Tuesday, November 3, 2009

Why Much Better Vitamin D then Swine Flu Vaccine

(NaturalNews) The news is out: Vitamin D is better than the swine flu vaccine at halting H1N1 infections. In fact, without vitamin D, chances are that a vaccine won't generate much of an immune response in the first place.

That's because vitamin D is essential for healthy, active immune function. That's just one of the reasons smart people are choosing vitamin D instead of the swine flu vaccine. Here are nineteen more reasons:

#1 Vitamin D activates your immune system to respond to any viral exposure (not just one virus).

#2 Vitamin D naturally belongs in your body.

#3 Vitamin D has been functioning as medicine in the human body since the beginning of the human species.

#4 Vitamin D is available right now and there's no shortage of it.

#5 Vitamin D won't cause your brain to swell and put you into a coma.

#6 Vitamin D doesn't require an injection with a scary needle.

#7 Vitamin D is found naturally in many foods such as sardines or salmon.

#8 Vitamin D has a perfect safety record. No one ever died from consuming it.

#9 Vitamin D is affordable. You can even get it for free (from sunlight).

#10 Vitamin D doesn't contain viral fragments from diseased animals (like vaccines often do).

#11 Vitamin D doesn't contain thimerosal or other chemical preservatives.

#12 Vitamin D doesn't need a warning sheet describing possible side effects.

#13 Vitamin D doesn't hurt your arm when you take it.

#14 Vitamin D also improves sugar metabolism, bone density and healthy moods.

#15 Vitamin D is safe for the environment.

#16 Vitamin D doesn't contain squalene or other inflammatory adjuvant chemicals.

#17 Vitamin D works on everyone and is safe for everyone, including infants and children.

#18 Vitamin D is made in nature, not a laboratory.

#19 Vitamin D is found naturally in breast milk.

#20 You can walk, and chew gum, and generate vitamin D from sunshine all at the same time!

Skip the vaccine. Get more Vitamin D!

Friday, October 16, 2009

Assesment To Sprain And Strain

Sprains and strains are among the most common injuries in sports. A large percentage of musculoskeletal injuries observed in the outpatient setting involve the ankle. Sprains constitute 85% of all ankle injuries. Of these, 85% are inversion sprains. Up to one sixth of participation time lost from sports results from ankle sprains. Proper rehabilitation begins with accurate diagnosis, because up to 40% of patients with untreated or misdiagnosed ankle injuries develop chronic symptoms. Most injuries respond to treatment. Pain reduction is essential, but improvement of any loss of motion, strength, and/or proprioception is equally important. Proper treatment of a sprain or strain is of utmost importance. Without the best treatment, a sprain of a ligament or a strain of a muscle can be a long recovery. Proper treatment of this injury can get you back quickly.

What is Sprain and Strain?

A sprain is a stretch and/or tear of a ligament, the fibrous band of connective tissue that joins the end of one bone with another. Ligaments stabilize and support the body's joints.

A strain is an injury of a muscle and/or tendon. Tendons are fibrous cords of tissue that attach muscles to bone.

What cause Sprain and Strain?

A sprain is caused by direct or indirect trauma (a fall, a blow to the body, etc.) that knocks a joint out of position, and overstretches, and, in severe cases, ruptures the supporting ligaments. Typically, this injury occurs when an individual lands on an outstretched arm; slides into a base; jumps up and lands on the side of the foot; or runs on an uneven surface. 

Chronic strains are the result of overuse (prolonged, repetitive movement) of muscles and tendons. Inadequate rest breaks during intensive training precipitates a strain. Acute strains are caused by a direct blow to the body, overstretching, or excessive muscle contraction.

What are the signs of sprain?

While the intensity varies, pain, bruising, swelling, and inflammation are common to all three categories of sprains: mild, moderate, severe. The individual will usually feel a tear or pop in the joint. A severe sprain produces excruciating pain at the moment of injury, as ligaments tear completely, or separate from the bone. This loosening makes the joint nonfunctional. A moderate sprain partially tears the ligament, producing joint instability, and some swelling. A ligament is stretched in a mild sprain, but there is no joint loosening.

What are the signs of a strain?

Typical indications include pain, muscle spasm, muscle weakness, swelling, inflammation, and cramping. In severe strains, the muscle and/or tendon is partially or completely ruptured, often incapacitating the individual. Some muscle function will be lost with a moderate strain, where the muscle/tendon is overstretched and slightly torn. With a mild strain, the muscle/tendon is stretched or pulled, slightly.

Back strain. When the muscles that support the spine are twisted, pulled, or torn, the result is a back strain. Athletes who engage in excessive jumping (during basketball, volleyball, etc.) are vulnerable to this injury.

Hamstring muscle strain. A hamstring muscle strain is a tear or stretch of a major muscle in the back of the thigh. The injury can sideline a person for up to six months. The likely cause is muscle strength imbalance between the hamstrings and the muscles in the front of the thigh, the quadriceps. Kicking a football, running, or leaping to make a basket can pull a hamstring. Hamstring injuries tend to recur.

What is The symptom of sprain?

The symptoms of a sprain are almost exactly the same as that of a broken bone. When in doubt, sprains should be treated the same as broken bones. The most common symptoms are: pain

· swelling

· bruising

· inability to move

· inability to bear weight on the joint

· pain

· swelling

· bruising

· inability to move

· inability to bear weight on the joint

It is not necessary to have all of the symptoms of a sprain in order for the joint to be injured.

Sprain Severity

· Grade I Sprain: A grade I (mild) sprain causes overstretching or slight tearing of the ligaments with no joint instability. A person with a mild sprain usually experiences minimal pain, swelling, and little or no loss of functional ability. Bruising is absent or slight, and the person is usually able to put weight on the affected joint.

· Grade II Sprain: A grade II (moderate) sprain causes partial tearing of the ligament and is characterized by bruising, moderate pain, and swelling. A person with a moderate sprain usually has some difficulty putting weight on the affected joint and experiences some loss of function. An x-ray or MRI may be needed.

· Grade III Sprain: A grade III (severe) sprain results in a complete tear or rupture a ligament. Pain, swelling, and bruising are usually severe, and the patient is unable to put weight on the joint. An x-ray is usually taken to rule out a broken bone. This type of a muscle sprain often requires immobilization and possibly surgery. It can also increase the risk of an athlete having future muscles sprains in that area.

Strain Severity

Strains are categorized in a similar manner to sprains:

· Grade I Strain: This is a mild strain and only some muscle fibers have been damaged. Healing occurs within two to three weeks.

· Grade II Strain: This is a moderate strain with more extensive damage to muscle fibers, but the muscle is not completely ruptured. Healing occurs within three to six weeks.

· Grade III Strain: This is a severe injury with a complete rupture of a muscle. This typically requires a surgical repair of the muscle; the healing period can be up to three months.

First Aid

Use the RICE method to treat the sprain.

1. Rest the sprained joint by not placing weight on it. Use a cane or crutch on the uninjured side to lean away from the injury.

2. Ice the sprain with an ice pack.

3. Compress the sprain with a compression bandage. Ask a healthcare provider to show you how to properly apply a compression bandage.

4. Elevate the sprain above the level of the heart as often as possible during the first 48 hours.

Rest, ice, compression, and elevation usually will help minimize the damage. It is important in all but mild cases for a medical doctor to evaluate the injury and establish a treatment and rehabilitation plan. A severe sprain or strain may require surgery or immobilization followed by months of therapy. Mild sprains and strains may require rehabilitation exercises and activity modification during recovery.

Prevention Tips

No one is immune to sprains and strains, but here are some tips developed by the American Academy of Orthopaedic Surgeons to help reduce your injury risk:

· Participate in a conditioning program to build muscle strength

· Do stretching exercises daily

· Always wear properly fitting shoes

· Nourish your muscles by eating a well-balanced diet

· Warm up before any sports activity, including practice

· Use or wear protective equipment appropriate for that sport

When To See a Doctor for a Sprain or Strain

· You have severe pain and cannot put any weight on the injured joint.

· The area over the injured joint or next to it is very tender when you touch it.

· The injured area looks crooked or has lumps and bumps that you do not see on the uninjured joint.

· You cannot move the injured joint.

· You cannot walk more than four steps without significant pain.

· Your limb buckles or gives way when you try to use the joint.

· You have numbness in any part of the injured area.

· You see redness or red streaks spreading out from the injury.

· You injure an area that has been injured several times before.

· You have pain, swelling, or redness over a bony part of your foot.

Tuesday, August 18, 2009

Emergency Response System

This morning I joing a meeting at Renon, the goverment of Bali want to make a system of emergency in Bali that involve all aspect such as policement, fire service, medical ambulance, etc. But they confuse to built a good scenario to show to the investor, so I got an idea to put the video here, please watch and learn.



Join Vinefire!

Wednesday, August 12, 2009

Mesothelioma


Also called: Malignant mesothelioma

The tissue that lines your lungs, stomach, heart and other organs is called mesothelium. Mesothelioma is cancer of that tissue. It is a rare but serious type of cancer. It usually starts in the lungs, but can also start in the abdomen or other organs. Most people who develop mesothelioma have worked on jobs where they inhaled asbestos particles. It can take a long time - 30 to 50 years - between being around asbestos and getting the disease. Treatment includes surgery, radiation, chemotherapy or all three.

Definition

Malignant mesothelioma (me-zo-thee-le-O-muh) is a rare cancer that occurs in the thin layer of tissue that covers the majority of your internal organs (mesothelium).

Doctors divide mesothelioma into different types based on what part of the mesothelium is affected, including:

  • Pleural malignant mesothelioma, which affects the tissue that surrounds the lungs and is the most common form of mesothelioma.
  • Peritoneal mesothelioma, which occurs in the tissue in your abdomen.
  • Pericardial mesothelioma, which affects the tissue surrounding the heart.
  • Mesothelioma of the tunica vaginalis, which occurs in the lining around the testicles.

Between 2,000 and 3,000 people are diagnosed with mesothelioma in the United States each year, according to the American Cancer Society.

Symptoms

Signs and symptoms of mesothelioma vary depending on where the cancer occurs.

Pleural mesothelioma signs and symptoms may include:

  • Shortness of breath
  • Painful breathing (pleurisy)
  • Painful coughing
  • Chest pain under the rib cage
  • Unusual lumps of tissue under the skin on your chest
  • Unexplained weight loss
  • Dry (nonproductive) cough

Peritoneal mesothelioma signs and symptoms may include:

  • Abdominal pain
  • Abdominal swelling
  • A change in your bowel habits, such as more frequent diarrhea or constipation
  • Lumps of tissue in the abdomen
  • Unexplained weight loss

Other forms of mesothelioma
Signs and symptoms of pericardial mesothelioma and mesothelioma of the tunica vaginalis are unclear. These forms are so rare that not much information is available. Pericardial mesothelioma signs and symptoms may include difficulty breathing or chest pains. Mesothelioma of the tunica vaginalis may be first detected as a mass on a testicle.

When to see a doctor
See your doctor if you have signs and symptoms that may indicate mesothelioma. Signs and symptoms of mesothelioma aren't specific to this disease and, due to the rarity of mesothelioma, are more likely to be related to other conditions. If any persistent signs and symptoms seem unusual or bothersome to you, ask your doctor to evaluate them.

Causes

In general, cancer begins when a series of genetic mutations occur within a cell, causing the cell to grow and multiply out of control, when healthy cells would normally die. The accumulating abnormal cells form a mass (tumor). Cancer cells invade nearby tissues and can break off from an initial tumor to spread elsewhere in the body (metastasize).

It isn't clear what causes the initial genetic mutations that lead to mesothelioma, though researchers have identified factors that may increase the risk. It's likely that cancers form because of an interaction between many factors, such as inherited conditions, your environment, your health conditions and your lifestyle choices.

Benign pleural mesothelioma
A form of noncancerous (benign) tumor that can occur in the chest is sometimes called benign mesothelioma. However, this name is misleading. Benign mesothelioma doesn't begin in the same cells where the cancerous forms of mesothelioma begin. And, in a minority of cases, benign mesothelioma can be very aggressive, despite the term "benign." For this reason, some doctors now refer this tumor as solitary fibrous tumor.

Solitary fibrous tumor usually doesn't cause signs and symptoms. Most cases are inadvertently discovered during tests and procedures for other conditions. It isn't clear what causes solitary fibrous tumors, but they aren't linked to asbestos exposure. Treatment for solitary fibrous tumor typically includes surgery.

Risk factors

Asbestos exposure: The primary risk factor for mesothelioma
Asbestos is a mineral that's found naturally in the environment. Asbestos fibers are strong and resistant to heat, making them useful in a wide variety of applications, such as in insulation, cement, brakes, shingles, flooring and many other products. People who work around asbestos fibers are thought to have the greatest risk of mesothelioma.

When asbestos is broken up, such as during the mining process or when removing asbestos insulation, dust may be created. If the dust is inhaled or swallowed, the asbestos fibers may settle in the lungs or in the stomach, where they can cause irritation that may lead to mesothelioma, though how exactly this happens isn't understood.

Mesothelioma risk is believed to be increased in people who are exposed to high levels of asbestos, in people who are exposed to asbestos over a long period of time and in people exposed to asbestos at a young age. It can take 30 to 40 years or more for mesothelioma to develop as a result of asbestos exposure.

Some people with years of asbestos exposure never develop mesothelioma. And yet, others with very brief exposure develop the disease. This indicates that other factors may be involved in determining whether someone gets mesothelioma or doesn't. For instance, you could inherit a predisposition to cancer or some other condition could increase your risk.

Possible risk factors
Factors that may increase the risk of mesothelioma include:

  • Personal history of asbestos exposure. If you've been directly exposed to asbestos fibers at work or at home, your risk of mesothelioma is greatly increased.
  • Living with someone who works with asbestos. People who are exposed to asbestos may carry the fibers home on their skin and clothing. These stray fibers can put others in the home at risk of mesothelioma. People who work with asbestos should shower and change clothes before leaving work.
  • Smoking. Risk of mesothelioma is increased greatly in smokers who are exposed to asbestos.
  • SV40. Some research indicates a link between mesothelioma and simian virus 40 (SV40), a virus originally found in monkeys. Millions of people may have been exposed to SV40 when receiving polio vaccinations between 1955 and 1963, because the vaccine was developed using monkey cells. Once it was discovered that SV40 was linked to certain cancers, the virus was removed from the polio vaccine. Whether SV40 increases the risk of mesothelioma is a point of debate, and more research is needed.
  • Radiation. Some research links mesothelioma to the radioactive substance thorium dioxide, which was used along with X-rays to diagnose various health conditions from the 1920s to the 1950s. Thorium dioxide was later found to cause cancer and is no longer used.
  • Family history. A family history of mesothelioma may increase your risk of mesothelioma, but more research is needed to understand this theory.

Complications

Complications from spreading cancer
As pleural mesothelioma spreads in the chest, it puts pressure on the structures in that area. This can cause complications, such as:

  • Difficulty breathing
  • Chest pain
  • Difficulty swallowing
  • Swelling caused by pressure on the large vein that leads from your upper body to your heart (superior vena cava syndrome)
  • Pain caused by pressure on the nerves and spinal cord
  • Accumulation of fluid in the chest (pleural effusion), which can compress the lung nearby and make breathing difficult

Death
Mesothelioma that progresses can lead to death. People who die of mesothelioma usually die from related complications, such as lung failure, heart problems, stroke and other causes.

Preparing for your appointment

You're likely to start by first seeing your family doctor or a general practitioner. However, in some cases when you call to set up an appointment, you may be referred immediately to a doctor who specializes in lung diseases (pulmonologist) or abdominal problems (gastroenterologist).

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

  • Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
  • Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
  • Write down key personal information, including any major stresses or recent life changes. If you're worried about mesothelioma, make a list of all your occupations, even those you had for only a few months.
  • Make a list of all medications, as well as any vitamins or supplements, that you're taking.
  • Take a family member or friend along, if possible. Sometimes it can be difficult to soak up all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
  • Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For mesothelioma, some basic questions to ask your doctor include:

  • What is likely causing my symptoms or condition?
  • What are other possible causes for my symptoms or condition?
  • What kinds of tests do I need?
  • Is my condition likely temporary or chronic?
  • What is the best course of action?
  • What are the alternatives to the primary approach that you're suggesting?
  • I have these other health conditions. How can I best manage them together?
  • Are there any restrictions that I need to follow?
  • Should I see a specialist? What will it cost, and will my insurance cover seeing a specialist?
  • Is there a generic alternative to the medicine you're prescribing me?
  • Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend?
  • What will determine whether I should plan for a follow-up visit?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may allow more time to cover other points you want to address. Your doctor may ask:

  • When did you first begin experiencing symptoms?
  • Have your symptoms been continuous, or occasional?
  • How severe are your symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
  • Do your symptoms affect your ability to work?

What you can do in the meantime
Try to avoid anything that worsens your signs and symptoms. For instance, if you're experiencing shortness of breath, try to take it easy until you can meet with your doctor.

Tests and diagnosis

If you have signs and symptoms that might indicate mesothelioma, your doctor will conduct a physical exam to check for any lumps or other unusual signs. Your doctor may order imaging scans, such as a chest X-ray or a computerized tomography (CT) scan of your chest or abdomen, to look for abnormalities.

It's not uncommon for mesothelioma to be misdiagnosed initially because mesothelioma is rare, and its signs and symptoms aren't specific. Your doctor will likely rule out other more common conditions before considering mesothelioma.

Biopsy
Biopsy, a procedure to remove a small portion of tissue for laboratory examination, is the only way to determine whether you have mesothelioma. Depending on what area of your body is affected, your doctor selects the right biopsy procedure for you. Options include:

  • Fine-needle aspiration. The doctor removes fluid or a piece of tissue with a small needle inserted into your chest or abdomen.
  • Thoracoscopy. Thoracoscopy allows the surgeon to see inside your chest. In this procedure, the surgeon makes one or more small incisions between your ribs. A tube with a tiny video camera is then inserted into your chest cavity — a procedure sometimes called video-assisted thoracoscopic surgery (VATS). Special surgical tools allow your surgeon to cut away tissue for testing.
  • Laparoscopy. Laparoscopy allows the surgeon to see inside your abdomen. Using one or more small incisions into your abdomen, the surgeon inserts a tiny camera and special surgical tools to obtain a small piece of tissue for examination.
  • Thoracotomy. Thoracotomy is surgery to open your chest between the ribs to allow a surgeon to check for signs of disease. He or she removes a sample of tissue for testing.
  • Laparotomy. Laparotomy is surgery to open your abdomen to allow a surgeon to check for signs of disease. He or she removes a sample of tissue for testing.

The tissue sample is analyzed under a microscope to see whether the abnormal tissue is mesothelioma and what types of cells are involved. The type of mesothelioma you have determines your treatment plan.

Staging
Once mesothelioma is diagnosed, your doctor orders other tests to determine the extent, or stage, of the cancer. Imaging tests that may help determine the stage of your cancer include:

  • Chest X-ray
  • CT scans of the chest and abdomen
  • Magnetic resonance imaging (MRI)
  • Positron emission tomography (PET)

Once the extent of pleural mesothelioma is determined, a stage is assigned. Formal stages aren't available for other types of mesothelioma because these types are rare and aren't well studied. The stages of pleural mesothelioma are:

  • I. Stage I pleural mesothelioma is considered localized cancer, meaning it's limited to one portion of the lining of the chest.
  • II. Stage II mesothelioma may have spread beyond the lining of the chest to the diaphragm or to a lung.
  • III. Stage III mesothelioma may have spread to other structures within the chest and may involve nearby lymph nodes.
  • IV. Stage IV mesothelioma is an advanced cancer that has spread to distant areas (metastasized). Mesothelioma most commonly spreads (metastasizes) to the brain, lymph nodes in the chest and areas of the lung that are away from the tumor.

Treatments and drugs

What treatment you undergo for mesothelioma depends on your health and certain aspects of your cancer, such as its stage and location. Unfortunately, mesothelioma often is an aggressive disease and for most people a cure isn't possible. Mesothelioma is usually diagnosed at an advanced stage — when it isn't possible to remove the cancer through an operation. Instead, your doctor may work to control your cancer to make you more comfortable.

Discuss treatment goals with your doctor. Some people want to do everything they can to treat their cancer, even if that means enduring side effects for a small chance of an improvement. Others prefer treatments that make them comfortable so that they can live their remaining months as symptom-free as possible.

Surgery
Surgeons work to remove mesothelioma in instances where it is diagnosed at an early stage. Sometimes it isn't possible to remove all of the cancer. In those cases, surgery may help to reduce the signs and symptoms caused by mesothelioma spreading in your body. Surgical options may include:

  • Surgery to decrease fluid buildup. Pleural mesothelioma may cause fluid to build up in your chest, causing difficulty breathing. Surgeons insert a tube or catheter into your chest to drain the fluid. Surgeons may also inject medicine into your chest to prevent fluid from returning (pleurodesis).
  • Surgery to remove the tissue around the lung or abdomen. Surgeons may remove the tissue lining the ribs and the lungs (pleurectomy) or the tissue lining the abdominal cavity (peritonectomy) in order to relieve signs and symptoms of mesothelioma.
  • Surgery to remove as much of the cancer as possible (debulking). If all of the cancer can't be removed, surgeons may attempt to remove as much as possible.
  • Surgery to remove a lung and the surrounding tissue. Removing the affected lung and the tissue that surrounds it may relieve signs and symptoms of pleural mesothelioma. This procedure also allows doctors to use higher doses of radiation against any remaining mesothelioma, since they won't need to worry about protecting your lung from damaging radiation.

Chemotherapy
Chemotherapy uses chemicals to kill cancer cells. Systemic chemotherapy travels throughout the body and may shrink or slow the growth of a pleural mesothelioma that can't be removed using surgery. Chemotherapy may also be used before surgery (neoadjuvant chemotherapy) to make an operation easier or after surgery (adjuvant chemotherapy) to reduce the chance that cancer will return.

Chemotherapy drugs may also be heated and administered directly into the abdominal cavity (intraperitoneal chemotherapy), in the case of peritoneal mesothelioma, or into the chest cavity (intrapleural chemotherapy), in the case of pleural mesothelioma. Using this strategy, chemotherapy drugs can reach the mesothelioma directly without injuring healthy cells in other parts of the body. This allows doctors to administer higher doses of chemotherapy drugs.

Intraperitoneal chemotherapy may also be used to reduce the signs and symptoms of peritoneal mesothelioma that can't be removed through surgery.

Radiation therapy
Radiation therapy focuses high-energy beams to a specific spot or spots on your body. Radiation may reduce signs and symptoms in people with pleural mesothelioma. Doctors aim radiation at the entire chest to obtain the best result. However, many sensitive organs are in the chest, such as the heart, lungs, esophagus and spinal cord, so doctors must use low doses of radiation to spare these organs. Radiation therapy is sometimes used after biopsy or surgery to prevent mesothelioma from spreading to the surgical incision.

Radiation therapy is used occasionally in people with peritoneal mesothelioma to reduce signs and symptoms caused by the cancer.

Combination therapy
Surgery, chemotherapy and radiation therapy may be combined. This aggressive therapy can be grueling and may not be appropriate for everyone. Younger, healthier people and those with earlier stage mesothelioma may be more able to endure this treatment. Combination therapy has shown the most promise in treating mesothelioma. However, most people will eventually experience a recurrence of this cancer despite aggressive treatment. Combination therapy has been used in both pleural mesothelioma and peritoneal mesothelioma.

Clinical trials
Clinical trials are studies of new mesothelioma treatment methods. People with mesothelioma may opt for a clinical trial for a chance to try new types of treatment. However, a cure isn't guaranteed. Carefully consider your treatment options and talk to your doctor about what clinical trials are open to you. Your participation in a clinical trial may help doctors better understand how to treat mesothelioma in the future.

Clinical trials are currently investigating a number of targeted drugs. Targeted drug therapy uses drugs to attack specific abnormalities within cancer cells. Targets being studied in mesothelioma include a substance that cancer cells make to attract new blood vessels to bring the cancer oxygen and nutrients. Another target is an enzyme that helps cancer cells develop resistance to chemotherapy drugs. Researchers hope drugs that target these areas can help kill mesothelioma cells.

Treatment for other types of mesothelioma
Pericardial mesothelioma and mesothelioma of the tunica vaginalis are very rare and can be very aggressive. Early-stage cancer may be removed through surgery. Doctors have yet to determine the best way to treat later stage cancers, though. Your doctor may recommend other treatments to improve your quality of life.

Alternative medicine

No alternative medicine treatments have proved helpful in treating mesothelioma. But complementary and alternative mesothelioma treatments may help control signs and symptoms. Discuss options with your doctor.

Mesothelioma can cause pressure within your chest that can make you feel as though you're always short of breath. Breathlessness can be distressing. Your doctor may recommend using an oxygen mask or taking medications to make you more comfortable, but often these aren't enough. Combining your doctor's recommended treatments with complementary and alternative approaches may help you feel better.

Alternative treatments that have shown some promise in helping people cope with breathlessness include:

  • Acupuncture. Acupuncture uses thin needles inserted at precise points into your skin.
  • Breath training. A nurse or physical therapist can teach you breathing techniques to use when you feel breathless. Sometimes you may feel breathless and begin to panic. Implementing these techniques may help you feel more in control of your breathing.
  • Relaxation exercises. Slowly tensing and relaxing different muscle groups may help you feel more at ease and breathe easier. Your doctor may refer you to a therapist who can teach you relaxation exercises so that you can do them on your own.
  • Sitting near a fan. Directing a fan to your face may help ease the sensation of breathlessness.

Coping and support

A diagnosis of mesothelioma can be devastating not only to you, but also to your family and friends. Take time to experience the sadness and despair and to grieve. And remember that you decide how you'll spend your time and with whom you'll spend it.

In order to regain a sense of control, try to:

  • Learn everything you can about mesothelioma. Write down a list of questions to ask your doctor. Ask your health care team for information to help you better understand your disease. Consult the National Cancer Institute (NCI) and the American Cancer Society (ACS). Both organizations have Web sites and toll-free telephone information lines. Call the NCI at 800-4-CANCER (800-422-6237). Call the ACS at 800-ACS-2345 (800-227-2345).
  • Surround yourself with a support network. Close friends or family can help you with everyday tasks, such as getting you to appointments or treatment. If you have trouble asking for help, learn to be honest with yourself and accept help when you need it.
  • Seek out other people with cancer. Ask your health care team about cancer support groups in your community. Sometimes there are questions that can only be answered by other people with cancer. Support groups offer a chance to ask these questions and receive support from people who understand your situation. Online support message boards, such as the ACS's Cancer Survivors Network, can offer similar benefits while allowing you to remain anonymous.
  • Plan for the unknown. Ask your health care team about advance directives that give your family guidance on your medical wishes in case you can no longer speak for yourself. Talk to a lawyer about your will, if you haven't already done so.

Prevention

Reducing your exposure to asbestos may lower your risk of mesothelioma.

Find out whether you work with asbestos
Most people with mesothelioma were exposed to the asbestos fibers at work. Workers who may encounter asbestos fibers include:

  • Miners
  • Factory workers
  • Insulation manufacturers
  • Railroad workers
  • Ship builders
  • Gas mask manufacturers
  • Construction workers
  • Auto mechanics

Ask your employer whether you have a risk of asbestos exposure on the job.

Follow your employer's safety regulations
Follow all safety precautions in your workplace, such as wearing protective equipment. You may also be required to shower and change out of your work clothes before taking a lunch break or going home. Talk to your doctor about other precautions you can take to protect yourself from asbestos exposure.

Be safe around asbestos in your home
Older homes and buildings may contain asbestos. In many cases, it's more dangerous to remove the asbestos than it is to leave it intact. Breaking up asbestos may cause fibers to become airborne, where they can be inhaled. Consult experts trained to detect asbestos in your home. These experts may test the air in your home to determine whether the asbestos is a risk to your health. Don't attempt to remove asbestos from your home — hire a qualified expert. The Environmental Protection Agency offers advice on its Web site for dealing with asbestos in the home.

Tuesday, August 11, 2009

Fisrt action if you see someone having Heart attact


A heart attack occurs when an artery supplying your heart with blood and oxygen becomes blocked. This loss of blood flow injures your heart muscle. A heart attack generally causes chest pain for more than 15 minutes, but it can also be "silent" and have no symptoms at all. 

Many people who suffer a heart attack have warning symptoms hours, days or weeks in advance. The earliest predictor of an attack may be recurrent chest pain that's triggered by exertion and relieved by rest (angina). 

Someone having an attack may experience any or all of the following: 
Uncomfortable pressure, fullness or squeezing pain in the center of the chest. The pain might last several minutes or come and go. It may be triggered by exertion and relieved by rest.
Prolonged pain in the upper abdomen.
Discomfort or pain spreading beyond the chest to the shoulders, neck, jaw, teeth, or one or both arms.
Shortness of breath.
Lightheadedness, dizziness, fainting.
Sweating.
Nausea.

If you or someone else may be having a heart attack: 

Dial 911 or your local emergency medical assistance number. Don't tough out the symptoms of a heart attack for more than five minutes. If you don't have access to emergency medical services, have a neighbor or a friend drive you to the nearest hospital. Police or fire-rescue units also may be a source of transportation. Drive yourself only as a last resort, if there are absolutely no other options, and realize that it places you and others at risk when you drive under these circumstances.

Chew and swallow an aspirin, unless you're allergic to aspirin or have been told by your doctor never to take aspirin. But seek emergency help first, such as calling 911.

Take nitroglycerin, if prescribed. If you think you're having a heart attack and your doctor has previously prescribed nitroglycerin for you, take it as directed. Do not take anyone else's nitroglycerin, because that could put you in more danger.

Begin CPR. If you're with a person who might be having a heart attack and he or she is unconscious, tell the 911 dispatcher or another emergency medical specialist. You may be advised to begin cardiopulmonary resuscitation (CPR). If you haven't received CPR training, doctors recommend skipping mouth-to-mouth rescue breathing and proceeding directly to chest compression. The dispatcher can instruct you in the proper procedures until help arrives.

Monday, August 10, 2009

Anti-Aging Cosmeceuticals

Introduction


Cosmeceuticals represent a marriage between cosmetics and pharmaceuticals. Like cosmetics, cosmeceuticals are topically applied, but they contain ingredients that influence the biological function of the skin. Cosmeceuticals improve appearance, but they do so by delivering nutrients necessary for healthy skin. Cosmeceuticals are the fastest-growing segment of the natural personal care industry. Consumers are always interested in maintaining a youthful appearance, and as the global population's median age increases, this market is increasingly expanding.

Cosmeceuticals are not subject to review by the Food and Drug Administration (FDA), and the term cosmeceutical is not recognized by the Federal Food, Drug, and Cosmetic Act. Although cosmetics and cosmeceuticals are tested for safety, testing to determine whether beneficial ingredients actually live up to a manufacturer's claims is not mandatory. In general, vitamins, herbs, various oils, and botanical extracts may be used in cosmeceuticals, but the manufacturer may not claim that these products penetrate beyond the skin's surface layers or that they have druglike or therapeutic effects. For cosmetic labels, no division between active ingredients and other ingredients is required; they are all listed together.

The most important botanicals pertaining to dermatologic uses, such as cosmeceuticals, include teas, soy, pomegranate, date, grape seed, Pycnogenol, horse chestnut, German chamomile, curcumin, comfrey, allantoin, and aloe; only green and black tea, soy, pomegranate, and date have been studied to the extent that clinical trials for the treatment of parameters of extrinsic aging have been published.1 Few botanical-based cosmeceuticals have uses that are supported by evidence-based science.

Chemoprevention by oral or topical use of dietary or pharmacologic agents to inhibit or reverse the development of cancer is a possibility.2 Potential cosmeceutical agents in this category include green tea, grape seed extract, vitamin E, and beta-carotene.


Moisturizers

The cutaneous permeability barrier is localized in the stratum corneum interstices, and it is mediated by the lamellar bilayers enriched in cholesterol, free fatty acids, and ceramides. Formulations containing skin-identical lipids have been suggested to facilitate a cascade of physiologic events in keratinocytes, normalizing damaged skin. When applied to the skin for an extended period, water can cause the excretion of cytokines. These proinflammatory molecules induce edema, vasodilation, and frank inflammation; therefore, water alone may alter both the structure and the function of the skin under some conditions. By the same token, moisturizers that make the stratum corneum softer and more pliant by increasing its hydration could be considered cosmeceuticals.

A multilamellar vesicular emulsion ceramide – containing liquid cleanser and moisturizing cream plus fluocinonide cream 0.05% was found to reduce eczema duration, clearance time, and symptoms compared with a bar cleanser plus fluocinonide cream 0.05% in the treatment of mild-to-moderate eczema.3

Retinoids


Retinoids are possibly the most prevalent cosmeceuticals in the market. Retinoids are vitamin A derivatives present in all living organisms either as preformed vitamin A or as carotenoids. Vitamin A (retinol) is the prototype of all other retinoids and is necessary for proper growth, bone development, and integrity of mucosal and epithelial surfaces. In vitamin A deficiency, the eyes and the skin are severely affected. The conjunctiva and the cornea develop metaplasia and keratinization, leading to night blindness. The skin develops follicular hyperkeratosis or phrynoderma. The hyperkeratotic follicular papules are usually clustered around bony prominences, such as the elbows and the knees, but in severe deficiency, the papules can be found throughout the entire skin surface.

Early civilizations recognized the benefits of vitamin A in treating and healing night blindness with diets rich in liver. In the 1930s, the clinical manifestations of vitamin A deficiency were recognized, and the idea to use vitamin A in the treatment of skin diseases was initiated. The advent of synthetic analogs of vitamin A in the 1970s brought new interest into their biological activity, especially on the skin. Since then, vitamin A and its derivatives have been useful in the treatment of many skin disorders, including ichthyosis, acne, and psoriasis. A great amount of research has concentrated on its use as an antiaging compound as well as its use for other cutaneous disorders; therefore, today, vitamin A is recognized as comprising a magnitude of biological effects far beyond those on the cornea.

Vitamin A and its derivatives have 2 main functions: they act as antioxidants, and they activate specific genes and proteins. As antioxidants, they protect cells from oxidative damage by 3 different mechanisms: (1) scavenging peroxyl radicals, (2) quenching singlet oxygen, and (3) triplet-state sensitizers. Vitamin A also exerts a hormonelike effect on the skin, activating specific genes through nuclear receptors. The receptors bind to target sequences called hormone response elements on DNA and activate gene transcription. Retinoic acid receptors (RARs) bind all-trans retinoic acid, and retinoic X receptors (RXRs) bind 9-cis retinoic acid. Vitamin A and its derivatives inhibit lipid peroxidation; increase levels of alpha-tocopherol (vitamin E); and activate growth factors, oncogenes, keratins, and transglutaminases.

Histologically, vitamin A and its derivatives induce epidermal thickening, increase mitoses, differentiate keratinocytes, and reduce the number of sebocytes. The dermis shows increased amounts of glycosaminoglycans (GAGs) and anchoring fibrils. Structural changes underlying the cosmetic benefits include correction of epidermal atrophy, deposition of new collagen, generation of new vessels, and enhancement of mitogenesis. This enhanced mitogenesis promotes the shedding of melanin-laden keratinocytes, resulting in bleaching and subsequent depigmentation. The ability of topical tretinoin to improve the appearance of aged and photo-damaged skin by reducing wrinkles, decreasing laxity, bleaching hyperpigmented spots, and bringing about a smoother surface have been well studied and documented. Further remedial qualities of retinoids remain to be elucidated.

Importantly, the effectiveness of the non – FDA-approved cosmetic retinoids has been studied. Clinical and histological evidence suggests structural changes induced by excessive sun exposure can be partially reversed by the use of topical retinoids, such as retinaldehyde. They have been used for the treatment of photoaged skin with demonstrated beneficial clinical and histological effects.4 Because clinical correlates of these in vitro findings are not entirely convincing, with most studies being poorly constructed, the utility of these preparations for their stated uses is regarded by many authorities as marginal at best.


Hydroxy Acids


Hydroxy acids are likely the second most available cosmeceutical, and in low concentrations, they are found in mass-marketed cosmetic formulation. Hydroxy acids are organic carboxylic acids classified into alpha hydroxy acids (AHAs) and beta hydroxy acids (BHAs) according to their molecular structure.

AHAs range from simple aliphatic compounds to complex molecules. Many are derived from natural sources and are often referred to as fruit acids. The different AHAs include the following: glycolic acid, lactic acid, citric acid, mandelic acid, malic acid, and tartaric acid.

AHAs have been shown to decrease the signs of aging. The skin appears smoother and more uniform. The likely cause of these changes is the property of AHAs to enhance epidermal shedding. Some claim that AHAs increase the synthesis of GAGs, improve the quality of elastic fibers, and increase the density of collagen. Scientific evidence to support such claims is still incomplete and controversial.

BHAs are aromatic compounds. Salicylic acid is the reference BHA; it has dermolytic properties and helps in various xerotic and ichthyotic disorders. Other BHAs include 2-hydroxy-5-octanoyl benzoic acid, also known as beta-lipohydroxyacid (B-LHA), and tropic acid.

Despite their popularity, the exact mechanisms of action of hydroxy acids remain unknown and are largely controversial; however, at least one aspect of its biological activities may be attributed to the inherent acid strength of the compounds. Studies show that AHAs may increase sensitivity to UV radiation and that sunscreen application may be advisable when these products are used.

Antioxidants


The skin is frequently exposed to a constant assault of endogenous and exogenous damaging agents. Agents such as UV radiation, drugs, air pollutants, and heat and/or cold are continually challenging the protective character of the skin. In addition to these external insults, the skin also has to cope with endogenous mitogens, most importantly reactive oxygen species (ROS) and other free radicals. These species are continuously produced during physiological cellular metabolism. To counteract the harmful effects of ROS, the skin is equipped with an antioxidant system to maintain equilibrium between the pro-oxidants, or damaging agents, and the antioxidants, or protective agents; these antioxidants intervene at different levels in the protective process.

Vitamin C

Vitamin C (L-ascorbic acid) is essential for life. Since its discovery in the 1930s, much work has been undertaken to elucidate its mechanisms of action. The roles of vitamin C are numerous. Vitamin C is necessary for the hydroxylation of procollagen, proline, and lysine. Deficiency results in purpura, keratotic follicles, and bleeding gums. Vitamin C is a water-soluble antioxidant that clenches free radicals and regenerates vitamin E. It is an important regulator of collagen expression stimulating its synthesis. Studies have shown that vitamin C levels on the skin are severely depleted after UV irradiation and that, histologically, vitamin C improves and normalizes the changes caused by photodamage. Thus far, however, studies on vitamin C have been few, and information about its effect in vivo is lacking.

Vitamin C has been used effectively to stimulate collagen repair, thus diminishing some of the effects of photoaging on skin. However, vitamin C is easily degraded by heat and light, which along with its high acidity, presents certain challenges for use in a multipurpose skin care formulation. A recently introduced synthetic collagen fraction offers greater stability and compatibility, along with improved efficacy.

Vitamin E

Vitamin E (alpha-tocopherol) is the major lipophilic antioxidant in plasma, membranes, and tissues. The term vitamin E collectively refers to 8 naturally occurring molecules (4 tocopherols and 4 tocotrienols), all of which exhibit vitamin E activity. Its major role is generally considered to be the arrest of chain propagation in lipid peroxidation by scavenging lipid peroxyl radicals, hence protecting the cell membrane from destruction. Vitamin E topically applied before UV irradiation has been shown to reduce erythema, edema, sunburn cells, immunosuppression caused by sunlight, and DNA adduct formation.

Panthenol

Panthenol, the alcohol analog of vitamin B-5, is a water-soluble humectant commonly found in various commercial skin creams, lipsticks, lotions, and hair preparations. It is stable in the presence of oxygen and light but unstable in the presence of acids, bases, and high temperatures. Panthenol is converted in the skin to pantothenic acid, which is an important component on coenzyme A essential for normal cellular metabolism.

Lipoic acid

Lipoic acid is a unique free radical protector. It is fat and water soluble. Once lipoic acid crosses the cell membrane, it is broken down into dihydrofolic acid, which is also an antioxidant. Alpha lipoic acid also recycles other key antioxidants, such as vitamin C, vitamin E, and glutathione.

Ubiquinone

Ubiquinone, also known as coenzyme Q, is a lipid-soluble quinone derivative that is present in the mitochondria and is used to generate adenosine triphosphate (ATP), enhancing energy. It has been shown to decrease peroxidation of the low-density lipoproteins better than vitamin E.

Niacinamide

Niacinamide (nicotinamide) is a basic amide that is a member of the vitamin B complex. It is used in the prophylaxis and treatment of pellagra. Niacinamide does not induce the peripheral flush that accompanies therapy with nicotinic acid. It is one of the newest vitamins in the marketplace. In vitro studies have shown anti–tumor activity on keratinocytes and suppression of UV-B photocarcinogenesis. The main reason for its surge in popularity is its stability. Niacinamide is stable in the presence of oxygen, acid, and high temperatures, and it is inexpensive to formulate. Most of its known effects are the result of increased epidermal turnover and exfoliation. Topical kinetin and niacinamide have been found to exert a synergistic antiaging cutaneous effect in people in the Republic of China.5

Dimethylaminoethanol

Topical preparations containing dimethylaminoethanol (DMAE) have been touted for their ability to improve skin firmness and to lift sagging skin. DMAE has been used as a dietary supplement and is associated with improving mental function and enhancing physical performance due in part to its ability to increase the neurotransmitter responsible for stimulating muscles. DMAE is able to diminish the cross-linking of proteins that occurs during aging, probably acting as a free-radical scavenger. It also increases the activity of these enzymes in a dose-dependent manner only in the particulate fractions glucose-6-phosphate dehydrogenase and 6-phosphogluconate dehydrogenase.

Spin traps

Free radical spin traps are species that react with reactive free radicals to produce fairly stable, unreactive free radicals, thus blocking the free radicals from damaging cellular components.

  • DMPO (5,5-dimethyl-1-pyrroline-N -oxide)
  • DEPMPO (5-diethoxyphosphoryl-5-methyl-1-pyrroline-N-oxide)
  • TEMPONE-H (1-hydroxy-2,2,6,6-tetramethyl-4-oxo-piperidine)

Melatonin

Melatonin, a hormone secreted by the pineal gland, is known to have antimutagenic and oncostatic actions. This beneficial action of melatonin has been explained in terms of its ability to scavenge free radicals and to augment the activities of antioxidant enzymes. It has been shown to suppress UV radiation–induced erythema.

Catalase

Catalase, an enzyme present in almost all cells of the human body, catalyzes the decomposition of hydrogen peroxide to water and oxygen. High amounts of this enzyme in the skin can impart antioxidative activity.

Glutathione

Glutathione is a tripeptide of glutamic acid, cysteine, and glycine. It is found in all active animal tissue. It is fundamental as an antioxidant, and significantly decreased amounts of glutathione are found after UV exposures.

Superoxide dismutase

Superoxide dismutase (SOD) is an enzyme that destroys superoxide (a highly ROS). SOD is a large molecule and has difficulty penetrating deep into the skin. In theory, once in the lower epidermis and dermis, SOD should decrease UV erythema and damage and act as an excellent antioxidant.

Peroxidase

Kulkarni and colleagues have developed a water-soluble fennel extract with measurable peroxidase activity. In vitro studies have shown far better consumption of oxygen than tocopherol, and they have also shown antibacterial activity.

Glucopyranosides

Resveratrol and polydatins are glucopyranosides found in many fruits and vegetables, the highest concentrations being found in grape skins, which synthesize these compounds in response to exposure to UV-A and UV-B and fungal pathogens. Biologic activities of these glucopyranosides include potent free radical scavenging activity, with cardioprotection and neuroprotection and inhibition of lipid peroxidation similar to that seen with vitamins C and E.

Polyphenols

Polyphenolic compounds (eg, catechins, flavonols, thioflavins, thearubigins), also known as epicatechins, are antioxidant in nature. These compounds, tested against human keratinocyte cells stressed by UV-B irradiation, showed high antioxidative properties. Many laboratories have shown that topical treatment or oral consumption of polyphenols inhibits chemical- or UV radiation–induced skin tumorigenesis in different animal models. It possesses anti-inflammatory activity. One of the major and most chemopreventive constituents responsible for the biochemical or pharmacologic effects is -epigallocatechin-3-gallate (EGCG) found in green tea. Genistein, the isoflavone found in soybeans, and Pycnogenol, an extract of the bark of French maritime pine (Pinus pinaster), has been shown to significantly prolong tumor latency and to decrease tumor multiplicity with a potent ability to scavenge free radicals.

Cysteine

Several recent studies have shown that cysteine derivatives can protect against the negative effects of UV exposure. In particular, N- acetylcysteine (NAC) is shown to be an effective protector against UV-B–induced immunosuppression, to modulate the expression of some oncogenes and tumor suppressor genes, and to increase the amounts of intracellular glutathione. Glutathione is known to be critical in protecting the body's cells against oxidative stress; however, taking glutathione itself does not raise the levels of glutathione in the blood as effectively as taking its precursor NAC. Current research has NAC in the center for measures to combat the aging process.

Allantoin

Allantoin promotes cell proliferation, aiding in the healing process. Allantoin has long been known to enhance the effectiveness and desirability of cosmetic creams and lotions by its action as a skin protectant. Allantoin has been incorporated into shampoos, lipsticks, shaving creams, suntanning products, bath foams, hair gels, baby powders, and various aerosol preparations. It has also been used in topical pharmaceutical markets. Most recently, allantoin has been used in various dental preparations, such as toothpaste and mouthwash. Allantoin has been called a cell proliferant, an epithelization stimulant, and a chemical debrider. It is said to clean away necrotic tissue, hastening the growth of new healthy tissue.

Furfuryladenine

Furfuryladenine (Kinerase) is a natural plant growth factor that retards the aging process in plants. Cut leaves dipped in a solution that contains furfuryladenine remain green, while untreated leaves turn brown. It is marketed as the natural evolution of antiaging treatment with similar effects in vitro on human skin cells as that in plants, helping to slow and reverse alterations that naturally occur in the cell-aging process.

Uric acid

In the past, uric acid was generally looked upon as merely an end product of purine metabolism. More recently, uric acid has become increasingly recognized as an important biological antioxidant. Scientific studies have demonstrated that uric acid is a potent physiological antioxidant, playing a major role in both extracellular defense mechanisms and intracellular defense mechanisms. Although the precise biochemical mechanism is not completely determined, uric acid appears to have a sparing action in plasma ascorbate, probably by complexing transition metals, such as iron and copper.

Carnosine

Carnosine (beta-alanyl-L-histidine) is a physiological dipeptide that can rejuvenate senescent cultured human fibroblasts. Carnosine has been shown to contain antioxidant, free radical- and metal ion–scavenging activities.


Depigmenting Agents


Hyperpigmentation, the most common and distressing condition afflicting a large subset of the population, requires dermatologists to familiarize themselves with cosmeceutical skin-lightening agents and corrective camouflage formulations.6 Combination agents with sunscreen are often the most effective treatment available.

Hyperpigmentation is the result of an increased amount of melanin in the epidermis, the dermis, or both. This pigmentary change can be divided into 2 pathophysiologic processes: melanocytosis (increased number of melanocytes) and melanosis (increased amount of melanin). Depigmenting agents work best when melanosis or melanocytosis is restricted to the epidermis. Other methods of depigmentation being used are chemical peels.

Patients with Fitzpatrick skin types I-III benefit from local pigment lightening for the treatment of hormonally induced melasma and postinflammatory hyperpigmentation caused by acne and trauma, whereas those with Fitzpatrick skin types IV and darker may also seek therapy for pigmentary changes that occur around the eyes, in the intertriginous areas, following dermatitis, or with acne and trauma.7 The criterion standard dermatologic agent for skin lightening had been hydroquinone, until its safety was questioned, which has encouraged use of alternative agents such as retinoids, mequinol, azelaic acid, arbutin, kojic acid, aleosin, licorice extract, ascorbic acid, soy proteins, and N -acetyl glucosamine.

Depigmenting agents can be divided into several groups:

Phenolic compounds include the following:

  • Hydroquinone
  • Monobenzylether of hydroquinone
  • 4-Methoxyphenol
  • 4-Isopropylcatechol
  • 4-Hydroxyanisol
  • N -acetyl-4-S-cysteaminylphenol

Nonphenolic compounds include the following:

  • Corticosteroids
  • Tretinoin
  • Azelaic acid
  • N -acetylcystein
  • L-ascorbyl-2-phosphate
  • Kojic acid

Combination formulas include the following:

  • Kligman's formula
  • Pathak's formula
  • Westerhof's formula

N- acetyl-4-S- cysteanimylphenol

A phenolic thioether, N- acetyl-4-S- cysteaminylphenol is a new type of depigmenting agent. It claims to be more stable and less irritating to the skin than HQ and is specific to melanin-synthesizing cells. A monophenol compound tert-butyl-4-hydroxyanisole (mequinol) has been studied in the treatment of solar lentigines and related hyperpigmented lesions. The topical combination product containing 2% 4-hydroxyanisole/0.01% tretinoin solution (Solage) is well tolerated and superior to either active component.

Vitamin C

Vitamin C (L-ascorbic acid) and its derivatives are believed to act as reducing agents on melanin intermediates. They block the oxidative chain reaction from tyrosine/dihydroxyphenylalanine (DOPA) to melanin at various points.

Kojic acid

Kojic acid (5-hydroxy-2-[hydroxymethyl]-4-pyrone), a fungal metabolic product, has been increasingly used as a skin-depigmenting agent in skin care products marketed in Japan since 1988. Several studies have shown Kojic acid to inhibit tyrosinase activity; this finding has been attributed to its ability to chelate the copper required by tyrosinase.

Arbutin

Arbutin, or hydroquinone-beta-D-glucopyranoside, consists of HQ bound to glucose; arbutin is a naturally occurring beta-D-glucopyranoside derivative of HQ. Arbutin can inhibit melanogenesis by affecting the activity of tyrosinase rather than by killing melanocytes and decreasing the synthesis of melanin. Arbutin executes its activity by mimicking the amino acid tyrosine, the usual substrate of tyrosinase.

Azaleic acid

Azaleic acid (AZA) is a dicarboxylic acid originally isolated from Plasmodium ovale. It has been reported to have depigmenting effects, while showing no significant activity on normal skin. AZA is believed to selectively inhibit tyrosinase in hyperactive melanocytes.

Paper-mulberry compound

The compound 5-(3-2,4-[dihydroxyphenyl]propyl)-3,4-bis (3-methyl-2-butenyl)-1,2-benzenediol from paper-mulberry root bark has been shown to inhibit mushroom tyrosinase, to scavenge free radicals, and to depigment UV-induced hyperpigmentation in guinea pigs. Studies in humans show no irritation or sensitization.

Chemical peeling agents

Chemical peeling has become an established technique in treating cutaneous hyperpigmentation. Chemical peeling agents include glycolic acid, resorcinol, and salicylic acid.

Chemical compounds

Kligman's formula consists of 5% hydroquinone (HQ), 0.1% tretinoin, and 0.1% dexamethasone in hydrophilic ointment.

Pathak's formula consists of 2% HQ and 0.05-0.1% tretinoin.

Westerhof's formula consists of 4.7% N -acetylcysteine (NAC), 2% HQ, and 0.1% triamcinolonacetonide.


Other Cosmeceuticals


Botanicals

Because of the awareness of the environmental damage caused by industrialization, a trend has developed to use products with natural ingredients. No other ingredient can serve this purpose as well as botanicals. Botanicals are now part of every product in the market from cosmetics to soft drinks. Avocado, banana, lemon, and other similar botanicals are listed on thousands of labels. They exert their purported effects through the mechanisms of antioxidants, AHAs, BHAs, and other unclear properties.

Some examples of botanicals include chamomile, which inhibits the release of histamine and has anti-inflammatory properties, and ginseng, which stimulates the biosynthesis of proteins, RNA, and lipids. Ginkgo biloba extract was found to locally induce SOD and to catalase enzyme activity in the epidermis after topical application as well as to systemically increase the activity of both enzymes in the liver, the heart, and kidneys. Curcumin found in curry has anti-inflammatory activity by inhibiting leukotriene formation, inhibiting platelet aggregation, and stabilizing neutrophilic lysosomal membranes. Glycyrrhizin found in licorice roots inhibits proinflammatory activities of prostaglandins and leukotrienes. Capsaicin inhibits substance P, a peptide transmitter of the inflammatory process. Aloe vera has been shown to accelerate wound healing and to protect and soothe the skin.

Glycosaminoglycans

Hyaluronic acid (HA), or hyaluronan, is the prototype of all other GAGs. Studies have demonstrated that decreased amounts are present in aged skin and that topically applied HA accelerates wound repair. Other studies have noted epidermal regeneration after the application of low molecular weight HA.

Anticellulites

Lipolysis is mediated, in part, by beta-adrenergic receptors, which induces fat breakdown, and alpha2-adrenergic receptors, which inhibits fat breakdown. Agents that bind to these receptors may hypothetically serve a therapeutic effect on cellulite. Beta-adrenergic stimulators include theobromine, theophylline, aminophylline, caffeine, isopropylarterenol hydrochloride, and epinephrine. Alpha2-adrenergic inhibitors include yohimbine, piperoxan, phentolamine, and dihydroergotamine.

Enzymes

Papain

Papain, an enzyme found in the papaya fruit, chemically digests intercellular bonds. Papain has been studied in the treatment of hypertrophic scars, and it can be used to exfoliate keratotic skin.

Deoxyribonucleic acid (DNA) repair enzymes

UV-B radiation–induced cyclobutane pyrimidine dimers in the DNA of epidermal cells are detrimental to human health by causing mutations and immunosuppressive effects that contribute to photocarcinogenesis. Lotions containing bacteria-derived DNA repair enzymes, and photolyase-containing liposomes have been shown to reduce the incidence of cancerous and precancerous lesions. When the bacterial DNA repair enzyme T4 endonuclease V is intracellularly delivered, it increases the rate of repair of sunlight-induced DNA damage in human cells.

Yarosh et al8 showed that the topical application of a DNA repair enzyme to sun-damaged skin lowered the rate of development of actinic keratoses and basal cell epitheliomas during 1 year of treatment. Topical application of photolyase-containing liposomes to UV-B–irradiated skin and subsequent exposure to photoreactivating light decreased the number of UV-B radiation–induced dimers by 40-45%. Photolyase-induced dimer repair completely prevented UV-B radiation–induced immunosuppressive effects as well as erythema and sunburn-cell formation. These studies demonstrate that the topical application of bacterial DNA repair enzymes might be effective in dimer reversal, leading to immunoprotection and a decrease in photocarcinogenesis.

Growth factors

Epidermal growth factor

Epidermal growth factor (EGF) is found in plasma, sweat, urine, saliva, and semen. When EDG is bound to the epidermal growth factor receptor (EGFR), it stimulates epidermal growth and differentiation. It has been used in the treatment of burns and excision wounds, where it accelerates re-epithelization.

Transforming growth factor

Transforming growth factor (TGF) stimulates normal skin growth and cellular growth and repair. TGF exerts positive regulatory effects on the accumulation of the body's extracellular matrix proteins. TGF is also a mediator of fibrosis (repair tissue formation) and angiogenesis (development of new blood cells), and it promotes the healing of wounds.

Hormones

Hormonal creams claim to be the most effective means to stop or slow the aging process by reversing the loss in tone and elasticity of the skin. Confirmatory evidence of this claim is yet to be published.

Estrogens

Some studies have shown antiaging effects of estrogens. One investigation found that after 6 months of applying 0.01% estradiol and 0.3% estriol compounds, the elasticity, firmness, wrinkle depth, and pore sizes of the skin were markedly improved. On immunohistochemical analysis, significant increases of type III collagen labeling were combined with increased numbers of collagen fibers at the end of the treatment period. Also, no systemic adverse effects were noted. However, better studies are needed before these agents are routinely used for their antiaging effects.

Progesterone

Progesterone creams are being marketed as formulations that reverse the chemical changes that occur in collagen with aging and that normalize the immune system. Some manufacturers' claims also state that progesterone cream heals skin conditions, such as acne, psoriasis, rosacea, seborrhea, and keratoses. Other manufacturers claim that progesterone creams are a topical supplement for women who experience symptoms relating to premenstrual syndrome (PMS), menopause, or osteoporosis. None of these claims is supported by well-designed studies.

Testosterone

Topical application is quickly becoming the preferred method of testosterone administration. Theoretically, when topically applied, testosterone bypasses the stomach and the liver and does not cause an undesirable rise in estrogen. Manufacturers claim that testosterone creams have many benefits, such as memory enhancement, antidepressant effects, increased resistance to stress, and the ability to treat disorders associated with hypogonadism (eg, increased storage of fat, shrinkage of muscle mass). Recent studies have shown that testosterone gel applied to the skin once daily restored blood levels of the hormone in men with hypogonadism.

Growth hormone

Growth hormone (GH) and its mediator insulinlike growth factor-1 (IGF-1) are responsible for many effects on growth, development, immunity, and metabolism. Produced and secreted by the anterior pituitary gland in the brain, GH is released in pulses in response to signals from the hypothalamus. GH exerts anabolic effects throughout the body, favoring the growth of tissues, bones, and muscles. Studies have shown that the aging population has lowering levels of GH in the body, with resultant decreased lean body mass, fat deposits, immunity, and overall energy.

Botulinum A exotoxin

Botulinum A exotoxin is a neurotoxin produced by the bacterium Clostridium botulinum. This toxin is now being used by cosmetically oriented specialists for the treatment of a large variety of movement-associated wrinkles on the face and neck. As a simple and effective nonsurgical procedure, the injection of botulinum toxin A seems to be an effective method of eliminating crow's feet and wrinkle lines that are on the upper third of the face and producing temporary browlift. This form of temporary chemical denervation compliments the cosmetic practitioner's armamentarium. In addition, the use of botulinum toxin to block sympathetic innervation of eccrine sweat glands is proving to be valuable in treating hyperhidrosis of the axillae, palms, and soles.

Peptides

Microcollagen pentapeptides

Fibroblasts in aged tissue produce less collagen than those in younger skin, but their capability to produce collagen is still present. Fibroblast collagen production has been reported to be stimulated by a pentapeptide fragment of the collagen molecule.

At the carboxyl-terminal end of the collagen molecule is a fragment that has been identified as a participant in the regulation of its own synthesis. Lys-Thr-Thr-Lys-Ser pentapeptide is a potent stimulator of collagen and fibronectin synthesis, which are­ both important components of the interstitial matrix.

Copper peptides

The copper-dependent lysyl oxidase (LO) plays a critical role in the biogenesis of connective tissue matrices by cross-linking the extracellular matrix proteins collagen and elastin. Levels of LO increase in many fibrotic diseases, while expression of the enzyme is decreased in certain diseases involving impaired copper metabolism.

Within the past decade, the gene encoding LO has been cloned, facilitating investigations of the regulation of expression of the enzyme in response to diverse stimuli and in numerous disease states. Transforming growth factor-beta, platelet-derived growth factor, angiotensin II, retinoic acid, fibroblast growth factor, altered serum conditions, and shear stress are among the effectors or conditions that regulate LO expression. Since the production of both collagen and elastin is reduced in aging skin and in skin exposed to ultraviolet light, copper peptides may be able to help produce new collagen and hence repair aged skin.

Antimicrobial agents

The use of antimicrobial agents in cosmetics and related toiletries has been rampant in recent years. It is increasingly found in baby oils, creams, and lotions to help prevent and control impetigo and milia; in deodorants, to inhibit microbial decomposition of perspiration; and in various scalp preparations, to inhibit microorganisms that are associated with seborrheic dermatitis.

Triclosan

This is the latest rage in the arsenal of antibacterial chemicals, included in detergents, dishwashing fluids, soaps, deodorants, cosmetics, lotions, creams, and even toothpaste. Triclosan (2, 4, 4'-trichloro-2'-hydroxydiphenyl ether) is a broad-spectrum antimicrobial agent, routinely used in various personal care products. It is also incorporated into polymers through melt-mixing, with the aim of providing persistent antibacterial action on the surface of the polymer.

Chlorhexidine

Chlorhexidine is effective against a wide range of gram-negative and gram-positive vegetative bacteria, yeasts, dermatophyte fungi, and lipophilic viruses. It is inactive against bacterial spores except at elevated temperatures.

Povidone iodine

This compound is soluble in water, forming a golden brown solution. Like iodine, the solution of the iodine complex is bactericidal and fungicidal. However, unlike solutions of iodine, it is does not stain. The antiseptic action of povidone-iodine solutions is due to the available iodine present in the complex.

PCMX (para-chloro-meta-xylenol)

PCMX is effective against both gram-positive and gram-negative bacteria and fungal and yeast microorganisms. PCMX has been tested as safe for use in long-term wound care and is more effective on a broader range of microorganisms than the other antiseptics.

Hydrogen peroxide

In solution, hydrogen peroxide provides mechanical cleansing and some debridement of wounds by its effervescent action; however, it can cause ulceration of newly formed tissue and can create granulomas. It is toxic to fibroblasts and, therefore, should never be used as an aftercare solution for wounds.

Antidandruff preparations

Most preparations for the treatment of dandruff largely depend on antimicrobial agents for their therapeutic effect. One leading antidandruff lotion is a combination of benzethonium chloride and N- trichloroethyl mercapto-4-cyclohexene-1,2-dicarboximide. Biphenamine hydrochloride provides an excellent bacteriostatic antifungal property and local anesthetic action.

Zinc pyrithione

Zinc-2-pyridine-thiol-1-oxide is one of the most widely used antimicrobial agents, while lauryl isoquinolinium bromide and bislauryltrimethylammonium polythionate are 2 other popular agents. In addition to their antiseborrheic properties, 2,2'-thiobis-4-chlorophenol and diiodohydroxyquin also exhibit antiseptic qualities.

Deodorants

Antimicrobial substances, such as hexachlorophene, aluminum phenolsulfonate, and zinc peroxide, as well as various quaternaries, such as cetyltrimethylammonium bromide, alkyldimethylbenzylammonium chloride, and diisobutylphenoxyethyldimethylbenzylammonium chloride, have been used in antiperspirant and deodorant formulations.

Tyrothricin and neomycin have also been used in deodorant formulations. Studies have shown that neomycin alone or in combination with aluminum chlorhydroxide produces effective odor suppression, along with a significant increase in gram-negative organisms. Its effectiveness as a deodorant is essentially attributed to its exceptional suppression of gram-positive organisms.

Trichlorocarbanilide is a high-duty, wide-spectrum bacteriostatic agent also used in deodorants. It has lasting safe and stable bactericidal effect. It also has high effects on inhibiting and killing gram-positive, gram-negative bacteria, fungus, saccharomycetes, and virus.

Other antimicrobial preparations

Several diverse chemical substances are used in the therapy for various fungal infections, including fatty acids and their derivatives (eg, zinc, calcium, alkanolamine undecylenates), phenolics (4-halothymols), halogenated quinolines (iodochlorhydroxyquin), quaternary ammonium salts (hexadecamethylenebis-isoquinolinium chloride), and sulfur and sulfur compounds (zinc ethylene bis -dithiocarbamate). Phenol and polyphenol derivatives that are used in cosmetic formulations include hexylresorcinol, p- chloro-m- xylenol, o- phenylphenol, and chlorothymol. Quaternary ammonium compounds that are used in cosmetic formulations include benzalkonium chloride, benzethonium chloride, cetylpyridinium chloride, and cetyltrimethylammonium bromide.

Topical anesthetics and antipruritics

Specific local anesthetic agents are often found in a variety of topical drugs and toiletry products, such as hand and scalp lotions, foot preparations, and aftershave products, to relieve local discomfort and to reduce pruritus. The anesthetic agents are also found in formulations designed to be useful in diaper dermatitis, sunburn, and acne vulgaris.

Ethyl aminobenzoate

Ethyl aminobenzoate (benzocaine) perhaps has been one of the most widely used local anesthetics; however, the increasing incidence of sensitization has prompted the introduction of noncaine anesthetics.

Benzyl alcohol

In creams, lotions, and ointments, benzyl alcohol at a 2% level provides effective local anesthetic effects and preservative qualities.

Diperodon hydrochloride

Diperodon hydrochloride and monohydrate are piperidine compounds in the class of N- substituted aminobenzenes. At approximately a 1% level, they provide local anesthetic effects and antipruritic actions.

Pramoxine hydrochloride

Pramoxine hydrochloride, which is reportedly more potent than cocaine, is used in topical preparations at concentrations of about 1%; however, the monohydrate salt is often preferred in some applications because it is not alkali sensitive, it is more soluble with various solvents, and it may avoid certain color changes or darkening in products that contain hydrochloride-sensitive components. Specific local anesthetic agents, such as benzocaine, pramoxine, and diperodon, exert their effects on mucous membranes and abraded, broken, or irritated cutaneous membranes. They are not effective on unbroken skin.

Menthol

Menthol and related cooling compounds are widely used in products that range from common cold medications to toothpastes, confectionery, cosmetics, and pesticides. Menthol affects the nerve endings to provide a cooling antipruritic action.

Capsaicin

Topical application of capsaicin is thought to deplete substance P from local sensory nerve terminals. In experiments on human skin, inflammation was induced by injection of substance P (SP) or histamine intradermally, UV irradiation, nonimmunologic contact urticaria, tuberculin reaction, contact allergens, and benzalkonium chloride with or without capsaicin pretreatment. The flare response to SP and histamine was suppressed by capsaicin pretreatment, whereas the wheal was enlarged. Interestingly, capsaicin pretreatment enhanced the responses to all other inflammatory agents.

Varicose vein sclerosing agents

Sclerosing agents can be subdivided in different groups depending on their mechanism of action.

Cleaning solutions

These types of sclerosants provoke damage of the endothelium by attacking the lipids of the membrane, thereby causing cell damage and inflammation. Sclerosing agents belonging to this group include polidodecanol (Aethoxysclerol), the sodium tetradecyl sulfate (Sotradecol), sodium morrhuate, and ethanolamine oleate (Ethamolin). Aethoxysclerol is a local anesthetic and is therefore painless and probably the most effective.

Osmotic solutions

These solutions work by dehydrating the endothelial cell by osmosis, until their destruction. Substances that belong to this group include hypertonic saline and Sclerodex (10% NaCl, 25% dextrose, 1% phenethyl alcohol).

Hair removal agents

Depilatory agents

The standard chemical depilatory agents, available in gels, creams, lotions, aerosols, or roll-on forms, are the salts of thioglycolic acid (sodium thioglycolate or calcium thioglycolate) that were patented in the 1930s for dehairing cattle hides. Thioglycolate depilatories work by hydrolyzing and disrupting disulfide bonds of hair keratin, causing the hair to break in half and allowing the hair to separate from the skin.

Hair loss treatments

Pinacidil, P-1075, cromakalim, and nicorandil

The opening of intracellular potassium channels is a common mechanism of action for a set of antihypertensive drugs that includes the hair-growth-inducing agent minoxidil. Recent work suggests potassium channel openers (PCOs) also influence hair growth. Correlative studies demonstrate that a series of PCOs, including pinacidil, P-1075 (an active pinacidil analog), cromakalim, and nicorandil, maintain hair growth in cultured follicles.

Cysteine and arginine

High sulfur proteins are cysteine-rich proteins synthesized during the differentiation of hair matrix cells, and they form hair fibers in association with hair keratin intermediate filaments. Trichohyalin (THH) is a major structural protein of the inner root sheath cells and medulla layer of the hair follicle and, to a lesser extent, of other specialized epithelia made from the conversion of arginine to citrulline.

Saw palmetto (Serenoa repens)

Saw palmetto seems to work locally at the actual site of hormone binding to receptors on cells. It apparently stops or at least reduces the receptor binding of androgens. It also locally inhibits 5-alpha reductase and 3-ketosteroid reductase, the enzymes that are involved in converting testosterone to the more potent DHT. Green tea has been associated with higher levels of sex hormone-binding globulin (SHBG). SHBG is a molecule that binds with high affinity to testosterone. Testosterone bound to SHBG is not bioactive and cannot bind to androgen receptors or be converted into DHT. Green tea may also have an effect on the type I 5 alpha reductase enzyme.

Scar management

Differentiating hypertrophic scars from keloids can be challenging. Key points that must be kept in mind are first, that scars can range between the ones that become hypertrophic in the first few months and then completely resolve with no treatment, and the more severe hypertrophic scars that become disfiguring and permanent and that keloids often do not recur for 6 months to as long as 2 years after surgery.

Silicone gel sheeting

Silicone gel sheeting has been a widely used clinical management option for hypertrophic scars and keloids since the early 1980s. The mechanism of action of silicone gel sheeting is unknown. Temperature differences of as small as 1°C, as found under silicone gel sheeting, can have a significant effect on collagenase kinetics and may alter scarring. Silicone itself has never been found in significant amounts in scars treated with sheeting so a direct chemical effect is unlikely. Others believe that static electricity generated by silicone gel sheeting induces a polarization of scar tissue that results in involution. Occlusion of scars by silicone gel sheeting might alter cytokine levels, which in turn would have an effect on scar remodeling.

Adhesive microporous hypoallergenic paper tape

The application of adhesive microporous hypoallergenic paper tape after surgery has been shown to be successful. The mechanism of benefit is unknown, but it may in part be mechanical (pressure therapy) and/or occlusive.

Miscellaneous compounds in scar management

  • Vitamin E
  • Onion extract cream
  • Allantoin-sulfomucopolysaccharide gel
  • Glycosaminoglycan gel
  • Extracts of Bulbine frutescens
  • Extracts of Centella asiatica
  • Topical retinoic acid
  • Colchicine
  • Systemic antihistamines

Conclusion


The use of cosmeceuticals has drastically risen in recent years. This significantly increases the armamentarium of the clinician in improving the treatment of skin conditions. However, at times, claims of effectiveness lack convincing evidence, thus the industry is challenged to provide convincing evidence of the effectiveness of these compounds.

Finally, remember that while the effectiveness of the non–FDA-approved cosmetic retinoids has been studied and clinical and histological evidence suggests structural changes induced by excessive sun exposure can be partially reversed by the use of topical retinoids, clinical correlates of these in vitro findings are not entirely convincing. Most studies are poorly designed, and many authorities regard the utility of these preparations for their stated uses as marginal at best.