Sunday, August 19

What is a Hemangioma? What are the Causes of Hemangioma?

Home > Reddened skin > What is a Hemangioma? Causes of Hemangioma.
Hemangioma is a benign tumor formed by the abnormal growth and buildup of blood vessels. The cause of hemangioma is unknown.
Hemangioma usually appears on the skin, especially on the head, face and neck. It may form in the top skin layers (capillary) or deeper in the skin (cavernous). It may also appear on the internal organs like liver, spine and vertebrae. The term hemangioma comes from Greek words meaning "blood-vessel-tumor".

These lesions are the most common benign tumors in children. These lesions may be present at birth as birth marks having faint reddened areas or develop after birth in the early months. Usually these tumors grow rapidly for about twelve months. Then there is a resting phase with little change in appearance for another twelve months. Then the involution phase starts and causes the lesions to diminish in size and disappear in ten years. In rare cases it may persist beyond ten years.

Hemangiomas and vascular malformations

     Earlier the term hemangioma was used to denote a variety of vascular lesions of infancy and childhood. Mulliken JB. and Glowacki J. categorized these conditions into  hemangiomas and vascular malformations. Hemangiomas have a proliferating phase characterized by endothelial hyperplasia which causes rapid growth of tumor. Then there is an involution phase with histological fibrosis and fat deposition followed by a regression phase. Under the microscope, these lesions appear as aggregates of closely packed capillaries filled with blood having endothelial lining.

     Vascular malformations are usually seen at birth and they grow proportionately with the child-growth. Vascular malformations consist of abnormal arteries, veins and capillaries and are essentially permanent. This categorization helps in deciding on the type of treatment required, if any.

Causes of hemangioma

     The exact cause of this benign tumor is unknown. Several views and hypotheses have been suggested as possible causes of these lesions. Several studies suggested a role for the estrogen hormone for their development. A study suggested that higher levels of estrogen circulating in the infant blood coupled with the localized tissue hypoxia may be a cause or a triggering factor for these lesions.

     Another study hypothesized that embolisms of maternal placenta on to dermis of fetus may be the cause of hemangioma. However this view was contradicted by the DNA studies of the mother and lesion tissue. More research is required to know the cause of the explosive rate of growth of these tumors.

     Hemangioma is more prevalent in Caucasian infants than in Asian infants. It is rarely found in African-American infants. About 5% of Caucasian infants are born with these lesions. The cause of this ethnic variation is unknown. The low amount of melanocytes present in fairer skin may be a cause for the development of these tumors. Premature infants and small infants are more prone to have or develop these tumors. Further, when compared to males more number of female infants are affected.

     These tumors have potential for complications and permanent scarring. The risks involved include visual obstruction, breathing obstruction, ear canal obstruction facial disfigurement or bleeding ulceration. The tumors of the internal organs can lead to pain, impaired organ function or failure. When the tumor is very large it may create excess load and stress on the heart. The presence of lesions may have a psychological impact on the child and cause emotional distress and behavioral problems. Hence the presence of hemangioma in infants requires medical advice and early treatment.
Skin Care topics of interest:
1. Carrots carotene and orange skin.
2. Types of Urticaria (hives).
3. Treatment of chronic idiopathic urticaria.
4. Acute Urticaria (hives).
5. Types of albinism disorders - Causes and genetics

Current Skin Care topic:
What is a Hemangioma? Causes of Hemangioma.

References:
 1. Haggstrom AN et al. (September 2006). Pediatrics 118 (3): 882–7. doi:10.1542/peds.2006-0413. PMID 16950977. "Prospective study of infantile hemangiomas: clinical characteristics predicting complications and treatment".
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Saturday, August 18

Carotene in carrots - Orange skin discoloration

Orange skin discoloration - Carotene in carrots
Excess consumption of carotene in carrots causes orange yellow skin discoloration. The β-carotene in carrots contributes to its orange color.
Though cosmetically displeasing to some, there is no apparent health impact of orange skin discoloration (carotenemia). However possible health effects of this condition have to be well researched.

Carotene in carrots

Carrots ((Daucus carota subsp. sativus) belong to Apiaceae family and are cultivated throughout the world. In a research study done in Netherlands it was found that regular consumption of carrots lowered the risk of cardiovascular disease (CVD). It was found to be due to the antioxidant activities of the carotenoids and polyacetylenes (falcarinol and falcarindiol) present in carrots.

Carotenes are a type carotenoids (tetraterpenoid organic pigments) which lack oxygen in their structure and are pure hydrocarbons. These fat-soluble carotenoids occur in the chloroplasts and chromoplasts of plants and occur in higher concentrations in some plants as in carrots giving them orange color.

Professor Heinrich Wilhelm Ferdinand Wackenroder (8 March 1798 – 4 September 1854), a German chemist and a professor at the University of Jena, isolated carotin (carotene) from carrots. Its structure was determined by Professor Paul Karrer (April 21, 1889 - June 18, 1971, a Nobel laureate, in early 1930s. Alpha-carotene present in carrots is found to be protective against the proliferation of human cancer cells.

β-carotene (C40H56) is the most studied of about fifty carotenoids identified in the human diet. Carrots are high in the (all-E)-beta-carotene isomer. It is an isomer form having higher bioavailability, provitamin A activity, and antioxidant activity when compared to Z (cis) isomer form of this carotenoid. The levels of all three Z isomers in raw carrots are low and are about 1.8% of the total isomers. Storage at low temperatures in fact increases the (all-E)-beta isomers.

There is thermal isomerization during cooking of carrots causing generation of all the three Z isomers. To get the maximum benefits, carrots should be stored at low temperatures. Carrots should be consumed raw or boiled for less than fifteen minutes to limit Z isomerization.

β-Carotene in fruits and vegetables

The β-carotene in many fruits and vegetables contributes to orange color. Orange and yellow fruits like mangoes, cantaloupe and papayas and orange roots like yam and carrots are rich sources of this carotenoid.

Though the Vietnamese gac fruit (Momordica cochinchinensis) and crude palm oil contain the highest amount of β-carotene, nearly ten times higher than carrots, gac fruit is less known outside Southeast Asia and the crude palm oil loses the β-carotene while processing and refining.

Carrots and yellow/orange skin discoloration

Excessive consumption of fruits and vegetables containing β-carotene causes carotenosis (carotenodermia, carotenemia or hypercarotenemia), a harmless condition giving a yellow-orange tint to the epidermis. This is due to deposition of these carotenoids in the outermost epidermal layer of skin.

This yellow-orange discoloration differs from that caused by the jaundice disease. In jaundice apart from yellowish pigmentation of the epidermis, the conjunctival membranes over the sclerae (whites of the eyes) also turn yellow whereas in carotenodermia sclerae remain white.

Carotenes have vitamin A activity and get partially converted into vitamin A (retinol) within the intestinal mucosa by a dioxygenase enzyme. If the vitamin A status of the individual is high, the conversion decreases and the excess carotenoids are stored/deposited in the fat tissues and epidermal layers. These carotenoids are deposited in the intercellular lipids of the stratum corneum of the skin.

Though the orange coloration can be generalised, it is more prominent in areas where stratum corneum is thicker and also in areas where there is profuse sweating. Palms, soles, nasolabial folds and behind ears are more prone to discoloration. The orange discoloration of epidermis reverses on cessation of consumption of carrots and other foods containing this carotenoid.

Some underlying health disorders may cause secondary carotenemia wherein increased serum lipids and decreased metabolism of carotenoids are the causes. In such cases treating the disease condition will resolve carotenemia.

If the orange skin discoloration is due to excess consumption of carrots, fruits or other vegetables, cessation of excess intake will reverse the skin condition without any blemishes, spots and marks.


Related topics:

Popular topics:

References:
1.Imsic M, Winkler S, Tomkins B, Jones R. Effect of storage and cooking on beta-carotene isomers in carrots ( Daucus carota L. cv. 'Stefano'). J Agric Food Chem. 2010 Apr 28;58(8):5109-13.
Current Natural Skin Care topic: Carrots - Carotene - Orange skin discoloration
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Sunday, August 5

Chronic idiopathic urticaria (hives) treatment

Chronic idiopathic urticaria treatment
Treatment of chronic or idiopathic urticaria involves use of antihistamine medications and avoidance of triggers or aggravating factors.
In the treatment of chronic idiopathic urticaria the principle approach is to control mast cells by suppressing IgE stimulation and/or the histamine release. Mast cells release three major types of histamines, H1, H2 and H3. As the skin contains both H1 and H2 histamine receptors, use of H1 and H2 antihistamines is usually considered for chronic idiopathic urticaria treatment.

Oral antihistamines for treatment of chronic idiopathic urticaria

     Oral antihistamines have been the first line treatment for all patients with chronic or idiopathic urticaria. Non-sedating 2nd generation H1 antihistamines are used with good treatment response. When itching is intense, especially in the night, sedative first generation H1 antihistamines are given in the night and non-sedating 2nd generation H1 antihistamines are given during the day for the idiopathic urticaria patient. Increasing the dosage up to four fold is recommended if the response to the initial dosage is found inadequate during chronic idiopathic urticaria treatment.
Image: chronic idiopathic
urticaria on hand
credit: James Heilman MD
wikimedia/User:Jmh649
(CC BY-SA 3.0)

First generation H1 antihistamines for chronic or idiopathic urticaria
Chlorpheniramine, hydroxyzine, and diphenhydramine are the first generation H1 antihistamines having side effect of sedation. Though these antihistamines have proven record of efficacy in urticaria treatment, with the advent of second generation drugs their sedative effects appear as a big drawback in the treatment of chronic idiopathic urticaria.

Non–sedating 2nd generation H1 antihistamines in urticaria treatment
Loratadine, fexofenadine, cetirizine, levocetirizine, terfenadine, desloratadine and mizolastine are non sedating second generation H1 antihistamines very much in use in the treatment of chronic idiopathic urticaria.

Nonsedating H2 antihistamines for chronic idiopathic urticaria
Cimetidine, ranitidine, famotidine and nizatadine are H2 antihistamines having no sedating side effect. These drugs have been used successfully along with H1 drugs for the treatment of chronic or idiopathic urticaria.

Treatment of antihistamine –resistant chronic idiopathic urticaria

Some forms of chronic idiopathic urticaria do not respond well to antihistamine treatment. In some patients chronic idiopathic urticaria may become antihistamine -resistant. In such instances non antihistamine medications like systemic corticosteroids, leukotriene modifiers or immunosuppressants may be considered during urticaria treatment. However their use has many limitations due to their side effects.

Role for systemic corticosteroids
Systemic glucocorticoids like prednisone have been used for lessening swelling, inflammation and itch in chronic idiopathic urticaria. However they can be used only for a short treatment periods as they have serious side effects like Cushing syndrome, skin damage, increased blood glucose levels, sleep disturbances, weight gain and psychological effects. Corticosteroids can weaken the immune system and worsen the existing infections of patients with idiopathic urticaria.

Leukotriene modifiers for chronic idiopathic urticaria
     Asthma medications like montelukast and zafirlukast are  leukotriene receptor antagonists (LTRA). They have been found to be effective in the treatment of chronic idiopathic urticaria when used along with non–sedating 2nd generation H1 antihistamines like loratadine. Side effects of leukotriene modifiers include gastrointestinal disturbances, headaches, general hypersensitivity, insomnia, sleep disorders, aggression, anxiousness, hallucinations, depression, irritability, and increased bleeding tendency.

Immunosuppressant drugs
Immunosuppressant drugs like cyclosporine and cyclosporin G are useful in the treatment especially of chronic autoimmune urticaria. As immunosuppressants they suppress the activity of the immunological system by obstructing the activity and growth of T cells. Treatment with immunosuppressants may be associated with a number of potentially serious adverse drug reactions (ADRs) like gastrointestinal disturbances, peptic ulcers, pancreatitis, convulsions, kidney and liver dysfunction, increased vulnerability to opportunistic infections and flare-up of current infections. Ciclosporin is listed as IARC Group 1 carcinogens as sufficient evidence of carcinogenicity in humans has been established.

Maintenance treatment
Once the symptoms resolve the treatment must be continued and tapered off after three months. The dosage of the medication is gradually reduced every two weeks. In many cases relapse has occurred when the medication is withdrawn soon after the resolution of symptoms.

Topical agents
Certain topical agents like calamine lotion, menthol with aqueous cream, and crotamiton lotion have been found to soothe the inflammation and itching. Applying cold compress or ice to the affected area for about 15 minutes relieves swelling, itching and pain. This may be followed up with application of calamine lotion.

Considerations for children
There are specific approvals and restrictions by FDA for use of various antihistamine medications in children considering their age. Please check the drug information provided by the manufacturer for use in children before usage.

Considerations for pregnant women
First-generation antihistamine such as chlorpheniramine is the safest choice for treatment of chronic idiopathic urticaria in pregnant women. Considerable usage experience is gained in its long term use without any fetal harm.
For drugs like cetirizine and loratadine there are no  controlled data in human pregnancy and have been assigned to pregnancy category B by the FDA. These drugs are recommended for use during pregnancy when need benefit outweighs risk. They are excreted into human milk. Hence their use is not recommended in nursing mothers.
Like cetrizine, montelukast and zafirlukast have been assigned to pregnancy category B by the FDA.
Cyclosporine and prednisone have been assigned to pregnancy category C by the FDA and are potentially harmful to fetus.

Avoidance of triggers or exacerbating factors

In some cases of chronic urticaria the triggers are identifiable. In such cases avoiding the trigger itself is the treatment. However in idiopathic urticaria the causes are not known. Avoiding the possible causes may bring relief to the patient affected by the idiopathic allergy.
  • Avoid tight fitting clothes, shoes and belts.
  • Try to keep your surroundings cool.
  • Avoid hot or cold baths.
  • Avoid stress and tension.
  • Do not do strenuous exercise.
  • Inform the doctor about your proneness to urticaria when he prescribes medications.
  • Avoid possible food triggers.
  • Avoid exposure to sun.
  • Avoid exposure to cold winds.
  • Avoid exposure to germicides, pesticides and detergents.
Avoiding the triggers and proper and complete treatment will help in resolving chronic idiopathic urticaria without any skin scars, blemishes or discolorations.
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Topic of interest:
Types of urticaria - Types of physical urticaria

Reference:
1. Kaplan AP, Greaves M. Pathogenesis of chronic urticaria. Clin Exp Allergy. 2009 Jun;39(6):777-87. Epub 2009 Apr 22.
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Thursday, August 2

Types of urticaria (hives) - Types of physical urticaria

Home > Types of urticaria - Types of physical urticaria
Classification of urticaria types into acute and chronic are accepted worldwide. Arbitrarily, the urticaria lasting less than six weeks is called acute type whereas the one lasting longer than six weeks is considered chronic.
Further, if psychosomatic and physical influences trigger this condition it is called physical urticaria. The conditions are called idiopathic when the causes are not known. Nearly 50% of the occurrences are caused by unknown factors.

Physical urticaria

    These types are very distinct and are induced by exogenous physical stimulus. The source of stimulus can be thermal, mechanical and cholinergic. Ten percent of chronic urticaria are physical urticaria. Considering the types of stimuli, these typs are categorized into sub-groups like dermatographism, delayed-pressure, cholinergic, cold, solar, heat, aquagenic and vibratory urticaria.

    Dermatographism is very common and induced by scratching or firmly stroking the skin. The swollen skin spots may appear immediately and resolve in about 30 minutes. In a normal healthy person though scratching may produce linear reddening without itching, in dermographism, itchy swelling develops. If the skin swelling persists or causes discomfort, taking antihistamines may resolve them.

    Cholinergic or stress type is widespread  and is caused due to rise in the core body temperature. Strenuous exercise and warm or hot bath may trigger the condition. Numerous small welts appear causing itching, tingling and burning sensation. The red spots appear quickly and last up to two hours. It is considered that psychosomatic influences stimulate parasympathetic nervous system leading to release of histamine throughout the body.

    Cold influenced physical urticaria is common in youngsters. On exposure to cold winds, cold water and cold climate, red spots appear on exposed parts like face, neck and hands. There is another hereditary type which may cause red swollen spots all over the body, nine to eighteen hours  after exposure. For persons with this condition, there is a grave danger in swimming in cold waters, as there may be massive release of histamine leading to low blood pressure and shock.

    Delayed-pressure urticaria is a rare physical type and skin swelling occurs in the areas where there is sustained pressure. Usually in this delayed type, swollen spots appear approximately six hours from initial stimulus and may last between eight hours to three days. Belts, straps, tight-fitted clothing and activities giving sustained pressure on the skin can trigger this condition.

    Heat induced urticaria is a rare physical type wherein swollen spots appear on continued application of heat. The spots may appear within two to three minutes of exposure and may last up to one hour.

    Solar or sun induced urticaria is caused on exposure to sun on the exposed skin areas. Though this physical type appears within a few minutes of exposure, it resolves within a few hours from withdrawing the sun exposure. Depending upon the wavelength of light triggering the condition, six different types are known.

    Water (aquagenic) urticaria is triggered on contact with water and the response is not temperature dependent. The skin swelling appears within one to ten minutes after the contact and may last up to two hours. Histamine release is not involved in this condition and there is a opinion that sensitivity of skin to additives in the water may the triggering factor.

    Vibratory urticaria is a rare physical type and develops on contact with vibration. Painful angioedema develops within five minutes after contact with vibration and may last up to one hour.

    Exercise-induced anaphylaxis is a rare physical type causing skin swelling and itchiness, shortage of breath and low blood pressure. The symptoms may appear within thirty minutes from the start of exercise and sometimes may prove fatal. Unlike cholinergic Urticaria, in this type hot bath does not trigger the condition. Hospitalization and treatment with antihistamines, epinephrine and ventilator support may be required.

Drug-induced type of urticaria

    Many drugs have been found to cause allergic reactions like minor skin rashes and urticaria. The most common causes of drug induced allergy are pencillin and related antibiotics like amoxicillin and ampicillin. Other common urticaria inducing drugs are sulfonamides, antiepileptic drugs, antidiabetic drugs, insulin preparations, aspirin, dextroamphetamine and clotrimazole. Some of them can lead to severe physical symptoms like angioedema, severe asthma, anaphylaxis and cardio-respiratory failure.

    Knowing and avoiding the triggering factors and use of appropriate antihistamine medicines can resolve all types of physical urticaria without leaving any skin blemishes, discolorations and scars.
Related topic of interest:
Acute urticaria
Image:
James Heilman, MD, http://commons.wikimedia.org/wiki/User:Jmh649/CC BY-SA 3.0

References:
1.Marcus Maurer and Jürgen Grabbe, Urticaria: Its History-Based Diagnosis and Etiologically Oriented Treatment, Dtsch Arztebl Int. 2008 June; 105(25): 458–466. PMCID: PMC2696901
2.Barbaud A, [Physical urticaria], Ann Dermatol Venereol. 2003 May;130 Spec No 1:1S16-27, PMID: 12843805
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Wednesday, August 1

Laser skin treatment - Cosmetic Laser

Skin treatments with cosmetic lasers
Laser (light amplification by stimulated emission of radiation) is being increasingly used in cosmetic skin treatments.
Laser technologies are making inroads into traditional beauty and skin care industry and these cosmetic treatments are replacing traditional methods. Of late lasers are being used for skin and beauty care methods like,
  • skin tightening,
  • collagen rejuvenation,
  • laser resurfacing,
  • freckles, age spots, wrinkles, sun spots and stretch marks removal,
  • scar removal,
  • hair removal,
  • tattoo removal,
  • laser removal of pigmented lesions,
  • pseudofolliculitis (shave bumps) removal,
  • spider veins (telangiectasia) removal,
  • laser removal of vascular lesions and
  • removal of warts, rosacea, acne and acne blemishes.

How does cosmetic laser works?

Laser emits intense beam of light energy of a particular wavelength. The narrow intense beam may be visible or invisible depending upon its wavelength. On reaching the target tissues it is absorbed and converted into heat energy inactivating and destroying the target tissue cells without affecting the other surrounding cells.
Ablative and non-ablative lasers are the two basic types. Ablative lasers remove the top layer of skin. The non ablative devices heat up the inner skin tissue to stimulate collagen deposit and do not affecting the outer epidermis layer.

The facial plastic surgeon is the right person for deciding on the type of cosmetic laser therapy to be undertaken, considering all the pros and cons of the options available. Depending upon the plan of action and strategy and the blemish involved one may need more than one session at the clinic.

After the completion of the laser session, the patient may develop swelling and reddening of the skin. He may be prescribed anti inflammatory medicine and antibiotics to reduce inflammation and to prevent infection. The full impact of the method will be apparent only after one or two months.

The effectiveness of the cosmetic treatment depends upon choice of the right type of laser device, training and skill of the operator of the device and the correct settings of wave length, power, pulse, duration and time lapse between the pulse.

Risks associated with cosmetic Laser treatment

  • If proper eye protection is not worn during the performance there is a risk of eye damage.
  • Pain, reddening, burns, inflammation and swelling are the usual after effects.
  • The healing process may get prolonged for some individuals. The inflammation may get infected in some cases.
  • There may be hypopigmentation or hyperpigmentation of the wound (which is usually temporary).
  • In some cases the change in pigmentation may become permanent.
  • In case of use of wrong device or improper methodology permanent scars may result.
  • Though each session may be short, the whole procedure may be time consuming requiring several trips.
  • Cosmetic laser treatments are usually expensive.
  • The effectiveness may vary from person to person and some having complete satisfaction and some getting disappointed with the result.

Contraindications for cosmetic Laser treatments

These methods are absolutely contraindicated in the following situations like,
  • pregnancy,
  • keloid scarring,
  • severe reactions to earlier treatments,
  • medications contraindicating bright light exposure of the user,
  • dermis being sensitive to light exposure,
  • severe and serious illness and
  • having implants.
Individuals with chronic diseases must inform their doctor about their ailments and take his advice about undergoing cosmetic Laser treatment.

Current topic: Cosmetic skin treatment with lasers
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