#ulcers #legs - Chronic Venous Ulcers: an overview.

Venous leg ulcers are the commonest cause of chronic, non-healing ulcers of the leg. They occur in adults, males and females, and can take a long time to heal. There are many other causes of chronic leg ulcers and an evaluation by a doctor is needed to make sure the diagnosis.

The legs veins are responsible to return the blood from the lower extremities to the heart, helped by valves that ensure the “one-way” upward flow of blood. In many patients with venous leg ulcers, these valves do not work properly, causing accumulation of venous blood in the lower legs. This can lead to swelling and darkening of the skin, and eventually to the development of venous leg ulcers.

Risk factors include:

1. past history of a blood clot in the leg veins (deep vein thrombosis)
2. lower leg injury
3. varicosities
4. obesity
5. smoking
6. prolonged standing
7. difficulty for walking, because of the loss of calf-muscle pump action. 

Most patients with venous leg disease complain of local pain and swelling, especially towards the end of the day. The skin becomes dark brown or red in colour; an itchy red rash with scaling and crusting can also occur. Small or large varicose veins can be seen. Venous leg ulcers are often located just above the ankle. They are usually wet,oozing and very painful.

Once the diagnosis is confirmed, venous leg ulcers can be treated effectively by good wound care and the use of compression therapy. The latter can improve the venous flow and decrease the swelling of the legs. Compression therapy usually consists of special “elastic” bandages. The arterial blood supply of the lower limbs must be adequate (and checked to be so) before compression therapy is started.

Once the leg ulcer is healed, it is important to prevent recurrences by wearing support stockings, which must be replaced every 3 to 6 months or as soon as they lose their elasticity. Other important measures include:

1. good skin care and hydration
2. regular exercise
3. weight management
4. stopping smoking
5. leg elevation above the level of the heart when lying down.

#running - just 5 minutes/day are enough to increase life expectancy.

Runners may live an average three years longer than people who don’t run, according to new research. But, the best news from this study is that it appears that you can reap this benefit even if you run at slow speeds for mere minutes every day, the 15-year study suggests.

It’s not clear from the study whether the longer lifespan is directly caused by running. The researchers were only able to prove a strong link between running and living longer. There could be other reasons that runners live longer. It could be that healthy people are the ones who choose to run, noted the study’s authors. 

Current U.S. guidelines for physical activity call for a minimum of 75 minutes per week of running or other vigorous-intensity aerobic activity, or 30 minutes of moderate-intensity exercise most days of the week. But people who exercised less than that still received significant health benefits, according to the new research.

Running modest amounts each week — less than 51 minutes, fewer than 6 miles, slower than 6 miles per hour, or only one to two times — was still associated with solid health benefits compared to no running, the researchers reported in the Aug. 5 issue of the Journal of the American College of Cardiology.

The study involved more than 55,000 adults aged 18 to 100, who were followed during a 15-year period to determine whether there is a relationship between running and longevity. About one quarter of this group were runners. Participants were asked to complete a questionnaire about their running habits, and researchers kept track of those who died during the study period.

The researchers discovered that people who didn’t run had a life expectancy three years less than that of runners. Running was linked to a 30% lower risk of death from any cause and a 45% lower risk of death from heart disease or stroke, compared to no running. Even less-avid runners received significant benefits. Running a minimum 30 minutes to 59 minutes each week — which equates to just 5 to 10 minutes a day — was associated with a 28% lower overall risk of death and a 58% reduced risk of death from heart disease, compared with no running. However, runners need to keep at it. Persistent runners — those who had been running regularly for an average of six years — had the greatest benefit, according to the study. Improved heart and lung function appears to be key to running’s health benefits.

Dr. Michael Scott Emery, co-chair of the American College of Cardiology’s Sports and Exercise Cardiology Council, found it “a little surprising that 5 or 10 minutes of running had such an impact on health.” 

He noted, however, that running does have more potential for injury than walking, including joint problems, ankle sprains, shin splints, back pain and muscle pulls. People might gain similar benefits from walking the same distance for a longer period of time: one has to find a proper, a balance so that people interested in running should start out slow and build up over time.

#psoriasis - review on the best treatment options.

In deciding which therapy to use, many factors must be taken into consideration, including safety, efficacy, availability, and cost. Long-term side effects will, of course, become better known as experience with each therapy grows. In particular, biologic medications are already in their second decade of use in rheumatology, but there is much less experience than with more traditional therapies. Comparisons of efficacy between therapies are hampered by the lack of quality comparative clinical trials. 

The first approach of the patients with psoriasis who require systemic therapy is done by performing a complete history and cutaneous examination. If there are no contraindications, narrow-band-UVB phototherapy with or without acitretin is usually started. If phototherapy is not an option due to logistical issues, methotrexate can be used. Occasionally PUVA is considered for patients with extremely thick plaques or patients with type V or VI skin. For many patients these conventional treatments are very effective. If there is not an adequate response after approximately 12 weeks, then patients may be switched to the alternative therapy or switched to a biologic medication. Cyclosporine is usually reserved for short-term treatment of flares, followed by transitioning to other therapies for long-term control.

In choosing a biologic medication, several situations may point to the use of one over another:

1. Etanercept is the most used biologic medication for psoriasis, in part because dermatologists have the most accumulated experience with it.
2. Obese patients may experience better efficacy with medications dosed using weight-based calculations with infliximab or ustekinumab.
3. Infliximab is one of the most efficacious therapies for psoriasis and in addition works very quickly. This may be the best treatment for patients with extremely severe psoriasis and in patients where hospitalization is a consideration.
4. Adalimumab and ustekinumab have also shown impressive results.

However, some longer-term trials have shown some loss of efficacy when using biologic medications. It may then become necessary to switch those patients to a different biologic medication. There are two different options: changing to a medication in the same class (i.e. from a TNF inhibitor to another TNF inhibitor), or changing to a medication in a different class (i.e. from a TNF inhibitor to an IL 12/23 blocker such as ustekinumab). There is no strong evidence in the literature to differentiate between these two options till this moment.

#cryotherapy - freezing to treat benign skin lesions.

Cryotherapy (a controlled frosbite) is an effective tool to treat benign skin tumors when clinical judgment and/or histology exclude a malignant skin condition (malignant lesions must be excised always). It destroys tissue through freezing which causes intracellular and extracellular ice crystals to form; vascular stasis causes tissue anoxia and necrosis. As a general rule, two freeze-thaw cycles are needed. This is enough for superficial lesions but warts can be deeper and it is then better to do multiple short freezes.

Indications:

1. acne cysts
2. actinic keratosis
3. actinic cheilitis
4. angioma
5. viral warts
6. condylomata (genital warts)
7. chondrodermatitis nodularis helicis
8. dermatofibroma
9. hypertrophic scarring
10. keloids
11. lentigo (simplex) and freckles
12. molluscum contagiosum
13. myxoid cyst
14. pyogenic granuloma
15. sebaceous hyperplasia
16. seborrheic keratosis

Never use cryotherapy in people with cold related conditions such as cryoglobulinaemia, cryofibrinogenaemia, cold urticaria and Raynaud’s disease.

There are side-effects, so apart from having experience in treating a specific lesion, it is always better to undertreat than over treat so as to minimize these risks. Risks include:

Commonly:

1. Pain: stronger upon rewarming (thaw) and minutes after. Richly innervated areas such as eyelids, ears, lips, fingers and soles are painful.
2. Blister formation: clear fluid or blood tinted.
3. Edema and swelling: common on forehead, periorbital region and pernieum.
4. Hypopigmentation and Hyperpigmentation. Hypopigmentation occurs if freezing lasts more than 30s. Pigmentation changes are more frequent in dark-skinned individuals.
5. Hair loss: freeze for less than 30s to avoid it.

Less commonly:

1. Hemorrhagea
2. Infection
3. Sensory changes: rarely permanent
4. Tendon rupture: can happen when deep freezing of the finger extensors
5. Extensive tissue destruction: more likely in damaged skin or when the vascular supply is diminished.
6. Scarring: limit freeze times on lips, eyelids & proximal nail folds.

#wrinkles #fillers - improving the skin and treating wrinkles with hyaluronic acid.

What is hyaluronic acid? How can it treat wrinkles?

Hyaluronic acid is a molecule which is rich in water and is responsible for the volume of the skin. It is produced in the dermis by a cell called fibroblast. The decrease in its production that occurs with aging is responsible for a sagging lax skin with its characteristic structural wrinkles. Injections of hyaluronic acid fill these wrinkles and improve the skin surface, due to a volume effect in the dermis.

What are the effective sites for the injection of hyaluronic acid?

-the nasogenial folds

-the lips

-wrinkles around the mouth linked to smoking

-wrinkles linking the nose and the mouth

-crow’s feet

-skin depressions in the jaws and cheeks

-depressed scars (burns, acne, trauma)

How is the treatment administered?

It consists of a series of injections with a very fine needle in the region of the undesirable volume loss.

How long does the treatment take? Is it painful?

The injections take just few minutes to be done (up to an hour): pain, when present, is limited to the needle insertion while injecting. The needles used are very thin. The pain can be diminished by applying a topical anesthetic before the treatment.

What to do after the injection?

The injection of hyaluronic acid is an outpatient procedure and most patients resume their daily activities after the treatment.

How long do the effects of hyaluronic acid last?

In general, the effect lasts between 6 and 18 months. The effects are therefore temporary and 1 to 2 treatments per year are needed to maintain the effect.

The duration of the effect varies according to:

1. the type of injected hyaluronic acid.
2. the natural speed of aging of the skin.
3. the injected area. In the lips, which are richly vascularized, the effect last only about 4 months, whereas on the eyelids, the effect may last for up to a year and a half.

Are there side-effects?

They are not frequent. Allergic reactions are extremely rare, because hyaluronic acid is a normal constituant of the dermis, being present in all living organisms. It is therefore not necessary to do “test” injections to screen for allergy.

• Frequently:

1. pain during the injection. The pain can be alleviated by applying an anesthetic cream before the treatment.
2. pronounced swelling which can last for up to 3 days.
3. slight chance of bruising.

• more rarely:

1. headaches
2. nausea
3. flu-like symptoms
4. reversible muscle pain

How to improve your appearance in addition to hyaluronic acid?

The injections of hyaluronic acid  fill up the volume (hence the term filler) caused by the aging loss. Conversely, injections of Botulinum Toxin work reducing the expression lines. The two treatments complement each other improving visible changes due to aging by acting at different levels. Creams, lasers and chemical peels are also effective.

#Ebola virus: what to know about the recent outbreak, spreading, symptoms and treatment. Font: NBC News

Ebola virus has infected two American health workers, a doctor and a hygienist, working in Liberia. It’s killed more than 660 people in the ongoing West African outbreak, the worst ever seen, and infected more than 1,100.

It's frightening, mysterious and yes, it could come here. Here are some things you need to know about Ebola:

It’s Deadly.

Ebola kills anywhere from 50 to 90 percent of patients, depending on the strain and on where the outbreak is. Doctors say patients die from the effects of high fever, vomiting and diarrhea, but early treatment can often save lives. In the current outbreak, the mortality rate’s been about 60 percent.

It Could Come Here.

No matter where you live, instant jet travel has made any infection capable of spreading worldwide, and that includes Ebola. A Liberian man carried Ebola to Lagos, Nigeria, the biggest city in Africa, by jet. He was isolated quickly but it's possible he could have infected someone else — experts are working to track down people he may have been in contact with.

We Don’t Know Where It Came From.

Bats are the No. 1 suspect, but it is not clear how Ebola jumps from animals to people. Bush meat is one possibility — Ebola can infect apes and monkeys, and people in affected areas often hunt for food. Antelope and porcupines also can spread Ebola when slaughtered. One thing is clear — once there is an outbreak, it’s spread from person to person.

We Don’t Know All the Ways It Spreads.

Ebola definitely spreads through bodily fluids — vomit and diarrhea for sure. Doctors and nurses have been infected while caring for patients and many victims have been infected while washing bodies to prepare burial. Ebola is one disease that remains infectious after a person has died, and so experts urge precautions during funerals and burials. One study has suggested that a man’s sperm can transmit the virus two months after he has recovered from an infection. But most doctors say people are no longer infectious after they stop showing symptoms. The incubation period — the time between when a person encounters another infected person and beginning to show symptoms themselves — is as long as 21 days, according to the WHO. 

It Doesn’t Make You Pour Blood.

Ebola doesn’t always cause bleeding and it’s hardly ever profuse bleeding on the outside. There are many viruses that can can cause hemorrhagic symptoms — Lassa fever, dengue and yellow fever, for instance. Most usually cause vague, flu-like symptoms such as a high fever, muscle aches as well as vomiting and diarrhea. Only 50 to 60 percent of patients develop hemorrhagic complications, which include internal bleeding as well as bleeding from the eyes and sometimes in spots on the skin.

There’s No Cure.

Researchers are working to develop drugs and other treatments for Ebola, but right now there’s nothing doctors can use except what’s called supportive care — giving saline and fever-reducing medication. Viruses are difficult to treat, and the few antivirals on the market don’t seem to help against Ebola. There’s no vaccine, either.

#weightloss - understanding the differences between subctaneous vs. visceral fat. Font: Natural Health Care.

As you go about your fat loss diet program, there's no question that your primary goal is to reduce that unsightly body fat, under your arms, on your lower abdomen, as well as in the inner and back thigh regions. But, in your quest to cure these trouble spots, one thing that you should consider for a second is the fact that often this body fat isn't really the biggest of your worries. What is more troublesome is the body fat that you don't even see. It is important a clear understanding of the types of body fat on your body as well as the implications of each.

Subcutaneous Body Fat

Subcutaneous body fat refers to all the body fat that you can see on your body: belly, arms, lower back, thighs, etc. This body fat isn't healthy to have because it is excess weight and will cause there to be excess stress on the joints due to all that weight coming down.

In addition to that, it will still put your health at risk as it can increase your risk of heart disease, high blood pressure, and inflammation, however it's not the most detrimental tissue that you need to be concerned about.

Visceral Body Fat

Visceral fat refers to fat that's located within body cavities and surrounds all the main organs in the body. This is the fat that may start to interfere with their proper function if it builds up to a high enough level and could potentially put you at risk for heart disease and stroke if it begins to crowd its way into your arteries.

Visceral body fat that's found in the abdominal cavity is especially worrisome and must be taken seriously because this is the fat that will really increase the risks of diabetes, cancer, inflammation, as well as heart disease.

You can often tell if you have a high amount of visceral body fat as the stomach will appear to be fat, yet be hard to the touch. The reason for this is because all that fat is lying underneath the muscle tissue, while subcutaneous lies on top of the muscle but just under the skin.

You will work to lose both types of body fat in the same manner – using a proper diet & a good workout program. Often you may not see the reduction in visceral fat like you would with subcutaneous fat but just know that if you are following your program it is happening and it's really putting you in a much more healthy state.

#warts (verrucae vulgaris) - causes and treatments.

What causes warts ?

• Warts are harmless skin growths caused by a virus. They can grow on any part of the body, like the face, along the forearms or on the fingers. Warts have a rough surface on which tiny, dark dots can often be seen. On pressure areas like the palms or the soles, they appear flat. Warts on the sole (called plantar warts) grow inward from the pressure of standing and walking and are often painful.
• Warts are common and can be a nuisance. They may bleed if injured. Common warts never turn cancerous. Warts are contagious, and may spread from one part of the body to another or to other children. It is not known why some people get warts while others don’t. There is no way to prevent warts.
• Warts often disappear by themselves, especially in young children. This spontaneous disappearance is less common in older children and adults.
• Warts on the genitals are usually sexually acquired.
• There is no perfect treatment for warts. Treatment consists of destroying the outer layer of skin where the wart grows on. This can be done by surgery, laser ablation, electrocautery (destroying with a weak current), by freezing (with liquid nitrogen) or with chemicals like salicylic acid. The treatment to be used depends on the location and size of the warts and the judgement of the dermatologist. Sometimes new warts will form while existing ones are being destroyed. All we can do is treat the new warts when they become large enough to be seen.
• No matter what treatment is used, warts occasionally fail to disappear. They may return weeks or even months after an apparent cure. Don’t be concerned if a wart recurs; just consult your dermatologist for further therapy. The treatment may be repeated, or a different method may be used to get rid of the warts.

  

  Multiple Warts (Viral Warts) on the Hand

Liquid Nitrogen Treatment

Liquid nitrogen treatment (cryotherapy) is the commonest treatment method for warts. Liquid nitrogen, when applied to the skin usually results in blister formation similar to a burn. The wart will fall off when the blister dries. Pain due to the procedure is easily controlled with simple pain killers. There is no need to cover the treated areas if the blisters are intact. At least a week must lapse between treatments, even if a blister does not form.

#isotretinoin #accutane - the pros and cons.

For many teens, living with acne is a serious problem. Not only because of physical appearance, but also because there is a real and direct link between skin and emotions.

For most of us, acne is an occasional pimple or cyst, or even a recurring breakout. But for some, it's a condition that we can't seem to get under control. And since it affects our faces, and thus, our confidence, it can seem like it's worth doing anything just to get it to go away.

Enter Accutane, the most buzzed-about acne medication on the market. Accutane is actually the brand name for the drug—it's technically called "isotretinoin," and Accutane no longer exists! But still, the chances are, you probably know someone who's currently taking isotretinoin. In fact, it's becoming standard procedure for lots of teens and young adults. But is that a good thing, necessarily? 

The Pros:
It works: isotretinoin is a pill derived from a high-strength Vitamin A that is thought to work by inducing cell death in the sebaceous (oil) glands of the skin, and also exerts antimicrobial effects. The oil glands are typically hyperactive in acne-prone patients, and oil obviously harbors bacteria. Decreasing the oil, therefore, clears blemishes. In the vast majority of patients, it improves both skin and self-esteem.

Besides, it's well known that the results last. Basically, the sebaceous glands shrink when someone is on isotretinoin, and once treatment is completed, they rarely become as large as they were before the treatment. Finally, it's pretty much the only option for the so called "severe nodulocystic, conglobata and scarring acne." If you think that you may be suffering from this condition, consult a dermatologist to see what your options are.

The Cons:
First of all, it's a commitment. One cycle of isotretinoin can take from eight to 10 months, and you have to take one pill per day. During this time, girls must be on birth control since the drug has been linked to severe birth defects. It's also necessary to take a monthly blood test so the doctor can make sure the drug isn't causing internal damage to the liver or kidneys.

Secondly, the drug's mild side effects include overall dryness and an increased sensitivity to the sun, but these symptoms are mostly easy to treat. You can up your moisture intake by drinking more water and soothe chapped skin by adapating a facial oil into your routine. You should also find an oil-free SPF that you can use on a daily basis without exacerbating your acne.

More importantly, though, is that Accutane is often too readily prescribed, when really, it should be looked into as a last resort. The patient and dermatologist together should determine eligibility. With appropriate guidance and close monitoring, it can be very helpful for the right candidate.

Some patients claim that Accutane could induce gastrointestinal disease, like ulcerative colitis. But the chances are your doctor will investigate your family's history for such diseases, and will also be able to take you off the drug if s/he detects an irregularity in your blood test. There have been some news reports that the drug is also linked to suicide among teenagers, but no studies have been able to substantiate those claims. Either way, your dermatologist may ask your parents to monitor your behavior and make sure you smoothly adjust to the medication.

#skinbooster - the newest concept in hydration and recovery of aged skin.

Skin hydration is essential to maintain the youthful appearance. And a very good news is now being presented in the recent Congresses and Meetings of Dermatologists, the so called Skin Booster concept, which means the use of injectable hyaluronic acid in various parts of the skin in order to moisturize in a more uniform way. 

Hyaluronic acid has the ability to osmotically pull water, improving elasticity and turgor and stimulating the production of new collagen fibers. Restylane Vital is among the products for this purpose: it is composed of a fluid form of hyaluronic acid, that acts hydrating the dermis and thus reducing wrinkles and fine lines. Its main indications of application are: face, neck, chest and back of hands. In the hands, for example, Skin Booster operates improving aged appearance, providing greater definition and volume.

#diabetes #obesity : the role of a new virus found in the guts of half the population!

The latest news: researchers at San Diego State University have stumbled onto a very old but previously undiscovered type of intestinal virus that may play a role in the development of diseases like diabetes and obesity. The researchers are calling the virus "crAssphage." Once they figured out where to find it, crAssphage turned up so often that the study authors say more than half of all people are likely walking around with it in their bellies. The fact that the virus is so common means it’s likely very old—maybe even as old as the human race, the authors suggest.  

Our intestines are full of bacteria, and we need them to help digest food and adsorb nutrients; phages like crAssphage control the growth of bacteria by infecting them and killing them, just like wolves control the populations of hares and deer.  

Two of the most common bacteria in the intestines are called Bacteroides and Firmicutes. The ratio of these two may have important implications for human health—especially when it comes to obesity and diabetes. Because crAssphage may infect both of these types of bacteria, it could also have a part in the development of those diseases.

For the future, identifying crAssphage could be a very important first step when it comes to developing new gut bacteria-based medical treatments that could one day be used to help diabetics and others with intestine-related health issues. Unfortunately, those types of gut-based treatments are still about 5 years away from lab or clinical trials. 

#melasma #chloasma

Melasma is a very troublesome condition especially in pigmented skin. It is important to note that only superficial located pigment can improve, but not the pigment located deeper in the dermis. Examination with Wood’s lamp (360nm, blue light) is a plus, although it may be less reliable in phototypes IV and above because the pigmentation is invariably seen in the dermis.

Whitenning creams act by four mechanisms:

• by killing the melanocyte (the cell that produces melanin): hydroquinone, resorcinol.

• by inhibiting melanin production: methimazole, kojic acid, azelaic acid, arbutin.

• by inhibiting the transfer of the pigment to the epidermis: soy bean extracts.

• by increasing celular turnover (shedding of dead cells): retinol, retinaldehyde, retinoic acid.

 Before beginning treatment it is useful to determine the depth where the pigment is located: 1) epidermal (superficial): easier to achieve good results; 
2) dermal (deep): more challenging to achieve results; 
3) mixed: more effective results on epidermal pigment.

Treating melasma

How to decide if a depigmenting cream is effective? On a practical point of view, it is wise to check if studies on a depigmenting agent are done at the three levels: 1) in vitro: cultured melanocytes where it is easiest to make pigment vanish; 2) in vivo: the cream is usually tried on hairless mice, and 3) in vivo in humans: to demonstrate proven efficacy and safety.

Existing depigmenting creams on the market:

• New:
  • deoxyarbutin
  • nicotinamide
  • methimazole
  • soybean extracts

• Old:
• hydroquinone
• azelaic acid, kojic acid, arbutin: studies done in vitro only.

First line treatment:

Hydroquinone: side effects are allergic contact dermatitis in 5% of cases. Ochronosis remains a rarity in reality and is more likely if concentration is more than 10%, if use is long-term and if skin phototype is IV or more. No skin cancer has ever been reported (Squamous Cell Carcinoma, Basal Cell Carcinoma, Malignant Melanoma). 

Retinoids: retinaldehyde has been shown to be twice as effective in depigmentation as retinïc acid but with a less irritating side-effect.

PRACTICALLY speaking the treatment is done in two phases:

• Intensive phase
  • duration: 3 months
  • Hydroquinone 3-5% combined with ascorbic acid 3-5% in alternate nights. Note that the association is only stable about three months.
  • Retinaldehyde 0.05% to apply in alternate nights.
• Maintenance phase
  • Hydroquinone to apply once a week at night.
  • Retinaldehyde 0.05% to apply every other day at night.

• It is important to apply the cream on the whole area where the skin lesion is and not on the lesion itself because a hypopigmented halo can form (except in skin phototypes I and II).

Aditional recommendations:

• For temporary improvement: alpha-hydroxy acid peels (30-70%)
• If topicals fail to be effective , IPL and Pigment lasers (NDYAG 1064) may me tried, but only performed by a medical doctor with knowledge of skin conditions as there is a risk the colour could get worse.
• All treatments must be accompanied by a broad spectrum sunscreen.

This advice is just for informational purposes and does not replace therapeutic judgement done by a skin doctor.

#melanoma - warning signs of this dangerous and aggressive type of skin cancer.

In the skin, we can find various types of spots or marks, flat or raised, in different colors (shades from pink to dark brown or black), which are generally called "moles". Even though very common in most people, some moles can be dangerous, premalignant or even malignant (melanoma). That's why it is very important to watch them closely: after reading this article, finding any symptom or warning sign, look for a dermatologist. 
Among the three forms in which skin cancer appears, the most dangerous is known as melanoma, the one that quickly spreads and causes early metastases. 

How to identify the signs of a possible melanoma? 

1. Asymmetry 

Moles or birthmarks that become asymmetric can be alarming. For a better comprehension, I compare such asymmetry to a geographical map, ie, instead of spherical or oval, its shape becomes quite irregular. 

2. Size 

Generally, moles have up to 1 cm in diameter. If a mole gets larger or a fast growing is noted, pay attention in the changes or go directly to your dermatologist. 

3. Sudden or unexpected mole: beware! 

A mole that suddenly presents colors changes or that is growing rapidly is also suspect: this is another warning sign of a malignant lesion. 

4. Variation of colors 

Normal moles, in most cases, have homogeneous and uniform colors. A mole that presents many different colors (light brown, dark brown, black, blue, white, red, etc.) is suspect and should be investigated by your doctor. 

5. A mole with symptoms: inflammation, pain, burning or bleeding 

In this case, pay attention to the changes occurring in the lesion and visit a dermatologist immediately. 

6. Undefined or irregular edges

If the beginning and the end of a mole is not easily found, or if the edges are not well defined, attention, because it can be a dangerous lesion: benign moles have regular and well defined borders. 

7. Positive family history

If your family has a positive history of skin cancer, especially melanoma, it is highly recommended a regular follow up with the dermatologist. Some genetic / hereditary factors may favor the onset of malignant skin lesions.

#skincare - the anti-aging agents with scientifically proven efficacy.

Among so many launches in cosmetics and perfumery, lets be direct: which are the most effective anti-aging agents & formulas (with scientifically proven efficacy) released till now? 

1) Retinol 
It is a derivative of vitamin A, with renewing and rejuvenating actions. It also stimulates the production of new collagen. In general, it is well tolerated and usually doesn't cause redness, dryness or irritations. It should be used at night in the forms of creams for the face or eyelids. 

Retinol improves skin texture, mitigating fine wrinkles, increasing the elasticity and reducing pores size. It also unifies skin coloration. Its use is recommended from the age of 35; follow up with a dermatologist is needed.

2) Vitamin C 
Present in citrus fruits like oranges, lemons and cashew, vitamin C (ascorbic acid) is a potent antioxidant, which can efficiently slow the aging process. It also stimulates the formation of collagen and helps protect the skin from the effects of the sun. It rarely causes irritation, but eventually it may occur on sensitive skin. It is found in many cosmetics for the face, neck and eyes area. Can be used during the day, before the sunscreen, and at night. 

It is suitable from the age of 25. And attention: because it is a chemically unstable compound, vitamin C quickly loses its properties when in contact with the light, oxygen and heat. Therefore, the best products are formulated with active and stabilized forms of the vitamin. The bottles, preferably amber, should protect the product against light and air. 

3) Aquaporins 
They are proteins naturally present in the epidermis, essential for the retention and maintenance of the water in the skin. However, the effectiveness of these natural proteins declines over the years and the skin becomes drier and wrinkled. Therefore, its synthetic version in cosmetics will help moisturize the skin. A well hydrated skin is brighter and has smoother texture and luminosity. Its applicability begins at the age of 30. 

4) Hyaluronic acid
It is a molecule naturally present in the skin, forming a kind of "gelatin" among the collagen and elastin fibers, providing firmness and elasticity. Its synthetic form has moisturizing effect and helps retain water in the skin. Their microparticles have the potential to reach the deep layers of the skin. In dermatologic clinics, the injectable form is used to fill wrinkles and creases. 

Its use can be started from the age of 25. There is no contraindication to the use of hyaluronic acid, except for pregnant women and nursing mothers. 

5) Vitamin E 
Present in foods like nuts, dark green vegetables, eggs yolk and beef liver, is an antioxidant capable of regenerating the skin collagen. Known as tocopherol, it works as an adjunct in the action of other antioxidants, enhancing the results. It also has a protective effect against solar radiation. For a better efficacy in anti-aging treatments, vitamin E is always associated with other ingredients. It is indicated for patients from 25 years and there are no contraindications.

#sunscreens - definitions, indications and recommendations.

What are sunscreens used for?

Excessive exposure to the ultraviolet, visible and infra-red radiation of the sun can cause sunburn, premature aging and wrinkling, brown pigmentation, hypersensitivity reactions to sunlight and skin cancer. Although our skin has its own natural defence mechanism, it’s not enough to prevent the damage caused by the ultraviolet radiation.

Sunscreens are creams, lotions or oils that protect the skin from the damaging effects of ultraviolet radiation of the sun by providing a chemical or physical barrier to sunlight.

How do they work?

Chemical sunscreens absorb ultraviolet radiation, ensuring that ultraviolet light reaches only the superficial layers of the skin. 

Physical sunscreens reflect and scatter light, thus preventing the ultraviolet radiation from penetrating the skin. Examples of some common active ingredients include zinc oxide and titanium dioxide.

What does SPF mean?

SPF (Sun Protection Factor) is an index to indicate the degree of protection from sunburning that can be expected from the product. The higher the SPF, the longer the duration of the protection. Choosing the best protection. People with fair skin should start with a sunscreen with an SPF of at 15+. Those with darker skin may use a sunscreen with an SPF 6 to 8. As the skin tans, a lower SPF may be adequate.

Skin sensitivity can differ from one part of the body to another. These areas usually burn easily: nose, lips, face, ears and shoulders. The intensity of the sun varies with the seasons, time of day and location. The type of protection (SPF) required would then vary accordingly. It is recommended to combine primary protection with the use of sunscreen:

• Avoiding the sun when it is strongest between 10am to 4pm
• Wearing protective clothes under the hot sun. Remember that the sun rays can be reflected off the sand and cause a burn even if you are under the shade on the beach.

How to use it correctly

• Dry your skin well before applying the sunscreen.
• Apply the sunscreen at least half an hour before going into the sun to allow for penetration and binding to the skin. * Apply the sunscreen liberally and evenly over the exposed areas of the whole body.
• Wait for the sunscreen to dry before putting on your clothes or make up.
• Re-apply every two hours, or every hour if you have been swimming with a water resistant sunscreen.
• With a non-water resistant sunscreen, re-apply after swimming or after heavy perspiration but make sure your skin is dry first.
• Do not stay out in the sun any longer than your skin and the sunscreen SPF will allow.
• Use the sunscreen even on cloudy or overcast days. The sun’s rays are as damaging to your skin on hazy days as they are on sunny days.
• Use sunscreen with SPF 15 or higher during high altitude activities such as skiing and mountain climbing. At high altitudes, there is less atmosphere to absorb the sun’s rays, so the risk of burning is greater.

Precautions

Sunscreens only form a barrier to the passage of ultraviolet radiation. They do not make the skin more resistant to sunlight. A sunscreen must be applied frequently to maintain protection. Sunscreens can irritate the skin and eyes. Some may cause an allergic rash. If you have oily or acne-prone skin, you should avoid greasy formulations of sunscreens. When in doubt, consult your doctor or pharmacist.

#skin whitening: comparing topical hydroquinone with a combination of ellagic/salicylic acids.

Hydroquinone is a skin-bleaching agent that is used to lighten areas of darkened skin such as freckles, chloasma (also known as melasma), age spots, and acne scars. Side effects of hydroquinone cream include severe burning, itching, crusting, or swelling of treated areas (possible allergic contact dermatitis) and any unusual skin discolouration. Prolonged use of hydroquinone has been associated with the development of exogenous ochronosis (a persistent blue-black pigmentation), especially in black people, but this is rare.

This study was done by L'Oreal pharmaceuticals. Its goal was to compare the topic use of hydroquinone vs. a combination of ellagic + salicylic acids regarding skin whitenning. They were included 54 females ranging from 30 to 65 years old, skin phototypes I to VI.

Methods:

1. the participants were randomly assigned to 2 groups;
2. application with either ellagic + salicylic acids or hydroquinone 4% was done twice a day for 12 weeks.

The results were based on the following:

1. Clinical efficacy evaluation (visual analog scale from 1 to 10)
2. Tolerance grading
3. Assessment: size and number of the dark spots, digital photography.

Conclusions:

The results showed that the association of ellagic + salicylic acids provides comparable skin depigmentation benefit as hydroquinone 4%, without the side effects related to hydroquinone. Moreover, the analysed new product was found to have better texture and pleasantness to use. 

#marijuana vs. #alcohol - comparing health consequences

 

"As has been well documented, I smoked pot as a kid, and I view it as a bad habit and a vice, not very different from the cigarettes that I smoked as a young person up through a big chunk of my adult life," president Obama said during an interview with The New Yorker magazine. "I don't think it is more dangerous than alcohol."

How apt is the comparison between these substances? While both are intoxicants used recreationally, their legality, patterns of use and long-term effects on the body make the two drugs difficult to compare.

Short-term health consequences 

Drinking too much alcohol can quickly kill a person. The inability to metabolize alcohol as quickly as it is consumed can lead to a buildup of alcohol in the brain that shuts down areas necessary for survival, such as those involved with heartbeat and respiration. Marijuana affects the cardiovascular system, increasing heart rate and blood pressure, but a person can't fatally overdose on pot like they can with alcohol.

Alcohol is more likely than marijuana to interact with other drugs. The way that alcohol is metabolized in the body is common to many drugs that are taken for a variety of conditions. This means that for people taking drugs or medications while drinking, the alcohol can increase or decrease levels of the active drug in the body.

Because marijuana can impair coordination and balance, there is the risk of hurting oneself, particularly if someone drives or chooses to have unprotected sex.

Long-term health consequences

The long-term effects of drinking heavily are well known: alcoholic liver disease can progress to fibrosis, which in turn can potentially lead to liver cancer. Why some people have a higher risk than others of developing liver disease from drinking is not understood medically or biochemically.

Unlike alcohol, the effects of chronic marijuana use are not as well established. Animal studies have indicated some possible impact on reproduction. Additionally, there is evidence marijuana can worsen psychiatric issues for people who are predisposed to them, or bring them on at a younger age. Finally, because the drug is typically smoked, it can bring on chronic bronchitis.

It's unclear why marijuana smoke does not have the same result as tobacco smoke on the lungs, but perhaps some beneficial compounds in the marijuana smoke cancel out the ill effects, or perhaps the other health habits of marijuana smokers are different from those of cigarette smokers. Researchers looking to study long-term marijuana use have had difficulty in finding people who regularly smoke marijuana but don’t also smoke tobacco cigarettes. And the illegality of marijuana has also limited research in this field. In young people, marijuana interferes with connections being made in the brain at a time when the brain should be accumulating memory and life experiences. Effects, however, vary from individual to individual and also depend on the consume.

Benefits

There is no known medical use for consumed alcohol, but there are health benefits observed in moderate drinkers, including lower rates of cardiovascular disease and possibly fewer colds.

As for marijuana, whose legalization for medical uses has been a matter of strong public policy debate for years, there is ample evidence that beneficial compounds can be found in the plant. Researchers are working to try to identify the ingredients in marijuana that have potential for use in cancer, multiple sclerosis, diabetes, glaucoma and other diseases.

The year 2014 has brought with it the first legal sales of marijuana to people who aren't using the drug for medical reasons in the United States since the 1930s, as voters in Colorado and Washington state brought about this policy change.

Public health researchers have said studying rates of injuries, accidents, mental illness and teen use in the wake of the new laws will lead to a better understanding of marijuana's public health effects.