Acne

Acne

Aretha Persaud, M.D.

Acne affects many individuals of all ages. Acne is a skin disorder characterized by clogged pores and pimples. Although acne is not a serious medical condition, it often causes emotional distress and can lead to scarring of the skin.
Acne can appear anywhere on the body, typically affecting the face, neck, chest, back and shoulders, which are the areas with the largest amount of oil glands. Acne appears in several forms. Whiteheads occur when the openings of hair follicles become clogged and blocked with oil secretions and dead skin. Blackheads are similar but are open to the skin surface and darken. Pimples are red, raised spots that indicate infection and inflammation in the hair follicle. Finally, cysts occur when there is a buildup of secretions beneath the surface of the skin deep within the hair follicles.
There are three main factors responsible for acne: overproduction of oil or sebum, irregular shedding of dead skin cells and buildup of bacteria. Pores, the openings of the sweat glands on your skin, are not normally involved in acne.
Contrary to common belief, foods have little effect on acne. Acne usually occurs when there are hormonal changes in your body—for females, during menstruation and pregnancy. Acne is also associated with certain medicines, such as cortisone or steroids.
Other causes include exposing the skin to greasy or oily substances. Scrubbing the skin too hard or with harsh chemicals can cause irritation and worsen acne. If there is a family history of acne, you have a greater risk of developing it. Friction or pressure on the skin caused by phones, collars or backpacks can lead to acne.
Treatment for acne focuses on reducing oil production, speeding up skin cell turnover and fighting bacterial infection. The treatment usually takes weeks before results are noted and the skin may appear worse before it gets better. Topical treatments that contain benzoyl peroxide, sulfur, resorcinol, salicylic acid or lactic acid as the active ingredients, are usually found over the counter. Prescription topical treatments include Tretinoin (Retin-A) or adapalene (Differin) which are derived from Vitamin A. These agents promote cell turnover and prevent plugging of the hair follicles. Topical antibiotics are also available and kill excess bacteria. Combining these products helps achieve optimal results.
Oral antibiotics are used for moderate to severe acne. Isotretinoin or Accutane is useful to treat deep cysts when oral antibiotics have failed. However, there are several serious side effects associated with Accutane. Severe birth defects may occur in females taking Accutane. Cholesterol, triglycerides and liver enzymes in the body may become elevated, so baseline blood testing and follow-up labs should be done routinely when Accutane is prescribed for acne treatment. Oral contraceptives have also been shown to improve acne but are associated with other side effects. Finally, cosmetic procedures, including microdermabrasion, chemical peels, IPL (intense pulse light) therapy or laser resurfacing, are options to diminish scarring caused by acne and enhance your complexion.

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Prednisolone and Withdrawal headache

Prednisolone does not reduce withdrawal headache

A randomized, double-blind study

Magne G. Bøe, MD, Åse Mygland, MD, PhD and Rolf Salvesen, MD, PhD

From the Department of Neurology, Sørlandet Hospital, Kristiansand, Norway (M.G.B., Å.M.); Hospital of Rehabilitation, Rikshospitalet University Hospital, Kristiansand, Norway (Å.M.); Institute of Clinical Medicine, University of Bergen, Bergen, Norway (Å.M.); Department of Neurology, Nordland Hospital, Bodø, Norway (R.S.); and Department of Neurology, University of Tromsø, Tromsø, Norway (R.S.)

Introduction: Medication overuse headache is a condition where abrupt drug withdrawal is considered the treatment of choice.

Objective: To study whether prednisolone given orally the first 6 days after medication withdrawal reduces headache intensity during the same period.

Methods: From August 2003 through November 2005, we included patients aged 18 to 70 years with probable medication overuse headache. The study was randomized, double-blind, and placebo controlled. The patients were hospitalized for 3 days to start medication withdrawal. They were randomly assigned to receive prednisolone 60 mg on days 1 and 2, 40 mg on days 3 and 4, and 20 mg on days 5 and 6 (Group A) or placebo tablets for 6 days (Group B). Headache intensity was recorded in a diary for a month before withdrawal (baseline) and throughout the study period of 28 days. The primary endpoint was a calculated mean headache (MH), based on number of days with headache and mean intensity the first 6 days after withdrawal.

Results: We included 26 men and 74 women. Sixty-five had migraine, 13 had tension-type headache, and 22 had both migraine and tension-type headache. Baseline headache days were 25.4 (CI 24.3 to 26.4). Baseline MH was 1.6 (CI 1.41 to 1.69). Fifty-one received Regimen A, and 49 received Regimen B. Baseline features were similar. During the first 6 days after withdrawal, headache was similar in Groups A and B (MH 1.48 [CI 1.28 to 1.68] vs 1.61 [CI 1.41 to 1.82], p = 0.34).

Conclusion: Prednisolone has no effect on withdrawal headache in unselected patients with chronic daily headache and medication overuse.

NEUROLOGY 2007;69:26-31
© 2007 American Academy of Neurology
http://www.neurology.org

Migraine: Association with socioeconomic status

Migraine in adolescents

Association with socioeconomic status and family history

M. E. Bigal, MD, PhD, R. B. Lipton, MD, P. Winner, DO, M. L. Reed, PhD, S. Diamond, MD, W. F. Stewart, PhD On behalf of the AMPP advisory group*

From the Departments of Neurology (M.E.B., R.B.L.) and Epidemiology and Population Health (R.B.L.), Albert Einstein College of Medicine, Bronx, NY; The Montefiore Headache Center (M.E.B., R.B.L.), Bronx, NY; The New England Center for Headache (M.E.B.), Stamford, CT; The Palm Beach Headache Center (P.W.), Palm Beach, FL; Vedanta Research (M.L.R.), Chapel Hill, NC; The Diamond Headache Center (S.D.), Chicago, IL; and The Center for Health Research and Rural Advocacy (W.F.S.), Danville, PA.

Objective: The influence of socioeconomic status on the prevalence of migraine is unknown in adolescents. Accordingly, we investigated the prevalence of migraine in a large sample of adolescents by sociodemographic features.

Methods: A validated headache questionnaire was mailed to 120,000 households representative of the US population. All individuals in the household were interviewed (probands and their parents). We calculated sex-specific prevalence estimates of migraine in adolescents derived by age, race, urban vs rural residence, household income, region of the country, and parental status of migraine, using log-linear models.

Results: A total of 32,015 adolescents were identified. Surveys were returned by 18,714 of them (58.4% response rate).The 1-year prevalence of migraine was 6.3% (5.0% in boys and 7.7% in girls). The prevalence was higher in girls than in boys older than 12 and in whites than African Americans. In families with an annual income lower than $22,500, the adjusted prevalence of migraine in adolescents without a parental history of migraine was 4.4%; in families earning $90,000 or more, it was 2.9% (OR = 0.49, 95% CI 0.38 to 0.63). In adolescents with a parental history of migraine, the prevalence in the lower vs the higher income group was 8.6% vs 8.4% (OR = 0.97, 0.81 to 1.15).

Conclusions: In adolescents with family history of migraine, household income does not have a significant effect, probably because of the higher biologic predisposition. In those without a strong predisposition, household income is associated with prevalence. This suggests social causation rather than social selection, highlighting the need for exploration of environmental risk factors related to low income and migraine and the search for specific comorbidities and stressors in this group.

NEUROLOGY 2007;69:16-25
© 2007 American Academy of Neurology

Predictors of Mental Health

Predictors of Mental Health Service Utilization by People Using Resources for Homeless People in Canada

Jean-Pierre Bonin, Ph.D., Louise Fournier, Ph.D. and Régis Blais, Ph.D.

OBJECTIVE: This study used Pescosolido's network episode model to examine mental health service utilization among impoverished people accessing resources for the homeless in Canada's universal health care setting.

METHODS: The sample consisted of 439 people who met DSM-IV criteria for affective or psychotic disorders who were assessed as part of a larger study of resources for homeless or impoverished people in Montreal and Quebec City. Interviews were organized into the framework of four network episode model concepts: sociodemographic characteristics, illness characteristics, illness history, and social network. These blocks of variables were then analyzed in terms of their accuracy in predicting mental health service utilization.

RESULTS: Eighty-four percent of the sample were male, the mean±SD age was 41±12 years, and 36% were homeless at the time of the interview, but nearly half (48%) of the population had been homeless previously. The research shows that each network episode model concept except illness history significantly predicted utilization of mental health services. Female gender, youth, never being homeless (sociodemographic characteristics), presence of antisocial personality disorders within the preceding year, past or current alcohol-related disorders (illness characteristics), hospitalization before the preceding year (illness history), and a larger social support network were related to utilization of mental health services.

CONCLUSIONS: In the absence of economic barriers to health care, there are other significant barriers to the use of mental health services for people who live in poverty. A better understanding of these factors will help in meeting the service needs of impoverished mentally ill people.

Psychiatr Serv 58:936-941, July 2007
© 2007 American Psychiatric Association
http://ps.psychiatryonline.org/

Assessment of Body Fatness

  Do Skinfold Measurements Provide Additional Information to Body Mass Index in the Assessment of Body Fatness Among Children and Adolescents?

Zuguo Mei, MD (a), Laurence M. Grummer-Strawn, PhD (a), Jack Wang, MS (b), John C. Thornton, PhD (b), David S. Freedman, PhD (a), Richard N. Pierson, Jr, MD (b), William H. Dietz, MD, PhD (a) and Mary Horlick, MD (c)
a) Division of Nutrition and Physical Activity, Centers for Disease Control and Prevention, Atlanta, Georgia; b) Body Composition Unit, Department of Medicine, Obesity Research Center, St Luke's-Roosevelt Hospital, New York, New York; c) National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland

OBJECTIVES. The purpose of this work was to validate the performance of age- and gender-specific BMI, triceps, and subscapular skinfold for the classification of excess of body fat in children and adolescents and to examine how much additional information these 2 skinfold measurements provide to BMI-for-age.
METHODS. The receiver operating characteristic curve was used to characterize the sensitivity and specificity of these 3 indices in classifying excess body fat. Percentage of body fat was determined by dual-energy radiograph absorptiometry. Both 85th and 95th percentile of percentage of body fat were used to define excess body fat. Data from the New York Pediatric Rosetta Body Composition Project were examined (n = 1196; aged 5–18 years).
RESULTS. For children aged 5 to 18 years, BMI-for-age, triceps skinfold-for-age, and subscapular skinfold-for-age each performed equally well alone in the receiver operating characteristic curves in the identification of excess body fat defined by either the 85th or 95th percentile of percentage of body fat by dual-energy radiograph absorptiometry. However, if BMI-for-age was already known and was >95th percentile, the additional measurement of skinfolds did not significantly increase the sensitivity or specificity in the identification of excess body fat.
CONCLUSIONS. In contrast to the recommendations of expert panels, skinfold measurements do not seem to provide additional information about excess body fat beyond BMI-for-age alone if the BMI-for-age is >95th percentile.

Key Words: dual-energy radiograph absorptiometry • BMI • skinfold • anthropometry • receiver operating characteristic curve • sensitivity • specificity

Abbreviations: DXA—dual-energy radiograph absorptiometry • CDC—Centers for Disease Control and Prevention • %BF—percentage of body fat • CV—coefficient of variation • ROC—receiver operating characteristic

PEDIATRICS Vol. 119 No. 6 June 2007, pp. e1306-e1313