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What’s your diagnosis? (March 2018)

A 43-year-old man went to the emergency room with a symmetrical rash of palpable purpura on his legs. He also complained of a fever and arthralgia, but denied any headache or neck pain. The patient disclosed a current infection with hepatitis C virus. (Photo courtesy of ©VisualDx 2017)
Dermatology Times – Dermatology

Quit smoking while pregnancy – No Smoking Day 8 March 2017

March 8th 2017 is national no smoking day and for the estimated 15.8 % of the UK population who regularly light up this is the day you are encouraged to kick the habit.

Parents to be are one particular group who should consider quitting smoking for the sake of their own health and that of their unborn child.

Currently statistics report that just over 10% of babies in the UK are born to mothers who smoke. Whilst this figure is still high, this is a reduction from the previous year of 11% and down from 15% a decade ago.

While this is good news there is no doubt that smoking in pregnancy is harmful to both the mother and the baby; even passive smoking is bad.

Cigarettes contains around 4,000 different chemicals which go into your lungs when you smoke. The types of chemicals found in cigarettes include; Acetone (found in nail polish remover), Ammonia  (a common household cleaner), Cadmium (active component in battery acid), Carbon Monoxide (released in car exhaust fumes), Formaldehyde (embalming fluid) and of course nicotine.

Once they’ve gone into your lungs, the nicotine, poisons and carbon monoxide cross the placenta to the baby. This can cause issues such as:

  • complications during labour
  • increased risk of miscarriage, still-birth and sudden unexpected death in infancy (sometimes referred to as SIDS or cot death)
  • premature birth
  • facial abnormalities at birth such as cleft lip
  • low birth-weight
  • behavioural problems such as ADHD (Attention Deficit Hyperactivity Disorder)
  • performing poorly at school

There is no safe level of smoking. There is no evidence that cutting down is beneficial, and so the only option is to stop smoking completely.

Stopping smoking is hard for most people and you shouldn’t be embarrassed to seek help to quit. If you are thinking of stopping or have recently stopped smoking and are pregnant speak to your midwife who may refer you to a stop smoking adviser. You can also talk to your GP or go to the NHS website – https://www.nhs.uk/smokefree – Support can be offered over the phone, via apps, emails or face to face.

You may be offered Nicotine Replacement Therapy (NRT) in the form of patches, chewing gum, mouth sprays etc. According to the Royal College of Obstetricians and Gynaecologists’, it is safe to use NRT in pregnancy. This is because NRT does not contain poisons such as tar and carbon monoxide, but does provide some nicotine to help manage withdrawal cravings once you have stopped smoking.

If your partner smokes then you need to encourage them to quit too as it will increase your chances of giving up too.

Quitting smoking will also save significant amounts of money. A 10 a day habit will save you around £2190  as well as ensuring you provide the best start in life to your baby.

talkhealth Blog

A is for Atopic March

A for Atopic March - Does Atopic Dermatitis march off to something else?We’re still at the letter A and the last one was on the confusing nomenclature of Eczema versus Atopic Dermatitis. This week (pardon last week’s absence, can’t promise it won’t happen again though as I’m so tied up with work, family and doing other things I enjoy) we’re onto Atopic March. Sometime last year, DrFelix.co.uk (a registered online UK doctor and pharmacy service) contributed a write-up on Atopic Triad, which covers eczema, asthma and allergic rhinitis (hay fever).

Atopy is a genetic tendency to develop certain allergies. Most commonly, Eczema, Asthma and Hay Fever. In fact, if either parent has at least one of the three, there is a high chance that their child will also develop the condition. In these three ailments, the body areas become inflamed and produce excess immunoglobulin E (IgE) in response to harmless stimuli such as dust or pollen.

It is very common for people who experience eczema to also have asthma and hay fever. The connection between these conditions can be summarised by one word: hypersensitivity.

The body including the skin and respiratory system are over sensitive towards certain substances and they overreact when exposed. Rashes on the skin and a congested nose are all ways in which the body is trying to protect itself from something that it deems to be harmful. Unfortunately, this overreaction can be very uncomfortable and unnecessary.

There are also other connections between the Eczema and the development of Asthma. 50-70% of children with Eczema go on to develop Asthma. Recent research undertaken by Washington University School of Medicine has discovered that Eczema damaged skin produces a protein called thymic stromal lymphopoietin (TSLP). TSLP has also been found to directly cause asthma symptoms. This research is still in its early stages and this mechanism has not yet been fully confirmed in humans, but it shows a promising new direction for pharmaceutical research that may be able to stop the development of secondary conditions in their tracks.

Byline: Dr Samuel Malloy, Medical Director at DrFelix.

We understand that atopic conditions are related, in the sense one’s hypersensitivity may manifest in other than skin. But what about the term Atopic March? Does one condition literally marches your child off to another?

While it is more commonly noted that Atopic Dermatitis (Eczema) progresses to asthma and hay fever, the progression is not the same for every child.

Some recent research on this:

Skin Barrier Dysfunction and Atopic March 1 – It was noted in the study that the atopic conditions should be viewed as causally related, as they are conditions related to the lack of filaggrin gene. Recent studies on skin barrier dysfunction suggest that if we can treat the skin defects early, there is a chance of stopping the progression to other atopic conditions.

The Atopic March: Progression from Atopic Dermatitis to Allergic Rhinitis and Asthma 2 – It was noted that the “concept of the atopic march has been supported by cross-sectional and longitudinal studies“; however, “whether AD in the march is necessary for progression to other atopic disorders remains to be defined”. The conclusion was that it is important to identify infants at risk as it presents a critical window of opportunity for therapeutic intervention.

Increasing Comorbidities Suggest that Atopic Dermatitis Is a Systemic Disorder 3 – The associations (even though causality is not proven) showed that AD is linked to the whole body, not just the skin.

Thus, while we see a progression of atopic conditions in a majority of children with eczema, it may not be a “march” of one onto another – not all children undergo the progression, and a few conditions may co-exist. What looks certain (and practical) is that there is urgency to treat the skin during infants as untreated eczema increases risks in many ways > scratching resulting in infection, dry and ‘porous’ skin to more opportunities for sensitization. Extract from WorldAllergy.org below:

From WorldAllergy.org

Atopic March is frequently misunderstood as the development from minor symptoms over a mild disease expression towards more severe chronic manifestations. It also has been misinterpreted as the exclusive development from atopic dermatitis in infancy to airway disease, particularly asthma in school-age. These interpretations have been shown to underestimate the variations and heterogeneity of atopy development during the first decade of life.

References:

  1. Clausen, ML., Agner, T. & Thomsen, S.F. Curr Treat Options Allergy (2015) 2: 218. doi:10.1007/s40521-015-0056-y

  2. Zheng T, Yu J, Oh MH, Zhu Z. The Atopic March: Progression from Atopic Dermatitis to Allergic Rhinitis and Asthma. Allergy Asthma Immunol Res. 2011 Apr;3(2):67-73. https://doi.org/10.4168/aair.2011.3.2.67

  3. Increasing Comorbidities Suggest that Atopic Dermatitis Is a Systemic Disorder Brunner, Patrick M.Bagot, Martine et al. Journal of Investigative Dermatology , Volume 137 , Issue 1 , 18 – 25

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