Diplomate, Board Certification of Emergency Medicine
We return to our series on evidence based medicine and will
discuss a topic of interest that I have not seen much written
about.
Some people are very concerned about this topic -- the issue
of wrinkles. There is actually a scientific name for this --
rhytides -- and they are definitely related to aging, but
there are other risks as well: hormonal status, especially
after menopause, and disease can cause this, as well as
overexposure to sunlight and ultraviolet light. Smokers seem
to have a prevalence -- another good reason not to smoke.
What happens is that the skin becomes more fragile, loses
elasticity and becomes creased.
OK, what can be done? According to the prestigious British
Medical Journal, the medications that best help this
problem are trentoins and isotretoins both which are also
used for acne. They help the finer type of wrinkles, but may
not help the coarser ones. The main side effect is skin
irritation, and one cannot get pregnant while taking these
drugs as they can cause birth defects.
Many drugs are used that may help, but there is not enough
evidence that they work or don't damage. They include vitamin
creams, sunscreens, laser treatments, dermabrasion,
facelifts, cartilage products, and antioxidants.
While it isn't the season, we were asked about heat stroke.
Heat stroke occurs often in the elderly and people who are
doing exercise or hard work in the heat of the day. The body
resets its normal thermostat, and as such temperatures can
rise to above 42. This requires a hospital and rapid cooling
through ice baths.
Heat exhaustion is more common. It is basically dehydration
from the heat and these people have normal temperatures. Both
diseases were part of the reason why the heavily armored
European crusaders lost the battle at Horns of Hittim in the
Galil against the more appropriately dressed Arab armies.
This was the turning point in the Crusader empire. The
treatment for heat exhaustion is fluids, especially ones with
balanced salts, and not regular water. Write me in care of
the Yated.
A message from GlaxoSmithKline, sponsor of this
column. Zofran is the most effective medication, and the
standard for anti-nausea treatment in the world. While it is
very effective in chemotherapy, it can be used against all
vomiting. I have not witnessed a failure with this
medication.
