Caffeine plus exercise

I am preparing a talk on exercise, and I figure I can't just say "You should," thank the audience, and head for the gym. On perusing articles on exercise and breast cancer (you should do the former to decrease risk of the latter!), I followed one of those delightful internet link trails and came across this interesting study on New Jersey mice (1).

Imagine being offered three choices: two weeks of daily Starbucks plus an obligatory work-up with a personal trainer (both free of course!) that same Starbucks sans gym work-out, or a caffeine-free opportunity to exercise only if you care to but never mind if you don't. These Jersey rodents were assigned the mousy equivalent of these choices, then all underwent tanning sessions under UV lights. Oh yeah, and then followed by skin biopsies...

All lost some of the fat lurking just beneath their furry hides, but the exercise plus caffeine group lost twice as much as the indolent coffee drinkers. Better yet for those buff little fellows that enhanced their exercise-enhanced physique with tans, those who drank caffeine-laced water AND exercised exhibited apoptosis of sun-damaged skin cells. In other words, caffeine inhibited DNA damage from UV light--and therefore tumor formation-- by promoting the destruction of UV-damaged cells.

If we're at all like mice, which we more or less are, caffeine plus exercise may equal some sort of cancer protection.
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Yao-Ping, L et al. Voluntary exercise together with oral caffeine markedly stimulates UVB light-induced apoptosis and decreases tissue fat in SKH-1 mice. PNAS July 31, 2007 vol. 104 no. 31 12936-1294.

Hydrosal, Drysol, and hyperhidrosis

I can now wear tops TWICE and can wear regular shoes. DrySol, you're the best!
--Comment from satisfied user on drugs.com

I had the mixed pleasure of dining at Red Robin recently. Always a pleasure to not cook dinner and not clean up afterwards, but the burger was just so-so. I was briefly alarmed to note as the host seated us that he had enormous sweat rings below his armpits, but then I realized that some misguided RR fashion designer had put darker panels of red material down the sides of the staff's red t-shirts.

Some people, of course, do suffer from axillary hyperhidrosis or excessively sweaty pits. And they suffer terribly, choosing clothing colors less likely to broadcast their problem, keeping their arms close to their bodies. Never raising their hands because they're sure it would be an embarrassing mistake.

Enter Drysol, one of medicine's best kept secrets. Part of the problem, my problem anyway, is the don't ask/don't tell mentality of hyperhidrosis. If I don't ask, patients mostly don't tell me that they suffer from sweaty pits, hair, hands, or feet. Last month, however, I had a patient ask for Drysol by name--he'd heard about it from his nephew. And now he says "It's changed my life."

Those are strong words indeed, praise I most often hear applied to antidepressants, anti-anxiety, and anti-acne medication. Drysol or aluminum chloride hexahydrate is strong stuff. It doesn't always work, and it stings like crazy if applied to wet or newly shaved skin, but when applied with care according to the directions, many hyperhidrotics lose their drip.

Hyperhidrosis is a disorder of sudomotor nerves or those nerves that hook up to and activate sweat glands in response to heat or emotion. While thermoregulation (keeping body temperature in a healthy range) is controlled by the hypothalamus deep and central in the brain, sweaty response to emotion is under the control of the anterior cingulate cortex behind the rational frontal brain and heavily connected to our fear-directing amygdala.

A new preparation of aluminum chloride hexahydrate has been released called Hydrasal which is in a salicyclic acid gel formulation rather than pure alcohol. Small studies recently released at the March meeting of the American Academy of Dermatologists show this product is better tolerated than the Drysol preparation and is also useful in patients who are undergoing Botox injections for hyperhidrosis with incomplete relief of excessive sweating.

Cures for the red face?

And who wants a red face? I had a new patient in yesterday who specifically complained of a red nose, and indeed, the tip of her nose was red with tiny enlarged blood vessels visible on its surface (but only seen by me with reading glasses assist!).

Thanks again to TheDermBlog.com (and I highly recommend this site to you), I am able to bring you a little more info on the subject. One of the most common causes of a red face is rosacea, an inflammatory skin condition that often causes red cheeks and nose (and occasionally eyes), that gets redder yet with alcohol consumption, and responds to topical antibiotics like Metrogel. Sun damage also permanently dilates the superficial blood vessels in our skin, particularly visible in those with Type I sun-sensitive skin (as in fair, easily burned, often in red heads and persons of Northern European ancestry). Dr. Benabio notes on his blog that laser treatment can take away those enlarged capillaries at the skin surface.

I also see persons with acne succumb, as did I, to overscrub syndrome, using washcloths and various exfoliants in a vain attempt (in both senses of the word vain) to liberate the pores from pus and oil. I have been following Dr. Benabio's advice to wash the face less often, but it still goes against my basic impulse to scrub early, scrub often and dab with astringent in between.

He recommends anti-inflammatory, anti-redness skin products for the those who carry the red badge of sun damage/acne/rosacea front and center on their face. In particular, he mentioned Aveeno calming lotions with the herb feverfew. Aveeno apparently has gone to some trouble along with a host of phytochemists to remove the pesky parthenolide component of feverfew (which sensitizes the skin i.e. makes it redder) leaving behind its beneficial anti-inflammatory components. In particular, the parthenolide-depleted feverfew inhibits 5-lipoxygenase, a pro-inflammatory molecule that is the target of a new anti-arthritis medication working its way through clinical trials. Maybe feverfew should join the A-list of herbals that we smear on and swallow (it's supposedly good for migraine prevention as well) along with vitamin C and green tea.

Well, of all my skin troubles, redness is not one. Testimonials for Aveeno (and Eucerin) anti-redness creams abound on the internet. Let me know if you try it and like it!

"Shampoo your hair, not your body"

It's dry skin city here in Denver year-round but especially in winter when the air is cold as well. As a result, I see any number of patients with bizarre skin rashes that look icky and infectious but are the result, rather, of too much hot water and not enough moisturizer.

This skin care tip comes from Dr. Jeffrey Benabio's The Dermatology Blog. He notes that shampoo is specifically designed to remove oils from your hair and will do the same to your skin. Rather than lather yourself like an Irish Spring commercial with rich shampoo bubbles (or soap bubbles for that matter), check out his other tips on this post and the rest of his blog.

A dark patch on the skin

A thirty-something year old lady came in today for her physical. Among other things, she complained of a dark patch on the outside of her left ankle along with pain in the same spot. Dark patch and pain, no connections so far.

So I check it out. The patch is slightly irregular and brown with faint overtones of red. It looks like nothing familiar so far, not fungal, not eczema, not psoriasis. Not tender to touch nor hot in an inflamed sort of way.

The pain occurs while walking, so I ask to see her walk barefoot across the room. Bingo. We have a too many toes sign signaling flat feet, flatter left than right. No wonder her collapsing left ankle hurts. But what about the dark patch?

Does it itch? You bet, she says. Do you scratch it? Are you kidding, she counters, all the time. Ah ha, it's that hyperpigmented Iscratchtoomuchandirritatemyskin chronic skin change sort of look. I see that lots in the middle of the back in older people still limber enough to reach around to scratch.

Patches of skin near the spine itch due to a radiculopathy (now how good a word is that) meaning that a little nerve branch going to the skin called a radicular nerve gets pinched as it passes out of an arthritic spine. The skin supplied by this nerve starts to itch or burn, the patient scratches it lots, and the skin gets dark from chronic irritation. Then I look like an amazing medical intuitive when I ask if that area bothers them.

The brown discoloration of chronically scratched at skin is caused by hemosiderin. This pigment is a breakdown product of hemoglobin. As people dig at itchy spots over time, tiny blood vessels rupture and release hemoglobin into the skin. This iron-carrying molecule from blood is deposited into the space between cells and is subsequently broken down into hemosiderin, leaving a permanent discoloration to the skin. You often see this same blotchy brown residue in the lower legs of elderly persons with varicose veins who develop an itchy condition known as stasis dermatitis.

Dr. Allan Conney and his colleagues went looking for a way to provide hairless mice with a safe summer glow.

Caffeine-laced lab water increased the mice's ability to kill off precancerous cells in their icky white skin by 100% as did regular work-outs on the exercise wheel. But go-getter mice who indulged in caffeine AND exercise between sessions with the UV lamp were nearly 400% more effective at policing their sun-damaged DNA.

The researchers were hopeful that this simple formula for sun protection would work for humans as well. They issued, however, this final note of caution:

Don't go out and exercise and drink a lot of coffee and assume you're going to be protected. Keep in mind that these are studies in mice.
--Allan Conney PhD, Rutgers cancer researcher

Ziana

One of the benefits of aging is the end, finally!, of acne. That doesn't mean that zits are not a topic of discussion in the household here, so I read with interest that a new twofer gel is available for those of us young enough to still breakout.

When I got my first zit, unkindly pointed out by Susan Millicent on a 6th grade field trip, the best my pediatrician had to offer was a suggestion to leave soapsuds on my face for a minute each evening. Red and scaly became the order of the decade, whether from soapsuds, sunlamps, or Retin-A. No matter the cause, though, red and scaly always preferable to pustules.

Enter lyrically labeled Ziana. Google Ziana, and you will find she will read your Tarot cards OR it will cure your acne. Per Dr. Wortzman of Medicis Pharmaceuticals, the gel version was more effective and produced less erythema and skin scaling as well as patient-reported burning and itching in clinical trials than use of its component parts. "Very little skin irritation," says he.

Ziana combines the antibacterial punch of topical clindamycin with the zit-digging power of tretinoin (Retin-A). Pricey though per one dude on acne.org:

Well guys...ixnay on the Ziana. I just found out that not only does it cost $250 WITH the $35 rebate the derm gave me, but that my parent's health care plan won't cover it because it's too damn expensive!!!

Cracked fingernails and why they don't split

Fingernails strong by design

If you've ever wondered why cracked fingernails don't just painfully split down the middle or simply been grateful that they don't, Dr. Roland Ennos can tell you why.

Fingernails have three fibrous layers. The outer and inner layer have fibers running in all directions that give the fingernail its flexibility. The outermost layer also wraps around the sides to help prevent cracks from forming in the first place. The thick middle layer has fibers that traverse the nail, sending those cracks laterally instead of into the quick.

To test his theory of nail mechanics, Dr. Ennos attached instrumented scissors to a measuring device and found that nails were twice as difficult to cut towards the base as across it...Consequently cracks are deflected around the end of the nail, protecting the nail bed from damage.

It's a wonder I get anything done. I did shovel the walk, do two loads of wash, and register a car at Denver Motor Vehicle today. But this evening, all I've accomplished is to follow a meandering line through the web that led from an article about tamoxifen and wound healing to an interesting new product for wrinkles.

My journey started with an article from the Archives of Facial Plastic Surgery about tamoxifen. Apparently, physicians have noted that women on tamoxifen have delayed wound healing but better scars. Tamoxifen delays cellular division in skin cells called fibroblasts by decreasing the production of various growth factors (GFs). These GFs are a good thing if you happen to slice your thumb open with the cat food can. But if you are an exuberant GF producer, even piercing your ears can result in an unsightly pile-up of skin known as a keloid or exuberant scar.

Now plastic surgeons hate exuberant scars, and the authors of this article proposed that tamoxifen may some day prove clinically useful in their profession to minimize scar formation. But I'm thinking a dense layer of fibroblasts below aging skin might be the very anti-wrinkle solution. So off to PubMed to check out whether anyone but me had the bright idea of putting transforming growth factor (TGF) into a topical cream.

And yes indeed, Topix pharmaceuticals had that very notion, and they combined TGF with vitamin C and black cohosh extract into Cell Rejuvenation Serum (aka CRS which also stands for Can't Remember S*** amongst women of a certain age). Preliminary studies suggest this dandy CRS significantly increases collagen production and decreases the appearance of wrinkles.

Shall I order some for sale through the office?

Your acne will go away after you get your first period."
--Dr. R, my pediatrician, 1962

Hah! Dr. R, perhaps my memory is shot (well...no perhaps about that) because maybe you actually told me that my acne would finally go away when my periods stopped. Which it did.

You also told me to stop drinking milk. To heck with the state of my skeleton in the decades to come, stop drinking milk you said. So I did. At least in that respect, you were correct, and over 48,000 female nurses have proven you so.

The Nurses Health Study II did a retrospective study correlating severe acne with consumption of dairy products during the high school years. Investigators found that total milk intake, specifically skim, was associated with an increased incidence of zits. They theorize that this may be the result of hormones and other 'bioactive' molecules in milk.

Bioactive. Great.

Of crow's feet and liver spots

The patient should never be dismissed with glib remarks about growing old gracefully.
--Mary Ruth Buchness, MD

All right, sorry, no more glib dismissals out of me. I take back the "Buck up! Quit whining! Consider Helen Hays!" remarks.

Activity of the muscles of facial expression causes creases of the overlying skin, which become permanent after may years, much like the creases in unironed fabric.
--Dr. Buchness, again

Believe me, I take this unironed skin thing very seriously. If I put on my reading glasses and look in the mirror, I can even see these folds and puckers in my own facial linen. So that you can join me in the know, calling wrinkles and liver spots by their proper names, check out my fancy skin glossary at:

Skin Aging

A Hair-raising story

Have you seen this lady...in your mirror? I certainly have looked at a personal version since I started this plunge into menopause.

Granted, there are more important body parts to worry about through midlife and beyond: brain, heart, liver, breasts. And there are far more important things to do than count how many hairs have bailed off the scalp during the morning shampoo. I know I'm not the only one who's done that; one patient, an elegant woman in her 60s with short, beautifully styled gray hair brought in a baggy with way too much of that hair in it to demonstrated her a.m. loss.

My best hair days were during pregnancy, my hair thick, long, and glossy. My worst hair days were last year in the opening months of menopause. The difference? Estrogen levels for one, but estrogen cream to scalp helped not at all. Progesterone levels for another, and progesterone cream to aging head three times per week has made all the difference. Within one month of using it, my hair loss dropped off dramatically--yes, I do count!

I order the cream for my patients from a compounding pharmacy. I make my own from progesterone out of a Prometrium capsule with a little Estrasorb all mixed in Lubiderm. If you'd like the recipe, please contact me.