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Volume 11 Issue 1 Recognizing truncal Celiac disease of the skin Canadian The OffSkin icial Publication of the Canadian Skin Patient Alliance Living with Complimentary Spring 2020

Avoiding lice and : A contagious itch

Engaging with your pharmacist www.canadianskin.ca skinfacts Suggestions and tips for skin patients and their families... If toenails could talk Maybe it’s time for us to focus on our feet Science of greys more often (and not just during sandal Your hair follicles have pigment cells season). Toenail colour changes can signal that make melanin, a chemical that health problems. Here’s what to watch for gives your hair its colour. As you and talk to your doctor about. age, these cells start to die. Without pigment, new hair strands grow in o Black toenail: This is commonly caused lighter and take on various shades of grey, silver by a bruise under the , technically called a subungual and eventually white. Once a follicle stops making hematoma. Expect your black toenail to grow out in melanin, it won’t make coloured strands again. about six to nine months. But it might also be malignant , a fungal , a chronic or What’s premature gray? other health problem. Some people go grey 10 or more years earlier than average. It’s premature if you’re grey before: o Yellow or white: When toenails turn yellow or white, • 20 years if you’re white • 25 years if you’re Asian a fungus is usually to blame. If left untreated, an infection • 30 years if you’re black can worsen or spread. o Got green: This might be What causes ? green-nail syndrome Cellulitis is a life-threatening (chloronychia), which that often strikes the arms and legs, but can is caused by an infection. appear anywhere on the body. Here are the The culprit is usually basics on cellulitis and how to protect yourself: bacteria that thrive in u Cellulitis is not contagious. damp or wet conditions. u It is caused by common bacteria getting into the skin’s o Shades of blue: If you get a blue spot for no apparent deeper layers—usually Streptococcus or Staphylococcus. reason then you might have a mole beneath the nail. u Some people develop cellulitis while others never do. In very rare cases, a type of mole called a cellular blue u Keep your fingernails and toenails clean and trimmed. can become cancer. u Practice proper wound cleaning—wash cuts o Brown streaks: Called , brown usually and wounds as soon as possible, and apply an appears as a line or streak going up and down the nail. antibacterial ointment. Causes range from injury to certain , but u Keep skin moisturized to prevent tiny cracks in there’s a small chance it could be something serious. the .

Spring 2020 n Volume 11 n Issue 1 Canadian Skin Patient Alliance: ISSN 1923-0729 111-223 Colonnade Road South, Ottawa, ON K2E 7K3 Toll Free: 1-877-505-CSPA (2772) • E-mail: [email protected] Publisher: BCS Communications Ltd. Canadian Publication Mail Sales Product Agreement No 40065546. Printed in Canada. www.bcsgroup.com Follow us on Facebook, Twitter and Instagram at: All rights reserved. ©2020. facebook.com/canadianskin • twitter.com/canadianskin Contents may not be reproduced. instagram@canadianskin.

To subscribe today to this complimentary magazine, call 1-877-505-2772 or email us at [email protected]

2 canadianskin.ca Spring 2020 Ask the Expert Treatment options for palmar , and is it dry skin or athlete’s foot? By Dr. Isabelle Delorme Learn more, live better. A Canadian health care professional answers your questions.

I have psoriasis on my phototherapy and systemic hands. My doctor has medications. The latter include Q prescribed topical cortisone oral drugs, such as methotrexate, cream, but it’s not working acitretin and ciclosporin, and injected the mainstay of treatment for this very well. What other options biological agents. These are long- condition. For more severe cases, do I have? term treatments. phototherapy is recommended. Tinea pedis usually presents Hand (or palmar) psoriasis The skin between my with redness, scaling, cracks and can be more difficult to treat always seems to bubble maceration between the toes, A than plaque psoriasis on Q and peel, especially after especially the last two web spaces. other parts of the body. It has a big a shower or bath. Is this just dry Vesicles can occur. Itchiness is impact on quality of life, as it can skin or could it be athlete’s foot? variable. Tinea pedis is a fungal interfere with daily activities and infection that can also affect the work. There are two forms of psoriasis “Bubbling” and “peeling” toenails. Treatment is usually with that can be seen on the palms and between the toes are a topical antifungal cream. cs soles. The plaque form causes dry signs of either dyshidrotic A Dr. Isabelle Delorme is a certified and scaly plaques and the pustular eczema or tinea pedis (athlete’s foot). dermatologist working in Drummondville, form causes pustules on the hands Dyshidrotic eczema is characterized Quebec. She was the CSPA Dermatologist and feet. by firm vesicles (bubbles) on the of the Year in 2017. A few lifestyle changes can ease soles and toes and the palms and the discomfort. Avoid friction and fingers. They initially contain clear Congratulations Vanessa T. (Calgary), wet-work. Protect your hands by fluid, and resolve after several days the winner of a $25 gift card. For your using cotton gloves under vinyl by peeling (more technically known chance to win, send us your question for gloves. Moisturize regularly, as desquamation). The bubbles the expert at [email protected]. immediately after hand washing and are usually very itchy. Dyshidrotic bathing, and anytime inbetween. eczema usually appears in adults, The treatment depends on the and people with condition’s severity. Milder forms or hay fever are at higher risk of Ask may be managed by a family doctor, developing it. normally last but if you have moderate or severe for about two to four weeks and the psoriasis then you might want to may be related to seasonal allergies, Expert ask for a referral to a dermatologist. changes in humidity or stress. Got a question? Send to Topical treatment is the first-line Occasionally, dyshidrotic eczema therapy. Topical medications used may be triggered by contact to [email protected]. to treat palmar psoriasis are topical allergens such as nickel, cobalt If your question is (more potent ones or balsam. published you such as are Management includes avoidance will receive a $25 preferred) and calcipotriol. of triggers. Soaks or cool compresses gift card. Good luck! Treatment options for moderate- 2 to 4 times daily can help to dry to-severe palmar psoriasis include blisters. Topical corticosteroids are

Spring 2020 canadianskin.ca 3 A contagious itch Lice and scabies By Matthew Ladda and Dr. Patrick Fleming Learn the difference between these conditions and how to treat them.

Head lice Head lice are small insects that infest and live on the human scalp. They feed on small amounts of human blood and lay eggs close to hair shafts. After being laid, lice eggs hatch within one to two weeks.

What are the symptoms? An itchy scalp is the most common symptom of a head lice infestation. Small red bumps can occasionally be seen on the scalp. However, it is pos- sible to have head lice without even noticing these symptoms. Lice are very small, but they can be seen on the scalp upon careful inspec- tion. Adult lice are no larger than a sesame seed and have a grey-coloured body that may appear redder after How are head lice spread? or pharmacist can recommend a feeding. Their eggs are small, brown It’s important to recognize that head particular product and provide you and difficult to see. However, after lice are highly contagious and spread with instructions on how to use it. hatching, the empty egg case (known easily among people, especially They include insecticide treatments as a “nit”), is white and remains at- children. Group settings such as such as permethrin, and non- tached to a person’s hair shaft, making classrooms, playgroups and camps insecticide treatments such as it easier to detect. are particularly susceptible to the silicone oil dimethicone, isopropyl spread of lice. However, head lice myristate/cyclomethicone and can only survive for one or two days benzyl alcohol lotion. People with when not on a human. head lice should repeat the same treatment one week later to ensure How do you treat head lice? any newly hatched lice are also killed. People only need to be treated for Home remedies such as applying head lice if live lice are found in their heat to the scalp or covering the hair. Because head lice are easily scalp with oil or petroleum jelly are spread from one person to another, not at all recommended. it is necessary to check the hair of all is also not effective and can often family members and anyone else who cause unnecessary irritation. has been in close contact. To ensure all lice have been There are several treatments eliminated and to prevent for head lice, and your doctor reinfestation, all bed linens, towels,

4 canadianskin.ca Spring 2020 hats and clothing should be washed Everybody who lives in the same in hot water and dried on high heat. home as a person with scabies, Items that cannot be washed, such whether they have symptoms or as pillows and jackets, should not, should be treated at the be sealed in a plastic bag for same time to prevent the at least two weeks. Combs, from being passed back and brushes, headbands and forth. Similar to head lice, all other hair-care items should linens and clothing in the be soaked in rubbing home should be washed in alcohol or thrown away. hot water and unwashable Children with head lice items sealed for two weeks. can return to school or The itching from scabies daycare as soon as they have can remain for four to eight been treated once. weeks after treatment. Itching can be treated with daily mois- Scabies turizing, topical cortisones and/or What is scabies? Scabies is a skin antihistamines after permethrin has condition caused by mites. These been used. mites are microscopic and cannot Children with scabies can return to be seen with the naked eye. Mites susceptible to outbreaks and it often school after a single treatment. cs that cause scabies burrow into the spreads within a household. Matthew Ladda, BSc(Pharm), is a top layer of skin to live, feed and pharmacy school graduate and a third- lay eggs. How do you treat scabies? year medical student at the University of Scabies must be treated with medica- Toronto with an interest in . tion as it will not resolve on its own. A treatment called permethrin at Dr. Patrick Fleming, MD, MSc, 5% concentration may be recom- FRCPC, FAAD, is a Royal College- mended by your doctor. It must be certified dermatologist and Assistant evenly applied to the entire body Professor of Medicine at the University from the neck down and be left on of Toronto. He has clinical and research for eight to 14 hours overnight. This interests in psoriasis and complex should be repeated one week after medical dermatology. the initial treatment to ensure any What are the symptoms? newly hatched mites are also killed. An intense itch that is worse at Rarely, a pill may be prescribed. night is one of the characteristics to watch for. Scabies can cause a Scabies is caused by a known as of small red bumps that can occur the Sarcoptes scabiei. Untreated, these microscopic mites can live in your skin anywhere on the body. It is especially for months. common on the web spaces of the A scabies hands and feet, and on the breasts 0.3 mm mite is only and genitals. 0.3mm long.

How is scabies spread? Also highly contagious, scabies can The mites will burrow into the top spread from an infected person to layer of your skin to live and feed. an uninfected person by skin-to- skin contact. The mites can survive for three to four days when not on a human. Anyone can get scabies, regardless of age, cleanliness or personal hygiene. Places with a higher Feces density of people are particularly Eggs

Spring 2020 canadianskin.ca 5 Truncal acne Often hidden or unrecognized By Muskaan Sachdeva and Dr. Jerry Tan

runcal acne occurs 3 Severe acne: Deep pustules called Cutibacterium acnes, which in more than half of and/or nodules, which can cover break down oils to free fatty acids individuals who present large areas and be painful. that trigger . with acne. It most Pathways to acne development include: frequently affects the • an increase in hormones, leading As you can see, several factors can back, then the chest— to higher and more inflammatory lead to inflammation within the oil Thence its name. Truncal acne is levels of sebum production glands, including modified sebum, characterized and divided into • pore blockage because of bacteria and free fatty acids. These three levels, based on severity. overproduction of create the visible features of acne: 1 Comedonal acne: Small white • an increased number of bacteria comedones (white or grey but with (known as “closed come- dones”) that result from complete or partial blockage of the seba- ceous ducts, or grey–white papules (“open comedones”) caused by an increase in sebum (the natural oils produced by the skin for moisturization). 2 Mild-to-moderate papulopustular acne: Superficial inflammatory .

6 canadianskin.ca Spring 2020 no redness), papules and pustules of the therapy, (otherwise known as zits), and Regardless people affected deeper, larger lumps called nodules by acne should be monitored frequently and . Other causes of truncal acne to ensure adherence to treatment and include certain medications, environmental exposures, hormonal positive therapeutic outcomes. imbalances (such as polycystic ovarian disease) and pore blockage from management (e.g. a low glycemic the use of hair products or wearing index diet), avoiding dairy and damp clothing. medications. New treatment options People with acne can be are also being developed specifically embarrassed by facial or truncal for truncal acne, some of which involvement. And while facial acne are available in Canada. Talk to your is readily visible, truncal acne is often doctor about the options that are hidden or undetected. Those with best for you. cs truncal acne might use clothing to there is increasing recognition of hide it and avoid situations where the value of topical medications Muskaan Sachdeva is an MD candidate they must expose their torso to others in treating less extensive forms of in the Faculty of Medicine at the University (such as swimming or changing in truncal acne. of Toronto. She has a special interest in a locker room). Others may not be For reasons of practicality, it’s understanding skin pathologies and aware of its presence, particularly if important that the affected indi- raising awareness about skin conditions. it’s on their back. vidual or a caregiver can reach the affected truncal regions to apply any Dr. Jerry Tan is a certified dermatologist prescribed therapy. There are other who works in Windsor, Ontario. Dr. Tan considerations too, such as recogniz- focuses his research on acne, and ing that products containing benzoyl psoriasis. He was the CSPA Dermatologist peroxide may bleach clothing or of the Year for 2018. bedding. Furthermore, topical agents containing and topical retinoids can increase skin For more If you have facial acne, it’s dryness and irritation. Various mea- important that your doctor also sures can reduce the risk of these information checks your torso. If inadequately side effects, however, such as using Visit the website of our treated, the consequences of acne moisturizers and applying the agents Affiliate Member, the Acne are similar whether facial or truncal— less frequently. and Rosacea Society of Canada: including psychological impacts Regardless of the therapy, www.acneaction.ca. The such as embarrassment, anxiety and people affected by acne should organization offers hope and depression, and physical outcomes be monitored frequently to ensure help to those with acne by such as scarring or stains. The risk adherence to treatment and positive providing independent, of thickened scars called or therapeutic outcomes, as this will reputable and current hypertrophic scars from acne is often mitigate the risk of psychosocial information on the conditions greater with acne on the torso. and physical consequences. The and raising awareness. most important aspect of therapy Treatment is to ensure a timely reduction in The treatment of truncal acne varies inflammation in order to reduce risks. from person to person, depending If you have acne and over-the- on its severity and extent. Those counter products are ineffective with more severe and extensive acne after two or three months of use are typically treated with systemic then it’s important to seek further medications such as pills, health care advice and management. hormonal medications called antian- There are now many treatments drogens or oral . However, that can help, including nutritional

Spring 2020 canadianskin.ca 7 : Celiac disease

of the skin By Priya Dhir Dermatitis herpetiformis (DH) is a that is caused by a reaction to eating gluten. The vast majority of people with DH also have celiac disease, which is a sensitivity to a protein called gluten that is found in wheat and other grains.

hen a person has an increased risk for both conditions. caused by the rash. diaminodiphenyl celiac disease DH can affect people of all ages, sulfone is a common antibacterial and eats gluten, but most often first appears between within this family that is used to treat their intestines make the ages of 30 and 40 years. DH, and typically brings relief within an antibody called 48–72 hours. However, this medica- immunoglobulin A Diagnosis and treatment tion does not replace the importance W(IgA). This antibody targets epidermal A diagnosis of DH can be made by of maintaining a gluten-free diet. transglutaminase in the small intestine. performing a specific type of skin However, IgA can also travel under the biopsy called a “punch biopsy.” This Coping and support skin and target the transglutaminase involves injecting a local anesthetic All diseases that are visible on the protein located there. This causes and using a small, cookie-cutter-like skin can cause people discomfort and what’s known as the DH rash. punch to remove a small sample of the unease in public. If you think you or a skin adjacent to a . The incision is family member may be living with DH then closed with one stitch. Skin biop- then you may also have celiac disease. The classic findings of DH are itchy sies from people with DH are positive Speak to your doctor about any signs blisters and red skin lesions that occur for IgA deposits in a specific pattern. or symptoms that you’re experiencing. in groups. These skin lesions usually Blood tests for antibodies that are Strict adherence to a gluten-free appear on both sides of the body, common in people with celiac disease diet can cause vitamin deficiencies, elbows, knees, the lower back region (e.g., anti-tissue glutaminase) also anemia and even gastrointestinal (the sacrum), buttocks and scalp. supplement the diagnosis of DH. If cancer. If you have been diagnosed Given the intensity of the itching, blood antibody tests are positive and with DH then it’s very important the lesions can sometimes rupture. the skin punch biopsy has the typical that you do not take food, drink or Individuals with this condition can also findings of DH then it isn’t necessary medications containing wheat, rye, have gastrointestinal symptoms such to conduct an intestinal biopsy to barley or oats as abdominal bloating, cramping, confirm the diagnosis of celiac disease. It can be difficult for some pain, diarrhea or constipation. Following a strict, life-long glu- people to maintain a gluten-free ten-free diet is important for con- diet. Make sure to discuss with your Causes trolling DH. A gluten-free diet can be doctor or dietitian, and try to learn Most people with DH also have celiac complex, so those with this condition more about any specific dietary disease, which can be confirmed by should be referred to a registered dieti- considerations and options. The a small intestine biopsy. However, tian with expertise in celiac disease for Canadian Celiac Association has many some may have a normal duodenal a nutrition assessment, education and local chapters with support groups biopsy but nevertheless have their DH follow-up. Unfortunately, even with to help share ideas and coping triggered by dietary gluten, which is adherence to a strictly gluten-free strategies: www.celiac.ca. cs why DH is sometimes referred to as diet, it can take a couple of years for “celiac disease of the skin.” DH affects the skin rash to totally resolve. Priya Dhir is a third-year medical student approximately 10–15% of people with A family of known as at the University of Toronto. She graduated celiac disease. First-degree relatives of sulfones can also be prescribed to re- from the University of Waterloo’s honours those with celiac disease and DH have duce the swelling and the discomfort biology program.

8 canadianskin.ca Spring 2020 Research Top Stories in Research By Irma Shaboian

What’s new on the research front? The articles from which these summaries of the latest in skin research are taken are so hot off the press the ink has barely dried.

Increased risk of squamous cell significant dose–response association outcomes. The researchers concluded carcinoma with indoor tanning between indoor tanning and that this method may prove useful among women SCC—and the association between for tracking pediatric AD therapeutic A prospective cohort study of cumulative exposure to indoor responses and to assess biomarkers women in Norway found that the tanning and risk of SCC remained for AD via skin sampling, in place of association between cumulative regardless of duration of use and the traditional biopsy method. exposure to indoor tanning and the age at initiation. These findings also risk of squamous cell carcinoma provide supporting evidence that the B cells linked to (SCC) was the same regardless of risk of SCC is greater among women immunotherapy for melanoma duration of use and with a higher cumulative number of Researchers in age at initiation. indoor tanning sessions. The findings Europe have found The purpose of will support policy development evidence that B the study was regarding indoor tanning. cells may play an to investigate a important role in dose–response Tape strips are a minimally immunotherapy for relationship invasive method for melanoma. B cells between lifetime evaluating atopic dermatitis are a type of white indoor tanning and Researchers have found that tape blood cell that originate in the SCC risk; the association between strips provide a minimally invasive bones and secrete antibodies. duration of use and age at initiation; option for evaluating atopic Typically, T cells—another type of and the association between age dermatitis (AD) in children. Currently, white blood cell—have been the at initiation and age at diagnosis. skin biopsies are the standard for focus of immunotherapy research This study is among the first evaluating AD; because of their ability to kill cancer to investigate a dose–response however, this cells. But these findings now show association between lifetime indoor is not always that B cells also play a critical role tanning and risk of SCC. feasible for in triggering melanoma-associated The cohort study included data children. The inflammation. It was observed that, from almost 160,000 women born objective of in the case of melanoma, B cells from 1927 to 1963, and baseline the study was directed T cells to the tumour when questionnaires were issued to to assess whether the tape-strip particular messenger molecules participants from 1991 to 2007. approach could be used to identify were secreted. Follow-up questionnaires were skin biomarkers in place of the Although further research is completed every five to seven years, traditional approach. needed, such as to determine the and the data were analyzed in 2018– A total of 51 children younger mechanism B cells use to support the 2019. The participants reported than five years were recruited, activation of T cells, this research has information such as pigmentation including children with both found that B cells play an important factors, , sunbathing moderate to severe AD and those part in the cancer-fighting process vacations and indoor tanning. without. Sixteen tape strips were and help T cells to find the tumour. cs The researchers also collected collected from both lesional and non- information on all cancer diagnoses lesional skin of children over a period Irma Shaboian holds a Bachelor’s and dates of emigration or death. of two years. Gene and protein of Science degree and is currently a The researchers found a expressions were evaluated as main law student.

Spring 2020 canadianskin.cacanadianskin.ca 99 HeadingFamily Focus

Can you find all 15 objects hidden in the picture?

. Why not get your family together Family walk with a smartphone and head out into your neighbourhood for a scavenger hunt? Find the items scavenger hunt on the list below and take a picture of each one you find. It’s been a long winter, and hopefully the weather is Go together or divide into teams for some starting to warm up a little where you are. friendly competition—the team with the most found items wins! o Number 8 o Colourful front door o Stop sign o Red car o Playing field o Baby Stroller/carriage o Swing set o A family o Squirrel o Lawn decoration o White fence o Taxi o Mailbox o Fire truck

10 canadianskin.ca Spring 2020 Living With... Living with Scleroderma By Marion Pacy, President of Scleroderma Manitoba

My personal story of scleroderma began on a cold winter’s night in 1989, when I thought I had gotten frostbite on my hands. couldn’t return to driving a bus—a the first meeting of the Scleroderma At the time, I job I had really enjoyed. Instead, I Society of Canada. We had people was working as a was asked to work indoors answering from B.C., Saskatchewan, Manitoba, Winnipeg Transit information phones for transit. Ontario and Alberta. bus driver and During this time my rheumatologist Scleroderma Manitoba promotes being in the cold put me on penicillamine, which I public awareness of scleroderma, was something I seemed to improve on. I was on supports those affected by the did every day. I did penicillamine for 9 years. Meanwhile, disease and helps raise funds for not think it was that cold, but my I was enjoying my job answering research, with the hope of finding hands were blue after a night of information phones. I continued a cure. Each June during work. I saw a doctor, who told me that job on a part-time basis for Scleroderma Awareness Month, I had Raynaud’s phenomenon and six years, until my acid reflux started the organization holds a walk in to try to keep my hands warm. to affect my voice. It often caused St. Vital Park to raise both money At the age of 40, in 1992, me to lose my voice in the middle of and awareness. I noticed that I was going a conversation. In 2019 the organization received through a roll of Scleroderma now a grant, which allowed it to revamp its antacids a day and I was affects my face, hands, website (www.sclerodermamanitoba. later diagnosed with acid upper arms, lower com) and to publish a magazine, reflux. That same year, I legs and esophagus. Scleroderma Manitoba: The Bulletin. underwent knee surgery It is often called the The magazine provides up-to-date and, as I was waking disease that “mummifies information on the progress of up, the anesthesiologist a person alive.” scleroderma research and other told me he thought I In 1992 I met a useful topics to help people cope had scleroderma in my lovely lady by the with the challenges they face esophagus and suggested name of Harriet in their daily lives. To receive a copy, that I see a rheumatologist. Carter, who was visit sclerodermamanitoba.com/ Nine months later I got to see a brave enough to invite scleroderma the-magazine-le-bulletin. cs specialist and was officially diagnosed patients into her home and start with scleroderma. the first support group, which has Marion Pacy has been involved with Then other symptoms started. continued to this day. In 200I I was Scleroderma Manitoba since 1993 and My hands curved inwards and the contacted by a wonderful group of became the organization’s President skin on them became very tight people in Calgary and was invited in 1995. She has lived with scleroderma and shiny, making it difficult to to attend a meeting that would be for 27 years. grip things. In November 1992, my Raynaud’s got much worse and, after discussing it with my family, I decided to take some time off from work. Within the next eight months, my condition declined further and I

Spring 2020 canadianskin.ca 11 Engaging with your dermatologist and pharmacist Why and how? By Dr. Ian Tin Yue Wong and Dr. Kerri Purdy

n addition to their primary health Dermatologists are experts who you are safe, help to promote care provider, there are two key can call on for diagnosis, treatment adherence and reinforce the patient’s members in a skin patient’s health and prevention of a wide variety knowledge about their medications care team: the dermatologist and of diseases. They provide skilled and possible side effects. Pharmacists the pharmacist. medical and surgical interventions, earn their bachelor or doctor of and non-pharmacologic measures. pharmacy degree after completing IDermatologists are recognized As such, the dermatologist’s clinical extensive training in pharmaceutical medical specialists who have received examination best positions them to care. Pharmacists are readily their medical degree and completed oversee the care of “skin patients” accessible at local pharmacies and a focused and comprehensive, five- from head to . are trained to share information year postgraduate residency training in a patient-friendly manner. The program in the field of dermatology. Pharmacists are medication checks and balances related to During this time they concentrate experts who ensure that medical having both a dermatologist and on the health of skin, hair and nails. interventions prescribed for patients pharmacist oversee medication

12 canadianskin.ca Spring 2020 Tips for being a proactive patient o Be aware of follow-up appointments and prescription refills: Patients or their primary caregiver should ask if they are to follow-up with their specialist or primary health care provider, or if no follow-up is planned. If no follow-up is arranged or required, ask your health care provider when and how you should seek medical attention. You can also ask your pharmacist how many refills your prescription has when it is being filled. In this way, you can plan ahead and set reminders for a follow-up or refills.

o Medication adherence is crucial: Taking treatments as prescribed is often the key to successful treatment. However, there are a variety of reasons why this doesn’t always happen, including the cost of medications, hesitancy to use medications because of safety concerns and therapeutic fatigue. Identifying barriers early on and working with your health care team to address them is key.

o Be curious, ask questions: Medical information can be found from a variety of sources, including the internet. However, asking specific questions of an expert health care provider, such a dermatologist, can be helpful in obtaining accurate, up-to-date answers based on the academic literature.

o Medications: Ask your local pharmacist for a list of your currently prescribed and previous medications to keep on-hand to show other health care providers. This list can be helpful for health care providers to get an understanding of the exact medications you have tried or are currently using.

o Medication counselling: Pharmacists often provide medication counselling to patients when new medications are being prescribed. This means outlining the purpose of a medication, describing how to take it and advising on possible side effects. Do not hesitate to talk to your local pharmacist and get further counselling.

o Be aware of contrary advice: There may be times when the information provided by pharmacists, dermatologists and other health care providers differs. For example, one health care provider may recommend liberal use of topical corticosteroids, whereas another might say to use them sparingly. This can be confusing and getting clarification is key. Encouraging dialogue between health care providers will help to ensure that everyone is clear on your optimal therapeutic plan.

management provide the best to recognize and better manage Ian Tin Yue Wong, BSc(Pharm), assurance of safety and effectiveness your medical conditions before your MD, was a practicing pharmacist of treatment for patients. disease progresses. You can also min- and is now a dermatology resident imize complications that might arise at the University of British Columbia. Patients should be an active partic- from medication misuse or He has a special interest in patient- ipant in their medical care, meaning lack of treatment. centred care and interdisciplinary they have a basic understanding of Being proactive may not be possible medicine. what their medical condition is, what for everyone. However, keeping in treatment options are available and regular communication with your Kerri Purdy, MD, FRCPC, is a why these treatments are used in dermatologist, primary health care dermatologist, an assistant professor their condition, and knowing when provider and pharmacist will reinforce at Dalhousie University’s Division of to seek a follow-up or further your care, help you to address Clinical Dermatology & Cutaneous medical attention. By being an potential knowledge gaps and Science, and President of the Canadian active participant, you will be able promote continuity of care. cs Dermatology Association.

Spring 2020 canadianskin.ca 13 CSPA in Action

CSPA in action: A spotlight on our latest activities, events and other information of importance to skin patients in Canada

Change in leadership at the CSPA “Decision-Making in an Age of Uncertainty.” Rachael Manion is now Executive Director Join Canadian and international delegates of both the CSPA and the Canadian Association from health research, governments, universities of Psoriasis Patients (CAPP), replacing and patient groups. For more information, Kathryn Andrews-Clay who has left to visit symposium.cadth.ca. start her semi-retirement. National Volunteer Week—April 19–25 Rachael previously worked as a consultant National Volunteer Week 2020 is also in April. with a public affairs firm, where she supported We’d like to take this opportunity to say thank national patient organizations and other clients you to the many volunteers who contribute in the health and life sciences sectors to navigate to this magazine and to our organization. the ever-changing policy, political and regulatory landscapes. A lawyer by background, Rachael Other upcoming awareness days, has advised Health Canada on regulating health weeks and months technologies, novel therapies and science policy. Follow us on Twitter (@CanadianSkin), She has consistently supported the not-for-profit Facebook (www.facebook.com/CanadianSkin) sector throughout her career, both professionally and Instagram (instagram@canadianskin) for and as a volunteer board member. Rachael has information on upcoming events. also worked on the frontlines of health care Rare Disease Day—February 29 in a community health centre for the street- Rosacea Awareness Month—April entrenched population and in a pharmacy. World Health Day—April 7 She has a law degree from the University of Awareness Month—May British Columbia and an honours degree in Melanoma Monday—May 11. cs mathematics from Dalhousie University. Welcome, Rachael! We appreciate our volunteers Dates to note Our sincere appreciation to Dr. Gordon Canadian Drugs and Technologies in Searles and Dr. Marc Bourcier, Health 2020 Symposium—April 19–21 Canadian certified dermatologists who The Canadian Drugs and Technologies in review the content of our magazine prior Health (CADTH) annual symposium will be to publication. Thank you! held in Toronto in April, with the theme of

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14 canadianskin.ca Spring 2020 CSPA AFFILIATES

Clinical trial: AboutFace: aboutface.ca Research study on lamellar ichthyosis Acne and Rosacea Society of Canada: The Reflect Study is testing the safety and effectiveness of a topical cream for acneaction.ca (acne) rosaceahelp.ca (rosacea) adults and adolescents living with lamellar ichthyosis (LI). This investigational cream is applied to the surface of the skin in an effort to reduce LI symptoms Alberta Lymphedema Association: such as dry and cracked skin. The Reflect Study aims to help improve symptoms albertalymphedema.com of LI for current and future generations. There will be two study sites in Canada. Alberta Society of Melanoma: melanoma.ca For more information, visit www.ichthyosisstudy.com. cs BC Lymphedema Association: bclymph.org SPONSOR OF CANADIAN SKIN MAGAZINE Canadian Foundation (CANAAF): AbbVie is the Founding Sponsor of the Canadian Skin Magazine canaaf.org and an ongoing supporter of CSPAs 2020 publications. Canadian Association for Porphyria: canadianassociationforporphyria.ca CSPA CORPORATE SPONSORS Canadian Association of Scarring Alopecias: casafiredup.com Canadian Burn Survivors Community: canadianburnsurvivors.ca Canadian Psoriasis Network: cpn-rcp.com Canadian Skin Cancer Foundation: canadianskincancerfoundation.com DEBRA Canada (epidermolysis bullosa): debracanada.org Eczema Society of Canada: CANADIAN SKIN MEDICAL ADVISORS + BOARD MEMBERS eczemahelp.ca Firefighters’ Burn Fund: Thank you to the Medical Advisors and Board Members who support the work burnfundmb.ca of the CSPA. For an updated list of names, visit: canadianskin.ca/about-us. HS Aware: hsaware.com Melanoma Network of Canada: Want to To have a chance of melanomanetwork.ca winning a $25 gift card, WIN Myositis Canada: a simply visit our website to find myositis.ca $ the answer to this question: Neurofibromatosis Society of Ontario: 25 Who represents nfon.ca Alberta on the CSPA Save Your Skin Foundation: gift card? Board of Directors? saveyourskin.ca Scleroderma Association of B.C.: Submit your answer by May 1, 2020, to [email protected], sclerodermabc.ca along with your name and contact information. Good luck! Scleroderma Canada: scleroderma.ca Scleroderma Manitoba: To subscribe today to this sclerodermamanitoba.com complimentary magazine, Scleroderma Society of Ontario: call 1-877-505-2772 sclerodermaontario.ca or email us at Stevens–Johnson Syndrome Canada: [email protected] sjscanada.org

Spring 2020 canadianskin.ca 15 What’s new with the Canadian Association of Psoriasis Patients?

1 Phase two of “My Skin and Bones” is now complete. The focus was to raise awareness of the connection between psoriasis and psoriatic arthritis. You may have seen ads on television, billboards and social media. Visit myskinandbones.ca for more information.

2 We continue to raise awareness of the challenges faced by individuals with psoriasis in accessing care and treatment. Visit psoserious.ca to get involved.

3 We have new resources on our website for children with psoriasis. This interactive section will be updated regularly, so visit Kids Corner on our website.

4 Sign up for our free quarterly newsletter at canadianpsoriasis.ca.

5 Follow us on social media—like, share and comment on our posts: facebook.com/canadapsoriasis twitter.com/Psoriasis_CAPP

Canadian Association of Psoriasis Patients Association canadienne des patients atteints de psoriasis