Hormone Replacement Therapy (HRT) and Cardioprotection

Conjugated Estrogens (Premarin)

In developed nations, the leading overall cause of mortality in women is coronary artery disease (CAD), (1) with the risk of the disease increasing dramatically after menopause. The hypothesis that loss of estrogen is the cause is supported by studies of younger women who are postmenopausal due to surgery. (2) In an effort to combat CAD, many postmenopausal women were placed on an estrogen replacement therapy regimen using conjugated equine estrogens believed to provide a wide spectrum of beneficial cardiovascular effects, such as

* relaxation of precontracted smooth muscle cells,

* inhibition of calcium entry,

* enhancement of nitric oxide synthase reactivity,

* stimulation of prostacyclin,

* prevention of myointimal hyperplasia, and

* endothelium-dependent vasodilation of coronary and brachial arteries.

However, newer clinical studies have shown that that this “magic bullet for menopause” not only failed to live up to its earlier promise, but also is responsible for concomitant adverse effects, ranging from hypertriglyceridemia, endometrial hyperplasia, tumorigenesis, and hypercoagulable states. In fact, the National Institutes of Health (NIH) discontinued several phases of the now famous Women’s Health Initiative (WHI) study (3) because the risks of hormone therapy, including estrogen-only therapy and combined estrogen plus progestogen therapy, far outweighed the documented benefits associated with these hormones.

Data from the discontinued estrogen-only study showed that estrogen not only had no effect on preventing heart disease after seven years of continuous use but also increased the risk of stroke, with a separate report pointing to “probable” dementia and/or mild cognitive impairment associated with estrogen-alone therapy. (4,5) The combined estrogen plus progestogen therapy also failed to live up to its promise. While it did prevent the stimulation of endometrial hyperplasia, it failed to provide lipid-lowering effects. (6) In addition, synthetic progestins presented an even greater risk of breast cancer than estrogen alone (7) and increased the risk of stroke, heart attacks, and blood clots in legs and lungs. (8) Fortunately, there are now other options available to women that afford cardioprotection and have a consistent safety profile.

Bioidentical Hormone Therapy

Since the 1930s, synthetic estrogens have been used to alleviate the major menopausal symptoms, with synthetic progestins becoming part of the therapy in the 1980s to counter the dramatic rise in uterine cancer that was related to estrogen-only treatment. (9) With the advent of bioidentical/natural hormone replacement therapy (BHRT), women now have a viable option that will alleviate menopausal symptoms while providing the cardiovascular protection formerly provided by their body’s own hormone supply. The therapy uses hormones derived from a range of sources, including plants (phytoestrogens) as well as dehydroepiandrosterone, pregnenolone, cortisol, growth hormone, estradiol, estrone, and estriol, along with natural progesterone and testosterone, if needed. (10)

[ILLUSTRATION OMITTED]

The importance of using a natural hormone, like natural progesterone, for example, versus synthetic progestins is twofold. First, research (11) has shown that progesterone can inhibit the change of cholesterol into cytoplasmic cholesteryl ester (CE) (a crucial early step of atherogenesis, more commonly known as “hardening of the arteries”) and decrease CE macrophage cellular levels. Second, natural progesterone can also block the increase of CE accumulation in macrophages. Unfortunately, this beneficial effect can be inhibited by synthetic progestins, demonstrating the importance in developing remedies derived from nature rather than synthesized in a laboratory environment. (12)

Cardioprotectants in Women: Whole Grains, Fruits, Vegetables, and Plant-Based Phytoestrogens

In addition to utilizing BHRT to address both menopausal symptoms and the increased risk of cardiovascular disease that can accompany them, women can also gain a level of cardioprotection from specific dietary choices–specifically, whole grains, plant-based phytoestrogens, fruits, and vegetables. This is especially important when other cardiovascular risk factors, such as hormone replacement therapy (HRT) use, smoking, alcohol consumption, saturated and trans-fatty acid intake, and sedentary lifestyle, exist.

Whole Grains and Ischemic Stroke

Various studies (13) have demonstrated the inverse association of the intake of whole grains and the risk of ischemic stroke and ischemic heart disease (IHD) among women. In each case, whole grains provided a significant benefit unmatched by refined and total grain intake. For example, in the Iowa Women’s Health Study, (14) involving 34,492 women, there was a one-third reduction in IHD risk noted during a nine-year follow-up period–even after controlling for many confounding variables such as dietary fat and cholesterol–which correlated inversely with whole grain intake.

My first column on censorship in medicine (Aug./Sept.) spotlighted defects in the peer review system that block the circulation of information about novel treatment. It focused on hindrances to publication in medical journals and barriers to presentations at scientific conferences, because these periodicals and meetings serve as primary outlets for reports on research that could improve patient care.

[ILLUSTRATION OMITTED]

This column reviews instances of dogma in clinical practice and looks at bars to obtaining grants for studies that challenge prevailing theories of treatment or explore nonconventional approaches. A third column about censorship will center on the blacklisting by the American Cancer Society of doctors who radically depart from majority norms.

Dogmatic Medicine: Radical Mastectomies, An Historical Example

The college dictionary atop a stack of cartons behind my desk gives

two meanings for “dogmatic.” The first: “Relating to or typical of dogma.” The second: “Marked by an authoritative, arrogant assertion of unproved or unprovable principles.” Referring back to this dictionary’s definition of “dogma,” I read that it equates “principle” with “belief, idea, or opinion, esp. one authoritatively considered to be absolute truth.”

WOW! In three short definitions, my handy general dictionary hits the essence of dogmatism in clinical practice right on the head. Let’s go to a close-up of a now notorious’ example in Western allopathic medicine–the treatment of breast cancer from the late 19th century through the last decade of the 20th century.

Attention deficit hyperactivity disorder (ADHD) is the most common psychiatric disorder of childhood and adolescence. It has been estimated that 3%-5% of children in the United States have the disorder, and estimates from other countries have rates of ADHD similar to the U.S. (Biederman, 2003).

The core symptoms of ADHD are inattention, impulsivity, and hyperactivity. The American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders IV (4th ed.) (see Table 1) criteria stipulate symptoms should occur in two or more settings of one’s life and be present for more than 6 months (APA, 2000). Former classifications of ADHD and ADD are no longer valid. The current nomenclature includes the four ADHD subtypes: ADHD-combined type if the child has symptoms of inattention, hyperactivity and impulsivity; ADHD-predominantly inattentive type; ADHD-predominantly hyperactive/impulsive type; and ADHD not otherwise specified if the child does not fully meet all of the criteria (APA, 2000).

ADHD is more common in boys than girls by a ratio of 3:1 (Ella, Ambrosini, & Rapoport, 1999). ADHD is often associated with co-morbid conditions of oppositional defiant disorder (50%), depression (9%-38%), anxiety (25%), learning disorders (20%-30%), and bipolar disorder (1%-5%) (Adesman, 2003). Children with ADHD also frequently have low self-esteem, school failure, and emotional and social difficulties (Biederman, 2003).

Virtual reality really eases pain, according to findings published in the journal NeuroReport. Researchers applied painful but tolerable heat to the feet of eight men for 30 seconds at a time while they given a “Snow World” virtual-reality tour. While so distracted, their perceptions of pain were lowered, they rated the experience as less unpleasant, they spent less time thinking about their pain, and pain-related activity in the brain decreased by at least 50 percent compared with when they looked at a non-virtual focal point. Other psychological techniques, such as guided imagery and hypnosis, also have shown promise in quelling pain.

Consistent use of condoms significantly reduced the recurrence of pelvic-inflammatory disease among 684 sexually active women, according to a three-year study published in the American Journal of Public Health. Using condoms also greatly decreased the risk of chronic pelvic pain and infertility associated with PID. The report was actually the first to show that condom use can block sexually transmitted bacteria as well as viruses. Most cases of PID are sexually transmitted.

RELATED ARTICLE: Broccoli is the new carrot.

Researchers at Johns Hopkins University School of Medicine discovered that sulforaphane, an antioxidant in broccoli, protects human eye cells from UV damage; the more sulforaphane applied to retina cells before exposure to ultraviolet light, the greater the level of defense. While future studies will determine the best dose, study author Paul Talalay, M.D., advises eating two to three servings of broccoli sprouts per week for added protection.

Helicobacter pylori (H. pylori) has been found to be associated with various gastrointestinal diseases. Confirmation of H. pylori infection includes invasive and non-invasive methods. There has been increasing interest in noninvasive tests recently. However, the geographical differences among H. pylori strains have been emphasized recently and the H. pylori strain in Taiwan showed a high cagA positive result and different vacA subtype when compared with those of Western countries. The aim of this study is to access and compare the reliability and the diagnostic accuracy of the stool H. pylori antigen tests by spectrophotometry and by the visual method, especially in Southern Taiwan. Thirty-two patients (18 men and 14 women; age range: 23-91 y/o, mean: 50.5 y/o) who underwent gastroendoscopy at Kaohsiung Medical University Hospital were enrolled in this study. H. pylori infection status was confirmed by culture or two positive test results on CLO test, histology and 13C-urea breath test (13C-UBT). The exclusion criteria included previous gastrointestinal tract surgery, use of antibiotics, proton pump inhibitor or compounds containing bismuth within 1 month of the study. Among them, 14 patients were with duodenal ulcer (DU), 4 with gastric ulcer (GU), 12 with non-ulcer dyspepsia, and 2 with GU and DU. Those patients had their stool collected for ELISA tests of H. pylori stool antigen (HpSA). The HpSA tests were positive in 16 of 18 patients diagnosed as H. pylori positive, and negative in 13 of 14 patients as H. pylori negative. The sensitivity and specificity were 88.9% and 92.9% respectively. The positive and negative predictive values were 94.1% and 86.7% respectively. The concordance of HpSA accessed by spectrophotometry and visual method is 100%, which makes this test even easier and cheaper. We concluded that stool HpSA test is a noninvasive, accurate, reliable, rapid and easy way to diagnose H. pylori infection in Southern Taiwan, either by spectrophotometry or by visual assessment.

A national population study, using a random sample of 1,057 geographically weighted cases, was conducted to determine the prevalence of chemical hypersensitivity, the medical diagnosis of multiple chemical sensitivities (MCS), (1) and their co-occurrence with asthma in the American population.

The study found that 11.2% of the sample reported a hypersensitivity to chemicals, and 2.5% reported being diagnosed with MCS. Additionally, 14.1% of the respondents reported being diagnosed with asthma. Of those with asthma, 27% reported also being hypersensitive to chemicals and 7.4% reported also being diagnosed with MCS. Of those diagnosed with MCS, 42% reported also being diagnosed with asthma.

Additionally, 31.1% of all respondents reported an aversion to scented products, and 17.6% of all respondents experienced negative physical reactions to air fresheners. Among those with asthma, 37.2% found scented products irritating and 29.7% said air fresheners caused breathing difficulties, both of which are common symptoms of MCS.

**********
Advertisement

Chemical hypersensitivity, often medically diagnosed as multiple chemical sensitivities (MCS), (1) is also known as toxicant-induced loss of tolerance (2) and environmental illness. MCS is characterized by adverse physical reactions to chemicals in common products such as household cleaners, laundry supplies, fresh paint, fragrances, synthetic building materials, new carpets, pesticides, and other petro-chemically based products. MCS is considered permanent and the only way that sufferers can prevent reactions is to completely avoid problematic chemicals. MCS reactions, which range from mild to severe, can result from exposures to even low levels of the irritating substances. (3)

Research indicates that MCS exhibits a two-step process. The first step, initiation, is when the hypersensitivity first develops. Initiation can result from a single high-level exposure to a particular toxic agent, or it can emerge after chronic exposure to one or more toxic substances, even at low levels. The second step in MCS, triggering, is when adverse physical reactions occur as a result of an exposure. Once the hypersensitivity has developed, symptoms can be triggered by an exposure to a range of offensive substances, usually much wider than the initiating substance, and even at very low levels.

In addition to growing concern about MCS, there has been mounting alarm about the increasing occurrence of asthma. This has stimulated researchers to investigate asthma’s linkage with other conditions. (4) Recent studies have explored the possible association of certain types of asthma with chemical hypersensitivity. (5) These studies have suggested that chemical hypersensitivity can be a symptom of some forms of asthma. (6) Asthma has numerous phenotypes based on age of onset, etiology, and characteristics. (7) Occupational asthma, one of the phenotypes, originates from workplace exposures to toxic substances. Occupational asthma is further categorized based on how rapidly the condition emerges. Occupational asthma can be either “with latency” or “without latency.” Occupational asthma with latency develops over time when continued exposure to a toxic substance creates allergic sensitization, while occupational asthma without latency occurs immediately after a single massive toxic inhalation. (8) Reactive airways dysfunction syndrome (RADS), which has also been termed irritant-induced asthma, (9) is a subset of occupational asthma without latency. (10) RADS is a persistent, airways hyperresponsiveness that occurs after a single high-level toxic exposure incident. RADS is a permanent condition (14) and once sensitized, individuals with it negatively react to much lower levels of the irritating substance.

RADS sufferers frequently exhibit chemical hypersensitivity, which has led some researchers to conclude that RADS and MCS are overlapping disorders. (15) Apparent similarities between MCS and RADS provided the impetus for a study utilizing animal models, which found that asthma and MCS have common etiologies and characteristics. (16) An additional study, which focused primarily on symptomatology, indicated that specific forms of asthma and MCS have similar dynamics which frequently overlap. (17) Thus, it is becoming evident that MCS has commonalities with at least some types of asthma.

While there is increasing evidence that chemical hypersensitivity is a symptom of some categories of asthma, there have been no prior national population studies of the co-occurrence of asthma and chemical hypersensitivity or of asthma and the medical diagnosis of MCS. There have been prevalence studies, however, of chemical hypersensitivity and the medical diagnosis of MCS in the American population, and separate epidemiological research on asthma.

MCS Prevalence

This study is the first to investigate the national prevalence of chemical hypersensitivity and the medical diagnosis of MCS using a randomly selected population-based sample. Prior to this study, the National Academy of Sciences estimated that up to 15% of the American population could experience some degree of hypersensitivity to common chemicals. (15) Regional studies have also been conducted. The California Department of Health Services found a MCS prevalence in California of 15.9% (n=4046), (16) while similar studies in the Atlanta, Georgia metropolitan area and the state of New Mexico found rates of 12.6% (n=1579) (17) and 16% (n=1813) respectively. (18) These three studies used accepted epidemiological methodology with randomly derived samples. Other published studies of the prevalence of chemical hypersensitivity have used anecdotal evidence, non-randomly or self-selected subjects, or a much broader definition of hypersensitivity, and they produced a wide range of findings. A study that relied exclusively on conversations with medical personnel in clinical settings estimated that between 2% and 10% of the population experiences chemical hypersensitivity. (19) Two subsequent studies in Arizona used self-selected subjects, young adult college students and elderly persons, and determined that approximately 15% (n=809) of the younger group (20) and more than 37% (n=160) of the elderly group (21) reported hypersensitivity to chemicals. A population survey in rural North Carolina, using a broader definition of chemical hypersensitivity that did not distinguish between an aversion to harsh chemical odors and true hyperreactiveness, found a rate of 33% (n=1027). (22)

BRITTAIN, Charmaine R. (Ed.). Understanding the Medical Diagnosis of Child Maltreatment: A Guide for Nonmedical Professionals (Third Edition). New York: Oxford University Press, 2006. 288pp. $27.50 (p).

This practical resource from the American Humane Association answers frequently asked questions about the medical aspects of child abuse and neglect. Designed for the nonmedical professional unfamiliar with medical terminology, the third edition translates injuries into clear language for child protective services workers working with medical providers. Thoroughly updated to reflect the latest research on child abuse and neglect, this edition covers burns, fractures, poisoning, sexual abuse, neglect, substance abuse, and family violence. Chapters also highlight the working relationship between CPS workers and medical providers, the importance of understanding differential diagnoses, and techniques to ensure culturally responsive practice. A wealth of charts, illustrations, checklists, and resources make this an accessible reference for any nonmedical professional working with children and families, and it can be used as a training tool and resource. The companion website contains additional materials for supervisors and staff, including photographs, protocols, relevant articles, memoranda of understanding, and useful links.

Medically known as cephalalgia, a headache is an ache or pain in the head, neck, and sometimes upper back. One of the most common afflictions, causes can range from stress, eye strain, and sinus tension, to aneurysms, meningitis, and tumors. They can also be caused by more outwardly obvious reasons, such as head injuries or blows to the neck or face.

What’s Hurting
The brain, as an organ, is not capable of feeling pain; it lacks the right nerve fibers to be pain-sensitive. But, there are areas near the brain where pain is able to be felt: a network of nerves surrounds the scalp, face, throat and neck. Additionally, the blood vessels, the surrounding membranes, and the muscles of the head all have the ability to perceive pain.

Types of Headaches
While there are many sub-categories, there are four types of headaches. These are vascular, myogenic, traction, and inflammatory.

Vascular: Vascular headaches are headaches caused by the swelling or irritation of blood vessels. They include migraines (headaches that involve severe pain, nausea and blurred vision), toxic headaches (headaches that are produced by a fever or from over-exposure to toxic chemicals, including alcohol), cluster headaches (headaches marked by clustered episodes of intense pain usually over one eye), and headaches caused by hypertension.

Myogenic: Myogenic headaches are caused when the muscles in the head and neck tighten, causing pain. A tension headache, the most common kind of headache, falls under the Myogenic category. These can either be episodic (coming on every once in a while) or chronic (occurring with frequency). They are often caused by the stresses of lack of sleep, emotional influences, nerves, bad posture, hunger, and physical exertion.

Traction and Inflammatory: Both Traction and Inflammatory headaches are symptoms of underlying medical conditions or disorders. Without treatment, these get worse and occur more often over time. An example of this is a sinus headache, a headache caused by inflammation of the sinuses. This inflammation can be the result of bacteria, fungus, viruses, allergies, or autoimmune reactions.

Diagnosis of Headaches
Though, from a statistical standpoint, most headaches don’t require medical attention, this isn’t always the case. Because some headaches may be warning signs of life-threatening conditions, a medical diagnosis may be needed, sometimes urgently.

Headaches that are persistent and worsening over time, headaches that are frequent in children, headaches that are caused by a blow to the head, and headaches that involve fever, stiff neck, confusion, or unconsciousness are just a few examples of headaches that warrant the attention of a healthcare professional. In these cases, CT scans and MRI’s of the head are typically performed.

Treatment of Headaches
Headaches that are not symptomatic of an underlying condition can usually be treated with over the counter painkillers. However, frequent and prolonged use of this kind of medication is not recommended and can actually lead to Rebound Headaches (headaches caused by withdrawal from medication). Caffeine and certain vitamins – Magnesium, Vitamin B2 – are also sometimes recommended.

Some people find that keeping a diary of when their headaches occur helps them to figure out the “trigger” of their headaches. For instance, certain foods and certain medication can lead to headaches. If a person is tracking when these foods and medications are used and realizes that they have headaches a few hours after consumption, something they are ingesting could be the cause.

Genetics and Headaches
While there is no genetic link among certain types of headaches, some types do tend to run in families. This is particularly true for migraines. Most children and teenagers who have reported repeated migraines also have relatives with the same affliction. In fact, if both parents of a child have repeated episode of migraines, there is roughly a 70 percent the child will develop them at some point. If only one parent has migraines, however, the chances of the child developing them drop to between 25 and 50 percent.

Headaches can be range from temporary pain and temporary discomfort to a warning signal your body is emitting. Anything that is prolonged or severe should never be ignored, no matter how common headaches may be.

About Us:The Center for Osteopathic Medicine in Boulder, Colorado believes in The Osteopathic Difference. In a medical industry focused on treating symptoms, The Center is more focused on finding the cause of these symptoms. The Osteopathic Difference is the application of “Hands on Therapeutics” for both the diagnosis and treatment of complaints, disorders, and pain. The Osteopathic Difference will apply the time proven osteopathic fact that function is directly related to structure, and poor structure will lead to poor function.

While The Center tries to focus on health, and above all else, prevention for all those who cross into its threshold, sometimes the best that can be done is to recognize the source of the “DIS-EASE,” and to teach every individual how to manage their symptoms. Believing that it is the most important aspect of any treatment regime, and that it is the primary job of the health care practitioner, The Center works to empower the patient in the maintenance of their own health.

Achieving health is also an elusive place, and The Center will work tirelessly to create a path to health which, when embraced by the patient over time, will allow the patient to enjoy a positive return on their rehabilitation investment. The Center teaches a Mindfulness Yoga Program that aims to educate the patient in the power of the mind to minimize, if not rid the body of, aches and pain. Although the ultimate goal of health is to live without the use of drugs, natural or otherwise, The Center for Osteopathic Medicine recognizes the importance of medicinals and their appropriate use. All styles of “Hands on Manipulation” are practiced at The Center. By combining these Manipulative techniques with Structural Integration, massage, meditation and Western Medicine, The Center for Osteopathic Medicine helps people to identify disease before it manifests, quiet pains that have been previously diagnosed as Chronic, and embrace a holistic mindset to Live in the Present- and within that presence, live completely well.

The information discussed in this article is for informational and educational purposes only. If you are experiencing symptoms of a health problem, please visit your doctor. The material discussed on this website is not meant to replace the opinion or diagnosis of a medical professional.

If you have received a diagnosis of clinical depression, you are not alone. Millions of people have been informed that they are suffering from this condition. It is natural to wonder about depression and what it is exactly.

What is clinical depression? What are the symptoms and how does it make a sufferer feel?

Different from a low mood or feelings of being down that may be occasionally experienced by most people when they are feeling “blue,” clinical depression is a medical diagnosis. The disorder manifests in feelings of intense melancholia or sadness. For sufferers, the despair they experience can interfere with and disrupt activities normally associated with daily living and can impact on social functioning. Suffers may feel they are running on empty, finding that their ability to feel emotion is challenged. Motivation can be difficult when a person feels loss of interest or pleasure in activities that formerly brought satisfaction.

Other symptoms of clinical depression may include fear, changed appetite, disturbed sleep patterns, psychomotor agitation or retardation, and loss of mental or physical energy. In defining what is clinical depression and how someone with the disorder experiences it, a description might include feelings of helplessness, hopelessness, worthlessness, loneliness, and anxiety. Decision making ability, focus, concentration, and memory may be affected. Finally, intrusive and reoccurring thoughts of suicide or death may be present. It is a serious condition that needs attention.

If you have been diagnosed as having clinical depression, you will be considering treatment options. Scientific advances have shed light on this condition and differing treatments are available. Conventional therapies may include prescription medications and psychotherapy. An additional treatment, when chemical treatment fails, may be electroconvulsive therapy or ECT. Alternatively, Natural therapies may be turned to. Natural remedies will include nutritional supplementation.

Research has revealed that nutritional deficiencies in the brain and nervous system can be significant factors in malfunction of neurotransmitters and in cognitive impairment in the brain. In describing how nutritional deficiencies may affect brain functioning, an illustration may prove helpful. Picture a plant that grows in rich, nutrient-filled soil. The plant flourishes and is healthy. These are optimal conditions. What would happen if the soil became depleted, compromising the plant’s intake of necessary nutrients? The plant would probably live but would not thrive. This illustration may help in gaining an understanding of what is clinical depression and factors that may contribute to the condition.

Nutritional remedies are preparations containing amino acids, vitamins, minerals, and co-factors; enzymes, herbal extracts and specialty supplements. Effective ingredients include chamomile, used as a general tonic and useful for alleviating insomnia and anxiety; ginkgo biloba, beneficial in treating cognitive decline and depression and shown to promote mental clarity and concentration; green tea which has polyphenols, thought to be responsible for benefits it provides, one of which is improved cognitive performance; and valerian, which may have hypotensive properties and is used for treating insomnia, restlessness, anxiety-induced sleep disorders, and depression. These, as well as other essential ingredients, help in treating depression.

Natural remedies can be relied upon to offer safe and effective relief. By correcting imbalances that impair brain functioning, natural supplements offer hope to those suffering from clinical depression.

Acne is a disorder resulting from the action of hormones and other substances on the skin’s oil glands and hair follicles. These factors lead to plugged pores and outbreaks of lesions commonly called pimples or zits. Doctors describe acne as a disease of the pilosebaceous units (PSUs). Found over most of the body, PSUs are most numerous on the face, upper back and chest.

Acne is often treated by dermatologists. The goals of treatment are to heal existing lesion, stop new lesions from forming, prevent scarring and minimize the psychological stress. For mild signs of acne, doctors usually recommend an Over-The-Counter (OTC) or prescription topical medicine. Topical medicine is applied directly to the acne lesions or to the entire area of affected skin.

There are several OTC topical medicines used for mild acne. Each works a little differently. Following are the most common ones:

• Benzoyl peroxide – destroys P. acnes, and may also reduce oil production

• Resorcinol – can help break down blackheads and whiteheads

• Salicylic acid – helps break down blackheads and whiteheads. Also helps cut down the shedding of cells lining the hair follicles

• Sulfur – helps break down blackheads and whiteheads.

Topical OTC medicines are available in many forms, such as gels, lotions, creams, soaps, or pads. In some people, OTC acne medicines may cause side effects such as skin irritation, burning, or redness, which often get better or go away with continued use of the medicine. If you experience severe or prolonged side effects, you should report them to your doctor. OTC topical medicines are somewhat effective in treating acne when used regularly; however, it may take up to 8 weeks before you see noticeable improvement.

Please be reminded that the above information is for informational purposes only and it is not intended to replace any health care services you need. The information provided is strictly not meant to diagnose medical conditions, offer medical advice, or endorse specific products or services. Do not rely upon the information provided alone for medical diagnosis or treatment. Kindly consult your doctor about any personal health concerns.