3. What is SPF? SPF stands for sun protection factor and indicates the degree of sunburn protection given by sunscreens. It is a primary measure of UVB and to a lesser extent UVA. For a sun cream to be effective it needs to be applied liberally and 20 minutes before going outdoors.
  4. What type of sunscreen should I use? A broad-spectrum sunscreen, which involves UVA and UVB coverage, providing water resistance and a high sun-protection factor (SPF 30 or 50) should be used. Included in many sunscreens are antioxidants such as vitamin C, vitamin E and green tea polyphenols which can give additive protective effects. You may need to change the type of sunscreen you use according to what activity you are planning to do.
  5. How should I apply sunscreen? Apply 20 minutes before sun exposure. Reapply after 2 hours, after sweating or swimming. An adult requires 30 ml /body (2 tablespoons), with a teaspoon (5ml) used on the face, head and neck. For children the requirements vary according to size for example; 3 years: 10 ml (2 teaspoons), 7 years: 15 ml (3 teaspoons), 10 years: 20 ml (4teaspoons)
  6. Is it ok for babies to wear sunscreen? It is safe and recommended to use sunscreen in babies over 6 months. The best way to ensure babies and children are protected is to provide as much shade as possible, use protective clothing, hats and sunglasses. Physical sunscreens are less likely to irritate sensitive skin and eyes.

It is recommended that parents of babies under 6 months should consult a doctor before sunscreen use. This is due to the lack of development of metabolism and excretion of the chemically absorbed agents within sunscreen. If sunscreen is necessary, it should be limited and infrequently used on sun-exposed regions only.

For more advice on photoprotection, arrange a consultation with Dr Kara Heelan at either the Chelsea Outpatient Centre (020 3494 4024) or Sydney Street Outpatients & Diagnostic Centre (020 3733 9029).