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thehairclinic · 2 years ago

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Role Of Medicine In Hair Loss Treatment

Medical treatments for hair loss have come a long way over the past few years, with more advanced strategies emerging every day. For some people, these newer approaches work better than earlier ones, leading to improved results.

For others, though, they do not work or need to be used in combination with another treatment. This is particularly true for topical medications like minoxidil (the most common prescription drug for treating balding) and diazolines, which were once considered the best non-surgical option.

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It is important to note that many of these new options require several months to show effect, even when used consistently. People who are seeking relief should stick with each product for that time frame before evaluating whether it worked for them.

Medical therapies can help you avoid surgical procedures, but they will only do so if you use them properly. If your treatment does not seem to be helping after a certain amount of time, try switching brands or types of therapy to see if that changes how well it works.

If those fail, then go back to what we call the standard of care, which is still topically administered drugs such as minoxidil and thiazolidine. But remember, while they may not cure hair loss, they can definitely improve your quality of life by enhancing appearance-related issues.

Medical conditions that cause hair thinning

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Certain medical conditions can contribute to hair loss, sometimes actively and sometimes passively. Some conditions may even be able to induce total hair loss if you are sensitive to them.

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Certain diseases or treatments can actually promote hair shedding and/or complete baldness. This is referred to as alopecia.

Alopecia can occur due to inflammation or immune system reactions. For example, lupus is an autoimmune disease that can affect many parts of your body, including your skin.

People with lupus often develop scarring around their mouth and nose (called oral mucosal lesions) which can easily become infected. When bacteria enter the area, there is typically a lot of bleeding and fluid buildup which removes moisture from the exposed scalp surface. This could potentially lead to dry, flaky skin and hair loss.

Some antibiotics can also have severe side effects on patients who are susceptible to acne. These potential side effects include hair loss. People who are already experiencing hair loss can especially be at risk for this kind of reaction.

Treat hair loss with medication

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There are many ways to treat hair thinning, including drug treatments. Your doctor will evaluate your hair and scalp condition, as well as do some tests to determine if there is a risk factor for hair loss. They may recommend using tazorbuline or minoxidil (the main ingredient in Rogaine) topically to ensure optimal results.

There are several medications that can be used to treat male pattern baldness. These include topical drugs such as minoxidil and finasteride (brand name Propecia), oral drugs like dihydrotestosterone (DHT) inhibitors like flutamide and ketoconazole, and implants designed to release either Dihydrotestosterone (an androgen hormone) or estrogen which helps stimulate growth.

While each treatment has its own level of effectiveness, most find success when combined under one system. For example, men who suffer from stage three hair loss often experience a decrease in efficacy after taking finasteride orally. A cream containing minoxidil works better if applied directly to the skin. By combining these two products into one, you get the best possible outcome.

Treat hair loss with hair transplants

There are two main types of treatments for hair thinning or hair loss, both of which can be done by board-certified dermatologists. The first is topical products such as minoxidil (Xalderm) or diazolidinylurea (Avodart), which you apply directly to your scalp.

The second is internal therapies, such as finasteride (Propecia) or ketoconazole (Nizoral). Both work by inhibiting dihydrotestosterone (DHT), a hormone that stimulates hair growth. By suppressing DHT, hair follicles are prevented from moving on to the next stage of development, resulting in overall hair loss.

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The role of medicine in hair loss treatment ixnay not only in treating hair fall but also potential re-growth of hair. Because these medications are usually administered orally, they have the additional effect of improving skin health and quality of life.

However, they do come with some risks, so it’s important to discuss them with your doctor.

Hair loss prevention

There are several ways to help prevent hair thinning and total hair loss. These include using sun protection products, limiting your alcohol intake, eating well, exercising, and finding the right amount of stress you can bear.

Many people begin to notice hair thinning around age 30-40, so it is important to be aware of early signs of hair loss. This may be because of genetics or external factors such as diet and lifestyle.

It is very common for people to lose some hair during times of extreme stress, particularly related to health issues or life changes.

Drinking too much alcohol can have an adverse effect on how well hairs grow and stay thick. So drinking alcoholic beverages in moderation is best.

Exercise is another way to keep your heart pumping and maintain a healthy weight. Getting adequate sleep is also crucial for overall wellness and hair growth.

I would like to speak more about one specific cause of hair loss. More than half a century ago, surgeons used x-rays to determine if there was bone erosion under the skin of the scalp.

This procedure is now called a teledermatoscopy, which means “skin examination by X-ray.” Doctors use this test to identify patterns of hair loss that suggest either alopecia Universalis or patterned hair loss.

Look into the source of your hair loss

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When it comes to hair, nature can be quite dramatic at times! Some people suffer from more intense hair thinning or hair loss than others. This is due to genetics.

Some genes cause certain traits to strengthen hairs that are already there or to promote new growth, whereas other genes weaken this process.

It has been shown that some genetic factors play a much larger role in hair loss than others. For example, if you have very strong genetic hair-thinning markers, then lifestyle issues such as poor nutrition, weight gain, stress, and the use of harmful chemicals may also contribute to hair loss.

However, just because someone with similar genetics does not experience significant hair loss does not mean that their personal hair care routines are safe and effective for them.

There are many things that can affect how well your skin functions, so why would hair be any different? In fact, when performing a cost/benefit analysis of various treatments, looking beyond the surface-level effects is important.

Avoid hair loss by using a hair growth supplement

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There are several different types of supplements that claim to help promote hair growth or prevent hair thinning. While some work, many do not!

Before trying any new product, you must first determine if your current treatments and strategies are working for you.

If they are, then there is no need to try something new. If they are not, then it is probably best to stay with what works until you find one that does.

There are many ways to treat male pattern baldness so unless your symptoms get worse, there is no need to add another product to manage them.

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#hair problems #hair clinic near me #hair clinic in delhi #hair transplant #Youtube

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megamobilestylesposts · 2 years ago

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Everyone on TikTok is Drinking Organic Aloe Vera Juice... WHY?

Why is everyone drinking organic aloe vera juice? Keep reading to find out!

Ditch your average liquid cleanses and check out organic aloe vera juice.

While you may be used to kelp or spinach smoothies or juices, we have another green-colored one making its way — organic aloe vera juice. However, it’s not just a yummy treat… it also has many great benefits!

Check it all out below.

What is aloe vera juice?

Aloe vera is a succulent plant species in the genus Aloe. It grows profusely in tropical settings and has been used as a medicinal herb for centuries all over the world. Aloe vera juice is a viscous, sticky liquid derived from the flesh of the aloe vera plant leaf. It has historically been used both topically and orally.

What are the benefits?

There are tons of benefits, internally and externally, when you use aloe vera juice. Here’s a breakdown of both.

Internal benefits:

Contains antioxidants: Polyphenols, a class of antioxidant-rich plant chemicals, are thought to be responsible for their anti-inflammatory effect.

Helps with pre-diabetic treatments: Studies show that it helps with improving both blood sugar and blood fatty acid levels in those who are pre-diabetic.

Improves digestive issues: Anthraquinone glycosides are found in aloe vera juice, which are plant chemicals containing laxative properties that may help alleviate constipation. According to an early study, aloe vera syrup may help treat and lessen the symptoms of acid reflux, technically referred to as gastroesophageal reflux illness (GERD). Another preliminary study indicates that utilizing aloe vera extract to treat irritable bowel syndrome (IBS) has promising benefits.

External benefits:

Improves dental and oral health: The use of aloe vera mouthwash significantly decreased the intensity and suffering associated with oral mucositis. Aloe vera mouthwash may also help lower tooth plaque, as well as control pain and swelling during oral surgery.

Helps treat skin conditions and improve skin’s appearance: Because aloe vera is known to have anti-inflammatory characteristics, it might be used to treat burns and other skin conditions, such as atopic dermatitis. According to research, aloe vera consumption boosted collagen formation and decreased the appearance of wrinkles in a group of women over the age of 40.

How can I get it?

Luckily, you don’t have to go far to find aloe vera juice. Many grocery stores and supermarkets have them stocked on their shelves. If your local one doesn’t have it, we recommend checking Asian grocery stores, as well. If you have a juice shop close to your home, you can even try homemade juice. Or, if you’re adventurous, you can try to make one yourself!

Conclusion: Are you ready to try out organic aloe vera juice? Don’t let your health journey end there. Follow the MOBILESTYLES blog to get all the latest on the newest and healthiest trends, products, exercises, and more!

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poojascmi · 3 years ago

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Uses & Effectiveness of Iodine

Iodine shortage can be prevented and treated by taking iodine supplements by mouth, such as iodized salt. Iodine taken orally can help preserve the thyroid following a radiation emergency. However, it should not be utilised as a broad kind of radiation protection.

· Pink eye is a common ailment- The use of iodine-containing eye drops, such as povidone-iodine, appears to minimise the incidence of pink eye in infants. It also appears to benefit people with pink eye.

· Diabetes patients' foot sores- Iodine applied to foot ulcers may aid in the treatment of diabetes-related foot ulcers.

· Swelling (inflammation) of the uterine lining (endometritis).- Before a caesarean birth, wash the vagina with a solution containing iodine in the form of povidone-iodine to lessen the chance of uterine lining swelling.

· Breast cancer is a form of benign (non-cancerous) illness (fibrocystic breast disease). Breast soreness and discomfort can be reduced by taking molecular iodine in a quantity of 3000-6000 mcg per day. Lower dosages of 1500 mcg per day do not appear to be effective.

· Inside the mouth, there is swelling (inflammation) and sores (oral mucositis). Chemotherapy-induced pain and swelling within the mouth appear to be prevented by rinsing the mouth with an iodine solution.

· A severe periodontal infection (periodontitis). Using an iodine solution to rinse the mouth during non-surgical gum infection treatments can assist to minimise the depth of infected gum pockets.

· Infection following surgery. Iodine in the form of povidone-iodine minimises the risk of infection before and after surgery. However, it's unknown how it compares to other infection-prevention measures like chlorhexidine.

Get more details about Iodine- https://bit.ly/3GDH308

#Iodine

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erica-the-rn · 7 years ago

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Chemotherapy

What is chemotherapy?

Chemotherapy is a treatment option for cancer patients. It can be curative or palliative. It is described as cytotoxic, which means it is toxic to living cells. Most chemo-drugs are given IV and there is more than one type of chemo-drug.

Chemotherapy Drug Categories:

Alkylating Agents

Antimetabolites

Antimitotic Ages

Antitumor Antibiotics

Topoisomerase

As I call it, WILDCARDS (mechanism unknown)

Chemotherapy is often used with surgery or radiation, known as adjuvant therapy. The reason why is that chemo circulates systemically. So, while surgery may remove the local tumor, chemo helps to remove the metastasizing cancer. Oftentimes, more than one type of chemo is used at a time. Obviously, the more you use, the more the cancer is destroyed. However, there is a downside to that. While chemotherapy has a tendency to destroy more cancer cells than normal cells, it is still actively reducing your healthy cells. Chemo goes after the cells that produce most rapidly, so most often affected are the blood cells, skin, and hair.

Side Effects of Chemotherapy:

Nausea/Vomiting

Subsequent Weight Loss

Anemia

Fatigue

Changes in LOC

Skin Changes

Anemia

Neutropenia

Thrombocytopenia

Alopecia

Mucositis

Managing Side Effects of Chemo:

Patients experiencing chemo are going to have a couple problems that deal with their blood cells.

Firstly, they are anemic. subsequently, they are going to have fatigue because of their anemia. We usually treat this with epoetin alfa. This is a erythrocyte colony-stimulating factor. It will help increase energy and erythrocyte count.

They are also neutropenic. This means they have a low white blood cell count. Our good old friend, WBC, helps us to fight off infection. So, when our patients are neutropenic, they are at a risk for infection. What we can do, as nurses, is help protect from infection and teach our patients how to prevent infection.

These is normally called neutropenic precautions.

Handwashing is MOST important!

Teach patients to perform oral and perineal care Q12h.

These patients will likely have their own private room.

Visitors should be limited to healthy, infection free adults.

Teach patients to report any s/s of infection, as big or small as the sign may be.

Monitor WBC every day.

REPORT ANY SLIGHT FEVER, COUGH, SWEATING, SORES, PIMPLES, OR ANY SIGN OF INFECTION TO THE PROVIDER.

No fresh fruit or vegetables.

No live plants allowed in the room.

These patients are also experiencing whats called thrombocytopenia. Thrombocytopenia is decreased platelets and clotting factors. This puts them at a risk for bleeding. Along with their other symptoms (vomiting, fatigue, weakness, etc), this puts the patient at a horrible risk for injury.

So we have what is called bleeding precautions:

Handle the patient gentle. Skin tears are very common.

If venipuncture or injections have to be performed, hold pressure at the site for 10 minutes or until blood ooze has stopped.

Apply ice to areas of injury.

Monitor urine for blood.

Use a soft-bristled toothbrush.

DO NOT give the patient a water pick.

Follow fall prevention protocols.

Use an electric razor.

Do not give aspirin or let the patient take aspirin.

Teach patients to blow their nose gently.

Nausea/Vomiting caused by chemotherapy is called chemo-induced nausea and vomiting. For patients experiencing this, we usually give Ondansetron(Zofran). What you need to remember is that Zofran causes drowsiness. These patients need to be told not to drive or operate machinery when they have taken this drug. Inform them to rise and change positions slowly. You want to prevent a fall at all costs because they are a bleeding risk.

Chemotherapy Nursing Interventions:

Protect Yourself, too!

So, lets review some guidelines. Chemo is toxic to healthy cells. You need to remember that as a nurse. When administering chemo, make sure you have all of your protective equipment on. To take care of your patient, you must take care of yourself.

Oral Chemo-Agents

If your patient has an oral chemo-agent, your biggest role is education. These patients need to know that they need to take these oral drugs every day at the same time. Teach your patients that skipping a dose can lead to resistance in cancer cells. Every dose they miss or skip is a step back in progress and a reduced rate in survival.

Might I add, teach your patients not to crush or chew these oral agent. Most of them are for extended-release dosings, so crushing or chewing them can cause a bolus.

IV Chemotherapy

Chemo is generally given in an IV. Most chemo patients will have a new IV site with each patient, however, some may have a port put in place.

Because chemo is a TBSA dosage usually, you will want to weight your patients’ every time they have chemo. Since they probably have been experiencing CINV, their weight is going to fluctuate.

A lot of chemo-drugs are whats called vesicants. These damage tissues FAST. You have to check your IV site frequently and make sure than infiltration is not occuring. Skin blanching, coolness, pain, and any leaking at the IV site are your s/s of infiltration. Please do not forget that this is a HORRIBLE adverse event that you want to prevent.

You also want to perform your regular IV care. Monitor the site frequently and be mindful of the infusion rate.

Oh my, that was a long review! Shoot me any questions. :)

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oraal01 · 6 months ago

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The Role of Radiation Therapy in Mucositis Development

Radiation therapy kills oral cancer cells by exposing the patient to radioactive materials or external radiation beams. After surgery, radiation therapy is most frequently used to destroy any cancer cells that might still be present in the oral cavity. In this article, we are going to discuss the role of radiation therapy in mucositis development.

What is Radiation Therapy?

One kind of cancer treatment is radiation therapy, sometimes known as radiotherapy. Intense laser beams are used in this treatment to destroy cancer cells. Radiation therapy is the most frequent application of X-rays. However, there are other forms of radiation therapy as well, such as proton radiation, chemoradiation, and brachytherapy.

Both internal and external radiation therapy are possible for the body. External beam radiation therapy is the most popular type of radiation treatment. One huge instrument used in this treatment is a linear accelerator. The device points high-energy beams at a specific spot on your body.

What is Oral Mucositis?

The mucosa is the protective mucous membrane that lines the whole gastrointestinal (GI) tract, extending from the mouth to the intestines. A painful infection of this membrane is called mucositis. Although mucous membranes border many of the cavities and canals in your body, mucositis mostly affects the mucosa in your digestive system, especially the oral mucosa. It is a typical adverse reaction to a number of cancer treatments, including chemotherapy, radiation therapy, and bone marrow transplants including stem cells.

Role of Radiation Therapy in Mucositis Development

Radiation therapy, often used to treat head and neck cancers, can, unfortunately, lead to radiation mucositis, a painful inflammation, and ulceration of the mucous membranes lining the mouth. This condition significantly impacts a patient's quality of life and can complicate cancer treatment. Effective mucositis oral treatment is essential to manage pain and facilitate healing. Common mucositis treatments include oral rinses, pain relievers, and protective coatings for the mucous membranes. Additionally, maintaining good oral hygiene and staying hydrated are crucial steps in managing this condition. Advanced treatments like low-level laser therapy and the use of growth factors are also showing effectiveness in the treatment. Understanding the role of radiation therapy in mucositis development is vital for developing better preventive and therapeutic strategies, ultimately aiming to improve patient outcomes and comfort during cancer treatment.

Treatment for mucositis

If you have oral mucositis, your doctor may prescribe one of the following treatments oral pain relievers, which come in pills, spray, or gel, mouthwashes that protect, numb, and cleanse your mouth or sprays or gels that replace saliva in your mouth to keep it moist. The recommended course of action for treating gastrointestinal mucositis will change based on how severe your symptoms are.

About Oraal Spray

Oraal spray is a type of pharmaceutical spray used to treat oral mucositis caused by radiation therapy or chemotherapy. Oraal spray tackles pro-inflammatory proteins, toxins, and contaminants in three different ways to attain the best results. The ORAAL SPRAY is a multi-layered treatment for oral mucositis. After just two days of treatment, the Oraal spray reduces pain and mucositis. Along with its benefits for mucositis and discomfort, it has also been shown to prevent burns and infections related to oral mucositis.

Also Read This Blog Surprising Mouth Ulcer Home Remedies You Didn’t Know About

How cancer patients are treated with radiation therapy

Radiation therapy may be administered for different reasons or at different times, depending on the details of your cancer treatment plan. Radiation therapy may be advised by medical staff: Given that it is the first and only method of curing cancer, The goals of neoadjuvant therapy are to lessen cancer before surgery, while adjuvant therapy aims to stop any cancer cells that remain after surgery from growing. in addition to further treatments like chemotherapy to eradicate cancer cells and lessen the indications that the disease has progressed.

Common Side Effects of Radiation Therapy

The following are the most common side effects of radiation therapy on the oral cavity:

Changes in the skin that will look like a sunburn

Voicelessness

Taste changes

Dry mouth

Weakened teeth

Pain

Sores

Redness in the mouth

Tightness of the facial muscles and the surrounding areas of the jawbones, resulting in difficulty eating, chewing, and speaking

Conclusion

Although radiation therapy is helpful in the treatment of cancer, it has side effects too. Oral mucositis is one of those adverse effects that arise after chemotherapy and radiation therapy. Therefore, it is important to stop oral mucositis from developing. Mucositis can be treated with a variety of products, including tablets, mouthwashes, gels, and sprays.

#mouth cancer symptoms #दांतों में इन्फेक्शन #Oral Mucositis #Mucositis Development #Oral Cancer #Chemotherapy #oral hygiene

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mokshalifestyle-us · 3 years ago

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HOW TO USE ESSENTIAL OILS?

Many essential oils are made good for the skin, body, and hair. We get to buy them anywhere in any shops around the globe. Their smell is the much attractive one. They are used as medicines in many ways like to treat back pain, joint pain, muscle pain, for getting good sleep, for getting good hair and hair growth, getting good and glowing skin, and much more. They will have the best results when used properly. But many of us don’t know how well it has to be used and when to use them and all. So this article will show you how to use them effectively. Essential oils are considered the best as it is produced by making use of many plant materials in making the smell of the oil the best and in healing body and muscle pains and making ourselves look good and feel great in all aspects.

There are three best ways to use essential oil effectively:

Used as AromatherapyThis is a therapy that is used for smelling the fragrance of the essential oil that helps in improving your health. They act as an easy way to keep you in good mood as when you breathe in, the smell of the oil, immediately goes into your nervous system, given them an emotional response. When smelled again they are also helpful in taking away your anxiety and stress actions more quickly. For using the oil-in therapy method, there are various ways, but whichever method you choose, you have to make sure that you should not use the oil directly but have to dilute them first.

Used in the form of Ingestion

These oils can be used by putting a few drops on your hot water, teas, or even one to two drops on your tongue. To use them orally, you should seek help from an experienced herbalist, to avoid any allergic reaction. In certain cases, they may be sensitive or harmful as they are very strong. It is so that with just a few drops, you are taking in a large amount of plant essential components without even knowing. There is chanced in burning the mucosal line that is present in your mouth.

Form of Topical Application

They can be used by directly applying them to your skin, but to be applied only after the oil is being diluted. They can be poured into any bottle or that have the end as a type of rollerball and can be applied easily.

Moksha Lifestyles is one such essential oil manufacturers that are dealing with the promotion of fragrance oils in India. At Moksha lifestyles, the essential oils are sold at a reasonable price for customers. They always make sure that large options of pack sizes readily meet their customer's requirements. It is they who make sure that they maintain a great and perfect quality of control standards that are ethical and germs-free. They provide the essential oils that are of the best quality and that are of quality with the greatest effect.

#Essential Oils #essential oils wholesale

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your-dietician · 3 years ago

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The Overlooked Drugs to Reconsider When Prescribing for Pain

New Post has been published on https://depression-md.com/the-overlooked-drugs-to-reconsider-when-prescribing-for-pain/

The Overlooked Drugs to Reconsider When Prescribing for Pain

A review of pain medications of the past and how they may help to optimize the treatments of today.

Pain-treating clinicians are constantly searching for medications that improve patient outcomes and/or that can minimize the use of opioids. Perhaps, older treatment modalities just need to be reconsidered.

Background

The management of pain – whether acute or chronic – is one of the most difficult medical conditions to treat and when treatment options are limited, the patient is the one left to suffer while the clinician bears the burden of trying to help the patient. The current opioid crisis in the US has significantly shifted the pendulum of opioid prescribing practices due to various restrictive guidelines, laws, regulations, and policies at both the federal and state level. Clinicians are challenged and quite possibly hesitant with managing complex pain syndromes in individuals with medical comorbidities.

Not all pharmacologic treatment options are viable for every case due to patient-specific factors, compelling medical indications and comorbidities, drug interactions, and even pharmacogenetics. Over time, some pharmacologic options are withdrawn from the market by the manufacturer, forgotten, or underutilized due to a lack of clinician knowledge or familiarity.

Here, we revisit this “land of lost analgesics” with the goal of refamiliarizing pain-treating clinicians – whether in specialty or primary care – with alternative treatment options that are worth consideration when initial first and second-line pain therapies have been optimized or are contraindicated. Potential uses, clinical considerations, and US availability are noted for each.

Not all pharmacologic treatment options are viable for every patient. Here, we revisit the “land of lost analgesics” with the goal of refamiliarizing pain-treating clinicians – whether in specialty or primary care – with alternative treatment options. (Image: iStock)

Skeletal Muscle Relaxants

Skeletal muscle relaxants are a broad category of medications consisting of a wide spectrum of drugs with different indications and mechanisms of action. Muscle relaxants can be divided into two main categories: antispasmodic and antispasticity medications. Antispasmodics are used to reduce muscle spasms resulting from a painful condition whereas antispasticity medications are used to decrease spasticity that hinders functionality.1

Orphenadrine citrate

Orphenadrine citrate is classified as an antispasmodic with the mechanism of action being unclear, but is a derivative of diphenhydramine and its activity is believed to be related to its sedative effects. In four placebo-controlled trials, orphenadrine was found to be fairly effective in some musculoskeletal conditions (acute low back pain, neck pain, nocturnal leg cramps) as well as symptoms of pain intensity, stiffness, and functionality.2

However, given orphenadrine’s chemical nature, it consequently possesses anticholinergic activity and thus patients may experience dry mouth, blurry vision, constipation, urinary retention, and cognitive dysfunction.1 Orphenadrine citrate is indicated for mild to moderate pain of acute MSK disorders and as an adjunct to rest, PT, and other measures for relief of discomfort associated with acute painful MSK conditions. In 2020, FDA granted a supplemental ANDA for a combination formulation of orphenadrine citrate with aspirin and caffeine in 2020.

Brand names: Norflex, Norgesic, Orphenesic Forte

Formulations: oral, injectable

Potential targets: acute low back pain, neck pain, nocturnal leg cramps

Available in US: Yes

Tolperisone

Tolperisone is classified as an antispasmodic with the mechanism of action possessing lidocaine-like-activity by stabilizing nerve membranes of mono- and polysynaptic reflexes in the spinal cord by blocking in a dose-dependent manner.1 Tolperisone was shown to be more effective than placebo for patients with chronic low back pain and overall improvement with short term use over 21 days, but no reduction of muscle spasms or pain.1 Unlike other skeletal muscle relaxants, tolperisone has been shown to exhibit less somnolence or cognitive adverse effects when used with for up to 14 days.3 As a skeletal muscle relaxant with less CNS adverse effects than currently available in some analgesics, tolperisone may offer a more promising option for patients.

Brand names: Mydocalm

Formulation: oral

Potential targets: low back pain

Available in US: No, but the manufacturer is recruiting for Phase 3 STAR study under ClinicalTrials.gov #NCT04671082; utilized in Europe since the 1960s

Dantrolene sodium

Dantrolene is classified as an antispasmodic medication with the mechanism of action on the PNS by blocking the calcium channel of the sarcoplasmic reticulum to reduce the concentration of calcium and diminishing the potential for an actin-myosin interaction which could produce a muscle contraction.1,2 Dantrolene has shown some efficacy for use in spasticity in debilitating conditions that hinders functionality, but there is little evidence exhibiting effectiveness for musculoskeletal conditions.1 Despite dantrolene bypassing the CNS and avoiding the typical adverse effects, it is consequently associated with hepatotoxicity and muscular weakness.1

Dantrolene is still commercially available in oral and injectable formulations and FDA approved for the treatment of spasticity associated with upper motor neuron disorders such as cerebral palsy, multiple sclerosis, spinal cord injury, and stroke.

Brand names: Dantrium, Ryanodex

Formulations: Oral, injectable

Potential targets: Muscle relaxation after CNS injury

Available in US: Yes

See also, a case report and review of dantrolene for muscle spasticity.

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

NSAIDs are used to inhibit the enzyme cyclooxygenase (COX) which is a bifunctional membrane-bound hemoproteinthat catalyzes the reduction of arachidonicacid to cyclic endoperoxide by bis-dioxygenation for the biosynthesisof prostaglandins, prostacyclin and thromboxanes.4

There are two principle isoforms of COX enzymes which are bifunctional enzymes consisting of both cyclooxygenase and peroxidase activity: COX-1 and COX-2. COX-1 is predominantly responsible for the production of prostaglandins necessary for maintaining normal endocrine and renal function, gastric mucosal lining, and hemostasis by mediating thromboxane A2 production to cause vasoconstriction and activate platelet aggregation. COX-2 is produced in response to inflammatory and mitogenic stimuli which is important in facilitating inflammation as well as the production of prostacyclin to promote vasodilation and inhibit platelet aggregation.5

Rofecoxib

Rofecoxib is a COX-2 selective NSAID consisting of a methylsulfone moiety and a lactone ring structure that makes it >800 times more selective for COX-2 than COX-1.6 In comparison to other NSAIDs, rofecoxib is about 6 to >20 times more selective for COX-2 than celecoxib, diclofenac, indomethacin, or meloxicam. As an NSAID with significant COX-2 specificity, rofecoxib has benefits of yielding effective analgesic and anti-inflammatory activity with reduced potential for GI-related adverse effects.6 Rofecoxib was originally FDA-approved for the management of acute pain in adults, primary dysmenorrhea, and osteoarthritis.4,6

In a Cochrane review of 26 RCTs evaluating the efficacy and safety of rofecoxib use in osteoarthritis compared to placebo, celecoxib, diclofenac, ibuprofen, naproxen, nimesulide, nabumetone, acetaminophen, and diclofenac/misoprostol combination, evidence showed that rofecoxib was more effective than placebo, but displayed no difference in efficacy when compared to the other NSAIDs at equivalent doses. From a safety standpoint, rofecoxib resulted in fewer GI-related adverse effects compared to celecoxib, ibuprofen, and naproxen with only one trial comparing rofecoxib to celecoxib reporting on the overall rates of GI-related adverse events comparing high dose rofecoxib with low dose celecoxib.7

In a similar fashion, three trials examining cardiovascular safety of rofecoxib and celecoxib used non-comparable doses with the results of those studies suggesting that rofecoxib caused more patients to experience a significant increase in systolic blood pressure and peripheral edema. However, there was no difference between rofecoxib and celecoxib in studies conducted among the general populations.7

In another Cochrane review of two RCTs evaluating the efficacy and safety of rofecoxib use in rheumatoid arthritis, one trial compared to placebo which rofecoxib exhibited a greater degree of efficacy while having a similar a safety profile.The second trial, known as the VIOXX GI Outcomes Research (VIGOR) study,was primarily designed to assess the safety of rofecoxib compared to naproxen which showed similar efficacy and lower GI-related adverse effects and bleeding, but consequently revealed a greater incidental finding of non-fatal myocardial infarctionsin the rofecoxib population.8,9

Fortunately, the overall mortality rate and rate of death from cardiovascular causes were similar in the two study groups. In another significant study, the Adenomatous Polyp Prevention on VIOXX (APPROVe) trial compared rofecoxib to placebo to evaluate its effectiveness in preventing the recurrence of colon polyps, but was unfortunately terminated prematurely due to increased incidence of myocardial infarctions and ischemic cerebrovascular eventsinitially seen following 18 months of continuous treatment.9,10

Similar to other NSAIDs with nephrotoxic adverse effects, rofecoxib causes dose-independent reductions in glomerular filtration rate and acute renal failure as well as reversible interstitial nephritis.11 Rofecoxib was subsequently voluntarily withdrawn from the market in September 2004. However, other COX-2 selective NSAIDs such as celecoxib, diclofenac, etodolac, and meloxicam are still commercially available for clinical use.

Benoxaprofen

Benoxaprofen is a arylalkanoic and proprionic acid derivative NSAID initially FDA-approved for the treatment of osteoarthritis and rheumatoid arthritis. Unlike other NSAIDs, benoxaprofen is a weak COX inhibitor, but also has an additional mechanism of action by inhibiting 5-lipoxygenase and mononuclear leukocyte migration and their chemotactic response. Benoxaprofen had a long elimination half-life 28-35 hours which allowed for once daily dosing making it convenient for clinicians to prescribe and patients to be adherent to therapy.12,13

There was strong consideration that benoxaprofen had disease-modifying effects in rheumatoid arthritis.13 A clinical trial in 2,204 patients with either active rheumatoid arthritis or symptomatic osteoarthritis treated with benoxaprofen for an average period of 14 months was shown effective for continuous antirheumatic stabilization with a single daily dose.14

Compared to other NSAIDs in rheumatoid arthritis and osteoarthritis, benoxaprofen has been shown to be more effective than aspirin or ibuprofen and more effective than ibuprofen with comparable efficacy to aspirin respectively.14 When benoxaprofen was compared to other NSAIDs such as indomethacin, naproxen, and sulindac, there was no significant difference in efficacy with rheumatoid arthritis patients.12

From an adverse effect profile, benoxaprofen is somewhat unique as it is associated with low incidences of peripheral edema and peptic ulcers, but has a high frequency of phototoxicity and onycholysis.12,14 Photosensitivity typically appears within 48 hours of treatment initiation and resolves 48 hours following discontinuation. Unfortunately, benoxaprofen was voluntarily withdrawn from manufacturer due to cholestatic jaundice with nephrotoxicity and hepatotoxicity. However, benoxaprofen is not unique with respect to its dual activity as a weak inhibitor of COX and its inhibitory effects on mononuclear leukocytes as sulindac has comparable potency and is still commercially available for clinical use.12

Choline Magnesium Trisalicylate

Choline magnesium trisalicylate (CMT) is a non-acetylated salicylate arylpropionic acid and arylacetic acid derivative NSAID that structurally contains choline salicylate and magnesium salicylate with analgesic and anti-inflammatory properties similar to aspirin. CMT does not inhibit platelet aggregation induced by two physiological aggregating agents, collagen and arachidonic acid or spontaneous platelet aggregation.15 The acetyl moiety on aspirin’s hydroxyl group facilitates it to alter factors of platelet function by irreversible acetylation of COX and thus inhibits the conversion of arachidonic acid to thromboxane A2 resulting in suppressing platelet aggregation and prolonged bleeding time. Unlike aspirin, CMT lacks an acetyl moiety and has choline and magnesium substituents on the carboxyl groups of the three salicylate molecules in its structure and as a result there is no interference with platelet aggregation or effect on bleeding.16

CMT may be an alternative NSAID for patients prescribed lithium as non-acetylated salicylates may be preferred to minimize risk for potential drug interactions and inducing lithium toxicity.17 However, CMT should still be used with caution and or avoided in patients with renal dysfunction, and compelling cardiovascular comorbidities such as congestive heart failure and coronary artery disease while prescribed other anticoagulants such as P2Y12 antagonists, phosphodiesterase-3 enzyme inhibitors, vitamin k antagonists, and direct-acting oral anticoagulants.

The most common adverse effects with CMT are similar to traditional NSAIDs with tinnitus and gastrointestinal issues (ie, gastric upset, heartburn, epigastric pain, diarrhea). CMT is FDA-approved for use in the relief of mild to moderate pain, management of acute painful shoulder, management of pyrexia, relief of sighs/symptoms of osteoarthritis, rheumatoid arthritis, and other arthritis (long-term management and acute flares), and anti-inflammatory or analgesic management (in children) of juvenile idiopathic arthritis and other appropriate conditions.

Zomepirac

Zomepirac is a pyrrole acetic acid a NSAID structurally similar to tolmetin, but is more lipophilic and may potentially have central analgesic effects. Zomepirac is nearly equivalent in potency to indomethacin and tolmetin as a COX-1 inhibitor of prostaglandin synthesis and was 2 or 3 times less active than diclofenac, but more active than aspirin, ibuprofen, or naproxen.Zomepirac is typically dosed 100 mg every 4 to 6 hours as needed, but should not be dosed greater than 400mg/day for three months or longer or exceed 600mg/day as these doses have not been studied and are not recommended.18,19

In looking at the data, zomepirac has demonstrated efficacy in relieving moderate to severe acute postoperative orthopedic, gynecologic, abdominal, and thoracic as well as dental pain.18-20 Zomepirac displayed greater efficacy over some opioids and may have been considered a viable option as an opioid sparing analgesic. In singe-dose studies in patients with acute pain, zomepirac 100mg exhibited greater efficacy compared to codeine 60 mg as well as other single agent non-opioid analgesics and other analgesic combinations. In single-dose crossover studies comprised of patients with moderate to severe postoperative pain, oral zomepirac 100 or 200mg was compared to intramuscular morphine 16mg and provided comparable analgesic effects and suggesting a “ceiling effect” of analgesic activity while also indicating that oral zomepirac was about one-sixth as potent as intramuscular morphine, but with a slower onset and longer duration of action.19

Adverse effects of zomepirac are fairly similar to other commonly prescribed NSAIDs such as gastrointestinal-related, however zomepirac exhibited a higher incidence of urogenital symptoms (ie. dysuria, cystitis, urinary frequency, hematuria, pyuria, and urinary tract infections) compared to other common NSAIDs and should be monitored more closely if used longer than six months. Following a single 200-mg dose, zomepirac sodium was shown to prolong the template bleeding time and decrease platelet retention significantly. Unlike aspirin and similar to other NSAIDs, zomepirac platelet inhibition is reversible and returns to normal function after 24 to 48 hours following discontinuation of therapy.18,20 Unfortunately, zomepirac was voluntarily withdrawn in due to various case reports of anaphylactic reactions. However, other COX-1 selective NSAIDs such as indomethacin and tolmetin with similar potency are still commercially available for use clinically applicable.

Brand names: Zomax

Formulation: oral

Potential targets: moderate to severe acute postoperative orthopedic, gynecologic, abdominal, thoracic, and dental pain

Available in US: No

Adjuvant Analgesics

Neuropathic pain can be one of the more challenging pain syndromes as intolerable symptoms may be intermittent, constant, aggravated, or spontaneous. Adjuvant analgesics consisting of antidepressants, anticonvulsants, as well as other medications with unique properties affecting the nerve cell membrane may be used to help minimize the frequency and intensity in alleviating neuropathic pain symptoms. Some adjuvant analgesics may benefit other medical conditions as well, such as comorbid mental health disorders, potentially minimizing the need for polypharmacy and pill burden.

Maprotiline

Maprotiline is a dibenzo-bicyclo-octadiene secondary amine tetracyclic antidepressant with a large lipophilic carbocyclic moiety and is distinguishable from tricyclic antidepressants by the presence of an ethylene bridge rendering its three-dimensional stereochemical configuration. Maprotiline exhibits similar activity as amitriptyline and imipramine, but has a more rapid onset of action and less anticholinergic adverse effects.21,22

Similar to imipramine, maprotiline exhibits strong norepinephrine reuptake inhibition activity across the nerve cell membrane as well as weak alpha-2 adrenergic blocking activity. Maprotiline undergoes first-pass hepatic metabolism primarily by N-demethylation, oxidative deamination, and aliphatic and aromatic hydroxylation to active formation of aromatic methoxy derivatives.21, 22 Maprotiline may initiated at 75 mg/day and can be titrated up to 225-300mg/day.22

In a double-blind cross over study with maprotiline 75mg/day compared to placebo in patients with chronic tension headache, treatment with maprotiline over a 6-week period was shown to be superior to placebo with mild side effects (drowsiness, dry mouth, increased appetite/weight gain).23 A study group consisting of patients with pain and depression were treated with maprotiline and gradually titrated to a target dose up to 300mg/day (150mg/day if 60 years or older) as tolerated resulted in 72% of patients responding with a greater than a 50% reduction in pain.24 In a randomized, double-blind, crossover trial, maprotiline was compared with amitriptyline in the treatment of postherpetic neuralgia displaying some pain relief, but was not as effective as amitriptyline unless treatment with amitriptyline had failed.25

Maprotiline has similar adverse effect profile as traditional tricyclic antidepressants given its anticholinergic activity with dizziness/faintness, blurry vision, dry mouth, constipation, orthostatic hypotension and tachycardia, but to a lesser degree as well as cutaneous rashes which are more common. Cardiovascular effects have been demonstrated with maprotiline as it can cause a decrease in standing systolic pressure, flattening of T-waves, an increase in heart rate and PR interval, prolongation of the pre-ejection period, as well as QT prolongation.22

Brand names: Ludiomil

Formulation: oral

Potential targets: depressionand anxiety

Available in US: Yes

More on the overlap between chronic pain conditions and psychiatric disorders.

Antiarrhythmics

Mexiletine

Mexiletine is a class 1B antiarrythmic agent FDA-approved for the treatment of ventricular arrhythmias. Pharmacologically, mexiletine is a structural analogue of lidocaine and acts by blocking voltage-gated sodium channels decreasing the rate of depolarization of ventricular cardiac myocytes, but also has similar potency in local anesthetic properties.26,27

Mexiletine is a racemic mixture of R-(–)- and S-(+)-enantiomers that possess characteristic antiarrhythmic potency with the R-(–)-enantiomer exhibiting increased cardiac sodium channel binding and greater antiarrhythmic activity than the S-(+)-enantiomer, but neither of the isomers significantly changed the electrocardiographic intervals (PR, QRS, QTc) or refractory periods.26 Mexiletine has been used to treat various neuropathic pain syndromes including: alcoholic neuropathy, cancer and radiation-induced neuropathic pain, painful diabetic neuropathy, dysaesthetic pain associated with multiple sclerosis, HIV-induced neuropathy, myofascial pain, peripheral nerve disease, phantom limb pain, postherpetic neuralgia, spinal cord injury, thalamic (post-stroke) pain, and trigeminal neuralgia.28

Mexiletine has a narrow therapeutic range from 0.75 to 2 mg/L that correlates serum concentration level to both its antiarrhythmic efficacy as well as adverse effects.26 However, there are no serum mexiletine concentration levels that correlate with efficacy in relieving neuropathic pain syndromes that have been studied. Therapeutic doses of mexiletine have ranged from 300 to 675mg/day, but clinicians should be vigilant and avoid dosages that can result in serum concentrations exceeding >2 mg/L. Mexiletine is predominantly hepatically metabolized via CYP2D6 to p-Hydroxymexilitine so dosage adjustments are not necessary in patients with severe renal dysfunction or on hemodialysis.28 The consequences of genetic polymorphism to CYPD6 in patients receiving mexiletine for neuropathic pain remain unclear, but should be used with caution and monitored closely during initiation and dose titrations especially in the setting of potential clinically significant drug-drug interactions.26,28

Opioids may have a potential clinically significant drug interaction with mexiletine. Despite there being no studies designed to evaluate the effects of opioids on the pharmacokinetics of mexiletine, it has been reported that patients taking morphine have significantly lower mean concentrations of mexiletine 3 hours following the first dose. The mechanism caused by the lower mexiletine serum concentration is believed to be due to opioids inhibiting gastric emptying and in turn slowing the absorption of mexiletine.26 (More on opioids below.)

The most common adverse effects patients may experience with mexiletine are dizziness or lightheadedness, tremor, nervousness, ataxia, nausea, anorexia, and gastric irritation, but tolerability may be improved with food or reducing the dose.27 Mexiletineis still commercially available in oral formulations and FDA-approved for the management of ventricular arrhythmias, but may potentially be an alternative option as an adjunct analgesic for neuropathic pain who have failed response or cannot tolerate first line treatment options.

Brand names: Mexitil

Formulation: oral

Potential targets: neuropathic pain

Available in US: Yes

Opioids

Opioids are not just purely mu-opioid agonists; some can be mixedmu opioid receptor agonist-antagonists, as well as agonists of the delta and or kappa opioid receptors with varying pharmacodynamic effects. Mixedmu opioid receptor agonist-antagonists are not used as often as full mu-opioid agonists due to their limited commercial availability, but as a result of their antagonist activity has less dependence and abuse potential.

Opioid analgesics may be considered as adjunctive therapy upon initiation and during optimization of non-opioid analgesics especially for severe pain, but dose and duration of therapy should be kept to a minimum where possible and consideration should be made to taper toward discontinuation as goals of therapy are met and as overall pain improves with optimization of non-opioid analgesics. If opioids are to be used, risk mitigation strategies such as obtaining an opioid treatment agreement or consent, review of prescription drug monitoring program reports, and conducting urine drug testing should be performed periodically as clinically indicated as recommended per established clinical practice guidelines as well as state regulations.

Butorphanol

Butorphanol is a synthetic phenanthrene kappa opioid receptor agonist, mixed mu opioid receptor agonist-antagonist, as well as apartial sigma receptor agonist which is responsible for psychotomimetic effects such as dysphoria, respiratory and vasomotor stimulation.29 potency of parental butorphanol ranges from 4 to 8 times more than morphine, 30 to 40 times more than meperidine, and 15 to 24 times more than pentazocine whereas oral is about 7 times more than codeine and 6 times more than pentazocine.29,30

Butorphanol’s antagonist activity is about 30 times more than pentazocine while only a fraction (1/40) of naloxone and given its high binding affinity to the mu opioid receptor, higher doses of naloxone may be necessary in order to reverse any adverse effects of butorphanol compared to pure opioid agonists such as morphine.29 The absorption of butorphanol is adequate via oral and parenteral routes, but undergoes extensive first-pass hepatic metabolism primarily by hydroxylation to the major metabolite hydroxybutorphanol and N-dealkykation to minor metabolite norbutorphanol which leaves oral bioavailability yielding about only 5 to 17%. With transnasal administration of butorphanol on the other hand, this route of administration bypasses the gastrointestinal tract, and improving bioavailability to about 48 to 70% similar to parenteral administration.30

Additionally, transnasal butorphanol absorbs rapidly while providing onset of analgesia within 15 minutes making it an ideal short-term treatment option for patients with moderate to severe acute postoperative, musculoskeletal and migraine headache pain. The bioavailability and pharmacokinetics of transnasal butorphanol may be influenced by age and sex as the median value for tmax was marginally higher in the elderly (older than 65 years) in elderly men (75%), but was significantly lower in elderly women (48%). However, the bioavailability in young men (68%) and young women (70%) the Cmax and AUC values were relatively similar.30

The most common adverse effects to be expected from butorphanol are sedation, drowsiness, dizziness, as well as nausea and/or vomiting. Unlike pure opioid agonists such as morphine which can cause respiratory depression in a dose proportional manner, butorphanol exhibits a ‘ceiling effect’ with respect to the degree of respiratory depression such as increasing doses beyond 2mg may not result in a corresponding increase in degree of respiratory depression, but the duration of respiratory depression increases with higher doses.29,30 Butorphanol has hemodynamic effects similar to pentazocine but to a lesser degree with cardiovascular effects consisting of: increased pulmonary artery and wedge pressure, increased left ventricular end diastolic pressure, increased systemic arterial pressure, increased pulmonary vascular resistance, as well as increases to cardiac index and cardiac work.29

Considering these cardiovascular effects, butorphanol should be used with caution or avoided where possible in patients with acute myocardial infarction, coronary insufficiency, or ventricular dysfunction. Butorphanol is FDA-approved for use in the relief of moderate to severe pain, as a supplement to balanced anesthesia, for the relief of postpartum pain, and as preoperative or preanesthetic medication with the ladder three indications utilizing injectable formulations only.29

Brand names: Stadol (International)

Formulation: nasal, injectable

Potential targets: moderate to severe pain, postpartum pain, perioperative

Available in US: Yes (generic); Stadol (US) was discontinued due to severe hypertension

Nalbuphine

Nalbuphine is a semi-synthetic phenanthrene kappa opioid receptor agonist and mixed mu opioid receptor agonist-antagonist structurally similar to oxymorphone and naloxone.29,31,32The potency of parental nalbuphine is equivalent to approximately 0.7 to 0.8 times that of morphine whereas oral is 3 times more than codeine.29,32

In comparison to pentazocine, nalbuphine is about 3 to 4 times more potent with a longer duration of action and 10 times more effective with its antagonist activity.29,31 Similar to butorphanol, nalbuphine exhibits sufficient absorption via oral and parenteral routes, but undergoes extensive first-pass hepatic metabolism with oral bioavailability yielding only about 20%.29

Much like any other opioid, the most common adverse effects exhibited with nalbuphine include sedation, drowsiness, dizziness, as well as nausea and/or vomiting.29 Comparable to butorphanol, nalbuphine also exhibits a “ceiling effect”, but to both the degree and duration of respiratory depression as escalating doses does not prolong the duration of respiratory depression beyond 3 hours regardless of dose and thus resulting in a plateau of the respiratory depression curve.29,31,32 In a study comparing nalbuphine and morphine in patients with acute myocardial infarction, nalbuphine did not cause any adverse clinical or hemodynamic effects despite decreasing heart rate and contractility, but maintained aortic pressure and hence sustaining the balance between myocardial oxygen supply and demand.29

Nalbuphine’s cardiovascular benefits with decreasing heart rate and contractility while maintaining aortic perfusion pressure may prevent further cardiac ischemia in patients with acute myocardial infarction. Nalbuphine is FDA-approved for use as an analgesic for moderate to severe pain, for preoperative analgesia, as a supplement to surgical anesthesia, and as obstetrical analgesia during labor.29

Brand names: Nubain

Formulation: injectable

Potential targets: moderate to severe pain, perioperative, labor

Available in US: Yes

Propoxyphene

Propoxyphene is a synthetic diphenyl heptane mu opioid receptor agonist, kappa opioid receptor agonist, and noncompetitive N-methyl-D-aspartate (NMDA) receptor antagoniststructurally similar to methadone that has two centers of asymmetry and exists as four stereoisomers: alpha-dextrorotatory isomer, alpha-levorotatory isomer, dextropropoxyphene, and levopropoxyphene. Dextropropoxyphene exhibits analgesic activity and levopropoxyphene has antitussive activity while the other levorotatory isomers are relatively inactive, but overall none of the isomers can be converted into methadone.Propoxyphene is about 33.33% to 50% the potency of codeine which is deemed to be less efficacious than a 650 mg dose of aspirin.Propoxyphene has rapid absorption via oral route and undergoes extensive first-pass hepatic metabolism primarily by N-demethylation to norpropoxyphene and yielding bioavailability of about only 18-25% from a 65mg dose. Propoxyphene is both a CYP450 2D6 inhibitor and substrate and consequently may be subjected to genetic polymorphisms as well as potential drug interactions.33,34

In a review written by Miller and colleagues, among 243 articles referencing propoxyphene, only 20 double-blind or triple-blind clinical studies were identified creditable for review. Fifteen studies showed that codeine at lower or equal analgesic doses produced comparable or greater analgesic efficacy than propoxyphene, but within the same parameters no study demonstrated that codeine was inferior to propoxyphene. Seven studies showed that aspirin alone or aspirin in combination with phenacetin, and caffeine (at various doses) were comparable or had greater analgesic efficacy than propoxyphene.35

Not all of the comparison studies reviewed presented propoxyphene as inferior as two separate studies showed that propoxyphene hydrochloride 65 mg was superior to codeine 32.5 mg and aspirin 325 mg alone. When compared to placebo, nine studies showed propoxyphene to be superior while seven other studies it was not.35

Common adverse effects with propoxyphene are similar to other opioids which include: dizziness, lightheadedness, visual disturbances, somnolence, drowsiness, seizures, euphoria, nausea, vomiting, abdominal pain, constipation, urinary retention. The metabolite norpropoxyphene is primarily renally eliminated and if accumulated may result in potentially fatal CNS, cardiac, and respiratory adverse events such as cardiac arrest, pulmonary edema, seizures, and even mortality.34

Norpropoxyphene has more potent direct cardiac adverse effects which include: an increase in bradycardia, decreased contractility, decreased electrical conductivity, QTc interval prolongation, as well as local anesthetic properties similar to lidocaine or quinidine which may precipitate arrhythmias. Incidents of pulmonary edema and seizures were believed to be secondary to propoxyphene and its metabolite norpropoxyphene in both high-risk patients and at high doses. Prior to removal, propoxyphene was falling out of favor by clinicians and was perceived to have no therapeutic benefit in the management of acute and/or chronic pain while having greater mortality risk due to its cardiac and neurologic toxicity profile.34

In 2009, the FDA required the drug manufacturer to conduct a multiple-ascending dose (MAD) study which was a randomized, double-blind, placebo-controlled sequential multiple-ascending dose study of propoxyphene for 11 days evaluating 600 mg and 900 mg cohorts. The results of the MAD study were submitted to the FDA by the manufacturer showing significant QTc interval prolongations observed with propoxyphene 600 mg and 900 mg dose cohorts. In 2010, the FDA concluded that the safety risks of propoxyphene outweighed the benefits and recommended against its use due to significant abnormal heart rhythm and electrical activity changes with the prolonged PR interval, widened QRS complex and prolonged QT interval at therapeutically prescribed doses.36

Propoxyphene was withdrawn by the manufacturer promptly afterward due to the FDA’s cardiotoxicity warning. Other short-acting immediate-release opioids such as codeine, hydrocodone, and oxycodone alone or in combination with acetaminophen are still currently available for use in acute severe breakthrough pain as clinically indicated.

Brand names: Darvocet-N (propoxyphene and acetaminophen)

Formulation: oral

Potential targets: breakthrough pain

Available in US: No, but similar products are still available

Levorphanol

Levorphanol has been referred to as the “forgotten opioid” that is phenanthrene mu, delta, and kappa opioid receptor agonist and non-competitive NMDA receptor antagonist structurally similar to morphine, but without an oxygen and a 6-hydroxyl group.37-39 Similar to morphine, levorphanol has anticholinergic effects and like methadone, levorphanol inhibits the uptake of serotonin and norepinephrine.38 However, unlike methadone, levorphanol has a shorter and more predictable half-life of about 11 to 16 hours with a longer duration of action, and no CYP450 or P-gp drug interactions or associated with any QTc prolongation risk.37

Levorphanol exhibits good absorption through the intramuscular, subcutaneous, and oral routes of administration and undergoes phase II metabolism via glucuronidation to levorphanol-3-glucuronide that is renally eliminated. In some special populations such the elderly, palliative care, and SCI patients, levorphanol may be a viable option and may require a lesser need for coadministration of adjuvant analgesics.37

Common adverse effects with levorphanol are similar to other opioids such as nausea, vomiting, sedation, dizziness, constipation, pruritis, urinary retention, but a unique adverse effect is a potential increase in bile duct pressure which should be avoided in biliary surgery patients.39 Levorphanol is FDA-approved for management of pain severe enough to require an opioid analgesic and for which alternative treatments are inadequate.

Brand names: Levo-Dromoran

Formulation: oral

Potential targets: severe pain

Available in US: Yes

Clinical Takeaways

Pharmacologic options of the past for treating acute, chronic, and perioperative pain may still be of clinical use. While some analgesic medications, including adjuvants, have been voluntarily withdrawn from the market by the manufacturer, others are still available and simply remain forgotten or underutilized. Pain practitioners across specialties are encouraged to refamiliarize themselves with these drugs in case they may benefit a particular patient who is refractory to or contraindicated for more widely used products.

Not all pharmacologic treatment options, however, are viable for every case; as with any prescription, risks and benefits must be weighed. Having a fuller, even if older, arsenal of potential treatment modalities for pain management can only serve to benefit the clinician and the patient. All pharmacologic treatment options old and new should be reconsidered based within patient-specific clinical parameters and trialed as potential alternative analgesics where possible.

Miguel Escanelle, MD, and Christopher P. Emerson, MD, MS, contributed to the research of this article.

This commentary is the sole opinion of the author and does not reflect the opinion of employers, employee affiliates, and/or pharmaceutical companies mentioned or specific drugs discussed. It was not prepared as part of official government duties for Dr. Pham. Dr. Pham dedicates this article mentor and friend Jeffrey Fudin, PharmD.

Last updated on: September 8, 2021

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Yashtimadhu vedas cure

Yashtimadhu

Epilepsy or seizure problem is a very normal issue that effects around 1 million individuals in India, alone. The condition can't be restored yet the indications can be controlled and treated to help the patient's condition. Epilepsy brings about seizures because of the failing of nerve cells or neurons. There are a few reasons concerning why epilepsy occurs and a few sorts of medicines.

Yashtimadhu oil is an old ayurvedic substance that is known to make the alleviation epilepsy. It centers around adjusting the energies or doshas very much like other ayurvedic meds and mends the main driver of the issue. It is known to work for epilepsy by a comprehensive methodology.

HOW Could YASHTIMADHU HELP?

Yashtimadhu oil utilizes are huge. It is otherwise called mulethi in Hindi or Liquorice in English.

· Respiratory and Digestive issues – Yashtimadhu oil or Yashtimadhu powder is utilized by Ayurveda to treat a few issues identified with breath and processing. Mulethis is known to profit and work on enduring states of sharpness.

· To hold the cholesterol level under control – Yashtimadhu or Licorice plant's root is known to be viable for holding the cholesterol levels in line by expanding the great cholesterol and diminishing the terrible cholesterol and protects you from lethal failing of substantial organs.

· Improves the strength of your Liver – Yashtimadhu or mulethi is known to liberate the body from your poisons and keep your liver solid by sanitizing your body from within.

· Reduces pressure and sorrow – It helps in decreasing mental pressure and sadness by chipping away at adjusting the pressure chemicals or different chemicals connected with melancholy and stress.

· Immunity supporter – Mulethi is a well established realized cure consistently recommended by our grandparents for a few reasons and the most widely recognized one being invulnerability. In the event that our resistance is solid, there is none too little damage that can be caused to your wellbeing.

· Skin afflictions – Yashtimadhu oil or powder of the base of the plant, is valuable for a few skin-related infirmities because of mending properties. It likewise shields your skin from microscopic organisms and other unsafe substances to forestall wellbeing issues. It assists with messes like psoriasis, rashes, dry skin, and others.

· Helps in keeping up with weight – The base of the mulethi plant is known to assist with consuming the overabundance fat in your body and assisting you with keeping up with weight and not be overweight as being overweight welcomes a few issues.

· Throat-related concerns – Yashtimadhu powder is viewed as an astounding remedy for throat concerns like sore throat and hack. They likewise cause help against issues like asthma, bronchitis, and other respiratory parcel contaminations.

· Epilepsy – as of now referenced previously, it is known to assist with epilepsy.

COST OF YASHTIMADHU OIL

Yashtimadhu oil is an ayurvedic medication and it doesn't cost a lot. Ayurvedic medications are produced using normal or natural substances found in nature and the strategy to make this medication is additionally regular, subsequently, the expense is insignificant.

The creation cost of ayurvedic medications is insignificant, consequently even in the wake of adding a benefit, the selling cost is still low. Yashtimadhu oil and yashtimadhu powder are made by a few driving ayurvedic brands for you to look over them.

Dose OF YASHTIMADHU OIL

Dose of Yashtimadu oil or powder ought to rely upon the remedy. Overabundance of anything isn't useful for the body regardless of whether it is a helpful medication thus, adhering to the remedy is suggested.

Not after the medicine couldn't demolish things much more which is the reason an expert specialist would endorse it as indicated by your body and disease.

WHAT IS EPILEPSY?

Epilepsy is an issue that outcomes in unexpected seizures. Seizures occur because of failing or abrupt surge of electric action through the synapses. Seizures are of two kinds – Generalized seizures which influence the whole mind and halfway seizures which influence a piece of it. Fractional seizures are otherwise called central seizures.

While getting a seizure, an individual may likewise need mindfulness and become oblivious. It is a truly normal neurological issue that influences individuals of the two sexual orientations, ages, and nationality similarly. Epileptic seizures are unwarranted and abrupt. Individuals with epilepsy have various types of seizures and side effects which are diverse for various individuals.

More grounded seizures could cause more damage and manifestations like muscle jerking separated from blacking out.

Manifestations of incomplete epileptic seizures –

· An incomplete seizure would exclude manifestations like loss of awareness. It remembers changes for force or power of detecting by adjusting taste, smell, and so forth

· Partial seizures lead to dazedness.

· Twitching and shivering in the appendages are additionally normal in a halfway epileptic seizure.

· The unpredictable halfway seizure would include loss of cognizance, gazing vacantly.

· The unpredictable halfway seizure would likewise include lethargy and rehashing activities.

One of the extremely normal results of Radiation/Chemotherapy particularly of the head and neck malignancies is mucositis. Malignancy treatment or the actual disease might cause changes in the body science that outcomes in loss of craving, torment, sickness, regurgitating, loose bowels and extremely normal mucositis which makes eating troublesome. Loss of craving is trailed by an unfortunate deficiency of weight because of lacking measure of calories consistently which can prompt loss of bulk and strength and different difficulties by causing interferences of clinical treatment, hindering compelling disease treatment. Mucositis cause diminished resistance and personal satisfaction just as helpless resilience to medical procedure and modified adequacy of Chemotherapy and Radiotherapy. The current investigation is planned with the goal to limit the radiation prompted mucositis, skin response, xerostomia, change in voice and so forth with an Ayurvedic readiness Yashtimadhu Ghrita (prepared ghee). All out 75 patients were arbitrarily isolated into four gatherings and medications were regulated: Group A with neighborhood utilization of Yashtimadhu powder and nectar in the oral hole for few moments before radiotherapy alongside oral admission of Yashtimadhu Ghrita; Group B with just nearby use of the Yashtimadhu powder and nectar in the oral depression; Group C patients directed with just neighborhood use of nectar in the oral cavity; Group D on ordinary present day prescription controlled gathering. This load of patients under four gatherings had gotten Radiotherapy and Chemotherapy for greatest span of 7 weeks. Mucositis and Skin responses were seen in 100% of patients with shifting degree. The force of Radiation and Chemotherapy prompted mucositis was diminished generally by the preliminary medication. Yashtimadhu (Glycyrrhiza glabra) can be utilized viably in counteraction and therapy of oral mucositis post radiation and chemotheraphy in patients of malignant growth, particularly of the head and neck district. It demonstrates useful twoly: (I) there were no breaks in the treatment, and (ii) food admission was not seriously influenced prompting support of dietary status of the patients.

Catchphrases: Head and neck malignant growth, oral mucositis, radio-chemotherapy, Yashtimadhu ghrita

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Oral malignant growth is perhaps the most well-known diseases on the planet, commonest in India, Bangladesh, Srilanka and Pakistan. In India, head and neck carcinoma[1] (HNCA) represent 30-40% tumors at all locales, out of which 9.4% are oral malignancies. It is the 6th normal reason for death in guys and seventh in females. In North-east India, occurrence of tobacco related oral diseases is about 33%. The dismalness and mortality related with this sickness is a reason for significant worry around here. Many elements ensnared for its inclination are utilization of tobacco in its different structures, liquor, smoking propensities, helpless oral cleanliness, absence of mindfulness, and absence of appropriate sustenance. No entanglement of malignant growth treatment[2] is more intensely upsetting than stomatitis. The oral cavity, regularly a carefully adjusted and impeccably touchy entrance, can turn into a site of outrageous distress. Stomatitis, or oral mucositis, is characterized as the irritation of the oral mucous layers. Such irritation influences one's feeling of taste and smell, just as nourishment and hydration, and may well diminish the attractiveness of oral meds. Oral Mucositis[3] happens in 15-40% of patients getting standard chemotherapy and 100% of patients getting radiation treatment for head and neck malignancy are tormented with oral mucositis of fluctuating degree. At present, the overall populace with mucositis is assessed at 400,000 to 600,000 getting chemotherapy or radiation. Ionizing radiation[4] causes different changes in ordinary tissues, contingent upon firmly interrelated elements of absolute portion, fractionation plan (day by day portion and time), and Volume treated.

In Ayurvedic works of art like Charaka samhita[5] and Sushruta samhita[6] disease is portrayed as Arbuda (significant neoplasm) or Granthi (minor neoplasm) and Tridoshaja/Sannipataja assortments of as the harmful phase of neoplasms or unusual developments have been depicted. Ayurveda can be useful in the administration of malignant growth from various perspectives, as prophylactic, palliative, healing and, strong and without a doubt it assists with working on the personal satisfaction (QOL),[7] as an adjuvant treatment alongside chemotherapy or radiotherapy and post a medical procedure care, to limit the symptoms of these treatments. Albeit the unfavorable impacts of radiotherapy and chemotherapy can't be completely stayed away from, there are approaches to limit the results of these treatment systems. Subsequently, an endeavor has been made to limit the radiation prompted mucositis, skin response, xerostomia, change in voice and so on with an Ayurvedic Ghrita planning I. e. Yashtimadhu Ghrita.[8] Also, we have attempted to survey the viability of the pre-arranged medication in the recuperating or insurance of the above said

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chetan1234567890000000 · 3 years ago

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Vitiligo

Vitiligo is a skin issue in which smooth white regions (called macules or patches) show up on an individual's skin. It for the most part begins the hands, lower arms, feet and face. All around the world, about 1% or thereabouts of the populace has vitiligo.

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Side effects and Causes Conclusion and Tests The board and Treatment Counteraction Viewpoint/Forecast Living With Assets

Outline

Vitiligo

What is vitiligo?

Vitiligo (vit-il-EYE-go) is a skin issue that makes the skin lose its tone. Smooth white regions (called macules if under 5mm or patches if 5mm or bigger) show up on an individual's skin. In the event that you have vitiligo in a spot that has hair, the hair on your body may likewise become white.

The condition happens when melanocytes (the skin cells that produce melanin, the synthetic that gives skin its tone, or pigmentation) are annihilated by the body's safe framework.

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How does vitiligo advance?

Vitiligo ordinarily starts with a couple of little white fixes that may continuously spread over the body throughout a while. Vitiligo regularly starts on the hands, lower arms, feet, and face however can create on any piece of the body, including the mucous layers (soggy coating of the mouth, nose, genital, and rectal regions), the eyes, and internal ears.

Some of the time the bigger patches proceed to extend and spread, yet for the most part they stay in similar spot for quite a long time. The area of more modest macules moves and changes after some time, as specific spaces of skin lose and recapture their shades. Vitiligo changes in the measure of skin influenced, for certain patients encountering not many depigmented regions and others with broad loss of skin tone.

What are the kinds of vitiligo?

Vitiligo can be:

Summed up, which is the most widely recognized sort, when macules show up in different spots on the body.

Segmental, which is confined aside of the body or one region, like the hands or face.

Mucosal, which influences mucous layers of the mouth or potentially the private parts.

Central, which is an uncommon kind where the macules are in a little region and don't spread in a specific example inside one to two years.

Trichome, which implies that there is a white or drab focus, then, at that point a space of lighter pigmentation, and afterward a space of ordinarily hued skin.

All inclusive, another uncommon sort of vitiligo, and one in which over 80% of the skin of the body needs color.

How normal is vitiligo?

Vitiligo happens in about 1% or marginally a greater amount of the populace all through the world. Vitiligo influences all races and sexes similarly; in any case, it is more noticeable in individuals with more obscure skin. In spite of the fact that vitiligo can create in anybody at whatever stage in life, it most ordinarily shows up in individuals ages 10 to 30 years. Vitiligo once in a while shows up in the exceptionally youthful or extremely old.

Side effects AND CAUSES

What causes vitiligo?

Albeit the reasons for vitiligo aren't totally perceived, there are various speculations:

Immune system problem: The influenced individual's invulnerable framework may foster antibodies that obliterate melanocytes.

Hereditary elements: Certain variables that may expand the shot at getting vitiligo can be acquired. About 30% of vitiligo cases run in families.

Neurogenic elements: A substance that is poisonous to melanocytes might be delivered at sensitive spots in the skin.

Implosion: An imperfection in the melanocytes makes them annihilate themselves.

Vitiligo may likewise be set off by specific occasions, like physical or enthusiastic pressure. Since none of the clarifications appear to totally represent the condition, it's anything but's a mix of these variables is liable for vitiligo.

Is vitiligo difficult?

Vitiligo isn't difficult. Be that as it may, you can get difficult burns from the sun on the lighter patches of skin. Secure yourself against the sun with measures like utilizing sunscreen, avoiding the sun during the hours that it is most grounded, and wearing defensive attire. A few group with vitiligo have revealed having irritated skin in some cases, including before the depigmentation begins.

Would i be able to acquire vitiligo?

Vitiligo isn't really acquired. In any case, about 30% of individuals who have vitiligo do have somewhere around one direct relation who additionally has vitiligo.

What are the signs and side effects of vitiligo?

Signs and manifestations of vitiligo incorporate the accompanying:

Patches of skin lose shading. This can incorporate the eyes or potentially the mucous films in your mouth or nose.

Patches of hair on your head or face become rashly dark or white.

What issues are related with vitiligo?

Despite the fact that vitiligo is basically a restorative condition, individuals with vitiligo may encounter an assortment of issues:

Since they need melanocytes, macules are more delicate to daylight than the remainder of the skin, so they will consume as opposed to tan.

Individuals with vitiligo may have a few irregularities in their retinas (the internal layer of the eye that contains light-touchy cells) and some variety of shading in their irises (the hued part of the eye). At times, there is some irritation of the retina or iris, yet vision is generally not influenced.

Individuals with vitiligo might be bound to get other immune system illnesses (in which the body's resistant framework makes it assault itself), like hypothyroidism, diabetes, malignant weakness, Addison's infection, and alopecia areata. Likewise, individuals with immune system sicknesses are more in danger of creating vitiligo.

Individuals with vitiligo may feel humiliated or restless about their skin. At times individuals are impolite – they may gaze or express cruel things. This could make an individual with vitiligo foster low confidence. This thusly could make nervousness or sorrow issues and make somebody need to disconnect. On the off chance that this occurs, you should converse with your medical care supplier or your loved ones to help you discover an answer.

Analysis AND TESTS

How is vitiligo analyzed?

Normally the white patches are effectively apparent on the skin, however medical care suppliers can utilize a Wood's light, which sparkles bright (UV) light onto the skin to help separate from other skin conditions.

What different conditions take after vitiligo?

There are different conditions that make the skin change or lose pigmentation. These include:

Compound leukoderma: Openness to some mechanical synthetics cause harm to the skin cells, coming about in straight or splotchy white spaces of skin

Fungus versicolor: This yeast contamination can make dull spots that show on fair complexion, or light spots that show on hazier skin.

Albinism: This hereditary condition implies that you have lower levels of melanin in the skin, hair and additionally eyes.

Pityriasis alba: This condition gets going with red and textured spaces of skin, what blur into layered lighter patches of skin.

The board AND TREATMENT

How is vitiligo treated?

There is no remedy for vitiligo. The objective of clinical treatment is to make a uniform skin tone by either reestablishing shading (repigmentation) or wiping out the leftover tone (depigmentation). Normal medicines incorporate disguise treatment, repigmentation treatment, light treatment and medical procedure. Guiding may likewise be suggested.

Cover treatment:

Utilizing sunscreen with a SPF of 30 or higher. Likewise, the sunscreen should protect bright B light and bright A light (UVB and UVA). Utilization of sunscreens limits tanning, subsequently restricting the difference among influenced and typical skin.

Cosmetics help cover depigmented regions. One notable brand is Dermablend®.

Hair colors if vitiligo influences the hair.

Depigmentation treatment with the medication monobenzone can be utilized if the illness is broad. This drug is applied to pigmented patches of skin and will turn them white to coordinate with the spaces of vitiligo.

Repigmentation treatment:

Corticosteroids can be taken orally (as a pill) or topically (as a cream put on the skin). Results may require as long as 90 days. The specialist will screen the patient for any incidental effects, which can incorporate skin diminishing or striae (stretch imprints) whenever utilized for a delayed period.

Effective nutrient D analogs.

Effective immunomodulators, for example, calcineurin inhibitors.

Light treatment:

Limited band bright B (NB-UVB) expects a few treatment meetings each week for a while.

Excimer lasers emanates a frequency of bright light near that of limited band UVB. This is better for patients who don't have far reaching or enormous injuries since it is conveyed to little, designated regions.

Consolidating oral psoralen and UVA (PUVA) is utilized to treat huge spaces of skin with vitiligo. This treatment is supposed to be exceptionally viable for individuals with vitiligo in the space of the head, neck, trunk, upper arms and legs.

Medical procedure:

Autologous (from the patient) skin joins: Skin is taken from one piece of the patient and used to cover another part. Potential confusions incorporate scarring, disease or an inability to repigment. This may likewise be called little uniting.

Micropigmentation: A kind of inking that is normally applied to the lips of individuals influenced by vitiligo.

Guiding:

Vitiligo can cause mental trouble and can influence an individual's standpoint and social associations. In the event that this occurs, your parental figure may recommend that you discover an advocate or go to a care group.

Avoidance

How might I forestall vitiligo?

Since nobody knows for certain what causes vitiligo, nobody can disclose to you how to forestall it. As a general rule, it is keen for everybody to pursue safe sun openness routines and to take great consideration of your skin.

Viewpoint/Guess

What is the viewpoint for individuals with vitiligo?

About 10% to 20% of individuals who have vitiligo completely recover their skin tone. Individuals with the most obvious opportunity with regards to recapturing skin tone are the individuals who are youthful, whose vitiligo arrives at its top in under a half year and is found essentially on the facial region. Individuals who are more averse to recapture their shading are those

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digitalyogesh · 4 years ago

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What is vitiligo?

Vitiligo

Vitiligo is a skin issue in which smooth white regions (called macules or patches) show up on an individual’s skin. It for the most part begins the hands, lower arms, feet and face. Internationally, about 1% or so of the populace has vitiligo. Vitiligo

Arrangements and ACCESS

Get in touch with US

Indications and Causes Diagnosis and Tests Management and Treatment Prevention Outlook/Prognosis Living With Resources

Outline Vitiligo

What is vitiligo?

Vitiligo (vit-il-EYE-go) is a skin issue that makes the skin lose its tone. Smooth white regions (called macules if under 5mm or patches if 5mm or bigger) show up on an individual’s skin. In the event that you have vitiligo in a spot that has hair, the hair on your body may likewise become white.

The condition happens when melanocytes (the skin cells that produce melanin, the synthetic that gives skin its tone, or pigmentation) are annihilated by the body’s insusceptible framework.

How does vitiligo advance? Vitiligo

Vitiligo ordinarily starts with a couple of little white fixes that may continuously spread over the body throughout a while. Vitiligo normally starts on the hands, lower arms, feet, and face yet can create on any piece of the body, including the mucous layers (sodden coating of the mouth, nose, genital, and rectal regions), the eyes, and inward ears.

Some of the time the bigger patches proceed to extend and spread, however normally they stay in similar spot for quite a long time. The area of more modest macules moves and changes over the long haul, as specific spaces of skin lose and recapture their colors. Vitiligo changes in the measure of skin influenced, for certain patients encountering not many depigmented regions and others with inescapable loss of skin tone.

What are the sorts of Vitiligo ?

Vitiligo can be:

Summed up, which is the most widely recognized sort, when macules show up in different spots on the body. Vitiligo

Segmental, which is confined aside of the body or one region, like the hands or face.

Mucosal, which influences mucous films of the mouth and additionally the private parts.

Central, which is an uncommon kind where the macules are in a little region and don’t spread in a specific example inside one to two years. Vitiligo

Trichome, which implies that there is a white or vapid focus, then, at that point a space of lighter pigmentation, and afterward a space of typically hued skin.

General, another uncommon kind of vitiligo, and one in which over 80% of the skin of the body needs shade.

How normal is vitiligo? Vitiligo

Vitiligo happens in about 1% or somewhat a greater amount of the populace all through the world. Vitiligo influences all races and sexes similarly; notwithstanding, it is more noticeable in individuals with hazier skin. Despite the fact that vitiligo can create in anybody at whatever stage in life, it most regularly shows up in individuals ages 10 to 30 years. Vitiligo seldom shows up in the youthful or exceptionally old. Vitiligo

Side effects AND CAUSES

What causes vitiligo?

Albeit the reasons for vitiligo aren’t totally perceived, there are various hypotheses:

Immune system issue: The influenced individual’s invulnerable framework may foster antibodies that obliterate melanocytes. Vitiligo

Hereditary variables: Certain elements that may build the shot at getting vitiligo can be acquired. About 30% of vitiligo cases run in families. Vitiligo

Neurogenic variables: A substance that is poisonous to melanocytes might be delivered at sensitive spots in the skin. Vitiligo

Implosion: An imperfection in the melanocytes makes them annihilate themselves.

Vitiligo may likewise be set off by specific occasions, like physical or enthusiastic pressure. Since none of the clarifications appear to totally represent the condition, it’s anything but’s a blend of these variables is answerable for vitiligo.

Is vitiligo difficult?

Vitiligo isn’t agonizing. Nonetheless, you can get agonizing burns from the sun on the lighter patches of skin. Secure yourself against the sun with measures like utilizing sunscreen, avoiding the sun during the hours that it is most grounded, and wearing defensive apparel. A few group with vitiligo have detailed having bothersome skin in some cases, including before the depigmentation begins.

Would i be able to acquire vitiligo?

Vitiligo isn’t really acquired. Notwithstanding, about 30% of individuals who have vitiligo do have somewhere around one direct relation who additionally has vitiligo.

What are the signs and indications of vitiligo?

Signs and manifestations of vitiligo incorporate the accompanying:

Patches of skin lose shading. This can incorporate the eyes and additionally the mucous layers in your mouth or nose.

Patches of hair on your head or face become rashly dark or white.

What issues are related with vitiligo?

Despite the fact that vitiligo is predominantly a corrective condition, individuals with vitiligo may encounter an assortment of issues: Vitiligo

Since they need melanocytes, macules are more delicate to daylight than the remainder of the skin, so they will consume as opposed to tan.

Individuals with vitiligo may have a few anomalies in their retinas (the inward layer of the eye that contains light-delicate cells) and some variety of shading in their irises (the hued part of the eye). Sometimes, there is some irritation of the retina or iris, yet vision is normally not influenced. Vitiligo

Individuals with vitiligo might be bound to get other immune system sicknesses (in which the body’s safe framework makes it assault itself), like hypothyroidism, diabetes, malignant weakness, Addison’s infection, and alopecia areata. Additionally, individuals with immune system illnesses are more in danger of creating vitiligo.

Individuals with vitiligo may feel humiliated or restless about their skin. Now and then individuals are discourteous – they may gaze or express unpleasant things. This could make an individual with vitiligo foster low confidence. This thus could make uneasiness or discouragement issues and make somebody need to separate. On the off chance that this occurs, you should converse with your medical services supplier or your loved ones to help you discover an answer. Vitiligo

Conclusion AND TESTS

How is vitiligo analyzed? Vitiligo

Normally the white patches are effectively apparent on the skin, yet medical care suppliers can utilize a Wood’s light, which sparkles bright (UV) light onto the skin to help separate from other skin conditions.

What different conditions look like vitiligo?

There are different conditions that make the skin change or lose pigmentation. These include:

Substance leukoderma: Exposure to some mechanical synthetics cause harm to the skin cells, coming about in straight or splotchy white spaces of skin Vitiligo

Fungus versicolor: This yeast disease can make dull spots that show on fair complexion, or light spots that show on more obscure skin.

Albinism: This hereditary condition implies that you have lower levels of melanin in the skin, hair and additionally eyes. Vitiligo

Pityriasis alba: This condition gets going with red and textured spaces of skin, what blur into layered lighter patches of skin.

The executives AND TREATMENT

How is vitiligo treated?

There is no remedy for vitiligo. The objective of clinical treatment is to make a uniform skin tone by either reestablishing shading (repigmentation) or dispensing with the leftover tone (depigmentation). Normal medicines incorporate disguise treatment, repigmentation treatment, light treatment and medical procedure. Directing may likewise be suggested.

Disguise treatment:

Utilizing sunscreen with a SPF of 30 or higher. Additionally, the sunscreen should protect bright B light and bright A light (UVB and UVA). Utilization of sunscreens limits tanning, in this way restricting the differentiation among influenced and typical skin. Vitiligo

Cosmetics help cover depigmented regions. One notable brand is Dermablend®.

Hair colors if vitiligo influences the hair.

Depigmentation treatment with the medication monobenzone can be utilized if the sickness is broad. This prescription is applied to pigmented patches of skin and will turn them white to coordinate with the spaces of vitiligo. Vitiligo

Repigmentation treatment:

Corticosteroids can be taken orally (as a pill) or topically (as a cream put on the skin). Results may require as long as 90 days. The specialist will screen the patient for any results, which can incorporate skin diminishing or striae (stretch imprints) whenever utilized for a delayed period.

Effective nutrient D analogs.

Effective immunomodulators, for example, calcineurin inhibitors.

Light treatment:

Slender band bright B (NB-UVB) expects a few treatment meetings each week for a while.

Excimer lasers radiates a frequency of bright light near that of thin band UVB. This is better for patients who don’t have inescapable or enormous injuries since it is conveyed to little, designated regions.

Consolidating oral psoralen and UVA (PUVA) is utilized to treat enormous spaces of skin with vitiligo. This treatment is supposed to be exceptionally successful for individuals with vitiligo in the space of the head, neck, trunk, upper arms and legs. Vitiligo

Medical procedure:

Autologous (from the patient) skin joins: Skin is taken from one piece of the patient and used to cover another part. Potential inconveniences incorporate scarring, disease or an inability to repigment. This may likewise be called scaled down joining.

Micropigmentation: A sort of inking that is generally applied to the lips of individuals influenced by vitiligo.

Advising: Vitiligo

Vitiligo can cause mental pain and can influence an individual’s standpoint and social cooperations. On the off chance that this occurs, your parental figure may recommend that you discover an instructor or go to a care group.

Counteraction

How might I forestall vitiligo?

Since nobody knows for certain what causes vitiligo, nobody can disclose to you how to forestall it. As a rule, it is keen for everybody to pursue safe sun openness routines and to take great consideration of your skin.

Standpoint/PROGNOSIS

What is the viewpoint for individuals with vitiligo?

About 10% to 20% of individuals who have vitiligo completely recapture their skin tone. Individuals with the most obvious opportunity with regards to recapturing skin tone are the individuals who are youthful, whose vitiligo arrives at its top in under a half year and is found fundamentally on the facial region. Individuals who are less inclined to recapture their shading are the individuals who get vitiligo sometime down the road all the rage and appendages, particularly the hands. Vitiligo

Is vitiligo lethal?

No. What’s more, it’s anything but in any capacity infectious, all things considered.

LIVING WITH Vitiligo

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prathameshentclinic · 4 years ago

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DO YOU KNOW THAT A CHANGE IN YOUR VOICE CAN BE A SIGN OF LARYNGEAL CANCER?By : Dr. Amrapali Pawar

Hoarse voice, if it persists for more than 3 weeks , certainly needs to be evaluated as it can be a sign of laryngeal cancer or cancer of your voice box. But no need to panic! Just because your voice has changed its quality , it does not necessarily indicate that you have cancer. Other reasons why your voice may change or become hoarse are – laryngitis (inflammation of larynx), overuse or misuse of voice , acid reflux, allergies, trauma. So how do you know what has actually caused that change in your voice? For this you need to be properly evaluated by your ENT doctor who will infer from a proper and detailed history and examination, and if necessary , relevant investigations; your accurate diagnosis. He may need to do your laryngeal endoscopy to visualise and evaluate your voice box and surrounding structures. An examination of your neck to look for any enlarged lymph nodes, which may again be a sign of cancer is mandatory. If necessary, your ENT doctor will advise further investigations like a CT scan and / or biopsy. Although , most of the time , it is possible that your change of voice may be due to completely benign reasons which are stated above ; and if so, you will be prescribed some medications for your condition. If necessary, you will also be advised to undergo voice therapy for the same. The important thing to remember here is that- if at all you are suffering from a change of voice, please be sure to visit your ENT surgeon and get your condition diagnosed as soon as possible to avoid further complications. Any disease diagnosed in the early stage has the highest chance of recovery. The incidence of laryngeal cancer worldwide currently is 2.76 cases per year per one lakh inhabitants and 1.66 deaths per year per one lakh inhabitants . In India , laryngeal cancer contributes to approximately 3% -6% of all cancers in men. It is one of the 10 leading causes of cancer in Indian men. The 5 year survival rate for laryngeal cancer in India is approximately 28%. The factors most often implicated in the causation of laryngeal cancer according to Indian studies are : Smoking, alcohol consumption, tobacco, long term exposure to indoor air pollution ( from coal/ wood burning ) , spicy food . According to research more than 60% of laryngeal squamous cell carcinoma patients were cigarette smokers and nearly 75% of them had smoked for more than 30 years. In more than 75% of cases there was history of alcohol consumption. Change of voice or hoarse voice is not the only symptom of cancer of the larynx. Some of the patients also present with difficulty in swallowing, lump or swelling in the neck , weight loss, some even present with extreme pain in the ear (also known as referred nostalgia), in severe cases patients may present with difficulty in breathing. Depending on the stage and type of cancer , it can be treated by surgery (laryngectomy) , radiotherapy , chemotherapy or a combination of the above modalities of treatment. As stressed earlier, the management of laryngeal cancer is easier and the prognosis better if diagnosed early.

Is Your Morning Coffee Interfering With The Absorption Of Your Thyroid Supplement?By : Dr. Amrapali Pawar

For many of us, the day cannot start without your morning dose of Java! And why shouldn’t it? We all require the caffeine to overcome that morning drowsiness and make us alert to the long day ahead of us! Apart from the boost that it gives us we justify the morning cup and several cups thereafter with a list of its benefits like its fat-burning quality, essential nutrients like vitamin B2, vitamin B5, magnesium and potassium, some studies say it reduces the risk of type 2 diabetes, contains antioxidants etc.etc. Because of all these reasons having that morning joe has become a routine part of our life as soon as we wake up just like brushing your teeth, or having a bath. Hence when we are affected with thyroid problems at some point in our life and have to take life long supplements, we fail to realize the big hurdle in the absorption of our thyroid medication simply because the thought does not cross our mind! Taking coffee within an hour of taking your thyroid supplement can reduce the absorption of your medication and thus makes it less effective. Caffeine in coffee is known to increase the intestinal motility i.e. it can increase the movement of your intestines. This makes your oral medication of thyroid supplement to pass through your intestines rapidly thus leading to decreased absorption. And since the prescribed dose is less absorbed, it obviously increases your chance of developing hypothyroidism. Coffee also inhibits the conversion and absorption of the thyroid hormone and as such is not considered good for your thyroid health. Hence coffee should be taken at least an hour or later than your daily thyroid supplement. Likewise, you have to keep in mind that fiber-rich foods, calcium supplements such as calcium carbonate and iron supplements such as ferrous sulfate can interfere with the absorption of your thyroid medication, and this effect can last longer than an hour. Hence the schedule of these drugs should be adjusted after consultation with your ENT doctor or your endocrine specialist. Calcium and Iron supplements in a patient with hypothyroidism should be taken at least 4 hours after taking thyroid supplements. Commonly used antacids like proton pump inhibitors can also interfere with the absorption of thyroid supplements. Remember that thyroid supplement interacts with minerals such as iron, calcium, and magnesium. Any supplements which contain these can lower the activity of your thyroid medicine. Supplements of herbal preparation like Ashwagandha and Bladderwrack used for a variety of problems like obesity, insomnia, dementia, etc. may contain dangerous levels of iodine and need to be definitely avoided if you are on thyroid supplement. This article is for all those who are regular in taking their thyroid supplement but are wondering why it is still not under control. This is for persons with hypothyroidism taking thyroid supplements to ensure that their thyroid health is not affected by the simple medication that they might sometimes be put on, ignorant of the effect these might have on their thyroid hormone levels. So, in conclusion, patients of hypothyroidism on thyroid supplement can definitely enjoy their morning cup of coffee ...they should just remember to space it adequately after their thyroid supplement.

Can HPV Vaccination Prevent Head (Neck Cancers)By : Dr. Amrapali Pawar

What is HPV? HPV is Human Papilloma Virus and infection with the same is responsible for the development of genital warts , warts in the throat (recurrent respiratory papillomatosis), warts in the oral cavity (are uncommonly seen) but HPV infection here may manifest as mucosal hyperplasia. Many times these infections with HPV show absolutely no signs and symptoms but these persons still can transmit the infection. The type of HPV infection occurred depends on the strain of the HPV virus with which the person is infected. A person who has contracted a HPV infection is prone to development of cancer in that area. Studies have shown that about 14 million people including teens become infected with HPV every year. Many amongst these are prone to cancers caused by HPV infection. Screening tests are available for cervical cancer ( HPV related) for women . However no such screening tests are available for other cancers caused by HPV infection like cancers of the mouth and throat, cancer of anus, rectum, penis, vagina and vulva. Who should get HPV vaccination? • Recommended for preteens i.e. boys and girls at the age of 11–12 years. This ensures protection from the virus long before they are exposed to it or before they start being sexually active. Also young adults respond better to the vaccine than older ones. Vaccination given at this age requires only 2 doses as compared to three if given at a later age. • If they have missed the dose in their preteens , young men and women can be vaccinated till the age of 27yrs. The FDA (Federal Drug Authority) has approved HPV vaccination for males and females through age of 45 years but the ACIP (American Committee on Immunisation Practices) does not recommend routine vaccination after the age of 27 years as the effectiveness is questionable Ideally , HPV Vaccine should be administered before potential exposure to HPV through sexual contact. Are these vaccines easily available? These Vaccines are available with your Paediatrician, Gynaecologist, or ENT doctor and you can ask them for the same. For further information call us or email us at [email protected]

If i am Gaining Weight, is it because i have a Thyroid Problem?By : Dr. Amrapali Pawar

Not necessarily. There are many causes of weight gain like lack of exercise i.e. having a sedentary life style, improper dietary habits, regular intake of junk food or processed food, certain metabolic diseases, genetic makeup, leptin resisitance and many more. Thyroid hormone abnormality like hypothyroidism i.e. 1. Decrease in the production of thyroid hormones by the thyroid gland can cause you to gain weight. The weight gain is generally unexplainable and occurs inspite of a decreased appetite. 2. It is associated with other symptoms also like fatigue, muscle weakness or muscle aches, feeling sluggish 3. Sensitivity to cold 4. In females, there may be menstrual irregularities 5. Skin can be dry and itchy and there can be hair loss 6.Other symptoms like feeling depressed, constipation or decrease in concentration can also be noted. On the other hand, increase in the production of thyroid hormone known as hyper- thyroidism can cause you to lose weight inspite of an increase in appetite.

When is a Tonsillectomy Necessary?By : Dr. Amrapali Pawar

Tonsils are lymphoid tissues in the oral cavity which provide immunity in children till the age of 5 years. Inflammation of infection of these tissues is known commonly as Tonsillitis. Acute phase of this infection, known as acute Tonsillitis causes symptoms like pain in throat, difficulty in swallowing and fever and can be conventionally treated by antibiotics and anti-inflammatory agents. If these attacks of acute tonsillitis occur again and again, we call it Recurrent tonsillitis. If a person suffers from recurrent attacks of acute tonsillitis in a year for more than 2 years, we can say he is suffering from Chronic Tonsillitis.So how does the doctor decide that a person requires a Tonsillectomy? Tonsillectomy is done for a case of CHRONIC TONSILLITIS which means – “ If a person gets 3 or more attacks of acute tonsillitis for 2 or more consecutive years” What are the signs of chronic tonsillitis? The signs that your otolaryngologist looks for if he is suspecting a patient to be having chronic tonsillitis are – 1. Enlarged Jugulodigastric lymph nodes (these are lymph nodes present at the angle of jaw on either side) 2. congestion of anterior pillar ( the membranous structure in front of the the tonsils) 3. Enlarged / fibrosed tonsils Tonsillectomy is also performed 4-6 weeks after a case of PERITONSILLAR ABSCESS to prevent recurrence of the same. Peritosillar abscess or QUINSY is a condition or complication of acute tonsillitis in which pus collects in the tissues surrounding the tonsil and can cause severe symptoms of difficulty in swallowing , trismus ( difficulty in opening the jaw) , pain in throat and fever. Tonsillectomy is also indicated in cases of severly HYPERTROPHIC TONSILS (“KISSING TONSILS”) which actually meet in the midline and obstruct swallowing. Also in cases of SECRETORY OTITIS MEDIA (fluid collection in the middle ear) or ACUTE AND CHRONIC OTITIS MEDIA in children below the age of 12 yrs, Tonsillectomy is recommended as part of the treatment to reduce the attack of upper respiratory tract infection and prevent recurrence and halt progress of the disease. In adults , Tonsillectomy can be done as a part of surgery for OBSTRUCTIVE SLEEP APNEA and TONSILLAR CANCER.

What Causes Hoarseness of Voice/Change of Voice?By : Dr. Amrapali Pawar

Voice is produced by vibration of your vocal cords or vocal folds, which are membranous band like tissues inside your voice box. Whenever these are affected by trauma, infection or tumor or when the nerve supplying them is damaged, your voice changes quality or becomes hoarse. Causes of hoarseness of voice are cited below: 1. Acute or chronic laryngitis – acute or chronic inflammation of the vocal cords due bacterial or viral infection. 2. Overuse or misuse of voice – shouting or singing in a loud voice can cause trauma to the delicate vocal cords and cause a hoarse voice. Speaking in a high pitch for a long period of time e.g. teachers, speakers can damage the vocal cords. 3. Swellings or benign cysts, polyps or nodules of the vocal cords are common causes of voice change. 4. Cancerous tumors of the vocal cords are a cause of hoarseness and should be evaluated properly for early detection of the disease. 5. Chronic systemic conditions like Gastro esophageal reflux disease, allergies, some thyroid disorders can cause hoarseness. 6. Smoking can affect the vocal cords and cause voice change. 7. Neurological conditions can cause paralysis of one vocal cord and can cause hoarseness. If both the vocal cords are affected then person will have difficulty in breathing too. Tips to improve vocal hygiene: 1. Voice rest – if your voice is affected, giving it complete rest i.e. not speaking will recover them faster 2. Do not shout or whisper- we all know that shouting causes trauma to the vocal folds but note that whispering is also similarly traumatic and can damage these delicate structures. 3. Hydrate the throat. Drink plenty of fluids. Also if your occupation entails speaking for a long period of time, have sips of water every 15 -20 minutes which will lubricate and protect your vocal cords 4. Treatment of acid reflux- if you tend to suffer from acid reflux, get it treated as reflux can contribute to or even exacerbate voice problems 5. Stop smoking – the relation between smoking and laryngeal cancer is well known but smoking can also cause respiratory diseases, which can lead to hoarseness of voice. 6. Avoid excess alcohol – alcohol has a drying effect on mucosal lining of tissues and also contribute to acid reflux which can affect vocal health 7. Stop that compulsive practice of ‘throat clearing’. 8. Maintain a good posture –Slouching over your desk for extensive hours can in the long run affect the respiratory system. This in turn leads to a weak or hoarse voice. Also cradling the phone between your shoulder and ear is not recommended for the same reason. If your job entails having to use the phone often and for a prolonged period, then it is advised you switch to a headset. 9. Do NOT gargle – if you are experiencing voice problems gargling will further cause trauma to your vocal cords. You can sip on warm liquids instead. These will hydrate the vocal cords and provide steam to soothe them. Conclusion: If conservative management to treat hoarseness of voice caused by benign pathology fails, vocal cord surgery also known as Microlaryngeal surgery maybe required. It is best to visit an ENT surgeon to get an opinion about this condition. The well-known otolaryngologist in Mumbai, Dr Amrapali Pawar, has been treating patients for over 15 years to address this ailment. Don’t let your voice bother you when one of the best ENT doctor in Mumbai is right near you!

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