HEALTHOUGHTS
THE HEARTBREAK OF PSORIASIS
Psoriasis, a chronic, incurable skin disease characterized by scaling and inflammation of the skin, affects millions of Americans. The scaling caused by psoriasis occurs when cells in the outer layer of skin reproduce faster than normal and pile up on the skin's surface. Psoriasis' severity ranges from minor, covering just a few small areas, to severe, disabling cases that can involve the entire body. Treatments generally aim at slowing rampant growth of skin cells.
Arnold W. Gurevitch, M.D., chief of dermatology at USC, says that over the past few years, researchers have been able to improve some older treatments and have also found new methods of alleviating troublesome symptoms.
Topical steroids, ointments or creams used most commonly to treat psoriasis are much stronger and more effective than they were just a few years ago. Within the last five years, the U.S. Food and Drug Administration approved a powerful non-steroidal ointment called Dovonex, known generically as calcipotriene, for moderately severe cases of psoriasis.
Other treatments include non-steroidal topical creams, and decades-old standbys such as topical tar products, methotrexate and ultraviolet light therapy.
"Usually we can decrease the level of the problem but we can't make it go away entirely," Gurevitch says. "And for some people treatments begin to lose their effectiveness over time."
Gurevitch says that recent research points to psoriasis as a kind of immune disorder in which the body's white blood cells produce chemicals that stimulate skin cells to proliferate. For severe cases, physicians have found that cyclosporin, an immunosuppressant used to combat rejection of transplanted organs, is often effective.
Gurevitch emphasizes that the effectiveness of treatments can vary significantly for different people. He says anyone with psoriasis should consult a dermatologist to see what works best, including updating previously prescribed treatments.
CHEERS TO YOUR HEART
Wine, it appears, helps assuage more than the guilt of indulging in a single high-fat meal.
USC pharmacologist Alex Sevanian, Ph.D., and colleagues in Italy have shown that drinking wine with a meal may help rid the body of potentially damaging fats and other compounds before they reach the blood vessels. The build up of fatty streaks in the arteries causes them to narrow so blood flow is slowed. This process, known as atherosclerosis, is the leading cause of heart disease and stroke.
In the study, the team asked two participants to lunch on deep fried fish and pasta drenched in olive oil. As expected, researchers found that, directly after the high-fat meal, levels of unhealthy triglycerides in the blood shot sky high. So, too, did levels of molecules called lipid peroxides, the oxidized fats that appear to play a role in cardiovascular disease.
When the researchers added a glass of red wine to the same fat-filled menu, they discovered that the wine dramatically reduced levels of lipid peroxides and triglycerides in the blood stream. They concluded that the powerful antioxidants found in wine may help protect fatty molecules from oxidation and speed metabolism of fats while still in the gut.
"Common sense, and many scientific studies, tells us to avoid a high-fat diet. But if a sumptuous meal containing cooked fats is to be eaten, then a glass of wine taken with the meal appears to be beneficial," Sevanian says.
Drinking wine before or after dinner, however, probably will not help, since the antioxidants seem to protect against compounds in the food itself. And researchers caution that drinking too much alcohol brings its own health risks, including a higher risk of heart disease and cancer.
The idea that wine may prove protective to arteries is not new, Sevanian notes. Red wine's antioxidant properties has long been thought to explain the so-called French paradox-despite a diet rich in fats, the French have a lower risk of coronary disease than Americans. "We've assumed that this related to the daily intake of red wine," Sevanian says.
TUMMY TALK
Popping a couple of antacid tablets after a spicy meal is fine, but taking too many for too long can lead to potentially serious health problems.
Antacids contain calcium, magnesium or aluminum-each of which in large doses can produce dangerous side effects, says Robert Rude, M.D., USC professor of medicine.
"The side effect depends on which antacids you're taking," Rude says.
Antacids that contain calcium, such as Tums, may cause kidney stones if consumed in high quantities for months or years, he says. A single Tums contains 300 mg to 500 mg of calcium. While the suggested dietary calcium intake is 1,200 mg per day, people should consume no more than 2,500 mg of calcium a day, he says.
Another group of antacids, including Mylanta, contains magnesium, which can cause diarrhea when overused, Rude says. The recommended daily magnesium allowance from foods such as spinach, brown rice and milk is 320 mg for women and 420 mg for men. Another 350 mg a day in supplements is acceptable, Rude says.
But people with renal (kidney) disease who take too much magnesium can suffer from low blood pressure, breathing problems or even die. "People who have renal disease should not take magnesium supplements, period," Rude says.
Other antacids contain aluminum which, if taken in large doses for a long time, can lead to osteomalacia-a disease in which the bones become brittle and painful.
People who use antacids because they suffer from chronic heartburn or indigestion could have serious underlying medical problems, Rude warns. These symptoms could stem from peptic ulcer disease or gastroesophageal reflux disease, in which corrosive stomach acid bubbles up into the esophagus.
"A person who continually needs to take antacids should speak with a physician," advises Rude.
SEEKING IMMUNITY
Vaccines work by stimulating the immune system to recognize illnesses and fight them off. While most of us received multiple childhood immunizations, adults should make sure they are vaccinated against specific diseases.
"Adults should get immunized unless there is a contraindication, for example, an allergy to a component of the vaccine," says John L. Brodhead Jr., M.D., USC associate professor. He notes that a primary care physician should always be consulted before getting any immunization. For other diseases, he says, only specific groups need to get immunized.
Here are Brodhead's recommendations:
Tetanus: Everyone should get a booster shot every 10 years. People who suffer puncture wounds or deep skin abrasions usually are given boosters automatically when they go in for emergency room treatment.
Rubella (German measles): Health care workers and women of childbearing age should get vaccinations.
Hepatitis A: People at high risk, including intravenous drug users, homosexuals, institutionalized people and people traveling to or living in areas where it is endemic, should get vaccinations.
Hepatitis B and C: High-risk adults, dialysis patients and health care workers, should get a hepatitis B vaccination and should get tested for hepatitis C because it often exhibits no symptoms for years. There is not yet a vaccination for hepatitis C. Both of these diseases are transmitted through sexual contact, needle sharing or exposure to blood products.
Pneumonia: Vaccinations are recommended for people over 65, plus diabetics and people who have had their spleens removed or suffer chronic heart, lung or liver disease.
Influenza: Annual flu shots are recommended for the same group of people that should get pneumonia vaccinations, plus health care workers. A single vaccine cannot guard against all flu strains.
Travelers: People planning to visit foreign countries should contact those countries' embassies or consulates to ask if specific vaccinations are recommended or required. The Centers for Disease Control and Prevention also can recommend what shots foreign travelers should get. The web site address is: www.cdc.gov.
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