Elaine Moore's Blog
Posted by Elaine Moore
Livedo reticularis, which is also known as vasculitis racemosa, livedo racemosa, and livedo annularis, is as autoimmune-related skin disorder that causes a mottled, purple skin discoloration. Livedo reticularis is known to occur in several different autoimmune diseases, including systemic lupus erythematosus (SLE) , autoimmune hemolytic anemia, polyarteritis nodosa, dermatomyositis, rheumatoid arthritis cold agglutinin syndrome, cryoglobulinemia, vasculitis, and antiphospholipid syndrome. Livedo reticularis can also occur in other conditions such as lymphoma, pancreatitis, and tuberculosis.
Symptoms
Livedo reticularis causes a constriction or narrowing of the fine capillary blood vessels that feed the upper layers of the skin. In livedo reticularis, over time dilation of these vessels causes the blood to stagnate, which causes a mottled discoloration of the overlying skin. The rash in livedo reticularis is described as a reticular or lacy, net-like purplish coloration surrounding a pale central area.
Livedo reticularis occurs primarily on the legs, arms, and trunk with symptoms becoming more pronounced in cold weather. The mottled appearance is related to spasms that occur in the dilated vessels. Mottling is more common in the forearms, thighs and lower abdomen.
Sneddon’s Syndrome
Sneddon’s syndrome is a form of idiopathic or autoimmune livedo reticularis with systemic involvement. The blood vessels most affected are those in the brain, eye, and heart. Idiopathic livedo reticularis primarily occurs in young and middle-aged females.
Treatment
There is no treatment for livedo reticularis. Rewarming the skin may reverse the discoloration although eventually the capillaries become permanently dilated and the condition results in permanent discoloration.
Resources
Teresa Kauke, Livedo Reticularis and Cold Agglutinins, Tbe New England Journal of Medicine, Jan 18, 2007, vol 356 (3): 284.
Livedo Reticularis, DermNet NZ, accessed Jan 10, 2007.
Posted by Elaine Moore
Integrative medicine refers to the practice of incorporating alternative medical therapies into conventional or Western medical regimens or to the simultaneous use of conventional and alternative medical treatments by medical practitioners. An example would be a physician who recommends both prescription medications and acupuncture or dietary supplements as part of his patients' treatment plans. Integrative medicine has been used in Europe for many years although it is a relatively new concept in the United States.
Integrative medicine focuses on wellness, health promotion, and the healing process. The steps to healing typically include detoxification, regeneration, and nutrition. Treatments are specific for the individual depending on his lifestyle, other health conditions, his general constitution, emotional state, exposure to stress, and diet. In an ideal integrative program, the immediate symptoms would be reduced quickly by using conventional therapies, usually prescription medications, and the root of the illness would be addressed and healed with alternative medicine.
Because of the benefits offered by both medical disciplines, many integrative clinics have been established in the last decade where patients can receive conventional treatments such as physical therapy and alternative treatments such as massage or craniosacral therapy in the same office setting. In cities where integrative physicians aren't available, a conventional practitioner might work closely together with a naturopath or doctor of traditional Chinese medicine to develop an integrative treatment approach.
Federal Programs
In October 1998 the National Institutes of Health (NIH) of the U. S. Department of Health and Human Services in Bethesda, Maryland created a special branch dedicated to studying the effects of complementary and alternative medicine. This branch is called the National Center for Complementary and Alternative Medicine (NCAAM). NCAAM has four primary areas of focus: advancing scientific research in alternative and complementary medicine; training CAM researchers and encouraging experienced researchers to study CAM; sharing news and information through an information clearinghouse, continuing medical education programs, and on their website; supporting the integration of proven CAM therapies.
NCCAM regularly conducts clinical trials that study the effects of various complementary medicines on autoimmune disorders. It shares the results of these trials in articles submitted to medical journals and published on their website. NCCAM also maintains a database (CRISP) of current publications related to the study of alternative medicine.
Available Resources
In the early 1990s few integrative resources existed. One of the best known was Dr. Rudolph Ballentine's clinic in New York City, described in his popular book Radical Healing, which was first, released in 1998. Ballentine's interest in Eastern medical traditions led him to India and Asia where he learned Eastern medical traditions firsthand. When he returned to the United States he incorporated these treatments into his medical practice. In his book he describes the use of complementary alternative therapies including homeopathy, Ayurveda, traditional Chinese Medicine, and herbal medicine.
Today, programs in Integrative Medicine are offered at most of the major medical schools in the United States. And most large cities have one or more integrative clinics.
Resources:
Steven Gelberg, The Healing Potential of Hospital Food, Medscape General Medicine, July 19, 2005, online at http://www.medscape.com/viewarticle/507572
National Center for Complementary and Alternative Medicine, National Institutes of Health
Rudolph Ballentine, Radical Healing-Integrating the World's Great Therapeutic Traditions to Create a New Transformative Medicine, 2000, first reprint.
Posted by Elaine Moore
Recent studies show that people diagnosed with psoriasis may be at greater risk for developing heart disease. In patients with severe psoriasis who are younger than 50 years old, the risk is comparable to that seen in diabetes. In patients of all ages with psoriasis the risk for heart disease was higher than that seen in the general population, but in younger people with severe disease the risk was significantly higher.
One recent study conducted at the University of Pennsylvania School of Medicine confirmed earlier studies showing this link while controlling for age, gender, smoking, elevated cholesterol, and other risk factors. Several studies show that patients with psoriasis often have key components seen in metabolic syndrome, including hypertension, obesity, elevated lipids, and insulin resistance. Furthermore, the inflammatory process in psoriasis is similar to the inflammatory process that occurs in atherosclerosis, a condition commonly referred to as hardening of the arteries. Both conditions are associated with elevated levels of the inflammatory blood marker C-Reactive Protein (CRP).
Inflammation as the Culprit
Earlier studies from the Karolina Institute have shown a higher risk for heart disease in patients with rheumatoid arthritis and systemic lupus erythematosus. The common link, researchers believe, is the underlying inflammation. Inflammation is the immune system's response to injury in infection. In patients with psoriasis and other autoimmune disorders, the immune system persists in launching this inflammatory response. Chronic inflammation allows cholesterol and other cellular debris to build up forming plaques in the arteries.
Studies show that patients with psoriasis, particularly men, use alcohol and smoking as a form of self-medication to reduce the emotional consequences of psoriasis. Studies show an increased mortality in patients with psoriasis, attributed to heavy drinking. Smoking has also been cited as a major risk factor in psoriasis, particularly for pustular psoriasis. Severe psoriasis is also known to cause folate deficiency, which is linked to high levels of homocysteine. Elevated homocysteine levels are an additional risk factor for heart disease.
The fact that psoriasis is linked to high risk for heart disease suggests that psoriasis is a systemic inflammatory disorder. Researchers at Mayo Clinic report that the benefit of these studies is that younger patients can now monitor their other factors for heart disease and reduce known risk factors. Whether conventional treatments for psoriasis can reduce this increased risk of heart disease is not yet known.
Fish Oil as a Solution
Fish oil supplements have been suggested as a treatment for persistent inflammation. Fish oil supplements are now FDA approved for the treatment of lipid disorders, and available in prescription form as well as over the counter preparations. The EPA and DHA omega-3 components of fish work like aspirin, preventing platelets from adhering together and promoting clot formation. In this way, like aspirin, fish oils reduce the risk of heart attack
Resources
Rick Ansorge, Psoriasis May Up Risk of Heart Attack, WebMD Health, Oct 10, 2006, Medscape News Article
Evidence that People with Psoriasis Have Greater Risk For Developing Heart Disease Than General Population, Dermatology News, November 13, 2006.
Fishing for Answers, Foundations of Wellness, UC Berkeley Wellness Letter.
Moira Petty, Daily Mail, Psoriasis linked to heart disease, October 25, 2005.
Posted by Elaine Moore
Every Christmas, my husband presents me with a gift certificate for a half day at a local spa. This holiday special includes a facial, massage, hair wash and style, manicure and pedicure. This is the perfect present for someone who has the time for a half day of pampering before a big night out.
Since night outings are few and far between and it takes me an hour to drive to the spa, I always divide my gift certificate into 3-4 separate spa visits. Because I’m basically frugal and more of a gift-giver than receiver, I squander my special gift, using it for routine hair cuts instead of a half day of solace.
Lately, it’s occurred to me that I’m missing on many, many benefits by not indulging myself. And I’m not using my spa present in the spirit it was intended. This year, I’m going to do it right. If I’m lucky enough to get my annual spa certificate this Christmas, I’m not going to deprive myself. I’m going to take my tired, weary body to the spa and emerge 4 hours later refreshed and rejuvenated.
I’m also planning to give more spa gift certificates as presents this year. Instead of looking for the best bargains I can find, buying presents aimlessly, I’m going to give my friends and family members an opportunity for some serious pampering. Too many people I know consider spas an unjustified luxury. Despite my frugality, I don’t share this view. Understanding the holistic nature of spas, I realize that a present of a spa gift certificate shows caring on a spiritual as well as physical level. Still, I’ll make sure to find good deals on holiday spa specials when I begin my shopping.
Posted by Elaine Moore
Autoimmune pemphigus refers to several rare autoimmune dermatological conditions, which are characterized by blistering of the skin and mucous membranes. There are several different types of pemphigus. Each of these disorders causes different symptoms and has a different disease course. The three main types of pemphigus include: paraneoplastic pemphigus, pemphigus vulgaris and pemphigus foliaceus. Other autoimmune conditions that cause blistering and may be confused with pemphigus include bullous pemphigus, bullous lupus, and Hailey-Hailey disease.
PARANEOPLASTIC PEMPHIGUS
Paraneoplastic diseases are those that occur in conjunction with certain cancers. Paraneoplastic conditions may occur either before or after the cancerous condition is detected. Paraneoplastic pemphigus usually occurs in patients who are already diagnosed with an internal cancer. Paraneoplastic pemphigus is the most serious form of pemphigus and it is the most rare of the three types. It is characterized by painful sores of the mouth, lips and esophagus and by several types of skin lesions. The lungs may also be affected, causing a condition known as bronchiolitis obliterans, which causes a potentially fatal destruction of alveoli in lung tissue.
Paraneoplastic pemphigus doesn't respond well to treatment. Its presence suggests the presence of a hidden tumor in patients not yet diagnosed with cancer. The tumor itself may be benign, and its surgical removal will usually improve the condition of pemphigus.
PEMPHIGUS VULGARIS
Pemphigus Vulgaris (PV)is the most common form of pemphigus and represents approximately 70 percent of all pemphigus disorders. The sores in PV may not always resemble blisters because of their tendency to form erosions. PV is caused by circulating antibodies that attack the skin and bind to the desmoglein-3 protein found on skin cells. This protein normally allows skin cells to adhere to one another. When this protein is destroyed, the skin cells separate, causing a condition of acantholysis that results in blistering of the skin and mucous membranes of the mouth, eyes and genitals.
PEMPHIGUS FOLIACEUS
Pemphigus foliaceus, which is the least severe form of pemphigus, is characterized by crusted, scaly sores, or fragile blisters that usually occur on the scalp, later spreading to the face, chest, and back. Oral or other mucocutaneous blisters do not occur in this disorder. Circulating antibodies in pemphigus foliaceus bind to desmoglein-1 protein (found on the surface of the top dry layer of skin) rather than to the desmoglein-3 protein affected in PV. Unlike the blisters seen in PV, the lesions in pemphigus foliaceus may itch and may easily be confused with eczema or dermatitis.
CAUSES OF PEMPHIGUS
The causes of pemphigus are unknown. In some cases pemphigus has been found to occur as a side effect of certain medications. Drugs suspected of triggering pemphigus include ACE inhibitors such as Elanapril and chelating agents such as penicillamine. Pemphigus is known to occur in people with other autoimmune disorders, primarily myasthenia gravis and in people with certain cancers, for instance, thyroid cancer.
DIANOSING PEMPHIGUS
Diagnosed is made by tissue studies of exudates taken from lesions or from skin biopsies. Direct immunofluoresent antibody (IFA) techniques can be used to demonstrate the presence of desmoglein antibodies in tissue samples. Blood tests for desmoglein antibodies are also used to determine the specific type of pemphigus that is present. Antibodies to desmoglein-1 are seen in pemphigus foliaceus, and antibodies to desmoglein-3 occur in pemphigus vulgaris.
TREATMENT OF PEMPHIGUS DISORDERS
Pemphigus is usually treated with high doses of oral corticosteroids, usually Prednisone, and cytotoxic drugs such as Imuran and Cytoxan, which are added to reduce the effects of the steroids. In cases of pemphigus foliaceus, hydroxychloroquine (Plaquenil) and Dapsone are sometimes used. Because of the toxicity of these medications, blood and urine tests must be performed regularly.
The lesions in pemphigus must be cleaned and topical corticosteroids are used to prevent erosion. The blisters in pemphigus are open wounds prone to infection. Antibiotics are frequently used to prevent infection. Infections are one of the primary causes of mortality in patients with pemphigus.
Resources:
Pemphigus, Dermatologic Disease Database, American Osteopathic College of Dermatology, www.aocd.org/skin/dermatologic_diseases/pemphigus.html.
International Pemphigus Foundation, http://www.pemphigus.org/
