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Alert 19 icon

Steroids have adverse effects: growth retardation in children, immunosuppression, hypertension, inhibition of wound repair, osteoporosis, and metabolic disturbances. All these harmful properties contraindicate prolonged glucocorticoid therapy.

 

 

Alert 18 icon

Immunosuppressive drugs are applied to control autoimmune disorders and inflammation when excessive tissue damage occurs, as well as to prevent transplant rejection after an organ transplant. Increasing evidence shows that cordyceps is a bidirectional modulator with both potentiating and suppressive effects on the immune system through regulating innate and adaptive immunity. 

 

 

Reference:

Feng K, Yang Y. Q, Li S. P. Renggongchongcao. In: Li S. P, Wang Y. T, editors. Pharmacological Activity-Based Quality Control of Chinese Herbs. New York: Nova Science Publisher, Inc.; 2008. pp. 155–78.

Li S. P, Tsim K. W. The biological and pharmacological properties of Cordyceps sinensis, a traditional Chinese medicine that has broad clinical applications. In: Herbal and Traditional Medicine. New York: Marcel Dekker; 2004. pp. 657–82.

Ng T. B, Wang H. X. Pharmacological actions of Cordyceps, a prized folk medicine. J Pharm Pharmacol. 2005;57:1509–19.

Zhou X, Gong Z, Su Y, Lin J, Tang K. Cordyceps fungi: Natural products, pharmacological functions and developmental products. J Pharm Pharmacol. 2009a;61:279–91.

Alert 16 iconRosacea, perioral dermatitis, acne; Skin atrophy with telangiectasia, stellate pseudo scars(arms), purpura, striae (from anatomic occlusion, e.g., groin); Tinea incognito, impetigo incognito, scabies incognito; Ocular hypertension, glaucoma, cataracts; Allergic contact dermatitis; Systemic absorption; Burning, itching, irritation, dryness caused by vehicle(e.g., propylene glycol); Miliaria and folliculitus following occlusion with plastic dressing; Skin blanching from acute vasoconstriction; Rebound phenomenon (e.g., psoriasis becomes worse after treatment is stopped); Nonhealing leg ulcers; steroids applied to any leg ulcerated healing process; Hypopigmentation; Hypertrichosis of face.

 

Reference:

Thomas P. Habif: Clinical Dermatology,A Color Guide to Diagnosis and Therapy, 6th Edition.
2016. Elsevier. Page82-89

Alert 16 iconSteroids withdrawal (addiction) syndrome is a distinct clinical adverse effect of steroid misuse (Hagar T, Leshem YA, Hannifin JM, etc. 2015). Patients and physicians should be aware of its clinical features and risk factors to identify and prevent this complication. 76.7% of patients with steroid withdrawal syndrome received complete or partial clearance in 3 months, 12.5% in 6 months, 5.5% in 12 months and 5.1% over 12 months respectively after discontinuation use of steroid.

 

 

 

Reference:

Hagar T, Leshem YA, Hannifin JM, etc. (2015) Asystematic review of topical corticosteroid withdraw (steroid addiction) in patients with atopic dermatitis and other dermatoses. J Am Acad Dermatol 2015;72:541-549

Alert_15_iconThe prevalence of psoriasis in the US was estimated to be 7.4 million in 2013. Comparatively,psoriasis patients incurred incremental medical costs of $2284, experienced a $2203 reduction in HRQOL, and a $1935 reduction in productivity. The total burden of psoriasis was estimated as $35.2 billion, with $12.2 billion in incremental medical costs (35%), $11.8 billion from reduced HRQOL (34%), and $11.2 billion from productivity losses (32%).

 

 

 

Reference:

Jacqueline Vanderpuye-Orgle, Yang Zhao, Jackie Lu, etc. (2015) Evaluating the economic burden of psoriasis in the United States. J Am Acad Dermatol 2015;71:961-967

Alert_14_iconFrom 1956 to July 2013, there were 32 observational studies (512420 participants) of fatty acids from dietary intake; 17 observational studies (25721 participants) of fatty acid biomarkers; and 27 randomized, controlled trials (105085 participants) of fatty acid supplementation. Current evidence does not clearly support cardiovascular guidelines that encourage high consumption of polyunsaturated fatty acids and low consumption of total saturated fats.

 

 

 

Reference:

Rajiv Chowdhury, Samantha Warnakula, Setor Kunutsor et al. (2014) Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk: A Systematic Review and Meta-analysis. Ann Intern Med. 2014;160:398-406.

alert_12_iconThe health benefits of organic foods are unclear. To review evidence comparing the health effects of organic and conventional foods. MEDLINE (January 1966 to May 2011), EMBASE, CAB Direct, Agricola, TOXNET, Cochrane Library (January 1966 to May 2009), and bibliographies of retrieved articles. English-language reports of comparisons of organically and conventionally grown food or of populations consuming these foods. 17 studies in humans and 223 studies of nutrient and contaminant levels in foods met inclusion criteria.

 


Reference:
Crystal Smith-Spangler, Margaret L. Brandeau, Grace E. Hunter,  et al.  (2012). Are Organic Foods Safer or Healthier Than Conventional Alternatives? A Systematic Review.  Annals of Internal Medicine. 2012;157:348-366.

Alert_11_iconThe omega-6 fatty acids are the predominant polyunsaturated fats. The omega-6 and omega-3 fatty acids are metabolically distinct and have opposing physiologic functions. Animal and human studies support the hypothesis that omega-3 PUFA suppress cell mediated immune responses. The increased omega-6/omega-3 ratio in Western diets most likely contributes to an increased incidence of cardiovascular disease and inflammatory disorders.


 

Reference:
Virella G, Fourspring K, Hyman B, Haskill-Stroud R, Long L, Virella I, La Via M, Gross AJ, Lopes-Virella M. (1991). Immunosuppressive effects of fish oil in normal human volunteers: correlation with the in vitro effects of eicosapentanoic acid on human lymphocytes. Clinical Immunology and Immunopathology. 1991 Nov;61(2 Pt 1):161-76.

Park HJ, Park JS, Hayek MG, Reinhart GA, Chew BP. (2011). Dietary fish oil and flaxseed oil suppress inflammation and immunity in cats. Veterinary Immunology and Immunopathology. 2011 Jun 15;141(3-4):301-6. doi: 10.1016/j.vetimm.2011.02.024. Epub 2011 Mar 6.

Simopoulos AP. (2002). Omega-3 fatty acids in inflammation and autoimmune diseases. Journal of the American College of Nutrition. 2002 Dec;21(6):495-505.

Alert10_iconPearce and colleagues110 examined the cost-effectiveness of psoriasis treatments over a 12-week period comparing methotrexate, acitretin, cyclosporine, narrow band UV-B, PUVA, etanercept, and efalizumab. The total cost per completed treatment regimen was calculated based on drug acquisition costs, dosing and cost of physician visits, laboratory testing, phototherapy treatment charges, liver biopsy, and infusions charges.

 

 

Reference:
Li Kai & Armstrong April W. (2012). A Review of Health Outcomes in Patients with Psoriasis. Dermatologic Clinics. Volume 30, Issue 1, Pages 61-72, January 2012
Tagged in: Psoriasis

Alert9_icon

A 73-year-old man who had had plaque psoriasis for more than 20 years on the arms, legs, and scalp presented for consultation on a new rash. He had been using topical steroid creams and shampoos to control occasional psoriatic flares.

 

 

 

Reference:
Jashin J. Wu, Caroline Caperton. (2013). Psoriasis Flare from Koebner’s Phenomenon after Acupuncture. New England Journal of Medicine. 2013; 368:1635April 25, 2013DOI: 10.1056/NEJMicm120571

Tagged in: Psoriasis

Alert_8_icon

A total of 1095 patients with moderate to severe plaque psoriasis from 10 dermatology practices was studied,patients stopped systemic treatments (MTX, Acitretin, Cyclosporine) and phototherapy (UVB and PUVA) after medians of 6 to 12 months and biologic agents (Etanercept, Adalimumab, Infliximab) after medians of 12 to 20.5 months. Side effects and lost efficacy are important limiting factors for treatment persistence.

 

 

Reference:
Howa Yeung, Joy Wan, Abby S. Van Voorhees, Kristina Callis Duffin, Gerald G. Krueger,Robert E. Kalb, Jamie D. Weisman, Brian R. Sperber, Bruce A. Brod, Stephen M. Schleicher, Bruce F. Bebo, Jr, Daniel B. Shin, Andrea B. Troxel, Joel M. Gelfand. (2013). Patient-reported reasons for the discontinuation of commonly used treatments for moderate to severe psoriasis. Journal of the American Academy of Dermatology. 2013;68:64-72.

Tagged in: Psoriasis

Corticosteroids are commonly prescribed by practitioners in many medical specialties for the treatment of chronic inflammatory conditions. The use of corticosteroids in the treatment of chronic rhinosinusitis is well described and based on their anti-inflammatory effects. The duration of corticosteroid therapy in these conditions is often less than 1 month, in contrast to the treatment of chronic respiratory diseases (ie, asthma, chronic obstructive pulmonary disease) or autoimmune disorders (ie, rheumatoid arthritis, systemic lupus erythematosus, Crohn disease, and ulcerative colitis), which can last for years.

 

Reference:
David M. Poetker, Douglas D. Reh. (2010). A Comprehensive Review of the Adverse Effects of Systemic Corticosteroids.  Otolaryngologic Clinics of North America. 43 (2010) 753–768 doi:10.1016/j.otc.2010.04.003

This paper is to search for an effective immunosuppressant from Glycyrrhiza uralensis (Licorice, Gan Cao). Our results show the immunosuppressive activity of glycyrol and this activity should be due to its inhibitory effect on CN activity, thereby suppressing IL-2 production and regulating T lymphocytes. Thus, glycyrol could be a candidate for development as a novel immunomodulatory drug.

 

 

Reference:
Jiayu Li1, Ying Tu1, Li Tong, Wen Zhang, Jianquan Zheng, and Qun Wei. (2010). Immunosuppressive activity on the murine immune responses of glycyrol from Glycyrrhiza uralensis via inhibition of calcineurin activity. Pharmaceutical Biology, 2010; 48(10): 1177–1184

Biologic compounds are being used more frequently to treat a multitude of systemic inflammatory conditions. These novel compounds are composed of antibodies or other peptides that act through one of three mechanisms: inhibiting inflammatory cytokine signaling (typically tumor necrosis factor or TNF), inhibiting T-cell activation, or depleting B-cells. The increase in use and ever expanding list of new immune modulating therapies make knowledge of the infectious complications associated with immune modulation even more important. Of particular concern is the risk for developing atypical and opportunistic infections including tuberculosis, herpes zoster, Legionella pneumophila, and Listeria monocytogenes.

Reference:
Rachel Gordon, Rana Mays, Hung Doan, Whitney Lapolla, Stephen K. Tyring. (2012). Biologic Therapy and Risk of Infection. Skin therapy Letter. Volume 17, Number 4, Aprial 2012.

Alert4_iconIn this Volume 65, Issue 1 of the JAAD, Kerner et al report blunted adrenal responses after the use of topical corticosteroids. While it is reassuring that laboratory values remained within the normal range in this particular study, the blunted responses serve as a reminder that systemic absorption of topically applied corticosteroids can have systemic implications.

 

 

 

Reference:
Lynnette K. Nieman. (2011) Consequences of systemic absorption of topical glucocorticoids. Journal of the American Academy of Dermatology. Volume 65, Issue 1 , Pages 250-252

The role of resveratrol (can be extracted from grape, veratrum album which commonly known as the False Helleborine, also known as White Hellebore, European White Hellebore, White Veratrum) and curcumin (extracted from Turmeric, also known as yellow ginger) is well documented in cancer, inflammation, diabetes and various other diseases. However, their immuinnosuppressive action on T cells, B cells and macrophages is not well documented.

 

 

Reference:
Sharma S,Chopra K,Kulkarniand Sk, Agrewala JN. (2006). Resveratrol and curcumin suppress immune response through CD28/CTLA-4 and CD80 co-stimulatory pathway. Clinical and Experimental Immunology. 2006. 147:155-163.

alert2_iconThe use of anabolic supplements and other related drugs for bodybuilding and enhancing athletic performance is nowadays widespread and acutely pervasive all around the world. This alarming increase in the use of anabolic and amino acid supplements has been linked to a diverse array of pathologies. As previously reported, the abuse of androgenic steroids is not without severe physiological, psychiatric and physical costs.

Reference:
Ali A Samaha1, Walid Nasser-Eddine1, Elizabeth Shatila, John J Haddad, Jaafar Wazne and Ali H Eid. (2008). Multi-organ damage induced by anabolic steroid supplements: a case report and literature review. Journal of Medical Case Reports 2008, 2:340 doi:10.1186/1752-1947-2-340

alert1_iconThese cases demonstrate that atopic dermatitis and topical corticosteroids may be associated with cataracts in children as well as adults. The cause of cataracts in atopic dermatitis is not known. However, it has been suggested that habitual tapping and rubbing of the face may play a role. Care needs to be taken when prescribing corticosteroids. Inadequate treatment of atopic dermatitis may lead to other ocular complications such as keratitis and permanent visual loss.

Reference:
Andrew Tatham. (2008). Atopic dermatitis, cutaneous steroids and cataracts in children: two case reports. Journal of Medical Case Reports. 2008. 2:124. doi:10.1186/1752-1947-2-124