NZDSI Blog

Doctors strive for good care but with appointments which minimise up-close, face to face exposures.

When meeting with your dermatologist help them assess your skin more effectively.

Feel free to bring rash or lesion photos, your list of concerns and let your partner circle that changed lesion on your back they are worried about.

Bring your medication and allergies list if the names are hard to recall. Photograph those creams.

Come make-up free if you need a facial examination. At most keep this light and try to remove before your appointment. Caked thick make-up is super difficult to remove, means longer face to face exposure and is a barrier to good view of the skin.  Sunscreens and lighter moisturisers are fine, only avoid in areas where procedures are planned that might require a well-fixed dressing.

Wear easily removed jewellery and watches but better leave them safe at home. 

While fewer people in a clinic is safer for Covid risk it can be very helpful to have a caregiver present for people needing assistance, check with your clinic if not sure.  At the same time bringing your delightful 2-year-old twins to your skin check isn’t fun for them and won’t help in diagnosis of a subtle skin cancer or your recall of care advice.

Confused about levels and traffic lights? Wondering how busy Covid testing will be for Christmas travel fantasies?

Let’s face it…We are stuck in limbo, picnics are the only option.  Here’s how your dermatologist can help make your picnic safe.

Auckland, our trapped 40% of NZ – your UV level is very high, stay safe team of 2 million, this is spring, you are at red for UV, you need:

1. A hat
2. Clothing for cover, but aim for the shade
3. Umbrellas would be fab if the spring wind settles down
4. A mask is quite handy for UV protection, go for triple layers of cloth for Covid
5. Pack some sunscreen and renew old supplies
6. Wet wipes? Yes, if compostable, MIT free/fragrance free or just use a tissue. Parents - ice cream is essential and sticky, enjoy the small things, it’s all you can do to stay safe.

Spring is a good time to be aware if you are extra sun sensitive due to the medicines you take. Look out as the UV index is climbing to high levels now in northern Aotearoa and to moderate further south.  Try to use a combination of clothing/hats/seeking shade, avoiding high UV times of day, along with sunscreen.  Several prescription medicines can make you more sun sensitive and you should be extra vigilant. Ask your doctor if your medicine has a warning about sun sensitivity. Sometimes medicines need to be changed if this is more troublesome or severe.   

Thiazides are a common blood pressure treatment - thiazides reduce risk of heart attack and stroke but are also associated with sun sensitivity and increased risk of non-melanoma skin cancer, discuss this with your doctor if you have a history of skin cancers.  Immune suppressing medications can also increase your skin cancer risk and some, such as methotrexate and azathioprine, also cause direct sun sensitivity. Doxycycline and isotretinoin are two common medicines your dermatologist may have prescribed that increase sun sensitivity. 

Even creams can cause sun sensitivity. Take particular care if using Efudix cream, florid reactions to sunlight can develop.  This is not the best time to start Efudix prescribed for use in the winter unless you know you will take extreme care.  Over the counter items are also a potential source of sun induced rashes, ibuprofen along with some prescribed non-steroid anti-inflammatories, St John’s Wort and some other herbal supplements. DermNetNZ has a helpful page on Drug-induced photosensitivity but talk to your GP or dermatologist if you have particular concerns. 

With the lockdown just hours prior to the first sessions organisers did an awesome job to make an immediate shift to an online conference.

Highlights were numerous and included:

 Launch of a patch testing series relevant to exposures to products in NZ.  Established by a working party of our local contact dermatitis specialists, it’s out with the “European series” and in with the “NZ series”. Overseas speakers discussed new medications available or coming for dermatitis and psoriasis. We had instructive lessons in providing gender affirming health care.  Surgical sessions included tricks and tips and more advanced techniques to optimize surgery on the face such as  in the repair of difficult Mohs surgery defects.  An interesting bunch of cases from dermatopathologists coincidentally brought together reports of cases suspected to be reactions to antibacterial rinse chemical benzalkonium chloride.  If you have a recent underarm or groin rash check you have not switched to this as a laundry rinse in your efforts to fight Covid.  An excellent update on sunscreen standards brought a reminder the spring UV is here and it's time to start protecting again very regularly with both cover up clothing and creams.

Dermatologists will be returning to their practices this week, do be in contact if you have any urgent concerns as most will make online consultations available and they will work within protocols for the different Covid levels.

Covid-19 vaccination numbers will be boosted with the first New Zealand mass vaccinations finally starting.  Most people are flying through the process apart from mild discomfort at the injection site.  The second vaccine has tended to have a few more side effects, but this is just your body building immunity. Skin reactions and allergic are rare and generally fortunately mild.  It is common is to have some discomfort at the injection site, plan for an early night and extra fluids, a cool compress may help.  You are advised not to massage the site.

A recent study by dermatologists included the Pfizer vaccine, this was less likely to be associated with skin reactions than the Moderna vaccine. Most reactions are at the vaccination site but rare delayed episodes of welts (urticaria), viral mimic rashes and flares of existing skin conditions are reported along with classic chilblains.  Small numbers of a viral condition called pityriasis rosea have been noted and very rarely the shingles virus - zoster was reactivated.  These rare reports are not reasons not to be vaccinated but talk to your doctor if you have been recently unwell and your appointment is coming up, a short delay might be advised until your health is optimal.  Keep up your usual treatments for any existing skin conditions in discussion with your doctor.

Vaccine reactions are encouraged to be reported, doing this builds a knowledge bank about the vaccines. Do take photos and discuss with your dermatologist or GP if concerned.  The Ministry of Health Covid-19 website has a link to report vaccine related side effects and information on what to expect after vaccination. While it mentions you can take paracetamol or ibuprofen after vaccination there is little research on this and how this changes the way the vaccine works. Do not take these before vaccination unless they are your regular medication. First aim for rest, fluids, a cool compress if needed for the day after vaccination  rather than heading out on the town or doing a marathon gym workout.

Try to embrace the mask, it’s really not that hard even to wear one all day.

Masks protect people near you from infections such as Covid-19.  Masks do not cause infections such as Staph but just like your knickers regularly washing or changing to keep them clean is the only way to go.  Masks sometimes aggravate acne and contribute to other facial rashes hence the 2020 rise of "maskne".

Prolonged mask wearing can cause some irritation for some wearers.  If you are prone to dry skin, use gentle cleansers and apply a moisturiser whenever possible.  If prone to acne, use lighter moisturisers and limited make-up under the area on your face covered by a mask. Heavier products combined with the moist air inside a mask can aggravate acne. 

Underlying skin problems may be aggravated by prolonged mask wearing. If you experience skin problems on your face, see a dermatologist. 

Wash and dry or gel your hands before putting on a mask.  This way you will not spread bugs from your hands to your face.  Avoid touching the mask once in place as this also transfers bugs. When learning to wear a mask it is common for people to fiddle with their masks, practice at home to fit it and leave it in place.  Choose a mask that fits well and fix it on reasonably firmly.  Higher on the nose is best, if it has a wire inner this is designed to mold over your upper nose – it holds the mask in position, reduces fogging of glasses and improves the fit.  If the mask falls to only partly cover the lower nose or falls to become a chin cover then something is wrong with the fit - just try again with clean hands!!

Reusable masks reduce waste but should be washed daily.  Cotton and silk are kinder to the skin than synthetics as the inner - against skin - layer.  For added effectiveness non-woven polypropylene is a good mask filter.  In NZ there is also the HELIX.iso filter.  Best evidence supports washing at 60 Celcius and with soap.  Dry outside in the sun (UV kills lots of infections) and wind unless you are pollen sensitive, hot dryers are also helpful to clean and many can be hot ironed which is another cleaning step.  Gentle lukewarm hand washing is not so effective which is a downside to silk masks which may otherwise be excellent.  If the silk mask is unable to be hot washed include an antibacterial and rinse well in fresh water. Please note there are downsides to cleaning a mask in a microwave – fire risk – and don’t try the rice cooker.  If only wearing for a very short time you can increase the time between washes but not if you stuff the mask in the same bag or pocket as your keys, coins and dog treats.  Remove the mask from your face with clean hands and carefully place in a clean bag.

Extreme UV conditions persist across Aotearoa.  Dermatologists are seeing sunburns because people underestimate the power of the sun.  The commonest thread seems being caught out if it is overcast or the wind is cooler and over reliance  on limited applications of sunscreen.

People are coming into the dermatologist for post-holiday checks with tanned and freckled up skin which equals sun damage. Shoulders, necks and chests seem to be hit most by burning and this is most easily prevented with summer clothing with higher necklines and sleeves when outdoors.

These high UV days coincide with the summer sales.  A long-sleeved SPF 50 sunscreen is a great option as a summer gift.  Make the most of the sales and look for lighter weight UV protective clothes with more cover in the sleeves or legs, sarongs can be a great cover all for the beach. Avoid the potential for a fried chest and shoulders from a tank top, layer these with a good looser cotton or linen overshirt when outside.

Parents need to be alert for sun protection measures for children particularly when the sports and school swimming days are held over the next few months.  Educate the children to remember the slip slop slap shade message.  Outdoor sports days can be times of high risk especially for fairer children and proactive parents should push for Sunsmart measures in their schools.

Looking healthy is a common desire.   We are flooded with images of beauty and tips on achieving this.  Collagen supplements are a current enticing tool.  Are they worth the expense?  Watch NZDSI president Dr Louise Reiche in the collagen debate on Fair Go’s programme tonight on TV One or on TVNZ On Demand.

The skin is the largest organ in our body.  Our general health, daily habits and lifestyle impact on our skin’s quality and appearance.  Visible ageing changes such as wrinkling and dry skin are partly determined by our genetics and our age.  Diet and the environment are also major factors.  

Food we eat is broken down by our gut into small molecules that can be absorbed through the gut wall into the bloodstream and distributed throughout the body.  Cells absorb those building blocks to construct what the body needs. Collagen protein is a rope-like structure which provides strength to our skin, muscles and bones.   Collagen is rich in glycine, lysine, proline and hydroxyproline, but is an incomplete food protein because it lacks tryptophan which our bodies cannot make and thus require from the diet.  Collagen in our diet or in supplements can be broken down and reused for making new collagen or other proteins.  Manufacturing strong collagen in our body relies on additional nutrients (“cofactors”) such as Vitamin C and various minerals.  Consuming lots of collagen could create a nutrient imbalance and without other necessary cofactors the collagen production could either fail or be poor.

Having a balanced diet by eating a wide range of foods, ensures we will get plentiful nutrients, such as proteins, vitamins and anti-oxidants and are less likely to suffer imbalances, which can be the risk from taking supplements.  The Mediterranean diet - predominantly fresh vegetables and fruit, nuts, legumes and seafood, some white and smaller quantities of red meat, is the diet associated with best health outcomes and delayed ageing. Transport and storage reduces fresh food quality so choose locally grown and seasonal vegetables.  They are cheaper, and better for our environment and support our local communities economically.

Sun exposure is the biggest environmental factor contributing to visible skin ageing.  So habitually protecting your skin from the sun is key: seek the shade, wear a broad brim hat, wraparound sun glasses, high ultra-protective factor (UPF) clothing and a broad spectrum SPF50+ sunscreen to all exposed skin when going outdoors.   Regularly having a good night’s sleep, regular exercise, drinking plenty of water, avoiding smoking, and minimising alcohol consumption are additional ways to keep healthy and have healthy looking skin.

This weekend really is one to enjoy the outdoors in many parts of Aotearoa.  With almost summer temperatures in eastern areas the beach will lure the hardier swimmers. Crazy spring changeable weather given it was snowing at a few southern beaches last week that are reaching over 20 degrees today.  The spring school holidays are a time to take sun protection more seriously whatever the temperature.  The UV index is indicating sunburn risk - hitting 4s in the south and in the high range - 8 - in the north.  Invest in good wider brim hats and clothing for the beach and pools and consider working sun protection into the day’s plans well before the sunscreen goes on. Plan to be indoors or in the shade during the middle of the day. Some parents will find a midday siesta can work well for a break from the highest UV conditions.  Aim for SPF 50 long sleeve rash tops and SPF 50 sunscreen.  Remember to keep up the hat and sunscreen habit once back at school for Term 4.  If you are blessed with a pool at home it’s likely sited in a high UV position, don't wait for summer, add some effective shade now and limit exposure to that midday sunshine.

In a year of uncertainty we have a welcome constant coming up on the earth’s calendar.  Spring has arrived in the Southern Hemisphere. Our increasing daylight hours are welcome following Matariki. In northern Aotearoa the kowhai flowers are bursting, koanga, time for planting.

It’s almost spring equinox – officially 1.30am NZ time on September 23, 2020.

The equinox occurs twice a year when the earth’s axis is tilted neither toward nor away from the sun.  After this date we will be thrown into strengthening sunlight as the earth slowly tilts and brings the south pole closer to the sun.  The UV index will be creeping up.  NIWA’s Leigh UV station is recording 4-5 during the middle of the day, Wellington is also just starting to reach UVI 3-4 and southern NZ will not be far behind.  Three plus is where the UV level has burning potential and slip, slop, slap is recommended during the stronger sunshine hours of the day.   It can still be cold and windy but don’t underestimate the spring sun on skin that has been hidden over winter.

Remind yourself of your level of risk – fair skin, your activities, past sunburns, family history, medicines you take, medical conditions - talk to your dermatologist about these factors. Our spring blogs will cover some of these.  Meanwhile get out your hat, keep the long sleeves, renew your sunscreen and enjoy the spring.

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!

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

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.  

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.

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.

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.

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! 

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.