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New
Medication Approved to Treat Eczema
Atopic dermatitis is a chronic, hereditary skin condition
that causes redness, itching, and oozing lesions. It mainly affects
children but can persist into adulthood. Doctors often prescribe
oral or topical corticosteroids for serious cases. But while
steroids are very effective at quieting inflammation, they can
have adverse side effects. Steroid creams may cause thinning
of the skin and decreased collagen production, while oral corticosteroids
can have more serious adverse effects.
Now, dermatologists have high hopes for a new ointment, tacrolimus
(Protopic), which was recently approved by the FDA to treat moderate
to severe eczema in patients who cannot tolerate or are not adequately
helped by standard therapies. The FDA approved tacrolimus on
the basis of three 12-week studies that found 90% improvement
in about one-third of the patients who used the medication. Two
additional one-year studies, also considered by the FDA, found
that adults who used the drug intermittently over the course
of the year had no adverse effects except temporary burning and
stinging. Because tacrolimus can increase sensitivity to ultraviolet
(UV) light, users should avoid sunlight, tanning beds, and treatment
with UVA or UVB light.
March 2001 Update
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Does
Aspirin Prevent Preeclampsia?
Preeclampsia, also known as toxemia, is a condition
that affects pregnant women and their unborn baby. It is characterized
by high blood pressure, water retention, and protein in the urine.
The condition, which usually occurs after the 5th month of pregnancy,
can lead to seizures, kidney and liver damage, slow fetal growth,
and even fetal or maternal death. Preeclampsia affects up to 8%
of pregnancies, and is responsible for 10-15% of maternal deaths.
In the past decade, several studies have looked at the effectiveness
of aspirin in preventing preeclampsia.
Early studies showed promising results. But larger, more recent studies
failed to show any benefit.
In an effort to reconcile these conflicting results, British researchers
reviewed several studies involving over 30,000 women who were at
increased risk for preeclampsia. (Risk factors include preexisting
high blood pressure, diabetes, a first pregnancy, pregnancy as a
teenager or over the age of 40, and pregnancy involving multiple
fetuses.) The women had been randomized to receive an antiplatelet
drug (usually low-dose aspirin), a placebo, or no antiplatelet medication.
The researchers concluded that aspirin reduced the risk of preeclampsia
by 15%. Their review also showed that aspirin decreased the risk
of premature births by 8% and the risk of stillbirths or newborn
deaths by 14%. Based on these results — acknowledged
by the researchers as showing only small to moderate benefits — the
researchers recommended the use of aspirin. Several issues including
the optimal dosage, the proper time to start treatment, and which
women are most likely to benefit, remain unresolved.
Despite the results of this review, some leading experts are
unconvinced that aspirin is effective at preventing preeclampsia.
However, even physicians who doubt aspirin's efficacy agree that
at doses of less than 80 milligrams per day, aspirin is not harmful.
If your physician prescribes aspirin to prevent preeclampsia,
it may or may not be effective — but
in any case, it won't be harmful.
March
2001 Update
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Comparing
the Side Effects of Prostatectomy vs. Radiation Therapy
Prostate cancer is the most commonly diagnosed non-skin cancer among
men in the United States. When caught early, it is also among the
most treatable. Two of the more aggressive — and
common — methods
of treatment for early stage prostate cancer are radiation therapy
and surgery (radical prostatectomy) to remove the prostate gland.
Although both options have favorable outcomes, physicians have not
reached a consensus on which therapy is more effective. This means
that men who are treated with either surgery or radiation can usually
expect to live for many more years. The caveat is that they often
have to live with the side effects of their treatment. Deciding on
a treatment option, then, becomes a question of which side effects
are more likely with each therapy, and also which side effects are
more tolerable to a particular patient.
A recent analysis of data from the Prostate Cancer Outcomes Study
helps to clarify this issue by comparing the side effects of
the two therapies in men between the ages of 55 and 74, two years
after treatment. The results showed that men in both treatment
groups experienced significant decreases in sexual function.
Of the men in the surgery group, 80% became impotent, compared
to 62% of the men in the radiation group. Age and status of sexual
function prior to treatment affected these outcomes. Twelve percent
of the men who underwent surgery experienced dripping or leaking
urine, compared to only 2% of the men who had radiation therapy.
Few men in either group were bothered by bowel problems. Of the
men who were affected, however, radiation patients experienced
more diarrhea, bowel urgency, and painful hemorrhoids (33%, 30%,
and 19%, respectively) compared to surgery patients (22%, 16%,
and 10%).
Overall, this study showed that men who opt for surgery can expect
to have more urinary and sexual problems, while men who choose
radiation are more likely to suffer from bowel disturbances.
A man's age and initial health are also important factors in
the development and duration of long-term side effects from either
treatment. Physicians and their patients should use this information,
as well as a discussion of the patient's priorities, preferences,
and concerns, to help decide which treatment method is appropriate.
March
2001 Update
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Pneumonia:
How Long Before You Feel Better?
Pneumonia is a serious infection or inflammation of the lungs.
Uncomplicated pneumonia may be successfully treated with antibiotics
in one or two weeks, but many patients continue to experience the
symptoms of pneumonia, including cough, chest pain, fatigue, shortness
of breath, and fever, for some time after that. A team of Canadian
researchers set out to determine how long after treatment it should
take for pneumonia patients to be symptom-free.
The scientists asked a group of 535 adults who had undergone a
course of antibiotic treatment for pneumonia to complete questionnaires
about persisting symptoms at two and six weeks after the completion
of their treatment.
The average age of these patients was 62 years. Fifty-four percent
of the patients were admitted to the hospital for treatment of
their pneumonia, while a minority had a coexisting chronic illness
such as chronic obstructive pulmonary disease (26%), asthma (17%),
or congestive heart failure (12%).
At two weeks after therapy, 67% of patients reported fatigue, 56%
were coughing, 50% were short of breath, and 35% were producing
sputum. Six weeks after therapy, more than 60% of patients reported
continuing symptoms. Forty-five percent still had fatigue, 35%
continued to cough, and 16% had gastrointestinal symptoms. Older
patients, those who were sickest at onset of treatment, patients
with chronic obstructive pulmonary disease, and patients with asthma
suffered the most persistent symptoms.
Although hospitalizations are shorter and antibiotic treatments
briefer, complete recovery still takes time. Pneumonia patients
should be reassured that a "normal" period of recuperation
may vary from several weeks to several months.
March 2001 Update
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Reducing
Your Risk of Deep Vein Thrombosis During Airline Travel
Deep
vein thrombosis (DVT), recently featured in the news as "economy
class syndrome,"
is the formation of a blood clot in the deep veins of the legs
while sitting — particularly in the cramped seats of an
airplane (be it economy class or first class), car, bus, or
train — for long periods. You move less in tight quarters,
causing circulation to decrease and allowing blood to collect
and form a clot. The blood clot may cause pain and swelling
in the legs. Serious, even fatal complications can occur if
the blood clot breaks loose in the blood stream and travels
to the heart or lungs. Older people, and those who are obese
or have a family history of DVT tend to be at the highest risk.
While a blood clot can result from a number of causes, some
studies suggest an association between blood clots and airplane
travel. Many doctors believe this connection is simply a result
of being unable to move around, and not from sitting in economy
class seats or in an airplane, per se. However, it is
possible that pressurized air and dehydration may also play
a role in the connection between air travel and blood clots.
Many airlines have already begun to address this health issue
by preparing warning pamphlets for their passengers, including
articles in their in-flight magazines, posting notices on their
websites, or creating in-flight videos offering exercises aimed
at prevention. A member of the parliament in Australia has
even called for treadmills to be installed in airplanes that
carry passengers for six or more hours.
While treadmills may or may not appear on airplanes in the
near future, you can address this issue on your next lengthy
flight by taking a few simple measures to help prevent blood
clotting.
- Wear loose-fitting,
comfortable clothing during the flight.
- Eat a small meal
and drink plenty of fluids to help increase blood circulation.
Avoid alcohol and caffeine, as these contribute to dehydration.
- Do not cross your
legs while seated and make sure you adjust your position every
half hour.
- You may want to wear
elastic support hose to increase circulation in your legs.
- Most importantly,
try to walk up and down the aisle at least once an hour. Even
standing in front of your seat and gently shaking out your
legs or slowly rising up on your toes can help.
- If you can’t
get out of your seat, you can do the following exercises in
your seat to increase blood circulation. Perform each exercise
for 15 seconds, once an hour.
- Ankle rotations:
Draw a circle with your toes, rotating clockwise and
then counterclockwise with both feet.
- Foot pumps:
Slowly alternate between flexing and pointing your
toes.
- Leg lifts:
With your knee bent, lift your leg up off the seat
and hold for a few seconds. Alternate legs.
- Head and
shoulder rotations: Gently roll your head clockwise
and then counterclockwise, keeping your shoulders relaxed.
Then gently roll your shoulders forwards and backwards.
- Toe reach:
Slowly bend forward and extend your arms down towards
your toes and then gently sit back up.
- People who are at
high risk for blood clotting due to other conditions should
speak with their physician for additional advice before traveling.
Studies do not agree
on how long a flight needs to be to pose a risk of blood clotting.
A few studies even suggest that there is no association between
blood clots and air travel. Clearly, more research is necessary.
However, while we wait for a definitive answer to these questions,
heeding these simple instructions may help prevent problems.
March 2001 Update
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