Transcript Document

Snippets
The following items will be discussed:
@ Skin markers @ Rosacea: flaring factors
@ Cosmoticals: Peeling
@ Phtotherapy @ Biological therapies
@ Transdermal drug delivery
@ Therapeutic tips
S 1OO
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S 1OO stains a calcium binding protein that is expressed in melanocytes &
melanocytic tumors. However, it is not specific for melanocytes. It also stains glial &
Schwann cell tumors, granular cell tumors, eccrine coil neoplasm, Langerhans cells,
chondrocytes, smooth & skeletal muscle & their tumors, sarcomas & occasionally
breast adenocarcinoma.
Stains for malignant melanoma:
@ S 1OO : sensitive but not specific.
@ HMB 45:highly specific but poorly sensitive
@ Melan –A/ MART -1: specific but poorly sensitive
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CD 31
A sensitive marker for vascular tumors such as angiosarcoma
CD 34
A less sensitive marker for vascular tumors, also positive in dermatofibrosarcoma
protuberance, leukemia, lymphoma
CD 45
Positive in most leukemias & lymphomas.
Immunofluorecense
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Immunoglobulin deposits in the skin are a valuable source of diagnostic
information. Best results are usually obtained from peri-lesional skin . The
biopsy tissue has to be frozen & stained with fluorecein isothiocynate
labeled antibodies to IgG, IgM, IgA, C3 & fibrin.
Direct immune-fluorescernce is useful in:
@ Immunobullous disorders
@ Lupus
@ Vasculitis.
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Amyloid stain
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Amyloid is an amorphous material that can deposit in the skin leading to a
variety of clinical appearances. Congo red stains amyloid an orange – red
color & under polarised light green birefringence is seen, There are a
number of other stains used for amyloid including crystal violet, methyl
violet, PAS & Sirins red.
Rosacea
Flaring factors
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@ Heat:
Hot bath, saunas, excessively worm environments, overdressing
@ Exertion:
@ Alcohol
Exercise, lifting
Red wine, liquor, beer
@ Emotions: Anxiety , stress, embarrassment
@ Drugs: vasodilators, anxiety , topical steroid
@ Medical conditions: Chronic cough, menopause
@ Weather:
Sun, hot, cold, strong winds, humidity
@Food:
Spicy & thermally hot foods , foods high in histamine
@ Topical products:
Some cosmetics & hair sprays especially those containing alcohol,
witchhazel or fragrances, hydro alcohol or acetone
cosmecuetals
Botanicals
A. Lighteners/ brighteners
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@ Aloesin ,@ Bearberry .@ Black mulberry ,@ Blueberry ,@ Carrot ,@ Citrus
fruit ,@ Cranberry .@ Cucumber .@ Echinacea ,@ Ginseng ,@ Gingko ,@ Grape
seed ,@ Indian gooseberry ,@ Licorice ,@ Pear ,@ Soy , @ White mulberry ,@
White willow
B. Tighteners
@ Birch ,@ Gingko ,@ Horse chestnut ,@ Peppermint , @ Red sandalwood ,@
Spearmint ,@ Witchhazel
C. Photoprotective
@ Black tea , @ Cocoa ,@ Golden fern , @ Grape seed ,@ Green tea ,.@ Oat ,
@ Olive ,@ Pomegranate , @ White sandalwood
D. Emollients:
are substances that makes the skin feels smooth & soft, which is important to
consumer acceptability
@ Almond ,@ Aloe ,@Avocado ,@ Borage ,@ Coconut , @ Cucumber ,@Grape
, @Jojoba ,@Licorice , @Peanut ,@ Pomegranate ,@ Sattflower , @Sesame
,@Slippery elm.
Moisturizers
Commonly used moisturizing ingredients
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A. Occlusion:
@ Petrolatum, @ Waxes , @Lanolin ,@ Mineral oil ,@ Ceramides @
Sunflower oil ,@ Soybean oil ,@ Jojoba oil @ Olive oil ,@ Evening
primrose oil
B. Humectants :Draws water from the formulation base, atmosphere, & from
underlying epidermis to increase skin hydration:
@ Glycerol ,/Glycerin , @ Sorbitol ,@ Propylene glycol , @ Amino acids
,@ Lactate ,@ Urea ,@ Salts.
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• Symptoms of hair damage by perm products
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@ Hair loss : (Rare) ,@ Hair breakage (may be at hair root, in hair length,
near the ends) ,@ Hair modifications ( unwanted kinky curls, Curls without
springiness) ,@ Wet hair: feels plastified, spongy, extensible ,@ Dry hair: ,
dry hair feels rough, brittle, uncombable, “matting” ,dull, ready to break)
@ Skin damage : @ redness, ,@ pustules & @ irritant skin
Superficial chemical peels
Peeling agents
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@ Alfa hydroxy acid , @ TCA (Trichloroacetic acid) (1O-2O%) ,@
Salicylic acid ,@ Tretinoin ,@ Resorcinol ,@ Solid carbon dioxide ,@
Pyruvic acid (alfa-keto acid) ,@ Jessner’s solution ( resorcinol 14%, lactic
acid 14%, & salicylic acid 14% in alcohol)
Photobiology of topical retinoids:
Owing to their side chain containing multiple double bonds, retinoids
strongly absorb UV light. Therefore, it is recommended to avoid UV
exposure when using topical retinoids.
Complications associated with superficial peels:
@ Pigmentary changes ,@ Infection ,@ Reactivation of herpes simplex
,@ Contact dermatitis ,@ Prolonged erythema /pruritus ,@ Lines of
demarcation ,@ Milia ,@ Enlarged pores
Medium depth chemical peels
• A. Agents used:
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@ 4O- 5O% TCA
@ Combination 35% TCA + Solid CO2 (Brody : Chemical peeling &
resurfacing , Mosby(1997) p. 11O
@ Combination 35% TCA + Jessner’s solution (Monheit:J. Dermatol. Surg.
Oncol 15,945 , 1989).
@ Combination of 35% TCA + 7O% glycolic acid ( Coleman & Futrell: J.
Dermatol. Surg Oncol 2O, 76,1994)
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@ Treatment of actinic keratose\s ,@ Resurfacing moderate to advanced
photoaged skin ,@Improving pigmentary dyschromias , @ Improving mild
acne scars ,
Microdermasbrasion
A. Indications
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@ Acne , @ Hyperpigmentaion ( Melasma ; Pos inflammatory) , @ Oily
skin (enlarged pores) , @ Photodamage ,@ Wrinkles
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B. Complications:
@ Milia & acne flare , @ Herpes simplex “breakthrough” infection
@ Bacterial infection , @ Fungal infection ,@ Hyperpigmentation ,@
Hypopigmentation ,
@ Scarring.
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Hydroxy acids
I. Alfa-hydroxy acids : Glycolic acid (sugar cane); Lactic acid (sour milk):
Water soluble, Action: exfoliative (Penetrate at high concentration)
II. Beta-hydroxy acid: Salicylic acid . Lipid soluble .Source: Willow bark,
wintergreen, sweet birch. Action: It is exfoliative comedolytic, antiinflammatory
Types of phototherapy
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Phototherapy is the use of UV radiation to treat skin disorders, four main
types of phototherapy are used in dermatology practice as shown in the
following table.
UVB phototherapy is most commonly used for psoriasis & purities.
Recently, there has been a trend towards using narrow band UVB rather
than broad band as it clears psoriasis more efficiently with reduced
erythema & reduced carcinogenicity. The commonest short term side effect
is a sunburn-like response, long term there is a risk of photo aging & skin
cancer
RePUVA is the combination of a systemic retinoid & PUVA, it is more
effective than PUVA with psoriasis clearing quicker with lower dose of UVA
radiation.
Advantage of PUVA phototherapy over UVB: @ Less frequent treatment @
More effective @ Often works in UVB resistant dermatoses.
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Types of phototherapy (continue)
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Advantages of UVB phototherapy over PUVA:
@ No photosensitizing agent is needed
@ Eye protection is more needed after treatment (systemic psoralen)
@ Less side effects
@ Safe in pregnancy & safer in young patients
@Shorter irradiation time.
Types of phototherapy
Therapy
Description
Frequency of
treatment
Broad band UVB
UVB light source of 29O -32O nm
3 – 5 times a week
Narrow band
UVB
UVB light source of 311 nm
2 -3 times a week
PUVA
Psoralen & a UVA light source
2 times a week
RePUVA
Systemic retinoid & psoralen & a
UVA light source
2 times a week
Biological agents
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The introduction of biological agents has transformed the treatment of
severe psoriasis. The use of these agents has been limited by their high
cost.
U.K criteria for a patient to be eligible for treatment with biological agents:
@severe psoriasis for over 6 months with a Psoriasis Area& Severity Index
(PASI) greater than 1O& Life Quality Index (DLQI) greater than 1O & one of:
@ have developed or at risk of developing drug related toxicity from a
systemic therapy for psoriasis
@ Intolerance of or contraindicated for standard systemic therapies
@ Poor clinical response for standard systemic therapies
@ Repeated inpatient admissions due to psoriasis.
@ Severe ,unstable or life threatening psoriasis.
A patient may also meet the criteria for a biological agent due to associated
psoriatic arthropathy.
Biological agents used in psoriasis
Etanercept
(Enbrel)
Fully human, anti-TNF monoclonal
antibody
25 mg or 5O mg twice weekly or
5O mg once weekly
Infliximab
(Remicade)
Chimeric (25% mouse, 75% human)
anti-TNF monoclonal antibody
5mg/kg by baseline, 2 weeks, 3
weeks then 8 -12 weekly
Adalimumab
(Humira)
Fully human, anti-TNF monoclonal
antibody.
First dose 8O mg then 4O mg
every two weeks
Alefacept
(Amevive)
Fully human, inhibitor of CD2&
LFA-3
15 mg weekly
Efalizumab
(Raptiva)
Fully human, inhibitor of CD11 a
1mg/kg weekly
Ustekinumab
(Stelara)
Fully human , inhibitor of IL-12 &
IL-23
45 mg at baseline, week 4 &
week 12 then 122 weekly.
Side effects of biological therapies
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@Injection site reactions occur with all biologic agents but are most
commonly seen with etanercept, they are rarely serious.
@ There is an increased risk of infection& serious infection with with all
biological agents, reactivation of latent tuberculosis is well recognised.
@ All biological agents carry small risk of malignancy, especially lymphoma.
@ Anti-TNF biological agents are associated with new onset demyelinasting
disorders & excerbation of pre- existing multiple sclerosis.
@ Some patients develop ANA antibodies whilst on biol;ogical therapies,
only rarely does this lead to a drug induced lupuswhich tends to resolve on
stopping the medication.
@ Patients may develop antibodies to the biological agents but this is only
clinically relevant for infliximab where antibodies are associatedf with an
increased risk of infusion reactions & reduced efficacy.
@ 2O% of patients on infliximab develop non serious infusion reactions
such as headache, flushing & nausea, 1% develop serious reactions as
anaphylaxis, hypotension & chest pain
Side effects of biological therapies
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@ adalinumab can be associated with leucopenia & thrombocytopenia;
alefacept with lymphopenia & efalizumab with thrombocytopenia
Absolute contraindications of biological agents:
@ sensitivity to the drug @ pregnancy @ Active or chronic infection
Relative contraindications for biological agents:
@ A family or personal history of demyelinating diseases @ history of
malignancy @ concomitant immunosuppressive treatment
Congestive heart failure is a contraindication for inflixmab & etancept.
Thrombocytopenea is a contraindication for treatment with efalizumamb &
lymphopenia is a contraindication for using alefacept. Patients treated with
biologic agents should not receive liver vaccine.
Liposomes size: 25 nm – 1OO um
Dendrimers size: 3 – 1O nm
• Dendrimers: are
highly
branched polymer with a
controlled 3 dimensional structure
& a central core .They can
accommodate more than 1Oo
terminal group.
Control of transdermal drug delivery
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Can we control the transdermal drug
delivery?
Yes, by use of polymers whether
natural or synthetic, is sensibly
combined with a drug or other active
agent in such a way that active agent
is released from the material in
presdesigned manner. The release of
the active agent may be constant over
a long period. It may be cyclic over a
long period or it may be activated by
the environment or other external
events.
The purpose of controlling the drug
daily : is to eliminate the potential for
both under or overdosing
Control of transdermal drug delivery
• Examples of polymers used for controlling transdermal drug delivery:
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@ Poly (3 hydroxy ethyl methacrylate)
@ Poly ( N- vinyl pyrrolidone) @ Poly Methyl methacrylate
@ Poly vinyl alcohol
@ Poly acrylic acid
@ Polyacrylamide
@ Poly ethyline -co - vinyl acetate
@ Poly ethylene glycol
@ Poly methacrylic acid.
@ Polylactides (PLA)
@ Polyglyclides (PGA)
@ Polyanhydrides
@ Poly orthoesters.
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The control release of the active agent of the drug can occur in the form:
@ Diffusion
@ Degradiation @ Swelling followed by diffusion. The
swelling ability can be triggered by environmental surrounding e.g. PH,
temperature & ionic strength.
Control of transdermal drug delivery
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Swelling release
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Diffusion system
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A. Bulk eroding
B. Surface eroding
Natural polymers
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Natural polymers: starch, lecithen,
chitosan , gelatin in nano. In drug
industry , they have been used as
binders, diluents, disintegrate &
matrixing agents. Nano
technology helps make significant
advances in their biomedical
applications, including drug
delivery techniques
Lecithen is yellow brownish fatty substance occurring in animal & plant tissues..
Lecithen can be isolated from egg yolk Sun flowers oil, brain tissue, fish. It can act as
LiPOSOMES, MICELLS for transdermal drug delivery. It can also as a type of surfactant ,
emulsifiers, lubricant. It is also taken as medicine in treating Alzheimer disease . It is also
used for treating eye , gall bladder , liver diseases & skin eczema
Transdermal drug delivery
Transdermal drug delivery
Temperature sensitive drug delivery for treatment
of tumors
Part I
Needles for mesotherapy
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3O g X 4 mm needle for
mesotherapy
No needle mesotherapy (needle free
procedure or electroporation)
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needle free procedure
(electrophoresis)
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Electric current is used for introducing
the ions of the drug mixture into the
tissues through water channels of the
skin
• Needles free procedure for
Botox : mesotherapy
• Totally non invasive
Isophoresis (mesotherapy): Dermal roller needle free
It creates a pinpoint punctures into the dermis , It sends a special electrical waves
A pulsed or modulated current to achieve molecules so as to allow them to permeate the
skin & penetrate into the tissue
Medical joke
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In the Egyptian pharmaceutical market, There is a great propaganda about
using selective serotonin reuptake inhibitors (SSRIs) which were developed
initially to treat psychiatric disorders , are being increasingly used as
unlicensed treatment of premature ejaculation based on their side effect of
delayed ejaculation ( Medascape news, MNT today) .Some tricyclic
antidepressants (anfranil) with SSRI like activity are used for their side
effect to delay premature ejaculation.
Taking advantage of a side effect common to these medications (Mayo
clinic for health information) for treatment of premature ejaculation is a real
medical joke. Moreover, SSRI can have another side effects: psychiatric
problems, skin reactions, changes in body weight, sexual side effect as loss
of libido , deleterious effect on semen parameters.
Tincture benzoin co.
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Tincture of benzoin has two medical uses :as a treatment for damaged
skin in the “compound” form & as an inhalant in the non compound form for
bronchial asthmas. The compound tincture of benzoin is used in the
following conditions:
@ During electrocautery of verruca vulgaris :If there is bleeding during the
treatment of wart, one can apply tincture benzoin co. as an emergency
bleeding control for contracting blood vessels (styptic action).
@ For treatment of bleeding fissures on palmer or planter surfaces. The
fissures occur in cases of palmoplanter hyperkeratosis. They are recurrent
and painful fissures
@ Treatment of cracked nipple in a nursing mother.
@ For minor cuts after shaving.
@ For canker sores in oral mucosa
How do I grow my fingernails faster?
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This question was from one of my
patients.
Of course healthy diet is most
important item. Vitamins are most
important supplement particularly
biotin.
Put your fingers in a bowel
containing water & add 2 tablets of
Alka-seltzer & soak your nails in
them twice daily,
Preparation of Alka- seltzer at
home is as follows:
- Two gram citric acid
- Four grams of sodium
bicarbonate.
- four tablets of aspirin.
Onychoschizia
Brittle breaking nail
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Brittle nail may be due to underlying nutritional problem. However, it is
usually due to overexposure of the nail to water e.g. excessive
dishwashing without gloves, over use of nail polish removers, exposure to
harsh activities with repeated trauma to nail bed or even exposure to cold.
Splitting of nail can be cured by:
@ Reduce exposure to water.
@ Alter your manicure practice.
@ Apply moisturizers to your nail bed
@ The use of vitamins like biotin, as a supplement, is sometimes
disappointing.
@ Soaking your nails in a gelatin or massaging gelatin into your nail (
Tyson, T. L.: J. Investigative Derm. 14: 323, 195O can actually strengthen
them & stimulate growth & hardness. However, the results are sometimes
disappointing.
• Nail cuticle & hang nail
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@ Jagged nail cuticle: baking
soda helps to soften & smooth
jagged cuticles, making them
easier to push back .
@ Yellow or discolored nails:
Using whitening tooth paste &
brush your finger nails regularly
everyday which can help to
reduce or even eliminate the
yellow tint in your nails. “
Toothpaste : it is not just for teeth
any more”
The longest finger nails
Human fingernails grow up to four times faster than toenails
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The rate of cell division in the hair
matrix determines the linear
growth rate, & the duration of
anagen growth phase determines
the maximum hair length that the
fiber can achieve.
These 3 sisters had an anagen
duration in excess of 7 years.
Their hair can reach a length in
excess of 2 m without breaking.
Protection from chemical insult &
weathering or measures to
strengthen hair are important to
achieve maximum potential length
Sinclair et al. British J. Derm. 166 (suppl 2)
27, 2O12
Hair damage
• Acquired:
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A. Abnormal hair fibers damage:
@ Environmental weathering
@ Repeated cosmetic treatment
@ Exposure to ultraviolet radiation @ Strong detergents
@ Chemical used permanent wave treatments & hair bleach
@ Brushing knotted hair, back combing& straightening hair while wet.
B. Abnormal hair follicle: conditions that lead to programmed hair follicle deletion
include:
@ Marie – Unna hypotrichosis
@ Keratosis pilaris decalvans
@ Acquired cicatricial alopecia
C. Abnormal hair cycles:
@ Androgenic alopecia
@ Telogen efflavium
@ Alopecia areata
@ Trichotillomania
As a result of acquired hair damage, the following hair shaft disorders can be seen:
1. Trichorrhexis nodosa
2. Split ends
3. Bubble hair
4. Knotted hair
Hair damage ( Continue)
• Congenital
• A. Abnormal hair fibers
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1. Associated hair fragility:
@ Monilethrix
@ Trichothiodystrophy
@ Netherton syndrome
@ Pili torti
@ Menkes syndrome
B. No associated fragility
@ Pili annulati
@ Uncombable hair
@ Wooly hair
@ Loose anagen hair
@ Marie – Unna hypotrichosis
B. Abnormal hair follicle: (congenital hair follicle agenesis or programed hair follicle
deletion)
Examples of agenesis include atrichia congenita, papular atrichia, hereditary
hypotrichosis, hereditary hypotrichosis & hypotrichosis simplex
C. Abnormal hair cycles:
@ Triangular alopecia @ Short anagen hair @ Loose anagen hair
Moisturizers in Egyptian market
December 2O12
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@ Vano cream: panthenol, Dimethicone, chamomile oil, zinc sulfate , cocoa
butter, tea tree oil, thyme oil , almond oil, glycerin.
@ Brother care: Propolis, glycerin, vitamin C, urea.
@Zerol cream: silicon fluid, poly dimethyl siloxan copolyl ( dimethicon
copolyl), hydrophilic onion extract, emu oil, cocoa butter, bees wax, almond
oil , liquid paraffin, propylene glycol. (N.B.: Propylene glycol is
carcinogenic).
@ Synobar skin cleanser: tea tree extract, salicylic acid, lexol 3OO, thyme
extract, glycerin, citric acid.
@ Skin tone cream: allantoin, olive oil, vitamin E, glycerin, promulogen D,
mineral oil, triethonolamine, methyl parapen (carcinogen).
@ Physiogel A. I cream: N-palmitoyletholamine, N – acetylethanolamine,
olive oil, glycerin, pentylene glycol, palm glycerides, vegetable oil,
hydrogenated lecthin, squalane, betaine, sarcosine, sodium carbomer,
carbomer xantham gum, water.
Moisturizers in Egyptian market
December 2O12
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@Revie 2: dimethicon, panthenol, chamomile extract, triclosan, vitamin A
,E, olive oil, almond oil, glycerin.
@ Divozine cream:Triclosan, zinc pyrithione, honey, zinc oxide, olive oil,
aloa vera, almond oil, glycerin, vitamin C, lanoline.
@ Emo soft cream: each 1OO gm contains: zinc oxide (1O gm),
caprylic,capric triglyceride ( 5 gm), hexyl laurate (2 gm), pantrhenol (O.5
gm), glycerol ( 4 gm), bisabolol ( O.2 gm).
@ Oiliderm cream: arachis oil.
@ Carbamide cream: urea 1O%
@ Heel fort ointment: urea 1O^, salicylic acid 12%
@ Foot smart ointment:urea 8%, lactic acid 2%
@ Neetoderm plus cream: urea 5%, sodium aclerate.
Wrinkling of the hands from water immersion
Smooth soft hands is aim of the game
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A patient asked that she wants her
hands to be smooth & soft.
Wrinkles occur particularly after
prolonged immersion of her hands
in water.
The answer was the use of
moisturizers. ( see lectures in this
site)
Genomics in the cosmetic treatment of skin aging
& discoloration
British J. of Dermatology 166 (supplement 2), 16, 2O12
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The cosmetic aspects of aging skin that can be improved include: matrix production,
barrier, lipid synthesis, antioxidant capacity & hyper pigmentation. The cosmetic
compounds that can be used to improve aging skin were identified after the use of
global gene expression profiling( transcriptomics or genomic ). They are:
@ Niacinamide
@ Pal-KTTKS : It contain matrikine peptide: palmteyl, lysine, threonine, lysine,
threonine, lysine, serine. It benefit collagen matrix (collagen I for renewal & healing),
fibrnoectin & basement membrane strengthening (collagen II). It reduce facial
wrinkles around the eye( crows feet).
@ Pal-KT
@Hexamidine
@ Retinyl propionate
@ Sodium dehydroacetate
@ Olive- derived fatty acid ethoxylates: They restore antioxidant capacity of aged
skin to form antiageing ingredients
@ Undecylenoyl phenylalanine: It is a skin lightening agent. It is formed from natural
amino acids with a lipid residue. It reduces melanin production by an adrenergic
receptor mechanism in melanocytes & inhibiting melanotropin.
Niacinamide
Vitamin B3
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It can be used in treatment of aging &
photo ageing , including uneven
texture, wrinkles, red blotchiness &
hyper pigmentation.
@ Topical preparations are associated
with reduced transepidermal water
loss indicating improved barrier
function. This is due to increase in
lipids such as ceramides & barrier
layer keratin, involucrin& filaggrin. The
improved barrier translates into less
irritation& redness, thus contributing to
a visible color benefits. .(British J. Derm.
166 (suppl. 2) 1,2O12 )
Pal –KT peptide
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Prox wrinkles smooth cream
contain Pal –KT peptides.
It smoothes uneven texture & the
look of fine lines
Retinyl propionate
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@ Reduce wrinkles @ Reduce
under eye dark circles & puffiness
@ Increase firmness & tightness
of delicate skin around the eyes.
Bunny lines” & “crow’s feet” are
caused by facial expressions
such as squinting or smiling.
Sodium dehydroacetate
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@ It is used in wide variety of
cosmetics which includes bath, skin
care, suntan, sunscreen, fragrance,
shaving, hair & nail products, eye
makeup, & facial make up too.
@ It prevents micro organisms from
reproduction & prevent their growth.
@ It is non irritating to the skin & is
used as preservative
Hexamidine
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Hexamidine up regulates biosynthesis
( cholesterol, fatty acid , ceramides)
uptake & processing of genes of
stratum corneum lipid consistent with
barrier improvement.
Undecylenol phenylalanine
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Pathways for the metabolism of
phenylalanine in humans.
Keratin smoothening treatment
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Keratin filaments are abundant in
keratinocytes in st. corneum. It is either:
@Alpha keratins in the hair (including wool),
horns, claws, hooves of mammals
@Hard B keratin found in nails, scales ,
claws of reptiles &beaks of birds
Keratin can be used as hair straightening p.
The process takes about 9O minutes or
longer depending on your hair length
&expect to last to 2 – 2i/2 months.
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Formaldehyde present in the product can cause a
problem to :
@ the workers in salons as occupational safety
@ to customer if she is sensitive to it causing
contact dermatitis.
There are reports that it can cause leukemia . It is
not safe to pregnant or nursing woman. It can cause
excessive falling & thinning of hair
Of course Keratin product without formaldehyde
might also not be good.
Brazilian keratin
Medical joke
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Keratin is insoluble protein. The presence of
extensive disulfide bonding contributes to
the insolubility of protein. Acids & enzymes
cannot digest it. Keratin taken orally has no
medicinal benefit. The use of Rhino horn is
not on medical basis , it is cultural believe.
• A medical joke, a great propaganda
on oral treatment of diffuse hair loss is the
use of pentogar, because it contains keratin.
Each capsule contains L- Cystine 2O mg,
Keratin 2O mg, para-aminobenzoic acid 2O
mg, Saccharomyces med ( vigar yeast) 1OO
mg, Calcium D panthenate 6O mg, By the
way saccharomyces med is brewer or baker
yeast
Creatine & hair loss
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Creatine is commonly used by athletes
as a performance enhancing
supplement that affect the muscle.
Creatine is naturally occurring amino
acids ( protein building block ) that is
found in meet & fish. Van Der Mer
(2OO9) showed that creatine
increases the level of dihydrosterone
in blood by 5O% after 7 days of its
ingestion ( Clinical J. of sport 19: 399.
2OO9). In another study , creatine
increases testosterone level after 1O
weeks of its use ( Wiekedia free).
Therefore , creatine can cause hair
loss & interfere with hair growth. It
enhances male pattern alopecia
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Creatine kinase (CK) is an enzyme found mainly in heart, brain & skeletal muscle that
tends to rise when inflammation occurs . The higher the CK , the greater the cellular
damager done. The normal range of CK is 4O -17O unit / liter. High blood levels of
CK showed greater than 5 times the normal levels. In dermatomyositis, kidney
damage occurs if there is no treatment& death on the more severe cases. With
initiation of effective treatment CK levels fall rapidly &periodic measurement are used
to follow disease activity over the course of long term follow up.
Clinically, increase of creatine kinase is assayed in blood tests as a marker of
myocardial infarction (heart attack) ,rapdomyolysis (severe muscle breakdown),
muscular dystrophy, the autoimmune myositis& acute renal failure . Lower CK an
indication of alcoholic liver disease & rheumatoid arthritis
CK which is also known as creatine phosphokinase is an important enzyme in the
following tissues: skeletal muscle, brain, photoreceptor cells of the retina, hair cells of
the inner ear, spermatozoa & smooth muscle . A kinase is a type of enzyme that
transfers phosphate groups from high energy downer molecule such as ATP to
specific substrate, a process referred to as phosphorylation.