Expert advice for your skin, nails and hair during cancer treatment. Cancer information and support. From Macmillan and Boots.

Transcription

1 Expert advice for your skin, nails and hair during cancer treatment. Cancer information and support. From Macmillan and Boots.

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3 Cancer may be the toughest fight you have to face but remember you are not alone. You might start to see certain changes in your appearance during and after treatment. But Boots Macmillan Beauty Advisors are here to help. Boots Macmillan Beauty Advisors are No7 Advisors, based in some Boots stores, who have been trained by Boots UK and Macmillan to provide support to people living with cancer. You may find that some of the side effects of treatment are having an impact on how you feel about yourself. If you want to manage or disguise any changes to your appearance, this leaflet has useful information to help you do this. This can go some way to helping you feel good again. You will find expert hints and tips from our Boots Macmillan Beauty Advisors about coping with changes to your skin, nails and hair during cancer treatment. Read on to find out more about what to expect from certain cancer treatments, suggestions about dealing with changes to your appearance, and where to go for further support in your local area. Leaflet contents: How cancer treatments may affect your appearance Changes to skin, nails and hair (including eyebrows and eyelashes) Your feelings Further information how you can get further support Other useful organisations 1

4 You can also access all the information in this booklet at macmillan.org.uk/visiblesideeffects As well as reading this leaflet, you may also find it helpful to speak to a Boots Macmillan Beauty Advisor. They can give you face to face advice about caring for your skin, nails and hair. They can also show you how to use products to disguise changes or enhance any facial features to help you look and feel good. Visit boots.com/storelocator to find your nearest Boots Macmillan Beauty Advisor. If a Boots Macmillan Beauty Advisor isn t available in your area, you should still be able to get support locally. A number of hospitals and support groups run workshops about coping with the visible effects of cancer treatment. You can ask your cancer nurse specialist or oncology team about the services that are available in your area, or call the Macmillan Support Line on Many think it's just older people who are affected by cancer it's not. It can hit anyone. For me it's about helping these people get their confidence back by offering them simple tips on what to do and not to do. Seeing them feel more confident at the end of a session is such a positive experience. Sam Brady, Boots Macmillan Beauty Advisor, Marldon 2

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6 How cancer treatments may affect your appearance Changes to the condition and appearance of your skin, nails and hair depend on the type of cancer treatment you re having. This chapter gives a brief overview of some common cancer treatments and how they can affect your skin, nails and hair. Chemotherapy This treatment is the most common cause of hair, nail and skin changes. Most people know that some chemotherapy treatments can cause hair loss from the head, but fewer people know that other areas of your body may be affected too. This can include hair loss from eyebrows, eyelashes, facial hair, underarm hair and pubic hair. Chemotherapy may affect your fingernails and toenails too. Your nails may become more brittle and develop lines or ridges. During treatment your skin may become dry and more sensitive. Steroids are often given with chemotherapy, which may make your skin more prone to spots and reddening. 4

7 Hormonal therapy This is used to treat cancers such as breast and prostate cancer, and can affect your skin, nails and hair. These effects are usually mild, but some people have more noticeable hair loss. Hormonal therapies may also cause dry skin, rashes, or in some rare cases, spots. Targeted therapy (also called biological therapy) Targeted therapies use drugs that mimic substances that are naturally present in the body to destroy cancer cells. Some targeted therapies, such as cetuximab, erlotinib, gefitinib, panitumumab and lapatinib can cause skin, hair and nail changes. They can make your skin drier and more sensitive. Skin rashes are also common. These treatments may cause hair loss from the head, but they can also make hair grow thicker or longer in other parts of the body. Your cancer nurse specialist or oncology team will give you specific advice on how to manage these changes if you re prescribed a targeted therapy. 5

8 When I was having chemotherapy my entire complexion became very dull. It becomes easy to forget to focus on how you look on the outside, or to even know where to start to make yourself feel better. Reconnecting with how you look on the outside is the first step to longer-term recovery. Venus Otar, 41, from Nottingham I want to be there for my customers because I really care about making them feel good about themselves. And the training I ve had from Boots and Macmillan means that I have a better awareness of what people with cancer may be facing. Karen White, Boots Macmillan Beauty Advisor, Northwich 6

9 Radiotherapy Radiotherapy can cause changes to your skin and hair, but only in the area(s) being treated. If you re having radiotherapy, you ll be told how to look after the skin and hair in the area(s) being treated. You should only use products in the affected area(s) that are recommended by one of your radiotherapy team. For detailed information about a particular treatment type, call the Macmillan Support Line on You can also order Macmillan s free information booklets from be.macmillan.org.uk 7

10 Changes to skin Depending on the type of treatment you have, and how you react to it, your skin may become: dry more sensitive to sunlight sore in some areas, such as the palms of your hands and the soles of your feet redder (if you have light skin), or darker with a blue or black tinge (if you have dark skin) more sensitive to some underarm deodorants, perfumes or perfumed products. You may also develop a rash, particularly if you re being treated with a targeted therapy. If you develop any pain or a rash, tell your cancer nurse specialist or oncology team, as they can give you treatment that will help. 8

11 Looking after dry skin If you have very dry skin, these tips may help: Clean your body with lukewarm water and non-perfumed bath and shower oils. Avoid using soap, as this will dry your skin out even more. If your skin feels sensitive or you re receiving targeted therapies as part of your treatment, avoid using perfumed or coloured skin products. Avoid long, hot showers or soaking in the bath, as hot water dries out the skin. Pat your skin dry with a clean, soft towel. Try these tips for cleansing your face: Use a gentle cleanser that won t strip the moisture out of your skin. Creamy formulations could be a good option, but make sure you apply the product carefully and avoid your eyes. Remove cleansers with a damp cotton wool pad or a clean, damp flannel. This will leave your skin feeling soft and clean. If you re using a toner, stay away from products that contain alcohol, as these can also dry out your skin. A skin freshener without alcohol would be more suitable. 9

12 My skin used to be quite oily, but chemotherapy changed it completely, and it became very dry and flaky. It was difficult going back to the drawing board everything I d normally use didn t really work for me any more. Vicki Whittaker-Stokes, 40, from Derby I had a lady in whose husband was going through cancer treatment and was having problems with dry skin. So I talked her through the options and recommended a moisturiser for men. Jay Hickson, Boots Macmillan Beauty Advisor, Manchester 10

13 Using moisturiser Use a moisturiser at least once a day on your face and body if you have dry skin. Some moisturising ingredients will help leave the skin feeling more comfortable and nourished. Look for rich and creamy moisturisers with some of the following ingredients: ceramides cholesterol glycerin hyaluronic acid shea butter or cocoa butter. Moisturisers that contain oatmeal can also be soothing for dry or sore skin. Try tying a muslin bag filled with oatmeal over your bath tap and letting the water run through. This is a great way to make bath-time a soothing and skin-softening experience. If your skin is very dry, it can become itchy. Using an emollient cream that contains oatmeal, menthol or 10% urea may help relieve the itchiness. Ask your cancer nurse specialist or oncology team for advice they may prescribe you something to reduce itching. If you re having radiotherapy or targeted therapies, the staff at the hospital will advise you on how to care for your skin. Check with them before using any skin products. 11

14 Looking after oily skin The following tips will help you look after your skin during cancer treatment: A wash-off cleanser could be a good option if you have oily skin. Remember to work the cleanser into your skin well, before washing it off. Using a soft flannel or muslin cloth can help remove the last traces of cleanser, which can make your skin feel even cleaner. Be careful not to overwork your skin avoid exfoliating products or harsh products that strip the skin of moisture. A good cleanser and a light, oil-free moisturiser should help keep your skin in good condition. If your skin is usually oily, you may notice it becomes less so during chemotherapy treatment. Changes in your skin tone You may notice changes in skin tone as your treatment goes on. The following tips may help. Using foundation If you wear foundation, you may need to change from your usual shade. Choose a base colour that isn t visible at your jawline. A tinted moisturiser can work well if you re not used to wearing a lot of make-up. Or a light-coverage foundation will help even out the tone of your skin. 12

15 Applying a bronzer Use a make-up brush to apply a bronzer lightly to your forehead, cheekbones and chin to add natural-looking contour to your face. Start slowly when applying colour to your face begin by adding a small amount and gently build this up. The colour should look more natural if you use a large brush to apply the bronzer. You could speak to a Boots Macmillan Beauty Advisor about other make-up options to enhance your skin tone. Flushed skin A green-tinted primer can help tone down rosy skin and even out the colouring on your cheeks, nose and chin. But try to use these products sparingly. When applying the primer, pat it gently into your skin rubbing your skin could make the redness even worse. If you have flushed skin, try using a medium-coverage foundation with sun protection. Make sure the foundation matches the areas of your face that are less red. Pat the foundation over the primer to avoid disturbing it. Rashes or spots If you develop a rash, always get it checked by your cancer nurse specialist or oncology team straightaway. They will know the cause and be able to give you some advice. Some targeted therapies can cause a rash that looks very similar to acne. However, this rash isn t caused by acne, and anti-acne products will make the problem worse. Your cancer nurse specialist or oncology team can give you treatment that will help. 13

16 General tips Whatever type of skin you have, the tips below may help: Protect yourself in the sun with minimum factor SP30 suncream with at least four or five UVA stars. Avoid staying in the sun, especially during the hottest times of the day. Wear a hat or scarf on your head when it s sunny. Wear loose clothes made of cotton or natural fibres. Use petroleum jelly (such as Vaseline ) or a lip balm on dry or sore lips. If you re having radiotherapy, your cancer nurse specialist or oncology team may suggest using a water-soluble lubricant, such as K-Y Jelly, during your treatment. Protect your skin from the damage caused by scratching. Keep nails short using an emery board. Clean and rub the itchy area rather than scratching it. If you get a rash or itchy skin, speak to your cancer specialist who will prescribe medicines or creams. Use an electric shaver instead of wet-shaving to minimise the risk of cuts. If you ve had treatment in an area where you would normally shave, ask your cancer nurse specialist or oncology team for their advice about shaving. If the palms of your hands and the soles of your feet are sore, speak to your specialist. They may need to adjust the dosage of your treatment. 14

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18 Changes to nails Chemotherapy or targeted therapy may make your fingernails and toenails grow more slowly or become brittle or flaky. You may notice white lines appearing across them, or changes in the shape or colour of your nails. Nails may, on occasion, become painful and be lost altogether. If your nails become painful or swollen, see your cancer nurse specialist or oncology team, as this may be due to an infection that needs treatment. Nails should go back to normal after chemotherapy or targeted therapy ends. What you can do During treatment, there are a number of things you can do to manage and disguise changes to your nails: Use a nail-strengthening cream. Use a hand, foot and nail cream regularly. Nail varnish will help minimise the appearance of discoloured nails, but don t use nail varnish if your nails are split or sore. Massaging a good cuticle cream into your cuticles will help prevent dryness, splitting and hangnails. Do not cut your cuticles. Use an emery board rather than cutting your nails. This will keep them short and smooth and avoid snagging. 16

19 If you re filing your nails, draw the emery board across your nail in one direction only, instead of using a sawing action. This can help prevent nails splitting further. Wear gloves while doing household chores, especially the washing-up. Excessive exposure to water can lead to fungal infections of the nail bed. Don t use false nails during treatment or when nails are sore or damaged. Wear comfortable shoes that aren t too tight. Some people experience discoloured, dry, brittle and cracked nails during cancer treatment. Sometimes they have ridges or lines on their nails. In certain circumstances, nails can fall off due to treatment. I generally advise people experiencing these problems to wear gloves when washing up or gardening and to moisturise to protect their nails. Julie Kiernan, Macmillan Gynae-Oncology Clinical Nurse Specialist, Manchester 17

20 Changes to hair Some cancer treatments cause changes to the texture and condition of hair. They may also cause hair thinning or complete hair loss. Hair loss depends on the type of treatment you have, the combination of drugs used, the dose, and how the drugs affect you personally. If you re having radiotherapy, the hair in the treatment area may be affected but other areas won t be. Hair usually grows back after cancer treatment has finished. For certain types of chemotherapy, hair loss may be prevented or reduced by using a cold cap. This works by reducing blood flow and the amount of drugs reaching the scalp. Your cancer nurse specialist or oncology team can tell you if this kind of treatment is suitable for you. It s helpful to have your hair short before starting any treatment that may cause hair loss. This is because the weight of long hair can pull on the scalp and can make the hair fall out faster. For some people, cutting their hair short before treatment helps them feel in control of their appearance. Wearing a wig If you re considering wearing a wig, ask about your options early on so that the wig can be as close a match as possible to your normal hair. The other advantage of arranging a wig early is that you ll already be prepared if you lose your hair more quickly than expected. It also gives you a chance to get used to the wig before you really need it. 18

21 NHS wigs are free if you live in Scotland or Wales. Health Service wigs are free if you live in Northern Ireland. In England, you may be entitled to a free wig on the NHS if you re having, or have had, cancer treatment and meet certain criteria. Visit macmillan.org.uk/hairloss or speak to your cancer nurse specialist or oncology team to find out more. Other options for covering up hair loss include: hats scarves turbans. It s important to do what makes you feel most comfortable. 12 days after my first chemotherapy session I noticed that my lovely long blonde hair was starting to fall out. At 14 days it was coming out in handfuls and I was completely distraught. This was one of the most traumatic times of my life. Michaela Pearce, 46, from Nottingham 19

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23 What you can do Avoid combing your hair if it s brittle or if your scalp is dry, as this can make your hair fall out faster. Use a soft brush or babies brush. Avoid using hairdryers, straighteners and curling tongs. Some people choose to wear a hairnet to bed to catch any hair that falls out. Consider using hats and scarves to protect your head from the sun or cold wind if you re not wearing a wig. These will also add a bit of colour and style. Macmillan s booklet Coping with hair loss has more detailed information and practical tips to help you look after your hair during and after cancer treatment. Many women with cancer lose their hair, their eyebrows, their eyelashes, and with it, their confidence. Seeing what these ladies go through makes it even more important to be able to give something back to them by offering tips and advice on how to apply make-up. Sam Brady, Boots Macmillan Beauty Advisor, Marldon 21

24 Changes to eyebrows and eyelashes Some cancer treatments affect the eyebrows and eyelashes. This could mean that they become thinner or fall out completely. Losing your eyebrows and eyelashes can change your appearance, and this can be upsetting. But remember that eyebrows and eyelashes usually grow back. The amount of hair that falls out depends on the type or combination of drugs used, the dose, and how the drugs affect you personally. You may find that you lose your eyelashes and eyebrows later than the hair on your head perhaps after treatment has ended. Or it can happen more gradually during treatment. You can learn to create new eyebrows with an eyebrow pencil if you want to, or use false eyelashes. Boots Macmillan Beauty Advisors can help you with the techniques described in this chapter. You can also see an advice video about these techniques at boots.com/macmillan 22

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26 Eyebrows You can redraw eyebrows with an eyebrow pencil that is slightly lighter than your normal hair colour. Another natural-looking way to redraw the eyebrows is by applying eyeshadow powder with a make-up brush. Boots Macmillan Beauty Advisors can show you how to redraw your eyebrows, as it can be daunting to try this at first if you re not used to it. You can also visit boots.com/macmillan to watch a video about redrawing your eyebrows. Creating natural-looking eyebrows If possible, practise drawing on your eyebrows before your treatment begins so you can get used to following the shape and arch of your brow. You may want to take a close-up photo of yourself before your treatment, so you can remember exactly where your eyebrows were and what they looked like. Try drawing a dot of colour above the outer and inner corners of each eye, and a dot where you think you ll create any arch. This way, you can then check for symmetry before you start drawing (see the illustration below). 24

27 Use your brow bone and your eyes to identify where your brows should be. Place the brow pencil alongside your nose and skirt the outer corner of your eye at a 45 angle (see the illustration below). This shows where a natural brow would start and finish. Use a lighter pencil than your normal hair colour. Draw from the centre of the brow line outward, using light, feathery strokes (see the illustration below). Plenty of tiny strokes with the pencil will look more realistic than a single line. 25

28 Create a brow that s thicker-looking at the inner end (nearest to the nose) and thinner at the outer edge. Light pressure is all that s needed, and then comb through the colour with an eyebrow wand to give a more natural appearance. Check for symmetry when you move on to your other eye (see the illustration below). Remember though that no two brows are identical, so just make them look more or less the same, not identical. Some people choose to have permanent or temporary tattooing to create new eyebrows. This should not be done during treatment. For more information, visit macmillan.org.uk/hairloss or call the Macmillan Support Line on Long and thick eyebrows If you re receiving certain types of targeted therapy, your eyebrows may grow long and thick. It s fine to trim them if this happens. 26

29 Eyelashes If your eyelashes have become thinner or have fallen out completely, there are a number of things you could try: Use a soft eyeliner and smudger to define your eyes and create the illusion of eyelashes. Lift the skin at your eyebrow when applying the make-up (see the illustration below). This will tighten your skin and make the pencil easier to apply. Use soft strokes along the eyelash line, by applying a smudger to soften the line and push colour further into the lashes. Apply the make-up lightly to ensure the eyelashes are well defined and look natural (see the illustration below). 27

30 If you have eyelashes, use a gentle teasing action when applying mascara. You may find that using a mascara wand with short bristles is easier to use on short and sparse eyelashes than a longer, eyelash-extending wand. Long or inward-growing eyelashes If your eyelashes grow very long or grow inwards, it can irritate your eye and you may need to have your eyelashes trimmed by a nurse. You should never try to do this yourself, but always get advice from your doctor or nurse. What you can do Avoid eyelash curlers, as they can damage fragile eyelashes. To remove eye make-up, hold a cotton pad soaked in eye make-up remover to the eye for a couple of seconds, before gently wiping away. This avoids unnecessary pulling of the lashes. Consider using mascara that will dissolve in warm water if your eyes are sensitive. Avoid waterproof mascara, as it can be harder to remove. To prevent eyelash loss, try not to rub your eyes. Using make-up may be the easiest way to disguise thin eyelashes. If you want to wear false eyelashes, check with your cancer nurse specialist or oncology team first, as the glue may irritate sensitive skin. 28

31 I was concerned about losing my eyelashes and eyebrows, as they frame your face so much and I knew I d really see the difference when they were gone. Making an effort with my appearance was a way of keeping a sense of normality for myself. Jeni Reeves, 44, from Kent A lady I saw didn t mention anything about her treatment until the end when she told me not to worry as she had no lashes because of her treatment. But I could see very fine, baby lashes, and so I gently brushed over the mascara, and she looked fabulous she couldn t believe the result. Karen White, Boots Macmillan Beauty Advisor, Northwich 29

32 Your feelings Having to cope with changes to your appearance as you undergo treatment can be tough, even if these changes are often temporary. The way you feel about your appearance is closely related to how you feel about yourself. If you re not happy with how you look, it may affect your confidence and your relationships. Some people feel they shouldn t worry about changes to their appearance when they have cancer. However, it s natural to feel upset about losing your hair or changes to your nails or skin. For many people, these issues are one of the biggest concerns during treatment, but most do adjust and find ways to cope. Talking about your feelings can be useful. If other people know how you feel, it makes it easier to support you. You can call the Macmillan Support Line on to speak to cancer support specialists about any emotional or practical issues that are on your mind. They re here for you Monday Friday, 9am 8pm. Sharing experiences with people in the same situation can also help. Try the Macmillan Online Community macmillan.org.uk/community Or ask your cancer nurse specialist or oncology team to put you in touch with a local support group. We hope our tips and suggestions help you discover what works best for you, so that you can feel confident and better about yourself during your treatment. 30

33 Further information Macmillan has more information about cancer types, treatments and tests, and about living with and after cancer. We also have details of other helpful organisations and support groups in your area. You can contact us using the following details: Macmillan Cancer Support 89 Albert Embankment, London SE1 7UQ General enquiries Questions about cancer? Call free on (Mon Fri, 9am 8pm) Alternatively, visit macmillan.org.uk Hard of hearing? Use textphone , or Text Relay. Non-English speaker? Interpreters available. To order any Macmillan booklets, log on to be.macmillan.org.uk or call us on Boots Macmillan Information Pharmacists Boots Macmillan Information Pharmacists are available in some Boots stores. They can talk to you about how to get more information and support about any concerns you have. They can also help connect you to cancer information services and experts in your local community, and signpost you to wider Macmillan services. 31

34 Other useful organisations Beauty, hair loss and cancer support organisations Changing Faces The Squire Centre, University Street, London WC1E 6JN Tel A charity for people with conditions, marks or scars that affect their appearance. Can arrange consultations with skin camouflage specialists, who can teach people to self-apply specialist cover creams. The Hairdressing and Beauty Suppliers Association (HBSA) 35A Colbourne Road, Hove BN3 1TA Tel info@thehbsa.co.uk A network of industry professionals who share knowledge and offer support where it s needed. The website has a searchable directory of suppliers of hairdressing and beauty products, including wig makers. Institute of Trichologists 107 Trinity Road, Upper Tooting, London SW17 7SQ Tel admin@trichologists.org.uk The foremost professional association for trichologists (hair health specialists) in the world. Gives information about hair health and hair loss. 32

35 Look Good Feel Better West Hill House, 32 West Hill, Epsom KT19 8JD Tel A support service for women and teenagers living with cancer. Holds free skincare and make-up workshops to help combat the visible side effects of cancer treatment and, in turn, boost confidence and well-being. Look Good...Feel Better is working towards offering support to men in the future, and its USA branch already provides online advice for men at Specialist hair services My New Hair info@mynewhair.org A charity with a network of salons that provide a wig-styling service for people with cancer and medical hair loss. The website has a list of recommended salons that have worked with Trevor Sorbie to ensure they offer expert advice and styling to make your wig individual to you. It also has information about hair loss and wigs. Consultations are free. Use the salons cut and blow-dry cost for a guide to styling charges, and contact the salons directly for specific prices. Some salons offer their service for free. 33

36 Philip Kingsley Trichological Clinic 54 Green Street, London W1K 6RU Tel Provides consultations and advice about hair health. Consultations are with qualified trichologists who have experience with hair loss caused by cancer treatment. Strength in Style with Toni & Guy Visit macmillan.org.uk/strengthinstyle, toniandguy.com or phone Macmillan is working in partnership with Toni & Guy to provide specialist haircare for people affected by cancer. Strength in Style consultants, who have been specially trained in the effects of cancer treatment on hair, can help clients with choosing, fitting, adjusting and cutting wigs. They also advise on hair as it grows again so that people affected by cancer can have one point of contact to help them deal with hair loss and regrowth. 34

37 Disclaimer We make every effort to ensure that the information we provide is accurate and up to date but it should not be relied upon as a substitute for specialist professional advice tailored to your situation. So far as is permitted by law, Macmillan does not accept liability in relation to the use of any information contained in this publication, or third-party information or websites included or referred to in it. Some photographs are of models. Thanks This booklet has been jointly written and developed by Boots UK and Macmillan s Cancer Information Development team. It has been approved by Macmillan s medical editor, Dr Tim Iveson, Consultant Medical Oncologist and Macmillan Chief Medical Editor. With thanks to: Boots UK; Angela Cleary, Macmillan Learning and Development Manager (People Affected by Cancer); Caroline Hood, Head and Neck Cancer Clinical Nurse Specialist, Crosshouse Hospital, Kilmarnock; Jenny King, Chemotherapy Nurse Specialist, Sussex Cancer Centre; Vanessa Linton, Macmillan Head and Neck Advanced Nurse Practitioner, Churchill Hospital, Oxford; and the people affected by cancer who reviewed this edition. 35

38 Sources Fingeret MC. The nature and extent of body image concerns among surgically treated patients with head and neck cancer. Psycho-oncology (8): Melissa I. Breast cancer treatment in older women: does getting what you want improve your long-term body image and mental health? Journal of Clinical Oncology (19): NHS Choices. Help with health costs. nhsengland/healthcosts/pages/wigsandfabricsupports. aspx (accessed 5 June 2013). Taylor-Ford M. Body image predicts quality of life in men with prostate cancer. Psycho-oncology (4): Tobias and Hochhauser. Cancer and its management Wiley and Blackwell. 36

39 Notes You can use this page to keep a record of any advice from your Boots Macmillan Beauty Advisor or questions for your cancer nurse specialist or oncology team. 37

40 More than one in three of us will get cancer. For most of us it will be the toughest fight we ever face. And the feelings of isolation and loneliness that so many people experience make it even harder. But you don t have to go through it alone. The Macmillan team is with you every step of the way, from the nurses and therapists helping you through treatment to the campaigners improving cancer care. Together, we are all Macmillan Cancer Support. For cancer support every step of the way, call Macmillan on (Mon Fri, 9am 8pm) or visit macmillan.org.uk Hard of hearing? Use textphone , or Text Relay. Non-English speaker? Interpreters available. Braille and large print versions on request. Cancer information and support. From Macmillan and Boots. Printed using sustainable material. Please recycle. Macmillan Cancer Support, August st edition. MAC Next planned review Macmillan Cancer Support, registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604).