Ever wonder how morning people do it?

It’s pretty easy to spot who is who. You’re either a night owl or a morning person and science still doesn’t exactly know why people are this way. But if you’re looking to join those bright and happy people of the morning, here are some awesome tips that can help you do just that. You know, if you feel like it.

Have you ever wanted to have an early-morning jog or marvel at the sun rising in the east? There’s only one way to fulfill that desire of yours, and that’s to become a morning person.

Sure that’s easier said than done especially if you have been a night owl for the longest time. However, this does not mean that being a morning bird is an impossible feat. There are a few tips and tricks that you may do for you to be able to jump out of your bed as soon as your alarm clock goes off, rather than fumble for the snooze button and get some more Z’s.

To become a morning person, it’s of utmost importance to note that getting long (7 to 9 hours) and quality sleep is imperative. If you wake up feeling refreshed and on cloud nine the following day, you know that you had just spent the right kind of trip to dreamland.

Here are some of the simplest yet most effective tips and tricks on how to become the morning person you have always wanted to be:

Quit drinking coffee at least 8 hours before hitting the sack. Naturally, having caffeine in your system can keep you from getting early to bed to become an early riser. It’s not just your favorite cup of joe you need to dodge in the afternoon if you want to become a morning bird, but also other caffeinated beverages like soda, tea and energy drinks.

Refrain from using alcohol as your sleep aid. While it’s true that alcohol can make you feel sleepy, the fact is the kind of sleep you can get from it is terrible. Ever wondered why drinking the night before makes you feel worn-out the following day? That’s the doing of the alcohol you guzzled down.

Stop using your bed for an assortment of tasks. Make sure that your bed is only for a couple of things: having sex and getting some shut-eye. In other words, quit watching your favorite movie, reading and replying to e-mails or sharing on social media as soon as you hop into bed.

Get your breakfast ready before hitting the sack. You can save a lot of time in the early morning if your breakfast is ready to eat. The night before, whip up a healthy breakfast, allow to cool for a while then stash it in the fridge. The next morning, simply pop it in the microwave and enjoy the most important meal of the day.

Take a shower of bath before jumping into bed. You will find it easier to get some sleep if you relax your muscles most especially after a really tiring day. A great way to prep your body for a trip to dreamland is by enjoying a shower or bath. Many swear by the effectiveness of a warm shower or bath in relaxing tired muscles.

Make sure that your alarm clock is facing the other way. Seeing the glowing time can actually make you feel anxious, making it harder for you to get a good night’s sleep and ultimately becoming a morning person. Set your alarm clock and turn it away from you, and quit worrying about the fact that you need to wake up early in the morning.

Switch on the light the minute you get off your bed. Waking up when it’s still dark outside will only make you want to get some more Z’s. A smart way to tell your body that it’s time to start your day even when the sun is not yet up is by turning on the light as soon as your alarm clock goes off.

Make your bed asap. After switching on the light, proceed with making your bed. This is a great way to tell your brain that the time spent in bed is actually over. It’s a great idea to ensure that your bed is trouble-free to make, so see to it that there’s not too many pillows and blankets strewn on the bed.

Source: http://www.healthdigezt.com/smart-tips-and-tricks-on-becoming-a-morning-person/

10 Things You Should Know Before Getting Your Face Waxed

1. What’s the difference between waxing and sugaring?waxing
With all the different kinds of hair removal on the menu, it can get confusing to navigate what is what and which one is right for you. Here’s a quick rundown.

“Waxing when you use a warm resin base that is applied to an area and then removed either with a strip or let dry and removed on its own, taking hairs out by the root,” explains esthetician Marta Grochowska of New York City’s Haven Spa. On the other hand, “sugaring is a warm sugar and lemon mix that’s applied to the skin and rolled across, thereby removing the hairs,” she adds.

2. Will waxing hurt my skin?
“If you’re very prone to breakouts, especially if you have acne mechanica, you should consider other options like electrolysis or laser,” advises Grochowska. (See no. 4 on this list for why your acne treatments are always necessary to disclose.)

More serious medical conditions, too, can play a part in whether waxing negatively affects you. “If you have an autoimmune disease like lupus, your skin is way more sensitive to getting burned or irritated,” warns Joyce Imahiyerobo-Ip, board certified dermatologist and consultant for HydroPeptide. If you’re not sure whether your skin could be at risk, especially if you plan on doing a wax at home without an esthetician’s expertise, consult with a dermatologist first.

3. Will the hair grow back thicker?
“The hair generally grows back the same — though everyone seems to have their own theory or old wives’ tale about it,” says Grochowska, who adds that generally, most people find that long-term waxing results in less regrowth. That said, the hair “will seem thicker if it’s broken than if it’s removed at the root” because it won’t have a tapered end.

4. Can my skin-care routine affect how the wax works?
Listen up! “Topical treatments like Retin-A and Differin thin the skin, making it much more sensitive and prone to tears and peeling,” warns Grochowska. But these aren’t the only meds you should be mindful of before getting a wax, oral medications can put you at risk too: “Accutane and many antibiotics will make your skin hypersensitive.”

5. What’s “double dipping” and why should I avoid it?
Double dipping is when the practitioner dips the stick into the wax, applies the wax to the skin, then dips the stick into the wax again for the next application, explains Grochowska. Basically, a big no-no. Why? Bacteria and pathogens form one person’s skin can get introduced back into the pot, passing onto the next person.

6. Will I be red afterward?
When you tear out hair and pull at your skin with wax, there’s a chance you will wind up with a little irritation. “Some people are red for a few minutes, some are red for 12 hours,” says Grochowska. “If you’ve never been waxed before or you’re trying a new place or wax, it’s best to err on the side of caution and give yourself plenty of time to recuperate.” If you’ve got a big event to go to and want to prep your brows or lip, schedule your wax a few days beforehand to ensure any redness goes down.

7. OK, so how do I make the irritation go away?
Most of the time, you just have to wait it out, but there are ways to help speed up the process. “Most people respond well to aloe gel,” says Grochowska. Dr. Imahiyerobo-Ip also advises using a little over-the-counter hydrocortisone to soothe the skin.

8. How long will it take to grow back?
The annoying thing about shaving is that if you’re particularly hairy, stubble will probably start cropping up within a day or two, which isn’t so much of a problem with waxing. “The great thing about waxing is that it’s semi-permanent — it lasts two to eight weeks,” says Dr. Imahiyerobo-Ip.

9. How can I tell if I’m having a bad reaction?
A little redness and irritation is normal, but there are some signs that you may be having more than the average reaction. If you’re noticing little pimples or pus-filled bumps around the waxed area, you could be experiencing folliculitis, which is an inflammation of the hair follicles, explains Dr. Imahiyerobo-Ip. While folliculitis can occur simply from the trauma of waxing, it can also be caused by exposure to bacteria in the wax and result in an infection. If this is the case, Dr. Imahiyerobo-Ip advises heading straight to the dermatologist.

Another big red flag: significant redness, swelling, and pain, which could indicate an allergy to the wax. “Wax contains a lot of additives like colors, fragrances, and essential oils that people may be allergic to, which we call contact dermatitis,” explains Dr. Imahiyerobo-Ip. “That won’t go away on its own — you may need topical medications or even oral meds,” so see a doctor as quickly as you can.

10. Is it safe to wax at home?
If you take all precautions and follow all the directions properly, like doing a patch test to check for an allergy, waxing at home can be safe. “A common mistake I see in at-home waxing procedures is not having a good gauge on the temperature of wax,” says Dr. Imahiyerobo-Ip. While burns can happen anywhere, even at a reputable spa, she warns that they’re more likely when waxing at home. “People think if they leave it on a little longer, it will be more effective, but you can get a temperature burn.” If your skin gets torn off along with the wax, you could put yourself at risk for scarring or an infection.

Another bad habit to avoid: Waxing on a day you’re doing lots of other treatments. “People do their waxing in the context of a ‘spa day,’ so they do it along with peels, face scrubs, and face masks, which make you more susceptible to negative reactions from the wax,” says Dr. Imahiyerobo-Ip. “For my patients who use retinoids or peels, I recommend they opt for other forms of hair removal like threading, which just grabs the hair instead of the skin and the hair.”
From: Good Housekeeping

How to help your Sciatica

Sciatic pain is something that many people experience on a regular basis. It is the region from your lower back, buttocks and thigh. Sometimes it can feel like pins and needles or shooting pain or anything in between. The best way to deal with this is to call Jon ‘Ric Nashua and get a massage scheduled today so that we can make the pain stop as quickly as possible.

Sciatica is the result of a trauma or damage to the sciatic nerve – a nerve that has the largest diameter among all of your nerves, and runs down your leg from the lower end of your spinal cord and through the back of your thigh.

The pain brought about by sciatica is distinctive. When you have it, you know that it’s sciatica. The pain experienced flows from the lower part of your back, through your behind and runs into your lower limbs. This pain usually worsens during movement. Sometimes you may also have tingling in your feet and toes, as well as weakness in the legs or feet.

Your doctor may recommend you to undergo physical therapy to help in strengthening your back muscles and to have your posture improved. Pain killers, muscle relaxants and even antidepressants may be prescribed in order to have the symptoms of sciatica managed. Sometimes the injection of steroid medication into the canal surrounding your spinal cord may be performed to ease the symptoms, although this is rarely done due to the unfavorable side effects it’s associated with.

In severe cases, such as when there’s loss of control of the urinary bladder or bowel, or when there’s severe weakness in the lower extremities, surgery may be warranted.

For mild to moderate cases of sciatica, there are numerous home remedies available that can help in easing the symptoms experienced. Some of the most effective ones include cold compresses, hot compresses, stretching and regular moderate exercises. Being sedentary for long periods at a time is not recommended for someone with sciatica.

There are also a handful of alternative treatments for sciatica that are sought by numerous sciatica sufferers and are actually recommended by some specialists due to their effectiveness in providing relief from the characteristic pain of the said condition. Some of them include seeing a massage therapist and a chiropractor. Hypnosis and acupuncture are other alternative treatments. Then there is also acupressure which may be easily performed at home.

In performing acupressure, all you have to do is apply pressure on certain areas on the body, which are referred to as pressure points. According to the proponents of acupressure, the application of pressure on specific points enables balance of the body and promotes its natural healing. Stimulating a pressure point may be done with the thumb as well as the second knuckle of the index finger while the hand is in a fist.

Acupressure is similar to acupuncture, which is known to be a very good alternative treatment available for individuals with sciatica. You may think of acupressure as acupuncture without involving the insertion of fine needles into your skin. Acupressure performed at home or even by an expert is ideal for you if you are on the hunt for an all-natural remedy for sciatica pain and being jabbed with needles is simply not regarded as an option.

Below you will find some of the pressure points in relieving sciatica pain. Generally, you have to apply pressure on these areas for about 30 seconds. The pressure applied should be heavy enough that there’s a feeling of soreness present.

For pain in the lower back:

. GV 2 – This is situated in the so-called hiatus of the sacrum, specifically where your 4th and 5th sacral bones meet.

. GV 3 – You can find this in the lower back, which is second to the lowest segment of your spine.

For pain at the side of the leg:

. GB 30 – Located on the lateral side of your buttock. Apply pressure on this spot while you are lying on your side.

. GB 31 – It is right in the middle of the side of the outer aspect of your thigh.

For pain at the back of the leg:

. B 57 – You can find it behind the leg, right in the middle of the bend of the knee and the base of your calf muscle.

. B 60 – This is the depression between your Achilles tendon and the prominence on the outer side of your ankle.

Source: http://www.healthdigezt.com/dealing-with-sciatica-pain-using-pressure-points/

Natural ways to lose weight

There are so many reasons why we hold onto weight and not all of them are a direct result of our habits or lifestyle. A lot of it has to do with hormone balance and genetics. There are some great natural ways to lose weight that can boost any medically assisted weight loss efforts. Call Jon ‘Ric today.

Ayurveda is the oldest holistic medicine which originated in India. It has been benefiting many inhabitants of this planet for more than 5,000 years now. Ayurveda covers a lot of health matters, including the promotion of weight loss. There are numerous Ayurveda tips that can help you attain the figure you have been dreaming about badly. Not only will these simple and all-natural solutions can make you look physically attractive, but also help you become a healthier individual.

Literally, Ayurveda means “knowledge of life”. It considers you as a whole person and not merely the sum of your individual parts – holistic, to describe it in a single word. This is a good thing because such approach allows for the determination of the root cause of your problem. For instance, if you are having a hard time shedding off excess pounds, Ayurveda will tackle it by taking into account your entire being in order to pin down the culprit behind it.

Since various Ayurveda solutions for excess weight reduction have been around way longer than any fad diet, supplement and equipment on the market, you can be certain that they work effectively and safely. Continue reading to learn some really simple tips and tricks on weight loss based on some the very reliable Ayurvedic holistic medicine.

Drink a Glass of Water with Lemon Juice in the Morning

The water should be warm and the lemon has to be organic. The consumption of such mixture first thing in the morning jump starts your digestive system, preparing it for the rigorous tasks it needs to perform throughout the day.

Make Exercise a Part of your Morning Ritual

Ayurveda or not, exercising is a very important component to weight reduction. Doing it even for as short as 30 minutes is enough, although the ideal length is 45 to 60 minutes. It’s a good idea to opt for exercises that you find interesting and enjoyable to carry out. This way, you can incorporate them into your daily morning grind without trouble.

Meditate for at Least 10 Minutes After Exercising

In this day and age, it’s important to meditate in order to keep at bay the unfavorable effects of stress, and one of them is gaining unwanted weight. Something as simple at doing deep-breathing exercises, guided imagery and yoga allows you to become a more mindful individual, letting you make the best possible decisions throughout the rest of your day.

Eat Three Times a Day

Scrap the adage “eat breakfast like a king, lunch like a prince and dinner like a pauper”. What you should do is have a medium-sized meal for breakfast. Opt for a large meal at noon because that’s where your metabolic rate is at its peak. It’s definitely important for you to have a small meal at dinner when your metabolism is at its slowest.

Steer Clear of Snacking in Between Your Meals

One of the most obvious weight saboteurs is snacking. You see, it causes you to supply your body with more calories than it needs and can burn. According to Ayurveda philosophy, it’s not a good idea to constantly supply your body with fuel by means of food. Otherwise, it will eventually forget how to burn excess calories and fat.

Go for Short Walks After Eating

Walking at a moderate pace for 10 to 20 minutes after every meal is a great idea. Not only will this allow you to burn a few extra calories, but also stimulate the digestive process so that you may properly absorb the nutrients in food.

Flush Out Toxins with an Easy-to-Make Detoxifying Tea

Getting rid of impurities in your body helps you drop unwanted pounds. There’s a simple Ayurvedic detoxifying tea that you can take sips of throughout the day: bring 4 to 5 cups of water to a boil and add 1/2 teaspoon of fennel, coriander and cumin seeds in it. Allow to boil for another 5 minutes. Transfer the resulting tea in a thermos and bring with you to work.

Source: http://www.healthdigezt.com/lose-weight-with-these-simple-ayurveda-tips-and-tricks/

5 New Hairstyles to Try for Winter

When the seasons change, so do hairstyles and fashion. As winter settles in here in New Hampshire, everything from head to toe will start to take on a more winter-flavored feel. Here are some of our favorite new hair trends that you’ll likely start seeing soon enough throughout New England. With each season comes an opportunity try our some unique and season driven styles. Here, we take a look at a break down of five fresh looks to try for winter from Elle Magazine.

Winter Hair

Ignoring a rash?

Many people do not think to get their skin looked at by a doctor or dermatologist and this can have sometimes deadly consequences. Whether it be melanoma or something more minor, keeping an eye on your skin is absolutely crucial. Below is some information on impetigo and how to prevent this skin condition.

Impetigo is a skin condition that is highly contagious. Caused by bacteria, it is very common in children and infants although adults may get it too, usually due to an infection or another condition affecting the skin.

This is something that can be quite embarrassing because it involves the formation or red sores on the face, neck and hands. Those itchy fluid-filled sacs may also appear on the diaper area. A mild case of impetigo may not require treatment. On the other hand, a severe case is usually treated with antibiotics. Impetigo tends to go away in 2 to 3 weeks.

Impetigo can be classified into 3 types, depending on the bacteria behind it and the signs and symptoms. Several different home remedies are also available for this skin condition that can help in its management, as well as in keeping it from spreading.


There are 2 kinds of bacteria which may cause impetigo: streptococcus pyogenes and staphylococcus aureus. The skin condition may get spread in a variety of ways. Definitely, an individual may obtain it from coming into direct contact with the skin of a person with impetigo. The bacteria which cause it may also be spread from using or touching items belonging to an infected individual, such as towels and toys.

It is also possible for the infection to be obtained by means of an insect or animal bite, as well as an injury to the skin.

Risk Factors

As mentioned earlier, impetigo is more common in children and infants than adults. Experts say that children between 2 to 6 years of age are at high risk of getting the skin condition. This is especially true among those who regularly attend school. Certainly, being in a crowded area wherein the bacteria behind impetigo may spread easily is also a risk factor.

Poor hygiene and the weather may also be blamed for the spreading of impetigo.

Someone with skin irritation due to an assortment of causes may end up with the skin condition as bacteria may easily get to the affected area and start an infection. Experts say that having dermatitis may also put you at risk of developing it.

Signs and Symptoms

Because red sores develop on the face, neck and hands on the individual, impetigo can be an embarrassing skin condition to have. Fluid-filled sacs may pop easily, leaving yellow crusts behind. Needless to say, the blisters are itchy. A person with impetigo may also have lesions on the skin. Since it is a form of bacterial infection, it may cause the lymph nodes to end up tender and swollen.

It’s important to note that the signs and symptoms of impetigo may vary from person to person. It usually depends on the type of impetigo involved.


These are the different types of impetigo:

. Bullous impetigo – Common in children below 2 years of age, sores form on the arms, legs and torso at first. Initially, the fluid inside the sacs is clear, ending up cloudy. The rash tends to last longer than the rash due to the other types of impetigo.

. Nonbullous impetigo – Also known as impetigo contagiosa, it is highly contagious and the most common type of impetigo in children. The sores tend to appear first around the mouth and nose. The rash involved is itchy but not painful. It usually involves the swelling of the lymph nodes.

. Ecythma – Since the layer of skin underneath the topmost is also affected, this is regarded as the most serious form of impetigo. The rash may be painful and end up as open sores, leaving scars when they heal. It also causes the lymph nodes to get swollen.


Mild impetigo cases may not require any treatment. Some home remedies are usually enough to have the signs and symptoms managed. Gently washing the affected areas using antibacterial soap may be done. It’s important for the person with the skin condition to refrain from touching or picking at the blisters.

Oral and/or topical antibiotics may be prescribed by a doctor, the type of which is dependent on the bacteria causing the infection.

Source: http://www.healthdigezt.com/important-information-on-impetigo/

Why Quitting Smoking is a Great Idea

The dangers of smoking are very well known for the heart and lungs but a less publicized casualty of smoking is your skin and your wallet among many other parts of your body. Your skin ages greatly and more wrinkles form as a result of smoking so if you’re thinking about quitting, just do it. Your skin will thank you.

Cigarette smoking and tobacco smoking have been around for decades and is not just a passing trend. The cigarette industry takes in millions every year and each person who smokes contributes to this. Lung Cancer is the number one death causing cancer so far and one of the leading causes of lung cancer is smoking and/or second hand smoking. Most people who smoke are aware of the causes of smoking to their body. It is a known fact that smoking is not good for the health, and still people are unable to stop. Here are fifteen reasons why you should quit smoking.

Non-Health Related Reasons

1. Less Money on Cigarettes, More money on the Bank

If you smoke 5-10 sticks a day, that would make 35-70 stick a week, 155-310 sticks a month. You would have spent at least 5% of your monthly income just for cigarettes. This money you have spent on cigarettes could have been saved up and used for something more important. A few months without cigarette, you could have saved for a car, your children’s college fund, additional food for your family, a gift for your wife or girlfriend or a well-deserved vacation in a tropical country.

2. Possible bonus at work

Some corporations have smoking cessation programs where employees who stopped smoking are given additional incentives.

3. No more restriction

There are bars and restaurants which are 100% smoke free all over the globe. Being smoke free yourself will increase your chances to be in these bars and restaurants, especially when you travel.

4. No more clutter

Cessation from smoking can increase the space in your purse or pocket, since you don’t have to bring your cigarettes, matches/lighters, additional breath mints (though you still need to bring these, you don’t need to bring a dozen pack anymore) and other smoking necessities.

5. Mother Nature will be Thankful

If you don’t smoke, the environment will take in less pollution, thus lessening the damage on the ozone layer.

6. Less Chances of Fire

If you quit smoking, the only chance of fire will be due to your hot ass because you look so good after quitting.

Health Related Reasons

7. Healthy Lungs

One of the main causes of lung cancer is smoking and/or second hand smoking. By quitting smoking, you are saving the lungs of the people around you and your own.

8. Nice and Pearly Whites

When you smoke, your teeth are also affected. The nicotine stains your teeth or your dentures. Quitting smoking will lessen the further staining for a more healthy and friendly looking smile.

9. Decrease Heart Problems

Since smoking constricts you blood vessels, which affects your hearts ability to pump blood. Since the organs need adequate amount of blood to function, and your vessels are constricted, your heart will pump more blood than usual, which might cause straining of the heart.

10. Lesser chance of Diabetes

Diabetes is caused by the clogging of the vessels due to decrease viscosity of the blood which may be caused by the nicotine in the cigarettes. Quitting smoking will decrease chances of diabetes.

11. Reynaud’s Disease

Reynaud’s Disease causes the extremities to feel numb and cold especially when exposed to very low temperature. Not enough blood can flow to these parts of the body because the vessels are constricted due to smoking.

12. Buerger’s Disease

Buerger’s Disease is an inflammation mostly to the legs which causes bluish discoloration to the fingers. This disease can also be due to smoking.

13. Less chances of Impotence
Since smoking affects circulation, males who smoke may experience impotence where erection is difficult to achieve since blood cannot flow easily to the genitals.

14. Birth Control in Control

Most pills used for birth control are not allowed to be given to women who smoke. This alters the effects of the drug to the body.

15. Menopause

Most women who starts smoking at a younger age may find their menopausal time arrive earlier.

Source: http://www.healthdigezt.com/fifteen-reasons-why-you-should-quit-smoking/

Emotions and Skin Disease

A new study shows that mental or emotional states influence how your skin performs its normal and necessary processes and therefore how healthy it is. Read the study below to get a larger scientific explanation of how this occurs on the macro and micro levels. Be sure to visit Jon ‘Ric for some of our fabulous dermatology procedures as well.

Immune-mediating neuropeptides may provide an avenue for addressing inflammatory skin diseases including psoriasis, said an expert at the 73rd American Academy of Dermatology Annual Meeting.

Richard D. Granstein, M.D.Richard D. Granstein, M.D., says, “Most patients and physicians believe that stress influences many inflammatory skin diseases. It is said that psoriasis, rosacea and acne all get worse with stress. This is a clinical impression; I believe it’s almost certainly true.” He is the George W. Hambrick, Jr., Professor and chairman of the department of dermatology at Weil Cornell Medical College.

READ: Researchers isolate psoriasis triggering proteins

Several studies support this impression anecdotally, he adds, but controlled studies are rare: “Where do you find a control group that’s not under stress?”

Soft data

One report showed that, after a large earthquake in Japan, the likelihood of atopic dermatitis (AD) flares rose in proportion to the severity of local damage.1 Dr. Granstein says that potential confounding variables include the fact that “perhaps people in the earthquake zone did not apply their ointments or creams because they had other things to worry about.”

Other studies show that combining pharmacological treatment with stress reduction interventions clears psoriasis faster than medical interventions alone, he says. Regarding AD, NC/Nga mice raised in a normal environment develop an itchy, eczema-like rash. Those raised in a cleaner, specific pathogen-free setting do not, unless exposed to psychological stress.2

READ: Treating acne and rosacea in patients with skin of color

Dr. Granstein says, “These are soft data. Nonetheless it all supports the idea that certain inflammatory skin diseases worsen with stress. The question is, how?”

Several laboratory studies elucidate mechanisms by which nerves may influence inflammatory skin disease, says Dr. Granstein. The observation in humans and certain animal models that denervating (either surgically or phamacologically) psoriatic skin resolves the psoriasis has been known since the 1970s, he says, “But people don’t talk about it much.” Although psoriasis certainly involves the immune system, he says that “the nerves contribute something.” Further support for this idea comes from clinical reports suggesting that botulinum toxin can clear psoriasis,3 says Dr. Granstein.



Pathogenesis clues

More recently, he says, “Our laboratory has demonstrated that 2 neuropeptides-pituitary adenylate cyclase-activating peptide (PACAP) and vasoactive intestinal polypeptide (VIP)4-influence Langerhans cells to present antigen preferentially for generation of Th17 cells and interleukin (IL)-17 production,” both of which are involved in the pathogenesis of psoriasis.

READ: Microbial considerations in rosacea treatment

“If stress causes release of PACAP and VIP from nerves in the skin,” he surmises, “this may cause the outcome of local immune responses to be skewed towards IL-17, which one might imagine could make psoriasis worse.” Because lymph nodes are innervated, he adds, “Perhaps antigen presentation occurring within the lymph nodes could also be affected.”

Furthermore, an unpublished in vitro study co-authored by Dr. Granstein suggests that the neuropeptide calcitonin gene-regulating peptide (CGRP) can also influence the outcome of antigen presentation-not directly, but through the effects of endothelial cells.5 The dermatologist says that, “If we treat endothelial cells with CGRP, then wash out the CGRP, when in the presence of Langerhans cells and responding T cells, those endothelial cells are also able to influence the outcome of antigen presentation towards IL-17.”

This is important, Dr. Granstein says, because blood vessels in the skin are innervated (by nerves that contain CGRP) and lined with endothelial cells. Also, he says, “norepinephrine, which is the principal neurotransmitter of the sympathetic nervous system, has the same effect as CGRP on endothelial cells. So certainly one would imagine that under periods of stress, as the sympathetic nervous system is activated as part of the fight-or-flight reaction, norepinephrine will be released and could influence endothelial cells” to skew antigen presentation toward IL-17.



Potential contributors

Regarding other potential contributors, says Dr. Granstein, “we’ve shown, for example, that although adenosine triphosphate (ATP) is important in the energy chain, it also is an extracellular messenger. And in fact, it’s a sympathetic co-transmitter-it comes out with norepinephrine when sympathetic nerves are activated.”6 ATP can induce endothelial cells to release chemokines that may attract certain inflammatory cells and IL-6, he notes. “So in this way, activation of the nervous system may nonspecifically amplify inflammation in the skin. In this scenario, under stress, the sympathetic nervous system is activated; ATP is released and binds to receptors on endothelial cells. This causes release of chemokines that allow for the accumulation of inflammatory cells,” Dr. Granstein says.

READ: Bariatric surgery associated with improved psoriasis, psoriatic arthritis

Also of interest, a recent paper reported that sensory nerves involved with pain sensation were needed for the development of psoriasiform inflammation in a mouse model of skin inflammation caused by a topically applied immune stimulator.7  In this report, the nerves appeared to induce release of the cytokine IL-23 from dendritic cells in the dermis; IL-23 is important in inducing IL-17 production by other cells, says Dr. Granstein, and it was reported to induce IL-17 release by a class of lymphocytes known as gamma-delta T cells. Whether stress would activate this pathway is unknown, he adds.

Some of the above pathways might provide drug targets, says Dr. Granstein, adding that “if one could imagine a way to block the effect of some of these neurotransmitters only in the skin and not in the rest of the body-perhaps with a cream, which would have negligible systemic absorption-this might be useful.”

For clinicians treating inflammatory skin conditions such as psoriasis or AD in patients who believe that stress is contributing to the disease, Dr. Granstein says that “it’s reasonable to recommend as part of the therapeutic armamentarium interventions to relieve stress.” Examples include relaxation techniques, support groups and perhaps, where appropriate, counseling or psychotherapy. “It’s reasonable for another reason-although stress may cause disease, disease causes stress. Psoriasis and AD are uncomfortable and often itchy. Sometimes people are disturbed by the appearance of their skin with these diseases. There are many reasons why measures to try to deal with stress may be useful” in combating skin disease, says Dr. Granstein..

READ: Rosacea’s surprising genetic link

Ultimately, he says, “You don’t need to postulate any of these mechanisms. If a patient says, ‘when I have trouble at work, my psoriasis flares,’ that’s all you need to know.”

Source: http://dermatologytimes.modernmedicine.com/dermatology-times/news/neurotransmitters-may-fuel-inflammatory-flares-skin-conditions

Advances in Hair Removal Treatments

Almost everyone on the planet deals with some form of unwanted body hair. It is a large industry that helps people eliminate this hair and there are several different methods available. Very few of them are permanent, leaving the field open for advancements. This is one such advancement known as miraSmooth.

The Food and Drug Administration has cleared miraDry – a microwave-based device already approved for eliminating underarm sweat glands – for the permanent reduction of underarm hair of all colors.

Following the FDA clearance, miraDry maker Miramar Labs, Santa Clara, Calif., announced the roll out of the miraSmooth brand, which targets patients looking to eliminate underarm hair. The miraDry/Smooth system is based on Miramar’s proprietary miraWave technology, which uses precisely controlled microwave energy. It is this technology that enables the elimination of underarm hair regardless of its color. Thus, Miramar is marketing miraDry/Smooth as the only FDA-cleared device for treating unwanted underarm hair of all colors as well as the permanent reduction of underarm sweat.

Mr. Ellis“MiraSmooth is the use of the miraDry system, in conjunction with laser hair treatment when appropriate, for axillary hair removal,” says Miramar Vice President of Marketing Rob Ellis. “It’s a versatile hair-removal option that can be used alone, or in combination with a series of laser hair-removal treatments, and also provides the unique benefit of simultaneously eliminating sweat. The treatment is quick and simple, takes about one hour and is only available in a physician’s office.”

The FDA clearance of miraDry for hair removal was based on a study performed at three private dermatology clinics. Study co-author Jeremy Brauer, M.D., a dermatologist at the Laser & Skin Surgery Center in New York, tells Cosmetic Surgery Times that the study recruited adult subjects seeking underarm-hair reduction.

Dr. Brauer“They were screened, and those eligible received up to two sessions, three months apart,” he says. “Fifty-six subjects were enrolled, with an average age of 33 years; 80% of the subjects were female and 88% were Caucasian.”

For the purpose of hair count and blinded physician assessment, photos were taken before each treatment and at each follow-up visit. Subjects gave feedback on their overall satisfaction with the treatment experience, as well as odor rating and sweat ratings, during follow-ups.

NEXT: Hair Reduction Results



Hair Reduction Results

According to Dr. Brauer, the study provides evidence for safe and effective axillary hair reduction.

“Based on the study, patients can expect at least 70% reduction in one to two treatments,” he says. “However, our study parameters and technique were optimized for sweat reduction, so while the results are promising, I think that they can and will be better once a protocol is defined for hair reduction. We only treated once or twice and evaluated at follow-up visits that were determined at the start of the study – the latter point being that it’s possible hair reduction is observed earlier than we noted.”

As for pain level and after effects, Dr. Brauer says that since local anesthesia is administered prior to treatment, most patients experience little or no discomfort.

“There is a strong safety record with the miraDry procedure,” he says. “After treatments patients may experience temporary swelling, soreness, tingling or numbness. These all resolve in a matter of a few days to weeks.”

Dr. Brauer says the study’s most significant finding was that there were no differences in the reduction of light or dark hair.

“For the first time, there was a device for hair removal that did not depend upon the pigment or color of the hair – essentially making it a ‘color-blind’ procedure,” he tells Cosmetic Surgery Times. “The implications for this are far-reaching: treatment of gray hair or blonde hair, and treatment of individuals of all skin types without the concerns associated with standard hair-removal devices.”

Helen M. Torok, a Medina, Ohio, dermatologist not involved in the study, says she has not used miraDry but knows about it.

“It was exclusively used for hyperhidrosis,” she says, “but during the procedures it was discovered that there was a decrease in hair – and it didn’t matter what hair, which translates to the fact that the energy delivered is deep. It would be nice to see if we can use this technology on the face for hirsutism, but the current device is probably too deep and would cause scarring.”

According to a Mirmar spokesperon, miraSmooth is currently only offered in the United States. The list price of miraDry is $84,450. For physicians who own a miraDry system, there is no additional cost or device required to offer the miraSmooth procedure.

Disclosure: Dr. Brauer served as a consultant to Miramar.

Source: http://cosmeticsurgerytimes.modernmedicine.com/cosmetic-surgery-times/news/hyperhidrosis-hair-removal-meet-mirasmooth

New Acne Treatments

The field of dermatology is a very exciting one as skin is technically our largest organ and the first attribute someone notices about another person. Acne is a condition that many people suffer from in varying degrees. New studies are showing promise that can help combat this condition to give patients better skin for life.

New agents targeting the different factors that contribute to the pathogenesis of the disease appear to be very effective and result in excellent clinical outcomes, according to one expert.

The currently available therapeutic modalities for acne include numerous treatment approaches such as antibacterial washes, topical creams, antibiotic pills, lasers, pulsed-light therapies, photodynamic therapy, and isotretinoin.

Linda F. Stein Gold, M.D.“There are several new breakthroughs we are seeing in acne therapy today including medications that have novel mechanisms of action, more effective vehicles, as well as newly FDA-approved combination therapies. These new agents are proving to be very effective for all severities of acne and could herald a new age in acne therapy,” says Linda F. Stein Gold, M.D., director of clinical research and division head of the Department of Dermatology at Henry Ford Hospital, Detroit, Mich.

READ: Acne pathogenesis

Two topical drugs in particular that are currently under development have a novel mechanism of action and also target the production of sebum in the skin; thereby potentially ameliorating the clinical symptoms of acne. The experimental drug known as SB204 (Novan Therapeutics) just completed a phase IIb clinical trial and has been shown to not only effectively decrease the sebum production in the skin but also reduce both the comedone and inflammatory lesions seen in acne.

According to Dr. Stein Gold, this novel nitric oxide based agent appears to have antimicrobial and anti-inflammatory activity, reduces sebum production, and affects the keratinocytes, while avoiding resistances so commonly associated with standard antibiotic therapies.

“Although it still has to go through phase III clinical trials starting early next year, the interim results look very promising,” Dr. Stein Gold adds.

The other experimental drug in the pipeline that also has been shown to reduce the production of sebum in preclinical studies is DRM01 (Dermira).

READ: Alternative treatment options for acne

“Both of these pipeline drugs could change the way we approach acne therapy, as these may be the first two agents that can achieve a reduction in sebum production topically, not orally, making them so unique and exciting. In addition, they could serve as a treatment alternative to help curb the overuse of topical and oral antibiotics in standard acne regimens,” Dr. Stein Gold says.



Combination therapies

Epiduo Forte (Galderma) gel, which recently received FDA-approval, is a new combination product that has also been shown to be very effective in the treatment of moderate to severe acne vulgaris. According to Dr. Stein Gold, the novel combination of adapalene 0.3% and benzoyl peroxide (BPO) 2.5% can be very useful in the improvement of acne lesions, particularly severe papulopustular acne.

READ: Acne and anxiety

Onexton gel (Valeant) is another relatively new combination acne therapy consisting of clindamycin 1.2% and benzoyl peroxide 3.75%. Upping the concentration of BPO from the standard 2.5% (as in Acanya gel, Valeant) to 3.75% has been shown to be very effective and can achieve significant improvements in moderate to severe acne.

It was previously thought that the concentration of benzoyl peroxide did not have any consequence on clinical outcome; however, the successes seen with Onexton gel has caused dermatologists to reconsider. In fact, it appears that the concentration of BPO does matter, Dr. Stein Gold says, as higher concentrations of BPO may increase the efficacy of combination therapies.

READ: Unique tips for treating acne scars

“This is a really an exciting time in acne therapy. We have some new formulations, some new molecules, and we are actually in a better position than ever before to get our patients under control and maintain control of their acne, from moderate to severe,” Dr. Stein Gold says.

Disclosure: Dr Stein Gold is an investigator/advisor for Galderma, Valeant, Dermira, Novan, and Allergan.

Source: http://dermatologytimes.modernmedicine.com/dermatology-times/news/whats-coming-acne-therapy