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Question of the Day: Should I stop my Acne medication?

Question Of The Day! 

 
Latif asks: should I stop my isotretinoin?
 
Disclaimer: if you are on any prescribed medications, speak to your doctor before you start/stop anything.
 
Isotretinoin better known under the guise of Roaccutane, Oratane, Accutane etc… it’s a wonder for severe cystic acne and many other skin conditions.
 
What concerns us in today’s question is that Latif was getting stomach aches about 6 days into using it and needed to know whether to be concerned or not.
 
Vien’s Answer: I said look probably a good idea to stop it and speak to your doctor the following Monday. In the meantime I did some digging around and basically found the following:
 
1) there is a long history of associations of isotretinoin and stomach issues like irritable bowel disease (IBD); a form in inflammation in the gut
 
2) whether there are links to Crohn’s disease (a much more severe form of inflammation that continually relapse) we cannot say for certain
 
3) some people have even gotten IBD AFTER stopping isotretinoin which may suggest a dormant form of IBD which may have been triggered by the drug.
 
4) It isn’t practical to check every single person for signs of inflammation so common sense should say: be more cautious if you have a family history of gut issues; if you take non-steroidal anti-inflammatories e.g. Nurofen, aspirin; and if you smoke.
 
Summary: before starting isotretinoin, review your medical history thoroughly with your doctor. If you notice anything out of the ordinary, err on the side of caution and tell your doctor!
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You’ve taken a fall and now you’ve got scars to show Q: What’s the best scar treatment?

This question comes from Iman who asks what scar creams are available apart from Vitamin E and Silicone?

This is an age old question and surprisingly it’s still a new field of dermatology that is yet to be revolutionized.

We’re still using old technology from the 70s aka the humble silicone gel sheets. But that’s because it works.

Scars are bothersome to us humans because they affect our self-esteem in public. Scars can be large, look red, itch like hell, and  feel hard to the touch which can affect our dexterity.

Scarring is the end process of skin healing following trauma be it a cut, burn, graze etc. Skin goes through three stages:

1) inflammation (things get swollen through extra blow flow to the area, pus forms as a by-product)

2) granulation (new blood vessels form, the structural components are laid down) and

3) matrix remodeling (a fancy word for collagen being packed down)

It’s this third stage that causes often gets out of hand and produces excess collagen and hence the raised look of a scar. The story gets worst in the case of keloid scars as they not only regrow but grow beyond the border of the original damage. See images :

 

(Left) Keloid Scars often overgrow the border of the damage site whereas (Right) Hypertrophic scars stay within the border and are less aggressive in growth.

Why do scars even occur? From a cave-man survival perspective…should we ever get a laceration or trauma, the best thing to ward of infection and ensure quick receovery is to have an inflammatory response that tells the body to lay down plenty of collagen to fill up the exposured areas. It’s a biological response. I read somewhere that only certain reptiles can actually rebuild skin to the exact specifications as the original!

So back to humans. Silicone gel sheets are the go-to. They work by occluding (form a protective barrier) the scar and adding hydration. Left on for at least 12hours a day for 6-12months. Downside is the impracticable nature of strapping on a silcone sheet to your body. Especially if it’s on flexure points like elbows or chin.

Compression Garments/Pressure therapy has been proven to reduce the size of scarring especially those across large areas of the body.  They are thought to work by mechanical pressue on the underlying blood vessels thereby restricting blood flow and hence collagen formation at the damage site. Another theory is they provide the shear forces to help re-organize new collagen. The downsides include the tedious nature of putting them on and off-they’re tight!; must be worn for 23 hours each day for up to one year; needs replacing every 2-3 months to maintain their pressure ~25-30mmHg. Here are some photos:

The combination of compression with silicone is superior to either alone and so there are brands they incorporate silicone into pressure garments.

Now for the white elephant in the room: Vitamin E oil. Known as an antioxidant, the main one in the skin in fact, people including doctors have always used it on anecdotable eveidence that it helps scars-but does it? I read lots of articles on it and nowhere is there solid proof that it works.

If anything it may cause some irriation. If used too early on fresh scars it can actually weaken the scar and cause the scar to widen. Its possible the type and strength of Vitamin E count for something…one study was using 320 IU per gram of cream. Typical Invite E cream in pharmcies is only 100IU per gram (Invite E oil is 25IU per drop).

Not surprisingly scientists decided to use Vitamin E with silicone gel sheets to see what wopuld happen and results blew them away-the combo dramatically improved scar colour, size and appearance.

invite e
Source: http://www.pinsdaddy.com/pure-vitamin-e-oil_6yJEc3SKpc4Ur*0Wu55Ru*QT3cKaAHw5FtCj1eyhdtU/

Now I could go on about the various other remedies out there but not much evidence exists so I’ll just briefly list them here:

  • Onion extract (only slightly better than using Vaseline!)
  • Imiquimod 5% (needs more research, some promise)
  • Vitamin A (aka retinoic acid; reduces scar sizes, can be a teratogen if absorbed into the body, needs more research)

 

More invasive options do exist however…

  • surgical excision (cutting it out) but for keloids, they recur in 45-100% of cases (reserve for resistant scars)
  • Steroid injections (corticosteroids): first line therapy for keloids. Response rate 50-100%, Recurrence of 9-50%. Painful. Side effects: discoloration, dimples, spider veins.
  • Radiotherapy: most effective treatment for keloids but high exposure to radiation. Response rate: 10-94%, Recurrence rate: 50-100%.
  • Laser (carbon dioxide, argon, flashlamp-pumped pulsed-dye): conflicting results. more research needed.
  • Cryotherapy: flattens keloids after two sessions. Side effects: permanent skin discoloration, pain, skin shrinkage. reserved for small scars.

An unusual observation is the use of paper tape to hold together fresh incisions made by a surgeon, used for several weeks, seemed to be “useful”. albeit not as effective as silicone, it could serve the purpose of prepping the skin prior to silicone gel sheets.

So for our friend Iman, I think sticking to silicone gel sheets like Scar FX or Cica-Care is her best bet with the addition of some Vitamin E oil (optional) and a pressure garment.

Sources:

Keloids

Pressure Garments

https://www.regionshospital.com/rh2/specialties-and-doctors/specialties/burn-center/garments/index.html

Burns Scars

http://www.smith-nephew.com/key-products/advanced-wound-management/cicacare/

Scar FX 1" x 22" Self-Adhesive Silicone Sheeting

 

 

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Kid’s Hives: the most frequent concern among Young Parents

The most common issue I see in pharmacy no matter where I work is hives aka rashes-both in kids and adults.

It’s the freakiest thing-to see your kid’s skin angry and red, blotchy and spread.

In the video above I’m gonna share my personal experience with never before seen photos of my hives.

I’ll explain why hives occur and a simple method to find the root cause.

“Often it’s rarely what you did today, but rather the factors leading up to it. The stresses on your immune system.”

Our immunity is like a battery and it can quickly run flat. Charging it up is simple but so many times we get it wrong. We try quick fixes like buying a new battery!

The pillars for charging this battery are: 8-10hrs sleep , good nutrition , hydration .

Where a boost is needed, I always turn to a good probiotic powder* for kids. (*See below for my recommendations)

Watch out for unwitting stacking of stresses on our kids. These include recent colds, ear infections, gastro, off ones food, dehydration.

On their own the stresses won’t cause hives but together they set the scene for a weakened immune system.

When our body reaches a tipping point, that’s when it will “react” with inflammation aka hives aka redness, itching, swelling.

This is when we reach for anti-histamines (anti-inflammation) but notice the initial gap in treatment. We haven’t dealt with underlying stresses when we pop a Zyrtec or other.

The pillars for charging this battery are: 8-10hrs sleep, good nutrition, and hydration.

That’s why I always take a full history whenever mums and dads come in with their kids. Sure I’ll give them the quick fix but I always address the underlying issues too.

If you found this informative leave a Reply below and Share it on. Bless ur health.  Vien

 

*There are so many brands of probiotics now, some kept in the fridge others outside. Exciting indications exist claiming to fix eczema, improve allergies, moderate cholesterol etc..I stick with what I know and that’s: Inner Health for Kids Powder 0-12yrs. It’s got the three main bacterium that normally colonize our guts.

Would like to know where to get probiotics?

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