What is Gout? To answer "what is gout?" you should know it is a relatively frequently occurring type of arthritis. The common condition is the result of having elevated levels of uric acid in your bloodstream. This excess of uric acid leads to uric acid crystal formation in the joints, notoriously the one on the base of the big toe. These crystals cause a number of alarming and uncomfortable symptoms. [youmaylike] Signs and Symptoms Gout can manifest in several different ways depending on the patient. In general, gout can be characterized as episodes of joint pain, swelling and redness. The pain itself can occur out of nowhere, and either turn into a general discomfort or disappear. Episodes of gout can occur abruptly and it is not uncommon for them to start in the middle of the night. The big toe is one of the most common appendages that is affected, although it can also affect the forefoot, knees, ankles, knees, elbows and bones in your hand or wrist. Types of Gout Although these all refer to the same illness, there are “types” of gout, which indicate different stages of the illness. Asymptomatic hyperuricemia: This is the earliest stage of the disease. Some of the crystals may be causing some tissue damage, but symptoms may be mild to non-existent. Acute: This refers to a more extreme event. In acute gout, patients experience acute episodes of intense pain in a “flare” that lasts a couple of days. Different events can trigger the onset of symptoms, including stress or alcohol. They may also appear seemingly out of nowhere. Intercritical: When flares die down but you still have gout, your body is still depositing excess urate crystals into your joint tissue. These periods are called intercritical gout, where you may not really feel symptoms but the damage is still happening. Chronic tophaceous: This is the most extreme form of the disease. It is debilitating and can get to the point where permanent and extreme damage has been done to the joints and kidneys. Huge lumps and pain may be chronically present at this point. There is also a condition that is referred to as pseudogout. This condition is not a form of gout, but it is very similar in terms of the symptoms someone might experience. These similar symptoms are not caused by urate crystals, but rather calcium pyrophosphate crystals. Generally, symptom expression is less severe in comparison to traditional gout. Treatment Options There are several different medications that may be prescribed to treat gout. Different medications may be used depending on the types of symptoms you are experiencing or expressing a desire to reduce. These medications include some which may manage uric acid levels (aloprim, zyloprim, ulroic or lesinurad), inflammation (colcrys) or painkillers. Talk to your doctor to find a solution which is best for you. Natural Remedies for Gout One of the best natural remedies for gout is making lifestyle changes. By making these tiny lifestyle changes, you will be able to minimize the flares of gout or even prevent it entirely. If you know that you have had a flare before or are at risk for developing gout, consider taking the following steps: Drink lots of water: Drinking the recommended amount of water a day can help keep your body in tip-top shape. Achieve a healthy body weight: Obesity puts a lot of pressure on your body. If you are overweight, try to achieve and maintain healthy body weight. Stay sober: Alcohol can be an especially big trigger for gout. Consider abstaining from alcohol use in order to keep your gout under control. Change your diet: To limit the about of uric acid coming into your body, make changes to your what you eat. There are some foods that will encourage very high levels of uric acid in your body, including: anchovies, sardines, mackerel, herring, lobster, shrimp, mussels, scallops, mushrooms, organs (especially liver and kidneys), fast food, soda and alcohol. Consider having healthier foods that encourage an overall healthy diet. Some of the best foods for managing gout include: Yogurt and skim milk. Nuts and grains. Fresh fruits and veggies. Potatoes. Most importantly, be sure to practice moderation. When to See a Doctor As soon as you notice that your symptoms are interfering with your daily life, you should make an appointment with a medical professional. This is a good practice in general. Even if you do not have gout, alarming symptoms may be a sign of a more serious underlying condition.
What is Melasma?
As early as 470 to 360 BC, during the time of Hippocrates, skin discoloration worsening after sun exposure and heat was discovered. Eventually, this skin condition was named chloasma and what we now commonly know as melasma. So, what is melasma?
Although it is not life-threatening, melasma can have an impact on a person’s physical appearance, leading to psychosocial and emotional distress. This can affect a person’s quality of life, self-esteem and wellbeing. This article will discuss what melasma is, what causes it and its common symptoms. We will also outline the top treatments for melasma and how it can be prevented.
Melasma Explained
Melasma is an acquired skin condition characterized by increased pigmentation in the face (hyperpigmentation). Melasma usually occurs more often in females and in people with darker skin. In America, it is common among people residing in the intertropical areas where there is greater exposure to ultraviolet radiation. Melasma usually appears between the age group of 20 to 40 years old, especially among females in their reproductive years. It is rarely seen before puberty.
What Causes Melasma?
The exact cause of melasma is unknown, but throughout the years, factors that trigger melasma have been identified. The main triggers are usually radiation and hormones.
Radiation, whether ultraviolet light, visible light, or infrared light can cause melasma. Sunlight exposure makes it worse and is the most important trigger. People who are exposed to ultraviolet radiation have an increased risk for developing melasma.
Furthermore, because it is affected by hormones, there is an increased risk for melasma during pregnancy. Around 50% to 70% of pregnant people report having it. People who take oral contraceptives or people who undergo hormonal therapy also have a higher risk for melasma.
Other risk factors include stress and exposure to certain cosmetics or medications (such as some anti-seizure and phototoxic medications). A family history of can also increase the chances of someone having this condition by 50%.
The exact cause of hyperpigmentation is still being studied, but it is observed that the effect leads to skin cells (melanocytes) being stimulated by hormones (estrogen or progesterone), which leads to the increased production of melanin pigments that cause hyperpigmentation. This is further exacerbated when exposed to radiation, such as being under the sun for significant periods of time. UV exposure is said to directly stimulate the activity of melanocytes, leading to increased pigmentation.
What Are the Symptoms?
It is characterized by hyperpigmentation. The hyperpigmentation is symmetric and presents as brown or grey patches. These patches usually have irregular contours. The patches are usually seen in various areas of the skin but especially in the sun-exposed areas, such as the face and neck. In Around 50% to 80% of cases of melasma, the hyperpigmentation is in the central facial area, which includes the forehead, upper lip and nose. There are cases wherein the area of the cheeks is affected and in a smaller group of people, the jawline and chin are affected.
What Are the Treatment Options?
Although melasma is a common disorder, management of the condition can still be difficult due to the recurrence rates and limited knowledge of disease progression. However, the treatment of melasma can be grouped into topical, oral and procedural therapies. These will be discussed below.
1. Avoiding Triggers
The best treatment for melasma is combining topical treatments while also avoiding triggers, such as sun or estrogen exposure. Because the sun is the most common trigger, avoiding sun exposure can do a lot in preventing melasma. Avoiding triggers can already have a big impact and can prevent a person from spending too much on expensive medications and treatments. Avoiding triggers also has a big effect on reducing recurrence rates.
People with or at high risk for developing melasma should avoid using too many cosmetics, especially if your skin is sensitive. Vigorous rubbing of cosmetic creams and other agents on hyperpigmented skin may worsen the condition.
Other than avoiding the sun, skin protection from sunburn is also important. The use of high SPF sunscreens (SPF of at least 50 or higher) can also prevent the development of melasma. When it is unavoidable to go out, wearing protection, such as hats or bringing an umbrella, can also help.
2. Topical Therapy
The first therapy option for melasma is topical therapy. Topical therapy includes a combination of hydroquinone, tretinoin and corticosteroids (commonly the corticosteroid fluocinolone acetonide is used). When a person has hypersensitivity to triple combinations or when they are unavailable, dual ingredients or single topical agents are given. The triple combination topical therapy is currently the treatment that is most effective and favorable. Topical bleaching creams can also be helpful, but results are not guaranteed and sometimes effects take too long and are minimal.
3. Oral Therapy
Usual oral therapies include tranexamic acid, glutathione and polypodium leucotomos. These oral therapies can help reduce symptoms. However, in terms of effectiveness, oral therapy shows various results in the resolution of melasma, thus they are usually used if topical therapy is unavailable or cannot be given. Although oral therapies are not the first option or standard of care for melasma at present, various studies show that they have promising results.
4. Procedural Therapy
Usual procedures to treat melasma include chemical peels, micro-needling, radiofrequency and lasers. Effectivity of procedures to treat melasma is mixed and can vary from person to person. In some cases, chemical peels and lasers can yield faster results compared to topical medications. However, there is no guarantee of the resolution from these treatments. Furthermore, these procedures may have adverse effects, such as skin damage, further hyperpigmentation due to inflammation and scarring. Lasers have also been found to be associated with increased recurrence rates. This is why these are usually used as adjuncts or second line therapies if other treatments are unavailable or have failed.
In Review
This condition is managed using one or more therapies. A combination of any of these treatments usually provides better results than using one type of treatment only. In some cases, it can even resolve on its own, especially if triggers are avoided.
Although melasma may not be life-threatening, its impact on appearance can be significant. Even if the primary reason for the treatment is aesthetic, its effect on a person’s confidence and self-esteem is irreplaceable.