Homemade Skin Care Recipes
Seven distinct antigenic botulinum toxins (BNT-A, -B, -C, -D, -E, -F, and -G) produced by different strains of Clostridium botulinum have been described. The human nervous system is susceptible to five toxin serotypes (BNT-A, -B, -E, -F, -G) and unaffected by 2 (BNT-C, -D). Although all toxins have different molecular targets, their action leads to the blockade of the cholinergic nerves. However, only the A and B toxins are available as drugs. In aesthetic medicine, the BNT predominately used has been of type A so far, even though some trials have been published utilizing type B BNT (Baumann et al. 2003).
The concept of calculating the dosage units for the different products Botox and Dysport is not easy to understand and may not be necessary. The user must only be aware that the dosage units of different products do not relate to each other. There are some attempts to offer ratios for these products. However, apart from one trial with severe methodological shortcomings (Lowe et al. 2005) there are no comparative clinical trials for aesthetic indications. For Botox and Dysport, based on the available data from placebo controlled clinical trials and dosages recommended at consensus conferences, the ratio is close to 1 2.5 - 1 3. The manufacturer claims that Xeomin has a 1 1 ratio to Botox. However, we have little Do not worry too much about off-label use. For Botox and Dysport there are enough studies proving efficacy and safety. The patient, however, must be informed when the product is used for an off-label indication.
The injection of botulinum toxin in the upper third before the use of suspension threads is quite new. As mentioned in the brow lift section (see Sect. 5.3), BNT-A may be used for lifting the brow, mainly its lateral parts. Surgical suspension threads (mersilene or prolene 3.0) are often used for lifting the brow, too. A blunt canulla of 2 mm is inserted at the m. frontalis level and the surgical thread is anchored into the subdermal or muscle layer below the brow hair. After the desired lifting effect is obtained, the thread is then sutured into the periosteum and or the galea at the hairline level. An over-correction is usually undertaken.
Photodamage is the primary trigger for extrinsic aging. It results from cumulative exposure to g ultraviolet light and is responsible for many unwanted aging signs. The most common clinical signs include aging spots on a shallow colored skin, keratoses, static rhytids, telangiectasia and loss of elasticity. The degree of photodamage varies from patient to patient and can be mild, moderate or severe. Fillers and botulinum toxin alone will not be able to solve every skin wrinkle. The best way to reduce static wrinkling is through ablative methods such as chemical peels. Skin renewal and collagen remodeling improves the appearance of photo-damaged skin. With dermal thickening, less wrinkling appears due to muscle traction onto the skin. When combining laser resurfacing and BNT-A, the injection of the botulinum toxin should be performed 1 or 2 weeks before the procedure. The concomitant injection of BNT-A, and the immediate use of lasers after, especially CO2, may not be advisable....
The advent of botulinum toxin has evidently changed the surgical approach to the face from the 1980s when very aggressive surgery with a coronal approach to the forehead was the rule, leading patients to complain about a very long downtime and sometimes an unnatural facial look.
Patients should be analyzed both in the static and dynamic positions. In the static analysis, the patients that will benefit from eyebrow lifting with botulinum toxin are those with a weak frontalis and strong depressors. Independent of age, the eyebrow has a low position especially its lateral aspect, and fullness in the upper eyelid can also be observed. There may be static lines, depend
There are several trials focusing on the optimal dosage of Botox in the area of the glabella. The standard dosage used is 20 Botox U. In the first large placebo-controlled trial, patients with moderate to severe glabellar lines at maximum frown received intramuscular injections of 20 U BNT-A or placebo into five glabellar sites (Fig. 1.1). A total of 264 patients were enrolled (203 treated with BNT-A, 61 with placebo). There was a significantly greater reduction in glabellar line severity with BTX-A than with placebo (all measures, every follow-up visit P 0.022). The effect was maintained for many patients throughout 120 days (Carruthers et al. 2002). Fig. 1.1. Injection points as in the early Botox-Glabella studies (based on Carruthers et al. 2002) Fig. 1.1. Injection points as in the early Botox-Glabella studies (based on Carruthers et al. 2002) rhytids in females. Eighty female subjects with moderate to severe wrinkles at maximum frown entered the study. Patients were randomly...
Cheek lines usually appear in advanced aging or earlier in patients with photo-damaged skin. The repeated contraction of the zygomaticus major and risorius on the thin or atrophic skin deepens the curvilinear cheek wrinkling. It is a typical facial area that presents both the static and dynamic component. In contrast to the gla-bella, for example, we do not want to block the muscle action completely, which would lead to functional impairment and atrophy. The use of fillers in such cases will lead to a thicker dermis. The single use of fillers, especially the biodegradable ones, may lead to quick absorption and diminish the result. The intradermal use of botulinum toxin on the cheek combined with fillers will enable the use of a smaller quantity of both products (see Sect. 6.3 on microinjections) (Fig. 8.3ab).
The microlift facelift appeals to the patient seeking a more long-lasting improvement than fillers and surface treatments offer but without the discomfort and cost of a surgical facelift. The technique utilizes three common treatments to improve facial contours liposuction of the neck and under the chin, injection of facial fillers into wrinkles and folds, and suspension of facial muscles using polypropylene or mersilene threads. Alongside this, injection of botulinum toxin in the upper, mid and lower thirds is also a rule. Chemical peels can be added for some patients to further improve skin appearance. Patients appreciate that the microlift technique offers little scarring, minimal discomfort, and a quick recovery time. (Fig. 8.7a,b)
Patients treated up to three times with 20 U Botox (Carruthers et al. 2004). In 235 patients who completed the follow-up, antibodies were found in 1.1 -1.4 of the samples which could be evaluated. However, in no case did the presence of antibodies lead to a decrease in drug efficiency.
At the moment several companies are working on new BNT preparations. These new products should be carefully evaluated and compared with the products presently on the market. It is always important to consider the evidence behind these new drugs. Randomized controlled clinical trials based on aesthetic indications should be the gold standard which new BNT preparations have to match. A 'This brand of botulinum toxin is comparable or even better than that brand of botulinum toxin without good supporting data is not enough.
So far there has been no data published. There is, however, information from a poster that was presented during the EADV 2004 (Carruthers A and Carruthers J, 2004). In this study, data from a 50-patient cohort was investigated. Patients needed to have at least ten treatments. The glabella was the most frequently treated area. No specific dosage for the glabella is given. The mean dosage for all areas treated was 40 Botox U. The median interval between treatments was 17.1 weeks with a range from 0.43 to 155.3 weeks. Answer to key question 2 There are two patient cohorts. Based on these data, patients treated with Botox returned three times a year,
When botulinum toxin started to be used for cosmetic purposes, one of the main complaints from patients was about the 'frozen look'. These times should be gone. Based on muscular behavior after the injection, patients can also be divided into three groups atonic, hypotonic and hypokinetic. When critically analyzing the result of the botulinum toxin injection, we should be able to have balanced the areas where we wanted a complete absence of movement but maintenance of position, and where a slight movement is desired. The resulting hypokinesis seems to be the most desired effect for many areas in the face. The decrease in muscle cycles and the slowdown of muscle excursion is one the most important aspects that leads to a natural look. However, patients must understand that some initial movement does not mean loss of effect and they must be told so before the treatment. It depends Injectors should initially analyze the muscular pattern, adaptation behavior and what would promote a...
BNT has to be stored either in the refrigerator (Botox, Dysport) or under normal room conditions (Xeomin). Dilution Vial with botulinum toxin, saline for dilution (if necessary), appropriate syringes and needles (30-gauge needles are a must, 32-gauge needles are great) The standard dilution for Botox and Dysport is 2.5 ml. Table 3.2. Botox U per ml for different dilutions Table 3.2. Botox U per ml for different dilutions Botox 100 U in
Eyebrow ptosis may contribute to upper eyelid skin excess and skin wrinkling. The lower eyelid may present with eye bags. Eye bags may result from the laxity of the orbicularis oculi and are considered to be a pseudo-herniation. It is not advisable to inject botulinum toxin for the treatment of crow's feet in patients with prominent eye-bags. If the muscle gets more relaxed, the eye-bags may get worse and a more tired look may result.
The intra-oral approach is less painful but it may be considered more difficult by some to inject into the correct level. The same needle may be used however, the injection must preferably be undertaken in two sites right beside the frenu-lum. The m. depressor septi nasi fibers are intertwined with the orbicularis oris, so at least half of the 30 gauge needle should be inserted with its bevel directed to the columella base. A total dose of 1-3 U Botox or 3-7 U Dysport at each side should be injected. Botox dose 1-2 U per side
In the treatment of patients suffering from facial paralysis, botulinum toxin may be considered as a single treatment, as a pre-operative test or as a complementary measure in post-surgical treatments. It may reduce facial deviations and rotations, minimizing aesthetic sequelae. Yet, its most important feature seems to be the potential for use in children and adolescents, who will greatly benefit from the treatment during muscular and skeletal development. The adverse events with the use of botulinum toxin are generally linked to high doses of the
Ahn MS et al. (2000) Temporal brow lift using botulinum toxin A. Plast Reconstr Surg i05(3) ii29-35 discussion pp 1136-9 Balikian RV, Zimbler MS (2005) Primary and adjunctive uses of botulinum toxin type A in the periorbital region. Facial Plast Surg Clin North Am 13(4 583-90 Bulstrode NW, Grobbelaar AO (2002) Long-term prospective follow-up of botulinum toxin treatment for facial rhytides. Aesthetic Plast Surg 26(5) 356-9 Chen AH, Frankel AS (2003) Altering brow contour with botulinum toxin. Facial Plast Surg Clin North Am ii(4) 457-64 with botulinum toxin. Dermatol Surg 27(9) 848 Frankel AS, Kamer FM (1998) Chemical browlift. Arch Otolaryngol Head Neck Surg 124(3) 321-3 Huilgol SC et al. (1999) Raising eyebrows with botulinum toxin. Dermatol Surg 25(5)373-5 discussion p 376 Klein AW (2004) Botox for the eyes and eyebrows. Der- Kokoska MS et al. (2002) Modifications of eyebrow position with botulinum exotoxin A. Arch Facial Plast Surg 4(4) 244-7 Kokoska MS et al. (2002) Modifications...
The BNT-A products differ in their amount of protein as well as in the amount of albumin added (Table 1.1). At the moment Botox, also marketed in some countries as Botox Aesthetic Vistabel Vistabex for aesthetic indications, and Dysport share the majority of the aesthetic market. The new German BNT-A preparation Xeo-min is only available in a few countries so far, and lacks clinical data on its efficacy in aesthetic medicine. NeuroBloc (also marketed as Myo-bloc) is the only commercially available type B BNT. Although there is some data on its efficacy in aesthetic indications, it is not often used for these indications (Baumann et al. 2003). Botox may be marketed as Botox Aesthetics, Vistabel or Vistabex. For simplification in this book we will talk only about Botox when referring to dosages.
Pharmacological aspects of therapeutic botulinum toxin preparations (modified from Dressier 2006) Table 1.1. Pharmacological aspects of therapeutic botulinum toxin preparations (modified from Dressier 2006) Botox Vistabel Clostridium-botulinum- to Botox BNT botulinum-neurotoxin, MU-A mouse-unit in the Allergan-mouse lethality assay, MU-E mouse-unit in the Elan-mouse lethality assay, MU-I mouse-unit in the Ipsen-mouse lethality assay, MU-M mouse-unit in the Merz-mouse lethality assay Botulinum toxin only acts after ingestion or injection. Topical application is insufficient. Claims of creams that induce botulinum toxin A effects have to be questioned.
Inversion of the upper lip while smiling. These patients are usually bad candidates for upper lip augmentation with fillers, which usually results in excessive filling of the vermillion. The best approach in these cases is a combination of fillers and botulinum toxin. The synergism of both treatments leads to a more natural look.
Hyperkinetic reaction of the muscle tissues due to the lack of tonus on the paralyzed side. This imbalance of vector forces creates facial deviations. The dynamic deviations to the 'normal' side are less evident in paralyses that have lasted a short time. With longer periods, there are also static deviations in the labial, nasal and orbital regions, leading to shortening of the face (Fig. 6.3). It is on this hyperkinetic or hypertonic side of the face that botulinum toxin plays the most important role.
Injections into the orbicularis oculi, corru-gator supercilii and procerus muscles have the highest risk of producing lid ptosis. Lid ptosis usually manifests within two to seven days and can last for weeks. Using Botox in the glabella area, Carruthers and colleagues reported a lid ptosis rate of 5.4 in their first large placebo-
Botox 16, 32, 48 U Botox 10, 20, 30, 40 U Botox 20 U, placebo Botox 20, 40, 60, 80 U Botox 18, 12, 6, 3 U, placebo Botox 16, 32, 48 U Botox 10, 20, 30,40 U Botox 20 U, placebo Botox 20, 40, 60, 80 U Botox 18, 12, 6, 3 U, placebo Botox 16, 32, 48 U Botox 10, 20, 30, 40 U Botox 20 U, placebo Botox 20, 40, 60, 80 U Botox 18, 12, 6, 3 U, placebo
The injection of botulinum toxin in the m. depressor septi nasi may achieve the following goals 1. Enhancement of the nasolabial angle in static and dynamic positions, 2. Slight upper lip lengthening, 3. Slight fullness of the upper lip, 4. Elevation of the tip of the nose, 5. Improvement of the horizontal lines between the upper lip rim and the nasal base (Figs. 5.64a,b and 5.65a,b). To inject into the dilator nasi, the patient should be asked to breathe in and the exact location of the muscle movement should be marked. The skin at this level is much adhered to the cartilage and injection may be quite painful. The bevel should be turned downwards, especially in patients with large pores in the skin. During the treatment, it is common to see an immediate bleaching with the injection, which subsides shortly after. A total of 1-2 U Botox and 3-5 U Dysport should be injected (Fig. 5.63a,b). Botox dose 1-2 U total dose
The C. botulinum toxin is a poisonous bacterium (a one-celled living thing that sometimes causes disease). It can cause paralysis and death when eaten in contaminated food. However, C. botuli-num can also heal people when used in a purified form by controlling muscle contractions. The bacteria and spores (forms of the bacteria that can grow into new bacteria) of C. botulinum are found in soils of farmlands and forests and sediments of streams, lakes, and coastal waters. The spores are also found on fruits and vegetables and in shellfish. The bacteria and spores cannot hurt humans. It is when they grow that the toxin is produced, which is the substance that harms people. There are seven varieties of C. botulinum, designated by the letters A, B, C, D, E, F, and G. Types A, B, E, and F cause human botulism, while types C and D cause animal botulism. Type G is found in soil primarily in Argentina but has not yet caused botulism.
For example, one of the most significant technological developments in the biomaterial field is that of bioengineered skin for burn victims. However, the medical procedure of harvesting the normal skin from a burn victim and using it to cover burned areas was developed in the United States in the mid 1970s. The skin-grafting procedure, which involves the painful operation of shaving large patches of the top layers of normal skin for use as a bandage over exposed fat and muscle, is not only painful for the patient, but there are potential complications from infection at the skin-harvesting site. However, if tissue engineering can be used to replicate a sample of the patient's tissue, then any amount of tissue can be generated, time permitting, without subjecting the patient to the trauma of skin harvesting. Furthermore, since the skin is genetically identical to the patient's own skin, there are no immunological issues that may result in rejection of the tissue or risk of viral...
To date the only treatment designed specifically to deal with glial boundaries is the inhibition of collagen synthesis in the lesion, which has succeeded in promoting some regeneration.77'78 In addition two of the treatments that affect axonal boundary crossing as well as growth on inhibitory substrates, namely increasing cAMP levels and blocking Rho have been applied. The Rho ribosylating toxin, C3 from Clostridium botulinum, has been applied to optic nerve and spinal cord injuries. In both cases axon regeneration was promoted.81,82 In the optic nerve experiments it is likely that the axons encountered a meningeal boundary, since these cells invade optic nerve crushes within 24 hours, and the crushed axons retracted from the injury and probably did not grow through it for at least 24 hours after crush. There has only been one experiment to manipulate cAMP levels in vivo, by injecting it directly into dorsal root ganglia. This promoted some regeneration in the spinal cord, although it...
Abnormal fat accumulation may be visceral (omentum, mesentery, retroperitoneum, pelvic areas), associated with abdominal fullness and bloating (syntomatic fat deposition) 128 , or peripheral 116 , ranging from benign bilateral symmetric lipomatosis 131 to multiple symmetric lipomatosis and to a dorsal ('buffalo hump') and or cervical fat pad ('bull neck') 118 . More recently, lipodystrophy syndrome has been better characterised 132-134 with case-definition signs. Fat redistribution (HARS) may have the aspect of either peripheral lipoatrophy dystrophy, involving the face (loss of buccal, parotid, Bichat's, and preauricular pads, sunken cheeks and eyes, prominent zygomatic arches) buttocks pronounced thinning of the arms and legs with prominence of subcutaneous veins, muscles, and bones loss of normal skin texture, folds and trophism or central lipohypertrophy, with accumulation of fat in the trunk, breast, and or dorso-cervix, leading to bull
The short-term and long-term effects of quitting smoking. Short-term advantages are being in better shape and feeling more energetic, having a better skin, better taste and smell, a better voice, and whiter teeth. Long-term effects are a better prognosis, adding years to life, less chance of, or improvement of, lung diseases and heart and vascular diseases, less chance of lung cancer and other forms of cancer. In this stage possible misconceptions must be dispelled. These topics must be discussed to help the patient make a conscious decision.
When cells undergo mitosis, two processes take place the division of the membrane and cytosol, and the regulated segregation of the centrosomes (spindle pole bodies) and the chromosomes (Fig. 4). These two components are essential for cell survival. Suppression of aurora and IpI1-like midbody-associated protein (AIM-1) kinase activity by dominant negative AIM-1 disrupts cleavage furrow formation without affecting nuclear division and without cytokinesis and subsequent cell death, suggesting that AIM-1 is required for the proper progression of cytokinesis in mammalian cells (222). The Rho family of small GTPases consists of Rho A, Rac, and Cdc42, and regulates many molecular switches of diverse biological function, including remodeling of cytoplasmic actin and microtubules (223). The small GTPase Rho localizes in the cleavage furrow during cytokinesis (223,225). In Xenopus eggs, microinjection of either the Rho-specific inhibitor C3, an exoenzyme from Clostridium botulinum, or a...
Walter et al. (1996) reported a case of suspected cannabis-induced hyperthermia. A male patient presented with a body temperature of 41 C, delirium, flushing, and hot and dry skin. He had been jogging on a warm day after smoking cannabis. The only link with cannabis was a temporal one. This reaction has never been reported in humans before, despite widespread use over three decades, suggesting the link with cannabis in this case was probably coincidental.
Have been helpful if the authors had given the actual values of signal densities and provided the range of values of each group. The findings of Shrestha et al. (1998) generally support those of Maelandsmo et al. (1997). Shrestha et al. (1998) found little or no S100A4 in several cell types derived from normal skin. Furthermore, neither did basal cell carcinomas or squamous cell carcinomas show any S100A4 immunoreactivity. The apparent lack of correlation of S100A4 with melanoma progression is in sharp contrast with the high degree of correlation found in B16 melanoma cell lines. One should state, notwithstanding, that a direct comparison of expression of the gene in tissue culture cell lines and tumour material, which is heterogeneous in cell composition, is probably not helpful, nor can it lead to meaningful conclusions.
In order for a skin replacement to be successful, it must be incorporated into the soft tissues and replaced by the normal skin elements. This process allows the skin replacement to be vascularized and populated by normal healthy host fibroblasts. Although one could conceivably ' seed the dermal portion of the skin replacement with host fibroblasts, the proper pore structure is necessary to allow the fibroblasts to divide and migrate within the device. An impermeable graft without pores would not provide any means for such migration. Since most of the epithelial and mesenchymal cells found in the wound bed are on the order of 10 im in diameter, pores consistent with that order of magnitude would allow free access into the graft material.
Of the detrusor muscle is extremely variable between individuals. Clinical approaches to treat this problem include anticholinergic (anti-muscarinic) medication if excessive intravesical pressures prevail. If the detrusor muscle cannot be relaxed adequately with such medication to provide continence between intermittent catherizations, an indwelling catheter or attached device such as a condom catheter is necessary. If, due to lack of sensation, voiding cannot be managed effectively or conveniently, an external appliance (condom drainage) may be used in males. However similar devices are notoriously difficult to maintain in females, resulting, instead, in the use of an indwelling Foley or suprapubic (inserted through the lower abdominal wall) catheter. Decreasing de-trusor contractions may also be accomplished by chemically blocking C-fiber bladder afferent neurotransmission with intravesical vanilloids such as capsaicin or resiniferatoxin or by intravesical administration of...
University of California researchers have also been criticized for patenting the anti-inflammatory agent pseudopterosin, a compound found in sea whips in the Caribbean and subsequently incorporated in a skin cream also marketed by Estee Lauder. The average annual royalty income received by the university for patented pseudopterosins is reported to be more than US 750,000 (Singh, 2000b).
Most interestingly, K14-Myc mice also present with a complete loss of epidermal tissue in areas associated with physical stress, such as around the head and neck, due to scratching. This observation raised the hypothesis that sustained elevated levels of c-Myc activity prevent the maintenance of epidermal stem cells (ESCs) in areas of high tissue renewal and repair. This theory is supported by the observation that putative epidermal stem cells, identified as BrdU label-retaining cells , are severely depleted within K14-Myc hypoplastic epidermis (Waikel et al. 2001). Epidermal loss was also observed in mice lacking Racl, a small GTP-binding protein of the Rho family that controls cell adhesion and cytoskeletal architecture, in the epidermis (Ben-itah et al. 2005). Similar to the K14-Myc mice, elimination of Racl in the epidermis caused a transient hyperplasia followed by epidermal thinning and finally loss of normal skin function, suggesting ESC depletion. Most strikingly, this...
Most soft tissue adhesives are intended to be temporary, that is, they are removed or degrade when wound healing is sufficiently advanced for the tissue to maintain its integrity. Effective adhesion can be obtained on dry skin or wound surfaces by using wound dressing strips with acrylate-based adhesives. However, on wound surfaces that are wet with tissue fluid or blood, the adhesive must be able to be spread on such wet surfaces, provide adequate working time, develop and maintain adhesion, desirably provide hemostasis, facilitate wound healing, and maintain biocompatibility. Positive antimicrobial action would be an additional advantage.
Poisoning cannot be overlooked in the evaluation of a child with vomiting and abdominal pain. Among the multiple agents most commonly associated with hospital visits are over-the-counter (OTC) analgesic drugs, cold remedies, insecticides, pesticides, personal care products, and fumes. In a child who presents with vomiting and abdominal pain, a cholinergic syndrome is likely. It is characterized by salivation, lacrimation, diarrhea, vomiting, diaphoresis, intestinal cramps, and seizures. Insecticides and nicotine are among the agents that may induce these symptoms. Antihistamines or tricyclic antidepressants produce dry skin, dry mucosae, urinary retention, and decreased bowel sounds (anticholinergic syndrome). Some medications and substances are radiopaque, such as iron tablets, mercury, lithium, tricyclic antidepressants, Play-Doh. and enteric-coated aspirin. Finding the likely agent of poisoning will mostly depend on the history given.
Some of the phage genes cause major phenotypic changes of the host cell, including antigenic variation, resistance to infection by related phages, and increased virulence. The first phage-encoded virulence factor identified was the diphtheria toxin coded by the P-phage of Corynebacterium diphtheriae (99). Numerous phage-encoded virulence factors have since been identified (69,100) These include many extracellular toxins (e.g., Shiga toxins by H-19B phage in E. coli, neurotoxin by P-phage in Clostridium botulinum, cholera toxin by CTX in V. cholerae), type III secretion effector proteins (SopE, SseI, and SspH1 by SopE, GIFSY-2, and GIFSY-3 phages, respectively in S. enterica), as well as proteins that alter antigenicity, various hydrolytic enzymes, and adhesins. Many of these virulence factors are encoded by genes of lysogenic phages that are not essential for phage replication and growth, but enhance the fitness of the bacteria. These prophage genes are called morons (101).
There is evidence of age-related accumulation of cells that are in the late stage of multi-stage process of carcinogenesis. Numerous experiments support this model. Thus, single skin application with 7,13-dimethylbenz a anthracene (DMBA) in mice aged 8 and 48 weeks at doses ranging from 10 to 300 Xg caused increased skin papilloma incidence in older mice 38. Also, the average diameter of the tumors was larger in the older animals. Of particular interest are the experiments using skin transplants. TPA failed to induce tumors in the skin of 2-month-old mice grafted to animals of different ages, but caused the same tumor incidence in the skin of 1-year-old donors irrespective of the recipient's age 39,40. These results indicate that the age of the target tissue, more than the age of the host, determines susceptibility to late-stage agents. Delaying wounding 16 weeks after initiation with a carcinogen led to a more pronounced skin tumor response compared with delay of only 6 weeks in...
The commonest skin conditions associated with IFN-ribavirin therapy are nonspecific skin rashes, itchiness, or dry, thickened skin, which may resemble either drug eruptions or a nonspecific dermatitis. Skin rash is more common with combination therapy than with ribavirin alone (28 vs 8 ). The rash can appear on any part of the body, and is frequently pruritic. In many cases, the rash is transient, and resolves over time, requiring no alteration of medication. In patients who have a major drug eruption, reduction in the dose of ribavirin, or even stopping ribavirin, may be necessary. In mild cases, a 0.05 steroid cream will improve the skin rash, and benadryl or other antihistamines can be used for the pruritis. Pruritus without skin rash is reported in 29 of patients taking Rebetron, compared to 9 on IFN. The dry skin can be treated by avoiding long baths or powerful soaps, and by using skin-moisturizing creams. Photo-allergic skin rash and sensitivity to UV light can be seen with...
Vitamin A is the generic name for compounds with the qualitative biological activity of retinol, i.e. retinoids, beta-carotene and provitamin A carotenoids. The RDA of vitamin A is 700 g for women over age 50 and 900 g for men over 50 (Table 3) 54 . Low serum retinol levels indicate vitamin A deficiency. The effects of vitamin A deficiency are night blindness (hemeralopy), dry-eye syndrome, keratomalacia, Bitot's spots on the conjunctiva, dry skin and follicular hyperkeratosis. Toxicity has been associated with abuse of vitamin A supplements and with diets extremely high in vitamin A content 39 .
Tied to a splint and with needles and tubes entering all orifices, with cuts through the skin to provide access to veins for cannulae for infusions, life is not pleasant for the neonatal infant requiring intensive care. And yet it is not unusual for no analgesic to be given (Mather and Mackie 1983 Beyer and Byers 1985), not even anaesthetic skin cream to ease injections. Non-verbal clues and common sense can help to appreciate what is being experienced and thus to try to alleviate any pain or distress. Again this kind of care demands a very high level of professional expertise and sensitivity.
Cassileth et al. reported on 50 patients with hairy cell leukemia treated with DCF and followed for a median of 39 months.24 After treatment for a median of 3 months, patients achieved a 64 CR and a 20 PR rate, with relapses in 6 of the 42 responders (14 ) (see Table 31.2). In another early trial through the National Cancer Institute-Canadian Clinical Trials Group, Johnston et al. documented a CR in 25 of 28 (89 ) evaluable patients with all remaining patients achieving a PR (11 ).25 Patients were treated with 4 mg m2 intravenously weekly for three consecutive weeks, repeated every 8 weeks, and continued for two additional cycles beyond CR. Overall toxicity included a 48 incidence of fever and infection, a 62 incidence of lethargy, and a 76 incidence of nausea and vomiting. Additional side effects included anorexia, dry skin, altered taste, and paresthesias.
Patients with hypothyroidism can present with a wide range of symptoms, including lethargy, weight gain, hair loss, dry skin, slowed mentation or for-getfulness, constipation, intolerance to cold, and a depressed affect. In older patients, hypothyroidism can be confused with Alzheimer disease and other conditions that cause dementia. In women, it is often confused with depression. Physical findings that can present in hypothyroid patients include low blood pressure, bradycardia, nonpitting edema, hair thinning or loss, dry skin, and a diminished relaxation phase of reflexes.
And increases risk of osteoporosis.14 Over 50 of older adults consume inadequate vitamin D. With age, the kidney is less able to convert dietary vitamin D to the active form, 1,25 (OH) vitamin D.15 The aging intestine is also less responsive to the signal from vitamin D to increase absorption of calcium. In younger people, significant amounts of vitamin D can be synthesized in sun-exposed skin, but aging skin is less able to synthesize the vitamin. Compounding this, many older adults, particularly those with disabilities, obtain little sunlight exposure. In older adults, particularly during the winter months in northern climates, vitamin D supplementation helps maintain bone density and prevent frac-tures.16
In skin, there is a need for a tissue 'filler' for cosmetic reasons. Currently, a popular treatment for wrinkles is the use of botulinum toxin. The effect of this agent is to cause the paralysis of muscles, which influences the development of wrinkles. Comparative studies of using botulinum toxin alone or in conjunction with HA in form of Hyalan B indicate that moderate to severe rhytides were treated better by botulinum toxin combined with HA than with botulinum toxin alone (115). This study was repeated with an HA-botulinum toxin combination where the HA was produced by a non-animal source. Restylane is an HA produced by bacterial fermentation incorporating recombinant gene technology. Again the results of combined therapy were superior to the use of botulinum toxin alone (116). The use of cosmetic fillers has produced quite a significant debate in the literature concerning their safety. The essential debate concerns the source of the materials and whether they produce adverse...
Skin care, nudity, and water go together and water evidently mattered a lot to the Greeks. They paid particular attention to water in their new-built settlements. For the Greeks a pure water supply was an important part of public policy and a very visible sign of civic growth and prosperity. They collected rainwater in stone cisterns and drew from springs and wells but from the sixth century bce, impressive new public water supplies were created from artificial conduits. The tyrants of Samos, Athens, and Piraeus all built water conduits to supply their towns and the same hydraulic knowledge was going into harnessing the source at new water sanctuaries and temples. Most longdistance conduits were underground, but from at least the fifth century there were some above-ground aqueducts.2
Anal fissures are often intensely painful due to sphincter spasm. Anaesthetic ointments and stool softening agents have been widely used, with surgery (lateral internal sphinterotomy) for severely affected cases, but this procedure can cause incontinence from loss of sphincter control. An alternative is topical application of nitrate which heals two-thirds of fissures. Preparations should be diluted to 0.2 as such use may be complicated by headache tolerance can develop. Intrasphincteric injection of botulinum toxin has also been shown to be effective.
Currently little is known about the cutaneous expression of different CA isozymes. Recent immunohistochemical studies (Mastrolorenzo et al. 2003) have provided additional evidence for the previously reported demonstration of the presence of CA in normal skin by Eichhorn et al. (1994). Data presented from an immunohistochemical investigation on the expression of three isozymes CA I, CA II and CA IX in some specimens of normal human skin clearly showed that in the epidermis both CA I and CA II were expressed in the spinous layers of the skin. In particular, moderate staining was predominantly observed in the cytoplasm, basolateral and apical plasma membrane of the prickle cells, and the basal cells displayed CA activity in their cytoplasm and in the apical and lateral membranes. No staining was found in the stratum granulosum and horny layer. A different pattern similar to the first description by Hansson (1967) of CAs I and II activity is less frequently shown with the staining at the...
Neurons transmit impulses from one part of the body to another. Many kinds of stimuli, including touch, sound, light, taste, temperature, and smell, cause neurons to fire in response. When you touch something, signals from touch sensors travel along sensory nerves from your skin, through your spinal cord, and into your brain. Your brain then sends out messages through your spinal cord to the motor nerves, telling your muscles how to respond. To evoke this response, nerve cells must transmit signals along their length and from one cell to the next.
The expression of chemokines is normally tightly regulated and is only transiently induced in response to mediators of the inflammatory response such as IL-1, tumor necrosis factor-a (TNF-a), and a variety of other agents (3). Interestingly, during tumor progression and chronic inflammation, this tight regulation of chemokine expression is disturbed such that numerous tumor lesions and chronically inflammed tissues have been reported to express chemokines continuously (2,6,44,46,50,63,66). For example, in the absence of cytokine stimulation, the expression of MGSA GRO is very low in normal melanocytes and normal retinal pigment epithelial cells, but is quite high in malignant melanoma (7,10,47,63,64). In normal skin keratinocytes, MGSA GRO expression appears to coincide with differentiation, as noted by the presence of immu-noreactive MGSA GRO in suprabasal keratinocytes and in the hair follicles, sebaceous glands, and sweat ducts. By contrast, lesional tissue from 7 7 squamous cell...
Hyperhidrosis is a disorder ersulting in debilitating, excess sweating on one, or more commonly both sides of the body due to overactivity of the upper thoracic sympathetic chain. It usually involves the upper extremities, frequently coexistent with hyperhidrosis of the feet, and frequently has a hereditary component. In severe cases conservative measures including topical aluminum chloride compounds (Drysol), oral anticholinergics, iontophoresis (electrcial current transmission via tap water) and Botulinum toxin injections are wholly unsatisfactory. The single most effective treatment is thoracic sympathectomy which is curative for palmar hyperhidrosis and frequently markedly improves hyperhidrosis of the feet as well.
The difference in tumor EC surface markers can be taken advantage of therapeutically. For example, Hoffman et al.369 have shown by phage display that peptides with the amino acid sequences CGKRK and CDTRL preferentially bind to tumor neovasculature in skin carcinomas compared to normal skin, and to some extent to premalignant dysplastic skin lesions. Such differences in the molecular diversity of tumor compared to normal ECs can be used to guide anticancer agents selectively to cancer neovas-culature and provide a novel mode of targeted
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