Gazhealth mc 030113 by The Gazette

Important News for People with Plaque Psoriasis Lawrence J. Green M.D. 15005 Shady Grove Rd., Ste. 440, Rockville, MD is conducting a research study for adults to test the effectiveness and Safety of an investigational medication, and inactive Placebo for Moderate to Severe Plaque Psoriasis. Plaque psoriasis is a lifelong disease of the immune system that causes red, scaly patches to appear on the skin. Approximately 1.5 million Americans suffer from moderate to severe plaque psoriasis. Qualifications Include: • Adults ages 18 years and older • Must currently have moderate to severe plaque psoriasis for at least 12 months prior to screening • No prior exposure to biologics for treatment of psoriatic arthritis or psoriasis Study Involves: • Examination by a Board Certified Dermatologist • Study related exams at no charge • Usage of study drug Qualified participants may be compensated for their time and participation. Health insurance is not needed to participate. There is no cost to you. 1863674

Call today to see if you qualify for this exciting trial. Our office number is 301-610-0663. Please ask to speak to Sarah or Susan to schedule your screening visit.

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2 Gazette Health | Spring 2013

A GAZETTE PUBLICATION

A publication of The Gazette | Spring 2013 Editors Designer Contributing Writers

Prepress Manager Special Sections Coordinator Corporate Advertising Director Advertising Director Creative Director

Kimberly Bamber Anna Joyce Anna Joyce Karen Finucan Clarkson Scott Harris Archana Pyati John Schmitz Ashby Rice Dennis Wilston Neil Burkinshaw Anna Joyce

The Gazette is a division of Post-Newsweek Media, Inc.

9030 Comprint Court, Gaithersburg, MD 20877 Gazette Health is produced by The Gazette’s Special Sections, Advertising and Creative Services departments. It does not involve The Gazette’s newsrooms. Send comments to specialsections@gazette.net. Content is for informational purposes only and should not be construed as medical advice, or as a substitute for seeing your own doctor. COVER PHOTO: TRACEY BROWN PHOTOGRAPHY, COURTESY OF WASHINGTON ADVENTIST HOSPITAL

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Spring 2013 | Gazette Health 3

Drinking too much, including binge drinking, results in about 23,000 deaths in women and girls each year. About 1 in 8 women age 18 and older and 1 in 5 high school girls binge drink. –CDC

New Hope for Peanut Allergy Sufferers

Cancer Deaths Dropping

Will Weed Lower Your IQ? A

study published last September of more than 1,000 people who began using marijuana at 13 and continued regular use into adulthood found that, by 38, their IQs had dropped an average of 8 points. “For context, a loss of 8 IQ points could drop a person of average intelligence into the lowest third of the intelligence range,” according to the National Institute on Drug Abuse. The study, conducted in New Zealand, also found that those who began using the drug regularly after 18 showed minor drops in IQ, and that those who had never used it showed no decline. According to the institute, 1 in 15 high school seniors uses marijuana regularly. Newer research, however, suggested that other factors, such as socioeconomic status, may have been the cause of the IQ decline seen in the regular marijuana users in the New Zealand study. Regardless, the institute said these studies and others show that “regular marijuana use in adolescence is known to be part of a cluster of behaviors that can produce enduring detrimental effects and alter the trajectory of a young person’s life—thwarting his or her potential. Beyond potentially lowering IQ, teen marijuana use is linked to school dropout, other drug use, mental health problems, etc.”

4 Gazette Health | Spring 2013

A GAZETTE PUBLICATION

Death from cancer declined from 2000 through 2009 in the United States, maintaining a trend seen since the early 1990s, according to a January report from the National Cancer Institute. Mortality fell for most cancer types, including the four most common in the U.S.—lung, colorectal, breast and prostate—although the trend varied by cancer type and across racial and ethnic groups. The declines in cancer death averaged 1.8 percent per year for men, 1.4 percent for women and 1.8 percent for children up to 14 during that same time period.

Vitamin D Does Not Help the Knee

Vitamin D supplements do not appear to help those with osteoarthritis in their knees, according to a study from Tufts Medical Center in Boston. “We found no effect either on the amount of knee pain that people experienced or on the amount of cartilage that they lost.”

–U.S. Department of Health & Human Services

I S T O C K P H O T O : B R A I N P U Z Z L E , M B O R T O L I N O ; M A R I J U A N A , P R I L L ; P E A N U T S , R E D H E L G A ; C A N C E R R I B B O N , B O O K A 1 ; V I TA M I N D , C A R L S S O N I N C

A liquid therapy placed underneath the tongues of people with peanut allergy can reduce their sensitivity to peanuts, a new study found. With further development, the experimental technique could make life easier for people whose only current option is to avoid everything that contains peanuts. In the study, the results of which were reported in January, a group received escalating doses of peanut powder. After 44 weeks of daily therapy, 70 percent were able to consume at least 10 times more peanut powder than they could at the beginning of the study. After 68 weeks, they could consume significantly more peanut powder without having an allergic reaction than those given a placebo in the study. The therapy caused only minor side effects, such as itching in the mouth. –National Institutes of Health

A healthy heart beats about 100,000 times a day. –American College of Cardiology

I S T O C K P H O T O : H E A R T B E AT, J U S U N ; P I L L S , S K H O W A R D

Overdose Alert M ore than 600 medications, both prescription and over-the-counter (OTC), contain the active ingredient acetaminophen to help relieve pain and reduce fever. Taken carefully and correctly, these can be safe and effective, but taking too much acetaminophen can lead to severe liver damage. Acetaminophen is a common medication for relieving mild to moderate pain from headaches, muscle aches, menstrual periods, colds and sore throats, toothaches, backaches and for reducing fever. It’s also used in combination medicines, those with more than one active ingredient to treat more than one symptom. The National Institutes of Health reported that Americans catch 1 billion colds per year and as many as 20 percent of Americans get the flu. Seven in 10 use OTC drugs to treat symptoms of those illnesses.

Consumers might not know that acetaminophen comes in combination with many other medications used to treat those symptoms. “So if you’re taking more than one medicine at a time, you may be putting yourself at risk for liver damage,” said Fathia Gibril, M.D., with the U.S. Food and Drug Administration (FDA). Symptoms of acetaminophen overdose may take many days to appear, and even when they become apparent, they may mimic flu or cold symptoms. The current maximum recommended adult dose of acetaminophen is 4,000 milligrams per day. To avoid exceeding that dose: don’t take more than one OTC product containing acetaminophen; don’t take a prescription and an OTC product containing acetaminophen; and don’t exceed the recommended dose on any product containing acetaminophen.

Check the Drug Facts label of OTC cold, cough and flu products before using two or more in the same time frame, Gibril said. If you’re still not sure which to buy, ask a pharmacist for advice. Acetaminophen is also used in many commonly prescribed medications in combination with pain relievers such as codeine, oxycodone and hydrocodone. The FDA reported that as of January 2011, overdoses from prescription medicines containing acetaminophen accounted for nearly half of all cases of acetaminophenrelated liver injury in the U.S. –FDA

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Spring 2013 | Gazette Health 5

Children’s Health

Plagiocephaly

An Unintended Consequence of ‘Back to Sleep’ BY ARCHANA PYATI

hen Matthew Crome was 2 months old, his parents noticed his tendency to lie on his right side no matter the circumstance—naps, bedtime, playtime. His mother Katie, 26, tried rotating him as he slept only to find him reverted back to his favorite position. She tried placing him on his stomach for so-called “tummy time,” but he hated it. By the time he was 5 months, the right side of Matthew’s skull looked flat. His pediatrician diagnosed him with plagiocephaly, a deformational flattening of a baby’s skull on one side, causing it to look asymmetrical. Katie Crome and her husband Matt, 27, brought their son to orthotics maker Hanger Clinic in Rockville to be outfitted with a cranial remolding band, or a helmet. Each band is specially designed for babies with cranial asymmetry, according to Lisa Hewitt, a cranial remolding specialist at Hanger.

“Because we recommended ‘Back to Sleep,’ we’ve seen a tremendous decrease of SIDS, but a tremendous increase in plagiocephaly,” said Toni Thompson-Chittams, D.O., a pediatrician and owner of TLC Pediatrics in Bowie. The good news is that after the campaign was launched, death by SIDS declined by 40 percent, according to a 2009 study in The Journal of Craniofacial Surgery. Yet, putting some babies on their backs for prolonged periods of time brought out a preference for one side or another, causing one side to flatten and, in some cases, the opposite side to protrude to accommodate the brain’s growth. The 2009 study noted the prevalence of deformational cranial asymmetry was between 18 and 19 percent among infants 6 to 18 months.

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ISTOCKPHOTO/JENJEN42

PLAGIOCEPHALY IS A COSMETIC issue and has no impact on brain development, said Rogers, co-author of the 2009 study and numerous othThat it’s cosmetic doesn’t mean it shouldn’t be ers. While surgery is never a recomtaken seriously: plagiocephaly can impact CRANIAL ASYMMETRY IS CALCULATED mended solution, the fact that the by the difference in the diagonal condition is cosmetic doesn’t mean it a child’s facial features. measurements of a baby’s skull. It shouldn’t be taken seriously; as in needs to be between 10 and 12 milMatthew’s case, plagiocephaly can limeters before being considered problematic, for close to five months, the 11-month-old retired impact a child’s facial features, causing an asymmetaccording to Gary F. Rogers, M.D., chief of pedi- the cornflower-blue, marble-swirl headgear for rical or slanted look of the eyes and ears. atric plastic and reconstructive surgery at Children’s good in January. The cause of plagiocephaly is what Rogers refers National Medical Center in Washington, D.C. “Me and my husband were completely happy to as “packaging issues”—how an infant is posiAt the time of his fitting, Matthew was 5 ½ with the shape of his head,” said Katie Crome, who tioned in utero. Babies who are born breech, in a months; his cranial asymmetry was 20 millimeters lives with her family in Walkersville. “All of our multiple birth (twins or triplets), prematurely, or and considered a severe case, according to Hewitt. family and friends were amazed at the improve- whose mother had a prolonged delivery or insuffiAsymmetry affects not simply skull shape, but ment. Nobody can tell he even had a problem with cient amniotic fluid for cushioning seem to be at facial features. Matthew’s right eye was a bit more his skull.” greater risk. Additionally, Rogers’ studies have forward and open and his forehead protruded on Researchers attribute the rise in plagiocephaly and found that boys are at greater risk than girls. one side. other forms of infant cranial asymmetry as an uninA separate condition that has a strong link to The progress Matthew made with helmet thera- tended consequence of the “Back to Sleep” campaign plagiocephaly is torticollis, sometimes called “wry py is staggering. After a month and a half of thera- launched in the early 1990s to combat sudden infant neck,” which is a tightening of an infant’s neck py, the asymmetry had decreased to 13 millimeters; death syndrome (SIDS). Although the cause of SIDS muscles in the womb because of inadequate space an additional three months reduced it to 3 millime- remains a mystery, stomach sleeping was determined or awkward positioning in the uterus. While tortiters. After wearing the helmet for 23 hours a day to be a major risk factor. collis doesn’t always lead to plagiocephaly, it occurs

in 15 to 25 percent of cases, said Rogers, who believes it is severely underdiagnosed because pediatricians don’t always know what to look for. Physical therapy may be part of the solution for a child who is diagnosed with torticollis, said Thompson-Chittams. In Matthew’s case, torticollis wasn’t identified by his pediatrician as a factor; nor did Katie Crome have a problematic pregnancy, noting only that Matthew was a “big baby” when he was born. The pediatrician guessed he may have been positioned on his right side in the womb, explaining why he preferred that position after birth. IF PARENTS CHOOSE HELMET THERAPY to correct plagiocephaly, their child’s head is scanned and a custom helmet is designed and manufactured specifically to accommodate brain growth on the flattened side. The inside of the helmet is lined with lightweight foam that can be shaved back once brain and skull growth begin to even out. Helmet therapy works best when a child is between 4 and 6 months because that’s the time when the brain is experiencing the most growth, said Leah Bowsher, a cranial

remolding specialist at Hanger. One of the drawbacks to helmet therapy is that it can be expensive and not all insurance companies foot the bill because it’s considered a cosmetic problem. In the Crome’s case, they had to pay for the helmet out-of-pocket. The costs of the helmet and follow-up visits at the Hanger Clinic are usually under $3,000, according to Hewitt. Costs vary depending on the orthotics company a family chooses. Hanger’s local competitors include Cranial Technologies in Annandale, Va., and STAR Cranial Center of Excellence in Columbia. For his part, Matthew has now discovered the joys of touching his head and feeling wind blow through his hair. Katie Crome admitted she missed the physical contact with her baby since the helmet was cumbersome, if not uncomfortable. Now, the barrier is gone between Matthew and the steady flow of affection from his parents and grandparents. “I feel bad for him; I’m kissing his head all the time!” she said. “I’m rubbing his head. My parents are so thrilled—they get to kiss his head. He can lay on your chest. I definitely missed it.”

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P H O T O S O F M AT T H E W C R O M E ’ S H E A D C O U R T E S Y O F K AT I E C R O M E ; P H O T O O F K AT I E A N D M AT T H E W B Y A R C H A N A P YAT I

Left: Matthew Crome’s head before he began wearing a helmet, top, and after five months of therapy, bottom. Right: Matthew and his mom Katie visit Hanger Clinic in Rockville, where he was treated for plagiocephaly.

GAZETTE.NET

Spring 2013 | Gazette Health 7

Children’s Health

SEPARATION ANXIETY Learn how to recognize what’s normal and what’s not—and how to manage it

BY ARCHANA PYATI

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A GAZETTE PUBLICATION

I S T O C K P H O T O / K I C K S TA N D

argaret Newman knew her son Matthew would be a sensitive child from the day he was born. There was a history of anxiety on her side of the family, and, from her husband, Matthew inherited shyness. He was so attached to Newman that he couldn’t tolerate separating from her for a moment, even if his father was close by. “I would need to go the bathroom, and Matt would just cry,” said Newman, a 52-year-old Silver Spring resident. She would have to allow Matthew into the bathroom with her to calm him down. “I knew he needed a lot more sense of security than other children.” Newman, who left a robust real estate career before having Matthew in 1999, sized up her son’s fragile temperament and realized he would need her undivided attention. She became a full-time mother and worked diligently to create an emotionally supportive environment for Matthew, enrolling him in special speech-therapy programs for latetalkers, accompanying him to a parent-child class at a local Waldorf school and keeping date nights with her husband to a minimum. She even gave him Pulsatilla, a homeopathic remedy, to calm his nerves. Thirteen years later, her sacrifices have paid off. Matthew is a chatty and exuberant tween who loves sports, goes on skiing trips with his dad, and—like any teenager—occasionally mouths off to his mom. The separation anxiety Matthew experienced to an extreme is a normal phase of early childhood development, local child psychologists and pediatricians said. Indeed, some children like Matthew may have a genetic predisposition to feeling higher levels of anxiety, but what makes all the difference among even the most fragile is how parents react to a child’s anxiety and the specific strategies employed to make separations emotionally manageable. “We see a lot of children in our day-to-day practice dealing with separation anxiety,” said Paul Feinberg, M.D., a pediatrician with The Pediatric Center of Frederick. “It’s important that parents remain calm and reassuring. The other thing is planning ahead. If you know your child is going to have a difficult time [separating from you], make that transition as easy as possible.”

ROOT CAUSES better on the weekends or when there The origin of separation anxiety is is no school.” rooted in an early awareness of ourWhile most children experience selves as separate beings from our separation anxiety to a certain extent, caregivers. Toddlers develop a sense if the distressed behavior lasts longer of “object permanence”—knowledge than four weeks and persists in differthat people and objects exist in their ent settings, a child may have separaabsence—leading them to question tion anxiety disorder, said Floyd. In whether people they’re attached to these cases, a family should consider will return or abandon them, said seeking professional counseling. Play Reena Bernards, a licensed clinical therapy—in the form of puppet marriage and family therapist with shows or role-playing with dolls or Jonah Green and Associates in action figures—can help a child Kensington. express underlying fears without hav“It’s a normal reaction, and part of ing to articulate the problem, accordthat is a feeling of ‘will they come ing to Floyd. Among older children, back? Will I be OK if they’re not who have the ability to verbalize here?’ That question stays with a fears, cognitive behavioral therapy, child for awhile,” she said. which targets patterns of thinking, For certain youngcan also be effective, sters, that insecurity she said. DENYING OR gets amplified when Psychologists and adjusting to new therapists might also MINIMIZING environments away meet with parents THEIR FEELINGS from home, like day separately to discuss WILL ONLY CAUSE care or a babysitter’s family dynamics and house. Excessive crypotentially triggering CHILDREN “TO DIG ing, temper tantrums, events. “Assessing IN THEIR HEELS physically clinging to the family situation parents, aggressive beto see if there’s anyAND BECOME havior toward peers, thing that has hapMORE RESISTANT pened to make the refusing food or child feel insecure—a sleep, and an inability TO CHANGING THE divorce, a death in to be consoled either BEHAVIOR.” the family, a new by other adults or child—gives some their peers are signs a child needs support making these sense of logic to what’s going on,” transitions, according to Jessica said Bernards. Denying or minimizing their feelFloyd, a clinical psychologist with a private practice in Bethesda who ings will only cause children “to dig works with families at the Reginald S. in their heels and become more resistLourie Center for Infants and Young ant to changing the behavior,” said Bernards. Instead, parents should Children in Rockville. “When the separation occurs, a encourage kids to articulate their child will exhibit these behaviors as a fears. When a child has some success way to express their feelings when with separation, praise the results, she they don’t have the words,” said added. Celebrate successful transiFloyd. “They don’t have the means to tions and separations with incentives, express themselves in verbal ways, such as stickers or a special reward, but can express themselves through said Floyd. Children regularly mimic their partheir bodies.” Separation anxiety also manifests ents, often unintentionally. If a parent itself through physical symptoms, has anxiety about being apart from such as abdominal pain, headaches, their children and trusting other sweating, vomiting or nausea, said adults to care for them, children can Feinberg. “The pain is real and the pick up on this. “The other thing that plays a big distress is real,” he said. “Often there’s a pattern where the physical role is parenting, and how they’re complaints are worse in the morning dealing with these emotions,” said before a child has to go to school or Kim Burgess, a child and adolescent preschool. They tend to be much psychologist, founder [continued on 21]

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Spring 2013 | Gazette Health 9

Seniors’ Health

Treatments for

Macular Degeneration BY SCOTT HARRIS

Macular degeneration causes vision loss in the center of your field of vision, according to the Mayo Clinic, and occurs when the macula, the center area of the retina on the inside back wall of the eyeball, deteriorates. There are two types of macular degeneration—dry and wet. Dry is the more common type and, if left untreated, can lead to the rarer, more severe wet type. Dry macular degeneration can cause blurred vision and difficulty seeing in low light, among other symptoms. The wet type of the disease produces similar symptoms, though it is more severe and can also involve the growth of vision-damaging irregular blood vessels behind the retina. The Alliance for Aging Research estimates that 1.75 million Americans 40 and older have advanced age-related macular degeneration, with another 7.3 million at substantial risk of losing vision as a result of the disease.

But, like many incurable diseases, modern medicine has made it a manageable chronic condition for those with access to the necessary care. New treatments are aimed at making it even more manageable—increasing time intervals between office visits and decreasing discomfort or side effects. But the search for a cure continues, and current research is exploring whether stem-cell therapy—a controversial but promising option for a host of diseases and conditions—may hold the key.

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I S T O C K P H O T O / C L A R K A N D C O M PA N Y; O P P O S I T E PA G E , P E E P O

here is no cure for macular degeneration.

SENIOR ADULTS ARE THE MOST VULNERABLE, according to Deborah Reid, M.D., an ophthalmologist with Retina Associates, a practice with multiple locations, including Bowie, Rockville and Silver Spring, that specializes in treating retina and macular diseases. Given the well-documented graying of the American population, Reid said, macular degeneration cases will only become more frequent. “Aging of the eye and the population is aging, so you put one and one together and see we have a growing issue,” Reid said. The good news for those with the dry type, according to Reid, is that the condition is treatable with certain vitamins and antioxidants, though that should be undertaken in collaboration with a doctor. “The dry type of macular degeneration can affect your ability to drive or live alone,” Reid said. “It’s treated with high-dose antioxidants. You can’t just go out and buy a vitamin ... it must be under a doctor’s supervision.” Fritz Allen, M.D., an ophthalmologist and retina specialist with Visionary Ophthalmology in Rockville, said along with aging, risk factors for the disease include smoking, high blood pressure and prolonged exposure to strong sunlight—fishermen and ski instructors,

for example, can have a higher risk for the condition. A study published in January by The Journal of the American Medical Association found that people who regularly took aspirin might have a higher risk of developing wet macular degeneration. “There’s no treatment, but the caution you take in stopping smoking and controlling blood pressure and eating vegetables can provide some protection,” Allen said. Mark Farbman, an optometrist with Longmeadow Optical in Frederick, said he refers a couple of patients a month with a possible diagnosis of macular degeneration to physicians. A basic test and a few simple pieces of information can provide big clues as to whether one has it, he said. “Red flags go up when someone has a family history of the disease and their vision is not correctable to 20/20 with glasses,” Farbman said. “Patients volunteer that their vision is distorted. A telephone pole might appear bent or bowed. If we want to take a

closer look, we dilate the pupil and look at the macula.” THOUGH THERE IS STILL NO CURE, treatments have come a long way in the past three decades. According to Reid, in the 1980s physicians used lasers to halt its progression. The laser treatments became less damaging over the years, but the next big breakthrough happened in 2006, when drugs were developed that could prevent the disease from advancing. According to Allen, that class of drugs, generally known as angiogenesis inhibitors (or drugs that slow blood vessel growth), were originally developed for use in cancer patients. In macular degeneration patients, they must be administered regularly for the rest of a patient’s life and can be quite expensive. “Right now, it’s about $2,000 per shot,” Allen said. “It’s very successful, but we have to inject it constantly to keep vessels from growing.” Much of the current macular degeneration research explores ways

of increasing intervals between injections. However, some facilities, including the Bascom Palmer Eye Institute of the University of Miami Health System, are investigating stem cells as a possible cure. “You would inject stem cells directly under the macula and hope they regenerate themselves,” Reid said. “It is only in clinical trials now for tissue loss as the result of aging.” Because of the controversy associated with embryonic stem cells, said Reid, working with stem cells engineered from the cells of living adults may also be an option. For now, the drug injections remain the most effective treatment if regularly administered. “It’s a repetitive treatment,” Reid said. “It’s a chronic disease and we can’t cure it. The injections don’t hurt, but it’s time and effort. It’s time in the doctor’s office for the rest of their lives. The best we can do is extend the time between visits, which we can do as many as once every two or three months.”

“RED FLAGS GO UP WHEN SOMEONE HAS A FAMILY HISTORY OF THE DISEASE AND THEIR VISION IS NOT CORRECTABLE TO 20/20 WITH GLASSES.” – MARK FARBMAN, OPTOMETRIST

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BY ARCHANA PYATI

s scientific understanding of fetal development has deepened over the past 30 years, many doctors are now taking a zero tolerance approach toward drinking alcohol during pregnancy. “The safest course is abstinence,” said Michelle Spector, M.D., an OB-GYN at Capital Women’s Care of Rockville and vice chair of the OB-GYN department at Shady Grove Adventist Hospital. While some doctors may believe the very occasional drink is OK for a pregnant patient, “I don’t know of any studies that demonstrate there is a safe level of alcohol consumption,” said Spector. “I recommend to patients to have no alcohol.” In an August 2011 opinion, The American College of Obstetricians and Gynecologists (ACOG) recommended that OB-GYNs screen all women for alcohol use once a year and during the first trimester for pregnant patients. For pregnant women or those who may become pregnant, the opinion urges physicians to “give compelling and clear advice to avoid alcohol use” and “provide assistance for achieving abstinence.” It also suggests specific screening

tools and questions to ask when assessing a woman’s alcohol use. According to Imelda Udo, M.D., an OB-GYN with Carroll Hospital Center in Westminster, the opinion is part of ACOG’s effort to identify women who are drinking at a time when they may not realize they’re pregnant. “They’re urging us to ask openended questions,” said Udo. “The point is to ask everyone, and not just people perceived to be at risk” for higher alcohol consumption, like women from a lower socioeconomic background, she said. Fetal alcohol syndrome was identified in the 1970s as a set of physical and developmental abnormalities evident in babies whose mothers had consumed alcohol during pregnancy. Now, doctors speak more about fetal alcohol spectrum disorders—or FASD—to describe a whole range, from mild to severe, of abnormalities that can be attributed to a mother’s alcohol use, some of which don’t present until later in a child’s life, according to Udo. Lower birth weight and head size, the absence of a ridge in the space between the nose and upper lip, and small eyes are signs of FASD at birth, according to the Centers for Disease Control and

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Prevention (CDC). Problems with attention and hyperactivity, low IQ and speech and language delays fall within the range of FASDs, according to the CDC, and might not be noticeable until a child reaches school age. Recent research has fine-tuned our understanding of when alcohol is particularly harmful to a developing fetus. Published in Alcoholism: Clinical and Experimental Research, a January 2012 study of 992 women from 1978 to 2005 found that prenatal alcohol exposure during the first trimester’s second half was the period associated with specific physical defects like smaller head circumference, lower body weight, and a thin border

outlining the lips from surrounding skin. Tobie Beckerman, M.D., of Beckerman Women’s Health in Rockville, always discusses alcohol use during preconception counseling. She believes there is no safe threshold for alcohol consumption during pregnancy, but is careful not to induce panic in those who discover they’re pregnant at a time when alcohol is a normal part of their lives. “I don’t condone it, but I also try to diffuse the fear,” she said. While the risk of birth defects may be minimal in the first few weeks of pregnancy, “not calling something dangerous isn’t calling something safe.”

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Women’s Health

H OW

local women lost weight

There’s no denying

that the payoff is big in terms of health, appearance and self-esteem. But the effort required to lose weight can be off-putting, which helps account for the fact that nearly 58 percent of Maryland women are overweight or obese, according to The Henry J. Kaiser Family Foundation. Maryland, more than a full point above the national average, ranks 19th among states in the percentage of women with weight issues.

BY KAREN FINUCAN CLARKSON

14 Gazette Health | Spring 2013

A GAZETTE PUBLICATION

before AGE: 38 POUNDS LOST: 39 POUNDS LEFT TO LOSE: 15 HOME: Upper Marlboro SUPPORT: Zumba classes ADVICE: “Take little steps. Instead of sitting on the couch or at a desk all day, get up and move around. Once you see a little [weight] come off, it’ll motivate you.”

t was the combination of a new job and the return of her brother and sister-inlaw to the area that jump-started Natasha Vandross’ weight loss. “I started moving again,” she said. No longer working from home, Vandross would regularly walk around the office and would use the stairs. Meanwhile, her health-conscious sister-inlaw met her for Zumba classes three times a week. “I’m not big on working out, but Zumba is a lot of fun.”

after As her activity level improved, Vandross began eating healthier—“salads and soups and smart lunches. I cut out processed foods and stopped eating a lot of starch. Dinner is fish and a veggie or chicken and a veggie.” Key to Vandross’ success is that she doesn’t let herself get hungry. “I’m good about eating six meals a day.” Her biggest obstacle is that “I’m lazy by nature and don’t like exercising much.” A recent increase in work-related travel has forced her to cut back on Zumba classes, something she hopes to change shortly. Now within 15 pounds of her goal, Vandross uses imagery to stay focused. “For the past few years I’ve told myself that by the time I’m 40 I’ll have that Halle Berry-Catwoman body. I still have some work to do to get there, but I’m closer now than I’ve been before.”

W O M E N C O U R T E S Y O F C A R O L F R E E D M A N , M E L I S S A L A D D , N ATA S H A VA N D R O S S

Despite the fact that Americans spend upward of $60 billion annually on products and services designed to help them drop excess pounds, according to MarketResearch.com, most women cannot achieve a normal weight. There are, however, success stories—women who have surveyed the weight-loss landscape and found a strategy, either a single technique or combination of approaches, that allows them to incorporate weight reduction into their lives.

Natasha Vandross

Melissa Ladd AGE: 33 POUNDS LOST: 75 POUNDS LEFT TO LOSE: At goal HOME: Rockville SUPPORT: Couch to 5k, www.c25k.com ADVICE: “Every day brings the chance for a new start. Just because you don’t eat well one meal doesn’t mean you should give up. The next meal is a new chance to eat healthy.”

after

before

ith her daughter entering her last year of preschool and a return to the workforce looming once kindergarten rolled around, Melissa Ladd knew the time was right. “I’d been overweight since college, but never had the determination. I simply woke up one day and realized I had this one year,” she said.

Ladd started slowly in September 2011. “I began exercising five days a week—a mix of cardio, yoga and strength training.” Her workouts served as motivation to change her diet. “I didn’t want to undo everything by eating badly.” So, Ladd made healthier food choices and tracked everything she ate. “I also

watched my portions and drank a lot of water.” Then she began running. “I had difficulty running for even one minute. But, within a year, I was able to train myself to run a half marathon.” In September, she completed the Parks Half-Marathon, running from Rockville to Bethesda

in 2:16:35. Her trainer was the Couch to 5k website c25k.com. Her greatest challenge came when she sprained her ankle. “I worried that because I couldn’t run I would gain the weight back. To keep things in check, I reminded myself that while I might not lose weight this week, there was no reason to gain.”

AGE: 57

ADVICE: Find friends “who have successfully lost weight and maintained it. Make dates with these people for coffee, lunch, walks or phone conversations to discuss your successes and hardships.” Freedman also suggested creating exercise opportunities that can serve as social events.

Carol Freedman POUNDS LOST: 38 POUNDS LEFT TO LOSE: “No set target, but will continue to forge on.” HOME: Bethesda SUPPORT: Nora Mann, personal trainer with Mann-Up Fitness in Bethesda, and Janet Zalman, nutritionist with Zalman Nutrition Group in Washington, D.C.

before

“B

etween my feet bothering me and my doctor saying, ‘Carol, it’s really time to do something,’ I decided to make some changes,” said Carol Freedman. After losing 12 pounds on her own in 2011, she joined forces with a nutritionist and a new personal trainer in early 2012 to lose another 26. Realizing that her craving for sugar was undermining her attempt

after to lose weight, Freedman sought out Janet Zalman, a nutritionist “who specializes in diets that eliminate sugar and reduce starch.” Today, Freedman avoids “any product with over 4 grams of sugar and double starches at any meal.” She’s also ramped up her exercise regimen. After working with personal trainer Nora Mann for a month, Freedman saw “such an impact—I was reducing inches and

gaining muscle—that I increased to twice a week.” Her other five to six hours of exercise during the week include ice-skating and cardio— mostly spinning. For years, Freedman allowed her fitness needs to take a backseat to the needs of others. “It wasn’t until my youngest son went off to college that I felt I could finally make myself a priority.” Unlike previous attempts to lose

weight, which she kept to herself, Freedman is sharing. “By [my] being open, my friends and family can support me. When I was secretive, my friends didn’t realize that they were undermining my diet.” She admitted that it is “hard to socialize and stay on a diet. So, I choose my social situations carefully —what restaurants to go to and how often.”

GAZETTE.NET

Spring 2013 | Gazette Health 15

T R A C E Y B R O W N P H O T O G R A P H Y, C O U R T E S Y O F W A S H I N G T O N A D V E N T I S T H O S P I TA L

A GAZETTE PUBLICATION

16 Gazette Health | Spring 2013

HIS STORY

Stabilizing a

Racing Heart

Cardiac Ablation Keeps 37-Year-Old Climbing

The feeling ranges from “a little jittery” to “a bouncing” that is impossible to ignore. These episodes of atrial fibrillation (Afib) are, according to Guillaume Marçais, unpredictable in their frequency, duration and intensity. Generally, “it feels as though my heart is beating too fast and too hard. I can actually feel it pumping in my chest and, if I walk around or am active, I can actually see my chest beating,” said the 37-year-old Boyds resident. Atrial fibrillation is caused by a disruption in the heart’s electrical system, which is responsible for coordinating the cardiac contractions that pump blood throughout the body. The electrical disruption prompts the two upper parts of the heart, the atria, to quiver or fibrillate. The result is a racing or uneven heartbeat. Afib affects some 2.5 million Americans. Although the condition in and of itself is not always life threatening, left untreated, it can lead to complications such as blood clots and heart failure. Stroke is five times more likely to afflict those with Afib than those without the condition, according to the American College of Cardiology.

“People around me think it’s pretty scary,” said Marçais, acknowledging that “there can be dire consequences …. My father-in-law had a similar condition and he died from it.” Because Marçais is young and fit— he enjoys running, biking and rock climbing—Afib has been more of a nuisance to him than a life-threatening ailment. “When young athletes go into atrial fibrillation, their hearts just don’t perform as well and, as a result, they just can’t do the things they want to do, such as long-distance running or, in Guillaume’s instance, climbing,” said Sean Beinart, M.D., an electrophysiologist and co-director of the Center for Cardiac & Vascular Research at Washington Adventist Hospital in Takoma Park. It “is a true burden to his quality of life.” ATRIAL FIBRILLATION IS FOUND MOST often in people with high blood pressure, coronary or rheumatic heart disease, heart failure, or structural or congenital heart defects, none of which apply to Marçais, who recalls first being diagnosed with Afib in late 2003 or early 2004. He may have had episodes as early as his teens. “I remember a few times where I could see my

heart beat through my chest, as early as 13 or 14 years old. But I never told anybody about it, as it was rare and just a curiosity for me.” While physicians have yet to identify what is responsible for Marçais’ Afib episodes, the working theory is “stress, like a sudden change in pace, is the trigger for me. It can happen when I’m sitting and jump up,” he said. IT WAS A MIDDLE-OF-THE-NIGHT CRY from his son that set Marçais’ heart racing in early 2012. “I jumped out of bed and ran to see him. When I got back to bed, I knew that my heart was not doing well.” While his heart would eventually calm down—“There’s not a whole lot they can do in the emergency room other than monitor,” he said— that Afib episode led Marçais to seek help from Beinart. The physician recommended a procedure known as cardiac ablation. Marçais had undergone ablation surgery in 2004, “but I knew it could take twice,” he said. “So I was prepared to do it again.” The idea was to perform the second ablation while Marçais was still young and healthy, “when any consequences are minimal,” he said. [continued on 20] GAZETTE.NET

“I can actually feel [my heart] pumping in my chest and, if I walk around or am active,

I can actually see my chest beating.”

BY KAREN FINUCAN CLARKSON

Spring 2013 | Gazette Health 17

Men’s Health

Seen a Doctor Lately? Why Men Are Less Likely to Make an Appointment

BY SCOTT HARRIS

18 Gazette Health | Spring 2013

A GAZETTE PUBLICATION

“Men don’t ask for directions. They try to solve problems on their own first,” Wielebinski said. “They don’t come out on a timely basis because their schedule doesn’t permit it, or they think they’re getting better on their own.” Many men, according to Sinha, view certain routine procedures, such as the in-office prostate screening, as intimidating or humiliating. He said one of the underlying reasons for this perception could be that, unlike some of the uncomfortable procedures that are part of a woman’s typical checkup, men are often not exposed to these procedures until later in life. “Physically, for women, the exams are equally, if not more, invasive,” Sinha said. “The reason why they have less of a problem there might be that they start earlier. For a man, you don’t usually get a prostate screening until you’re 40. A stigma builds up. The dreaded finger exam gains a reputation.” If this is the case, the antidote may lie in raising public awareness. Large-scale events like National Men’s Health Week, which takes place this year from June 10 to 16, can provide broad opportunities for conversations. “Education is very important,” Sinha said. “We may not inform them as much on the importance of

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all it asking-for-directions syndrome. Term it a case of turn-yourhead anxiety. No matter the label, millions of American men do not regularly visit the doctor, and the implications of their reluctance are very real for patients, families and the health care system. According to the Agency for Healthcare Research and Quality (AHRQ), men are 24 percent less likely than women to have visited a doctor within the past year and 22 percent more likely to have neglected their cholesterol tests. At the same time, men end up in the hospital more often for some common health problems: they are 28 percent more likely than women to be hospitalized for congestive heart failure, 32 percent more likely to be hospitalized for diabetes complications and 24 percent more likely to be hospitalized for pneumonia, AHRQ statistics show. “It definitely is something I’ve noticed,” said Vivek Sinha, M.D., a family care physician with Fort Washington Family Medical Center. “I’ve also noticed that male patients are sometimes a little sicker than females because they haven’t come to the doctor regularly or don’t come until there’s a problem.” The problem can indirectly lead not only to more acute problems, but also to more costly and timeconsuming care down the road. “Major medical problems have to be headed off at the pass,” said Paul Wielebinski, M.D., a Silver Spring-based internal medicine physician with Adventist Medical Group. “It’s always better and easier to treat something in the beginning stages rather than the advanced. If they have chest pains but keep denying it, they could be crippled for life. More complications make care more intense and more involved, and it will certainly add to the cost.” The reasons behind the reluctance will vary by person, but there may be a few common causes.

certain screenings. There is a lot of publicity around breast cancer, and rightly so, but we’re starting to see more about the importance of things like prostate exams, too.” Dialogue between a physician and a patient is another effective tool for alleviating discomfort over procedures and driving home the importance of regular doctor visits. “The apprehensive ones are usually only apprehensive the first time,” Sinha said. “Then they see it’s not a big deal for us or for them. I like to tell them that one of their responsibilities is taking care of their families, and to do that they first have to take care of themselves. If you have a son, you have to be a good example for him and break the cycle.” But for that dialogue to take place, patients have to first come in the door. That can be the biggest challenge and the most important conversation. “Oftentimes, it’s a woman who recruits the men in her life to come and get a screening,” said Beth Mowrey, program administrator for Frederick County Health Department’s preventive health programs, which include cancer and other disease screenings. “Women can point out the connection between health and physical performance or work stamina. They can also recruit men who they know have good habits to encourage other men to go,” she said. Changing the mindset of men reluctant to visit the doctor may mean changing a mindset when it comes to overall health. “Agree on an exercise routine that fits into his schedule,” Mowrey said. “Be active and maintain a healthy weight. If you smoke, try to stop. “Early in life, men have a feeling of invincibility, like nothing’s going to happen to them. That carries over into older age sometimes, so that they do reactive health care instead of proactive,” she said. “But the sooner an issue is identified, the better we’re able to manage it.”

Common Conditions

Must You Be Gluten-Free?

Celiac Disease: Easy to Treat, Hard to Pin Down

BY SCOTT HARRIS

I S T O C K P H O T O / B R E A D , J W B L I N N ; C L A M S , M A R K G I L L O W ; C O R N , J O E B I A F O R E ; B U T T E R , S E D N E VA A N N A

ary Denion feels great these days. Her new diet is treating her well. There’s just one problem. “I miss homemade bread,” said Denion, of Finksburg. “And pizza. They make gluten-free pizza now, but it’s not too good.” All is not lost, however. “They’re coming out with some terrific cake mixes,” Denion said. “And the pastas are good if you have a nice sauce to go with it.” Denion was diagnosed five years ago with celiac disease, a condition that harms the lining of the small intestine when a person eats foods containing gluten, a protein found in wheat, barley, rye and some varieties of oats. On top of common symptoms like abdominal discomfort, diarrhea and weight loss, those with celiac disease have trouble absorbing important vitamins and minerals. Though it is most common in non-Hispanic whites, celiac disease can affect people of all races, ethnicities, ages and genders. ACCORDING TO THE CELIAC DISEASE FOUNDATION, THE DISEASE, in which the immune system overreacts to gluten, affects 1 in 133 Americans. Although health care providers say the treatment—avoiding foods that contain gluten—is relatively simple, diagnosing the problem in the first place is far less so. And the ramifications can be quite serious. “The list of symptoms is extensive, and it varies a lot from person to person,” said Jean Daniello, a dietitian with Carroll Hospital Center in Westminster. “Risks that come from undiagnosed celiac disease can range from osteoporosis to stunted growth—anything that happens as a result of failure to absorb vitamins and minerals.” Even today, most cases remain undiagnosed, according to a study led by researchers from the Mayo Clinic and published in July by The American Journal of Gastroenterology. Further complicating the issue is the fact that a gluten-free diet

is the latest nutritional fad. The same study found that about 1.6 million Americans are going gluten-free despite not having been diagnosed with celiac disease. “It’s the latest member of the disease-of-the-month club,” according to Abdulhosein Adham, M.D., a gastroenterologist and internist at MedStar Southern Maryland Hospital Center in Clinton. “This should not be a disease of the month. This has been around and it will continue to be around.” The Mayo Clinic study revealed that celiac disease diagnoses are four times more common now than 50 years ago, but not necessarily because the actual condition is becoming more prevalent. Rather, health care providers are more aware of the condition and have better means of testing for it. Still, because celiac symptoms can vary widely and mimic those of other conditions, including irritable bowel syndrome or simple indigestion, the disease is notoriously difficult to identify. “It is underdiagnosed. Some people think 1 in 100 people have it, but others think 1 in 250 people have it. Patients should be suspicious, and bring it up,” said Adham, adding he personally cares for about 100 celiac patients. “Symptoms are all over the map. That’s why it’s been under the radar for so many years. There’s no classic presentation of celiac disease. Patients have to have a high index of suspicion. Celiac and other conditions are mixed up all the time.” DENION CREDITED THE SIMPLE PERSISTENCE OF HER AND HER physicians with finally discovering the cause of her ongoing health issues. “I was persistently complaining about digestive problems,” she said. “Usually when you’re complaining about digestive problems, they give you antacids and a colonoscopy. But they finally did the right test, and then I went to see a gastroenterologist who made the diagnosis.” [continued on 20] GAZETTE.NET

Naturally Gluten-Free • milk not flavored with

ingredients that contain gluten, such as malt • 100-percent fruit or vegetable juices • fresh fruits and vegetables

• butter • eggs • lentils • peanuts

• seeds, such as flax • tree nuts, like almonds • nongluten-containing grains, such as corn

• fresh fish, like cod • fresh shellfish, such

as clams • honey • water, including bottled, distilled, and spring –U.S. Food and Drug Administration

Spring 2013 | Gazette Health 19

HIS STORY, continued from 17

“And, it means I don’t have to take medicine.” “Drugs in a lot of patients are a very attractive and appropriate alternative,” said Beinart. “In younger patients, they tend to have significant side effects and can promote the decline in the quality of life that we’re trying to prevent in the first place.” CARDIAC ABLATION DESTROYS SMALL areas within the heart where rhythm problems start. Because the areas of tissue are very tiny, damaging them does not affect the heart’s ability to do its job. Physicians “use a spaghetti-sized wire, called a catheter, that delivers heat energy to specific, targeted areas of the heart,” said Beinart. The result is an elimination of “electrical signals in that area in a safe, very precisiondriven fashion.” The ablation procedure at Washington Adventist Hospital in May of last year took about four hours, according to Marçais. “Going through the procedure is somewhat

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CELIAC, continued from 19

According to Adham, the “gold standard” of testing for celiac disease is a biopsy of the duodenum, the first section of the small intestine. Blood tests can also work, but are not quite as accurate, he said. Once celiac disease is diagnosed, avoiding foods containing gluten tends to solve the problem. Daniello said that growing awareness of celiac disease and gluten-free dieting is making it easier to avoid gluten. “It’s a lot easier to manage [celiac disease] than it used to be because labeling guidelines now require that companies say if the product contains gluten. It has to be spelled out,” Daniello said. “Patients need to read these labels, and keep foods separated in the kitchen so they don’t accidentally cross-contaminate.” The biggest obstacle is when there are no labels to read. “Restaurant eating is still the biggest challenge,” Daniello said. “Bouillon cubes and even cold cuts can contain gluten. Any sauce has got to be checked. You just have to be vigilant.”

BECAUSE THE AREAS OF TISSUE ARE VERY TINY, DAMAGING THEM DOES NOT AFFECT THE HEART’S ABILITY TO DO ITS JOB. taxing. Because they put the catheter in through the groin area and up into the heart, the groin area is sore. The night after the procedure is painful and you must lie on your back for 24 hours. You cannot lift or run for a few days,” he said. It wasn’t long, however, before Marçais, a bioinformatics researcher at the University of Maryland in College Park, was back to work and enjoying athletic pursuits. And while there are no guarantees as to what the future holds—“I may need no other remediation … or maybe some small amount of blood thinners,”— he is optimistic that the racing in his heart has been permanently calmed and the potential “for other health crises” averted.

According to Daniello, companies now make gluten-free versions of everything from beer to Communion wafers for Christian churches. But though the gluten-free diet is trendy and can be healthful, it does not mean everyone should go gluten-free. “A gluten-free diet is very tedious and an expensive undertaking,” Adham said. “Someone based on their own judgment should not diagnose themselves, because they could literally pay a high price for it. Someone who goes to a gluten-free diet may feel better because gluten can produce gas and make you feel bad. But that doesn’t necessarily mean you have celiac disease.” Experts stress that anyone who believes they may be sensitive to gluten should consult a doctor. “The best treatment is making the correct diagnosis,” Adham said. “The actual solution is simple: avoid what causes the symptoms. Once the answer is there, the treatment is there. The difficulty comes in figuring it out. It’s all or none. You either have it or you don’t.”

Learn About Hearing Aids

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and director of Rockville’s Pediatric Psychology Center and an adjunct associate professor of behavioral sciences and pediatrics at The George Washington University School of Medicine and Health Sciences. “Some parents make it unintentionally worse. What’s not helpful is a child sensing a parent’s anxiety about letting a child go to a new place. Maybe it’s hard for them to let their child go, and maybe the child is worried about the parent.” Psychologist Renee Neely-Walters has worked with students whose frequent absences from school aren’t due to separation anxiety, but to attend to a parent’s emotional needs. “I’ve actually had cases where parents are depressed, maybe they’re exiting a relationship themselves, and they make the child feel like they need to take care of them,” said NeelyWalters, who counsels young children at the Metropolitan Psychological Group in Lanham and elementary students at a Washington public charter school. One solution was to find a volunteer opportunity for the mother at her child’s school, fulfilling her need to be close without compromising the child’s personal and intellectual development. SUCCESSFUL TRANSITIONS Parents can minimize their child’s stress during transitional times by staying upbeat, being up front about why you need to be apart and reassuring them of your return, said Bernards and Feinberg. In other words, sneaking out of your toddler’s classroom when she isn’t looking isn’t the best approach. Day care teachers and even classmates can be a parent’s allies in soothing a distressed child. Pairing them with a buddy or giving them a leadership role in the classroom—like asking them to help distribute juice and cookies during snack time—deflects attention from the distress and builds inner confidence and trust in the caregiver, according to Neely-Walters. “Try to do things in small chunks that are manageable for the child,” said Bernards. At day care, for example, a parent could say, “‘you’re going to go in there, and I’m going to go shopping, but then I’ll come back.’ They get to practice and have their feelings about it and their success.”

“GIVE THEM SOME TIME TO DEVELOP THE ABILITY TO SOOTHE THEMSELVES.” – JESSICA FLOYD, CLINICAL PSYCHOLOGIST

Another skill parents can help children develop early on is self-soothing, beginning at infancy, said Floyd. Too often, parents are unwilling to leave a child unattended during the first few minutes of a cry. “The child then learns that if they do this behavior, my parent will come,” said Floyd. “That’s not to say leave them crying all day, but give them some time to develop the ability to soothe themselves. It’s important for children to develop internal resources.” Jessica McCausland’s toddler Claire has always felt a strong attachment to her mother because she has never been bottle-fed. The bond they’ve shared over nursing makes longer separations harder on Claire, said McCausland, who recently relocated from Silver Spring to Florida. An attorney, McCausland, 39, returned to work when her daughter was 9 months old; caregivers cared for Claire at home. It went smoothly, she said, because the nanny was “on her daughter’s turf,” and each morning, the nanny, Claire and McCausland would have a warm-up period where they played together. When it was time for McCausland to leave for work, she sang a song— “heigh-ho, heigh-ho, it’s off to work I go”—which made her departure a cheerful, rather than distressing, event. She always made eye contact with her daughter, and the nanny, meanwhile, would have a book picked out for her and Claire to read. McCausland would take frequent breaks from work, which was only a block away from home, to breastfeed Claire, who understood her mom was never far away.

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experts’ advice National Institutes of Health

What’s That Rash? W

22 Gazette Health | Spring 2013

A GAZETTE PUBLICATION

I S T O C K P H O T O / Q U AY S I D E

“The most common form of dermatitis that is seen anywhere is an e often think of the skin as a barrier—it keeps the insides of our bodies in, and it keeps the outside world out. But skin is allergic contact dermatitis to nickel,” said Katz. “Why? Because of ear also filled with immune system cells that protect against piercing.” Many inexpensive earrings are made of nickel, and over time, viruses, bacteria and other threats. Whenever these cells detect a suspi- wearing nickel earrings can cause an allergic reaction to the metal. Other cious substance, they begin a chain reaction in the skin that leads to common causes of allergic dermatitis are poison oak and poison ivy. Mild cases of allergic contact dermatitis usually disappear after a few inflammation. The medical name for this reaction is dermatitis—a rash. There are many different types of dermatitis, and each has distinct days or weeks, but if the rash persists, is extremely uncomfortable or treatments. Sometimes the skin’s immune cells react to something that occurs on the face, it’s important to see a physician. A doctor can prescribe medications that will tone down the immune directly touches it. Other times, the immune system reaction in the skin. This eases swelling and itching flares in the skin because of a whole-body infection and will protect your eyes and face. or illness. The immune cells of the skin can also produce Symptoms of these different types of rashes often rashes when they react to invading germs—like bacoverlap. “Itching is a common symptom for all these teria, fungi and viruses. Bacterial and viral infections problems,” said Dr. Stephen I. Katz, director of the within your body can cause your skin to break out National Institutes of Health’s National Institute of in spots, as well. The chicken pox virus, for example, Arthritis and Musculoskeletal and Skin Diseases. can cause itchy spots in children. Years later, in older Many rashes are red, painful and irritated. Some adults, the same virus may reappear as shingles, types may lead to blisters or patches of raw skin. resulting in a painful rash and high fever. Vaccines While most rashes clear up fairly quickly, others are can prevent several rash-causing diseases, including long lasting and need to be cared for over long chicken pox, shingles and measles. periods of time. Eczema, or atopic dermatitis, is a dry, red, itchy CERTAIN DRUGS, INCLUDING ANTIBIOTICS LIKE rash that affects up to 1 in 5 infants and young chilamoxicillin, may also cause itchy rashes. If you’re dren. It often improves over time, although it can allergic to a drug, a rash can be the first sign of a serilast into adulthood or start later in life. In this conous reaction. As with other allergies, a drug reaction dition, the watertight barrier between skin cells gets may not occur the first time you take it. Not all drug weak, which lets moisture out and other things in. rashes are due to an allergy, however. If you break That’s why people with atopic dermatitis have to out in itchy spots after starting a new drug prescripmoisturize their skin, and why they’re more suscepPsoriasis, a condition tion, contact your doctor right away. tible to skin infections. where skin cells build While most rashes get better with time, some can RESEARCHERS HAVE RECENTLY IDENTIFIED SPECIFIC last a lifetime. Psoriasis, a condition where skin up into thick red genes that are involved in maintaining the skin barcells build up into thick red patches, tends to run in patches, tends to rier. People with certain versions of these genes are families. “It’s a complex genetic disease, in that run in families. more likely to get atopic dermatitis. there’s not one gene that causes psoriasis, but “The skin is the outermost sentinel for fighting off many,” said Katz. Other long-term diseases that bacteria and noxious agents,” said Katz. “If the barrier is broken some- can produce rashes include autoimmune diseases, such as lupus, and how, you can become more allergic to things.” some forms of cancer. A skin allergy, or allergic contact dermatitis, produces a red, itchy rash If you notice an itchy or painful rash on your skin and don’t know the that sometimes comes with small blisters or bumps. The rash arises when cause, think twice before going to the drugstore and getting some cream. the skin comes in contact with an allergen, a usually harmless substance “The creams that you buy can produce problems that make your original that the immune system attacks. Allergens can come from certain soaps, problem even worse,” Katz said. Because rashes can be caused by many creams and even pets. different things—bacteria, viruses, drugs, allergies, genetic disorders and Your immune system might not react the first time you encounter an even light—it’s important to figure out what kind of dermatitis you have. allergen. But over time, it can become sensitive to the substance. As a “If you have any significant rash, you should see a dermatologist.” –NIH News in Health result, your next contact may lead to inflammation and an allergic rash.

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