Monthly Archives: October 2017

what is eczema and what can you do about it?

Explainer: what is eczema and what can you do about it?

 

Eczema is a genetic disorder with an environmental trigger, which affects one in three people at some time in their life..

People with eczema essentially have sensitive skin that is easily irritated. The irritation produces dryness by disrupting the function of the external waterproof skin barrier, allowing water to leave the skin.

The main gene associated with eczema – or atopic dermatitis, as it’s known clinically – is filaggrin. Filaggrin mutations reduce the ability of the skin to withstand environmental insults and to repair itself after injury.

Disruption to the skin barrier allows allergens to enter the deeper layers of the skin and activate the immune system.

How the immune system reacts to these allergens determines the severity of the skin inflammation and the duration of the disruption to the skin barrier function.

What can you do about it?

If you or someone in your family has suffered with severe eczema, you’ve probably tried all sorts of remedies to alleviate the itching. Here are five tips to calm your skin:

1) Avoid things that irritate the skin. No matter how wonderful a hot shower feels on itchy skin, it actually aggravates eczema. Keep showers to five minutes or less and use luke-warm water.

Wash with water alone: no soap, no soap substitute, no soap-free wash and definitely no bubble bath. Just water.

2) Avoid overheating. Heat makes the itch worse, irrespective of the cause. Turn the heating down to 18 to 20 degrees Celsius (64 to 68 degrees Farenheit) and put on an extra layer of clothing.

Take the doona off your bed and sleep under good old-fashioned cotton blankets. Overheating at night leads to scratching in your sleep. If there is blood on your sheets in the morning, that is a sure sign your bed is too hot at night.

Apply moisturiser frequently and liberally. Kaspars Grinvalds/Shutterstock.
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3) Take a bleach bath. This is a simple method to reduce the bacteria on the surface of your skin. For a full tub of water, use half a cup of bleach. Never apply bleach directly to the skin. (More safety tips and instructions are available here.)

If the eczema is weeping, oozing or has honey-coloured crusts, there is almost always golden staph on the skin surface aggravating the eczema. Bleach baths are a good alternative to antibiotics.

4) Use lots and lots of moisturiser. To fix eczema you will also need to restore the skin barrier. That requires frequent and liberal use of moisturiser, including after the eczema appears to have cleared up.

There are lots of moisturisers on the market. Trial and error is the best way to find the right moisturiser for your skin. Keep in mind that if you use a light one, you need to reapply it more often than a heavy one.

While tablets can help stop the inflammation, in general that’s not enough to stop the eczema.

5) Use your topical corticosteroid creams as directed. Additives reduce the skin thinning that can occur with prolonged use of potent topical steroids. Your dermatologist is the best person to advise you on this.

Emerging therapies

Researchers are investigating whether a new class of drugs, called biologics, could help manage severe eczema.

Biologics show promise but they’re still several years away. Quayside/Shutterstock

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Biologics try to block critical steps within certain pathways, which can terminate inflammation.

Biologics are most commonly produced from bacteria or yeast cultures. Specific genes are inserted into bacteria and yeast that have been inactivated so they are no longer dangerous to humans.

Production of biologics in this way is slow, low-volume, high-tech and expensive. Consequently, biologics can cost tens of thousands of dollars per patient per year.

A number of clinical research trials are underway to test these agents. People with severe eczema, which is not adequately controlled with current treatments, may consider enrolling to participate in a research trial.

It will still take three to five years for the results of these trials to be fully assessed and to know whether biologic agents are safe and effective in the management of eczema. If they are, they could revolutionise the management of severe eczema.

Why we regain weight after drastic dieting

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Why we regain weight after drastic dieting

June 21, 2016 6.13am AEST

Disclosure statement

Sergio Diez Alvarez does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond the academic appointment above.

Partners

University of Newcastle provides funding as a member of The Conversation AU.

 

A few years ago I proudly lost almost 15% of my weight. However last week I stared with disbelief at my scale as I realised all my efforts were in vain and I had regained all of the previously lost weight.

This got me thinking about the mechanisms that underpin such dramatic fluctuations in weight (sometimes known as yo-yo dieting) and the defences the body uses for weight maintenance.

Even losing as little as 5% of our body weight has a myriad of health benefits, including reduced risk of heart attacks, lower blood pressure, improved glucose control in patients with diabetes, improved mental health and reduced risk of osteoarthritis and certain cancers.

Thus one would imagine the body would generally be supportive of weight loss. If so, why is persistent weight loss and weight maintenance so difficult?

Why the body fights weight loss

The control of weight is based on the balance between calorie consumption and the energy spent during our day to day living. The brain’s weight control centre is in an area called the hypothalamus.

The hypothalamus integrates the incoming signals from the body (such as hormonal signals) and other parts of the brain and then controls weight by affecting hunger and satiety.

It also communicates with other parts of the brain that control metabolism (such as the pituitary gland and sympathetic nervous systems). This complicated and fine-tuned system determines a “weight set-point” which is the weight the body is accustomed to and then works to defend it by fine tuning our metabolism and our calorie consumption.

Energy consumption is divided into the resting metabolic rate (about 70% of all energy used), the energy consumed in processing the food we eat (thermogenic metabolism) and exercise based energy expenditure.

A few studies have outlined the result of moderate weight loss. The body defends against weight loss by drastically reducing the energy expenditure. The body also goes into a sort of “starvation mode” to protect against lean body weight loss by preferentially depleting different energy stores including glycogen, fat and then eventually muscle.

The body spends a large percentage of energy in the maintenance of organ function, even when asleep. In obese people, the resting metabolic rate significantly increases, perhaps to try to prevent further weight gain. Unfortunately, when you lose weight, the opposite happens and the body’s metabolism turns right down.

This may occur through reductions in the active thyroid hormone (T3) and changes in the hormonal messages back to the brain promoting hunger.

A key finding in the above studies is the reduction in resting metabolic rate is disproportionately large, and potentially persists for long periods. This explains why a return to a pre-weight loss lifestyle inevitably results in weight re-gain, and possibly more than was lost.

Only by maintaining a healthy lifestyle with calorie restriction of around 25% and exercise can we avoid the inevitable. The reduction in resting metabolic rate may be particularly problematic in people with severe obesity.

Drastic long-term weight loss

This led me to examine the published data on contestants with severe obesity in The Biggest Loser. I wondered what had become of the contestants who had lost amazing amounts of weight over a relatively short period of time.

Majority of The Biggest Loser contestants regained a significant proportion of their lost weight. AAP Image/Channel Ten

One study confirmed that despite the rigorous exercise programs, the drop in resting metabolic rate persisted. In a study published this year that followed 14 of the original 16 contestants, the majority had regained a significant proportion of the weight loss. More importantly, their resting metabolic rate was still low, almost six years after the end of the show. This suggests the metabolic adaptation against rapid weight loss may be profound and sustained, possibly explaining why we potentially regain even more weight than we originally lost.

This same phenomenon was found after weight loss following a type of bariatric surgery, where weight loss is achieved by reducing the size of the stomach with a gastric band. The metabolic adaptation in these patients was very similar to that found with similar weight loss in The Biggest Loser.

The long-term data for bariatric surgery in terms of sustainability of weight loss suggests other factors (most likely related to gut hormones such as ghrelin) must be influencing energy balance as there is evidence that weight loss is maintained even after many years.

How to avoid the slowed metabolism

So is there a way to counter nature’s opposition to weight loss? Certain types of exercise such as strength exercises preserve muscle mass and this assists in preserving the resting metabolic rate. However it doesn’t always work.

Thus it may be that only sustained modest exercise and a permanent reduction in calories are both essential for weight loss and maintenance. Although there is no data on the rate of weight loss at which metabolic adaptation occurs, most guidelines recommend gradual and steady weight loss of between 0.5-1kg per week, as part of a sustainable lifestyle change which includes appropriate exercise activity and a balanced nutritious diet.

Is Hormone Replacement Therapy Safe in Women With a BRCA Mutation?

I have had many women concerned that they cannot have HRT due to being BRAC +ve, so they have had to suffer needlessly from the symptoms of menopause. This study can allay their fears
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Am J Clin Oncol. 2016 Feb 2. [Epub ahead of print]

Is Hormone Replacement Therapy Safe in Women With a BRCA Mutation?: A Systematic Review of the Contemporary Literature.

Abstract

OBJECTIVES:

Women with a BRCA1 or BRCA2 mutation are recommended to undergo prophylactic (or risk reducing) bilateral salpingo-oophorectomy (BSO) before age 40, resulting in surgical menopause. Given the concerns of estrogen deprivation on overall health, hormone therapy (HT) is often discussed, yet safety concerns persist.

MATERIALS AND METHODS:

We performed a systematic literature review of the safety of HT in women with a BRCA mutation undergoing prophylactic BSO.

RESULTS:

Although there remains a paucity of data on this topic, as evidenced by this systematic review of the contemporary literature, these patients do benefit from treatment, especially as it relates to menopausal symptoms without an apparently increased risk of breast cancer.

CONCLUSIONS:

Decisions regarding the use of HT in women who undergo BSO after detection of a BRCA mutation must be individualized based on careful consideration of the risks and benefits. However, the risks of a subsequent cancer diagnosis appear small, particularly in regards to the benefits of treatment afforded by HT

The effects of DHEA (dehydroepiandrosterone) on sexual function

Climacteric. 2017 Jan 24:1-12. doi: 10.1080/13697137.2017.1279141. [Epub ahead of print]

The effects of dehydroepiandrosterone on sexual function: a systematic review.

Author information

  • 1a Federal University of Rio de Janeiro, Institute of Psychiatry, Laboratory of Panic and Respiration , Rio de Janeiro , RJ , Brazil.
  • 2b Federal University of Rio de Janeiro, Institute of Psychiatry, Laboratory of Thanatology and Psychiatry in other Medical Conditions , Rio de Janeiro , RJ , Brazil.
  • 3c Translational Research Group in Mental Health , Dom Bosco Catholic University , Campo Grande , MS , Brazil.

Abstract

OBJECTIVE:

Faced with the growing interest about the action of dehydroepiandrosterone (DHEA) and its benefits, as well as the negative impacts that sexual dysfunctions have on people’s quality of life, this systematic review was undertaken with the objective of evaluating the effect of DHEA use on aspects of sexual function.

METHOD:

An electronic search was conducted in the databases of PubMed, ISI Web of Science and Virtual Health Library (VHL) combining the terms ‘DHEA treatment’ and ‘DHEA use’ with terms such as ‘sexual dysfunction’, ‘sexual frequency’ and ‘libido’. No limits on time and language were imposed. Clinical studies were considered eligible where individuals for any reason made use of DHEA and if they had any aspect of sexual function assessed. Preclinical studies and systematic reviews were considered ineligible.

RESULTS:

The search identified 183 references and 38 were considered eligible. DHEA improved aspects such as sexual interest, lubrication, pain, arousal, orgasm and sexual frequency. Its effect was better in populations with sexual dysfunction, especially in perimenopausal and postmenopausal women.

CONCLUSION:

Considering the studies currently published, DHEA is effective in improving several aspects of sexual function, but this effect did not reach all the populations studied.