NZDSI Blog

Vitamin D and the skin

22 Jul, 2020

As I write this blog, I am looking out of my office on to a cold, wet, blustery and overcast Auckland day. The UV index is about 2.5 so I am not so concerned with sun exposure but what about vitamin D?

Vitamin D is an essential vitamin. It is important for bone health and has other functions. New Zealand has one of the highest rates of skin cancer in the world but 90% of vitamin D is made by exposure of the skin to sunlight. Some foods contain natural sources of vitamin D and some have it added. How can we make enough vitamin D and at the same time minimise the risk of skin cancer?

Most New Zealanders have adequate levels of vitamin D. However, New Zealanders with skin of colour can develop deficiency especially when combined with clothing that covers a lot of the skin. Other New Zealanders may need to avoid the sun because they have skin conditions that are made worse by sunlight, for example systemic lupus erythematosus. Those who are at risk of skin cancer or who have had skin cancer are advised to protect against excessive sun exposure. Some medications can make you more sensitive to the sun, for example the antibiotic doxycycline.

The New Zealand Ministry of Health offers excellent advice on how to manage the problem of too little vitamin D and too much sun exposure, balancing benefit and risk. Different circumstances demand different solutions. This advice is easily accessible at the Ministry of Health website. If needed your doctor can prescribe a vitamin D tablet for you.

 

Level 1 and chilblains

11 Jun, 2020

Level 1 and what a relief to return to an “almost normal” normal. New Zealand dermatologists will fully open their clinics and you can book to see them.  For some of you, there may have been skin conditions for which you have not been able to seek an opinion because of the different lock down levels but now is the time to have them assessed and treated.

While being wary of Covid 19 it is possible to begin to turn away from this virus back to dermatology and consider dermatology in the winter. Can the cold cause rashes? Yes, several in fact including chilblains also known as pernio. Chilblains are a nuisance in winter. They are caused when the cold is sufficiently severe to damage the skin and cause painful, burning red or purplish bumps. Common sites are the hands, feet and occasionally other areas including the nose and ears. They can take a long time to resolve. Farmers sometimes get them on the hands driving quad bikes without gloves on cold days. Rarely there are other illnesses associated with chilblains and your dermatologist may need to check you for these conditions. A blood test or biopsy may be needed. Preventing them with warm clothing is important. Thermal gloves will help. Smoking makes the problem worse. A medication called nifedipine helps to open the small blood vessels in the skin and can be useful.

So stay warm while enjoying the new normal!

 

Alert level 2 and Covid toes.

22 May, 2020

Covid, alert level 3, dermatology and beyond

26 Apr, 2020

It goes without saying that the last month has been very strange for us all. With careful guidance and the impressive self-discipline of New Zealanders the curve of Covid has been flattened. The numbers of new cases are diminishing rapidly.

Tomorrow we go from level 4 to level 3. Not a huge change but so encouraging for us all and a great boost for morale. Hopefully level 2 will follow soon.

New Zealand dermatologists are now actively planning to adjust their work as the levels change. The last blog was on virtual consultations and at level 3 this will still be the majority. As we move toward level 2 then clinics will ease their restrictions with more normal activity. There will be considerable planning and preparation for safe consultations carefully following the advice of the New Zealand government.

You can help your dermatologist by considering these 3 questions* prior to making a Face to Face appointment:
1. In the last 14 days have you been overseas?
2. In the last 14 days have you been in contact with a person who has confirmed/probable Covid illness?
3. Are you unwell or are any of the people in your household bubble unwell with fever or new respiratory symptoms?

If the answer is “No” it is very unlikely that that you have Covid. If the answer is “Yes” then you must not attend the clinic appointment but seek advice from your General Practitioner and consider testing for the virus. Remember that it is not only important to think of your own health, but also of the well being of the healthcare providers with whom you will interact.

If you have a skin problem please do not hesitate to seek advice from your dermatologist. As we begin to leave Covid behind don’t allow your own personal health to suffer through delay.

*With grateful acknowledgement to Counties Manukau Health

 

Teledermatology during Covid 19

3 Apr, 2020

Covid 19 has arrived in New Zealand and this has produced rapid and profound change for us all in our work style. New Zealand dermatologists have adapted to the new environment and are strictly following the advice of the New Zealand government. Check the website of your dermatologist as this will explain the new procedures and give contact details.

Dermatology is well suited for telemedicine. Online virtual consultations are different but allow your care to continue during this period particularly for urgent problems. Ideally these are done in real time using video conferencing so that you can directly consult with your dermatologist. Sometimes it is easier to have the consultation on your smart phone rather than laptop or desktop so that the camera can be moved easily and the dermatologist can look at different areas of skin. It may be helpful to have someone who is with you in your “bubble” to help you move the phone to areas that you cannot easily reach. 

Some areas of New Zealand are very remote and internet access is unstable or poor quality. Another way to seek help is for you to take photographs and e mail them to your dermatologist who can phone you.  If you send photos make sure they are in focus and with a well-lit background so that the detail of the problem can be seen. For a dermatologist it is often helpful to see where the rash is on your body so take a “long shot” as well as “close ups” so that detail can be seen. 

Pharmacies remain open. Your dermatologist can send the prescription to the pharmacy. Remember to be very specific with the exact details of your pharmacy so that the prescription is sent to the right one!  Give the pharmacy a ring from home to make sure the medicine is ready to be picked up.  Do not go if you are immunocompromised or over 70 years old.

Major health insurers in New Zealand have agreed to fund virtual consultations during this period. The insurers who we understand have agreed to virtual consultations include Southern Cross, Accuro, NIB, AIA, AA, Police Plan, Sovereign and Partners Life.  Check with your insurer for details prior to the consultation.

Every New Zealand dermatologist extends their best wishes to you and your family/whānau during this time. Stay well, stay safe and be kind to each other.  

 

NZDSI Dermatologists: The Authority on Medical Dermatology, Surgical Dermatology and Cosmetic Dermatology. Why is this justified?

9 Feb, 2020

Although dermatologists are expert in all skin disorders, some have specialty interests and focus their work in specific areas. Some specialise in surgical dermatology especially skin cancer, some in medical dermatology (rashes) and some in cosmetic dermatology. If you look at the New Zealand Dermatological Society Inc (NZDSI) web page you will see the statement “The Authority on Medical Dermatology, Surgical Dermatology and Cosmetic Dermatology”. Why is this justified?

Training to become a dermatologist in New Zealand is rigorous. It may take 12-15 years. Initially there is the university course to graduate as a doctor, usually 6 years. Then follows post graduate training. The initial part is to pass the examinations of Royal Australasian College of Physicians which can be sat after 3 years. After passing these exams, the prospective dermatologist can then apply for a dermatology training position. This is a further 4 years whole time with 2 years spent overseas to build international experience. Some dermatologists will undertake specific additional training in their specific field of interest.
This detail is given so that you can understand the depth and length of training required to become a dermatologist in New Zealand and for you to have confidence in the dermatologist you choose to see. For example, if you have a specific cosmetic question, you will have assurance that the dermatologist will have a full understanding of all the medical (non-surgical) and surgical options for you based on deep and broad experience.

Only NZDSI Dermatologists are permitted to use the distinctive logo. Look for it.



 

Psoriasis-what is in a name?

16 Dec, 2019

Psoriasis, what is in a name?  A disorder that affects 1-2% of all New Zealanders and causes a huge amount of distress for those afflicted. It does not discriminate.

Psoriasis is a red scaly rash commonly on the elbows and knees but actually can affect any part of the skin including the scalp. It can also be found on body folds and on the nails causing them to become thickened and to split.

Many sufferers of psoriasis adapt their life to the disease, covering up and sometimes avoiding social contact. It can be very stigmatising. It may not be possible to swim at the beach or pool. For some, even a small area of psoriasis, depending on the body site, can be very distressing.

Seek treatment for psoriasis if you have it. There are a range of possible treatments including cream, light, tablets and medications called biologic agents. Light treatment called narrow band ultraviolet light can be very effective especially when there is too much psoriasis to treat with cream. There are a range of tablets which need to be suited to the individual. In New Zealand, there are four biologic agents, funded by Pharmac provided the correct criteria are reached.  These biologics are adalimumab, etanercept, infliximab and secukinumab. There are other biologic agents for psoriasis. These are currently not funded by Pharmac.

There is an enormous amount of research in to psoriasis going on around the world, including in New Zealand, and the future for new and effective treatments is very promising.

It is often commented that stress makes psoriasis worse. Here in New Zealand at the University of Auckland, with the Department of Psychological Medicine, the Faculty of Science and Dermatology there is a study for New Zealanders examining this problem and trying to answer the question – why? The study needs participants so if you are interested in taking part and New Zealand based please e mail Mikaela, a PhD candidate, at mlaw382@aucklanduni.ac.nz.

Psoriasis, what is in a name? The answer is complex.


Skin Cancer and Mohs Surgery

26 Oct, 2019

After our last blog you may have had a skin check! Although it is a chilly day for late October the NIWA alert for today recommends sun protection from 9.30 am to 4.30 pm. A cold day does not necessarily mean that no sun protection is needed!

Basal cell skin cancer is the most common form of skin cancer in New Zealand. These skin cancers are fully curable once they are completely removed. They are different from melanomas.

There are lots of ways to treat a basal cell skin cancer. It is important that the correct type of treatment is applied to the basal cell cancer depending on where it is on the body. The highest cure rate is getting it cut out with surgery. The other ways to treat them include freezing with liquid nitrogen, using a cream called imiquimod and a technique called curettage and cautery which involves scraping away the skin cancer with a special spoon shaped instrument and then cauterising the base.

Not all basal cell skin cancers are exactly the same when they are examined under the microscope. Some are more invasive than others which means they can spread further within the skin than can be seen with the naked eye. This can be a problem for surgery especially on the face, for example around the eyes and nose, as it may be impossible to know where they stop and start. 

A choice of treatment your dermatologist may recommend for some difficult basal cell skin cancers is called Mohs surgery. Skin cancers grow in a higgledy-piggledly way. Some of the “roots” may be longer than others and growing in lots of different directions. Frederic Mohs was an American surgeon who invented this technique. The technique involves carefully following the “roots” of the skin cancer until it is fully removed by examining the cut out skin cancer under a microscope during the operation and then returning to the exact location where the cancer remains if more needs to be removed. Mohs is usually done with a local anaesthetic and not general anaesthetic. For some this may mean re-entering the operating theatre several times during the day until the dermatologist is certain it has all gone. Once the skin cancer has been completely removed the hole that has been made by the surgery will be repaired.

Mohs surgery has an advantage that it only removes the exact amount of skin that is needed to get rid of the skin cancer and no more. Mohs surgery keeps the hole as small as possible and therefore the smallest scar so that the best possible cosmetic outcome can be obtained. Mohs has a high cure rate for difficult basal cell skin cancers. Five years after a Mohs operation for difficult basal cell skin cancers that have never had previous treatment, there is an approximate 98-99% cure rate and for those difficult basal cell skin cancers that have come back after a standard surgery, there is an approximate 95% cure rate.

The NZDSI has recently formed the New Zealand Society of Mohs Surgeons to promote the highest standard of Mohs surgery. The New Zealand standards adopted are intentionally equivalent to those of The Australasian College of Dermatologists which represents all Australian dermatologists. NZDSI approved Mohs surgeons have to complete additional mandatory continuous professional education to maintain their Mohs skills as this is a specialised technique not performed by all dermatologists. You can find more details about Mohs surgery and a list of NZDSI approved Mohs surgeons in this website.



Time to check your skin-its Spring!

21 Sep, 2019

September is here and Spring has sprung!  Longer daylight hours, bright blossoms and colourful flowers with the promise of warmer weather and sunshine.

New Zealand Dermatologists recommend this is a good time to check over your skin.

Normal moles are symmetrical in shape and colour, have a smooth outline and do not change in size in adults.  Most people have moles that look similar over their body. 

If a mole changes get it checked.

The ABCDE rule is useful to remember if your mole is changing.

  • Asymmetrical (draw a line through it and the two halves look different).
  • Irregular Border (uneven edges of the mole).
  • Varied Colours (these can include shades of black and brown, red, pink, pale and some have no colour).
  • Diameter bigger than 6 mm (bigger than the end of a big pencil).
  • Evolving (changing colour, shape, itchy or getting crusty).

These can be signs of a melanoma skin cancer so arrange to have it checked urgently. The earlier a melanoma is treated the better the outcome. Melanoma is curable if caught early.


NZDSI Wellington meeting 2019

27 Aug, 2019

What a week!

The NZDSI scientific meeting in Wellington ended on Saturday morning. Too many highlights to fit in to one blog! There was a lot of discussion about medical and surgical dermatology which was really interesting. We managed to keep warm despite the cold and it was really great to catch up with colleagues from around the country.

Some of the great talks were on surgical dermatology and particularly about the use of Mohs surgery for very early melanomas. If you are not sure what Mohs surgery is, take a look at the web site for more information. Melanoma in situ is an early melanoma just within the upper layer of the skin called the epidermis. These early melanomas are fully curable when they have been removed. Mohs is an excellent way to remove it all, especially on difficult areas like the face. Expertise and skill is needed to know where the edge of the melanoma stops and the normal skin starts. 

There is a new treatment for atopic eczema in adults called dupilumab. Atopic eczema is a distressing and itchy condition. A lot of New Zealand children have it and it often gets better with age, yet some carry it through to adulthood. This new treatment is a medicine that blocks a key molecule causing inflammation of the skin. Unfortunately, we do not have it in New Zealand yet but hopefully it will come soon. Our distinguished overseas visitors discussed the use of this medicine in the United Kingdom, it works well and has made such a difference to those suffering with this disease.

So despite the cold weather, this was an excellent conference. Well worth battling wild windy Welly! 

 

A new web site for the New Zealand Dermatological Society Incorporated (NZDSI)

19 Aug, 2019

Welcome to the New Zealand Dermatological Society Incorporated (NZDSI) news blog. NZDSI is the national organisation representing New Zealand dermatologists (Skin Specialists).

We hope you find it interesting and informative. On this website you can find a list of all NZDSI dermatologists in New Zealand, information on dermatology, updates from the society and more! Follow us on Twitter to find out what’s happening in the world of the NZDSI!

This blog will be the leading source of information for dermatology in New Zealand. We will bring you accurate, interesting, local and international dermatology news.

Did you know that in New Zealand it takes at least 13 long and rigorous years to train as a dermatologist from the time of entering medical school? Make sure your skin specialist is a dermatologist! Only NZDSI dermatologists are allowed to use the NZDSI logo so you can check if your skin specialist is a dermatologist by looking right here at the NZDSI site or the Medical Council of New Zealand site.

This week the NZDSI meets for its annual scientific meeting at Te Papa, Wellington. The meeting will explore the new scientific advances in dermatology. Distinguished international speakers will talk about the latest advances in psoriasis and skin cancer surgery. Expert New Zealand dermatologists will talk about specific areas of interest in dermatology.