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Over-the-counter steroid creams may pose health risk

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Rubbing cream into your skin to calm an itchy rash may seem harmless, but not all topical anti-itch formulas are created equal.

“People don’t understand the potential dangers of prescription-strength steroid creams,” said Dr. Lawrence Green, clinical professor of dermatology at George Washington University in Washington, D.C.

Hydrocortisone — a topical steroid often used to treat a rash or allergic reaction — is not approved by the U.S. Food and Drug Administration for over-the-counter use in a potency greater than 1 percent. But in some stores it is easy to obtain without a prescription, a new study warns.

The researchers found illegal corticosteroid creams at dozens of stores nationwide that specialize in foreign imports.

For the study, the investigators visited 80 stores in 13 cities in nine states. Posing as customers, they asked for cream to treat an “itchy rash.” Three dozen stores sold prescription-strength creams over-the-counter without a prescription.

The creams were made in 12 countries, including China, Mexico, Kenya, Korea and Switzerland, the study authors said.

All stores visited in Chicago and San Francisco sold illegal steroid creams, as did 80 percent of those visited in Minneapolis, 60 percent of those in Washington, D.C., and 36 percent in New York City. Even smaller cities — including Durham, N.C. and Madison, Wisc. — had stores selling illegal creams, the findings showed.

The report was published in the February issue of the Journal of the American Academy of Dermatology.

The results came as little surprise to study co-author Dr. Sara Hylwa, a dermatologist at Hennepin Healthcare in Minneapolis.

Hylwa works in a clinic that treats many immigrants. Occasionally, patients acknowledge using prescription-strength corticosteroid creams for rashes and even as skin-lightening formulas, she said.

In many other countries, the creams are available legally over-the-counter, she said, so it wouldn’t be unusual for a newcomer to expect to purchase them without a prescription. But misuse can bring serious side effects.

Hylwa recalled one patient whose use of a skin cream containing a potent steroid resulted in severe skin thinning — a common side effect often seen in sensitive areas, such as the face and around the eyes.

Other side effects include stretch marks; easy bruising; and glaucoma, cataracts or even blindness when applied to the eye area, according to the American Academy of Dermatology.

Green said he sees patients who have misused skin creams almost every day.

“Unfortunately, they’re getting inaccurate advice from the internet, friends, or just trying to help themselves with a previous prescription cream they have in their house — one that was prescribed for something else unrelated — until they go to the doctor, or trying to avoid going to the doctor altogether,” he said.

While consumers may think liberal use of topical medications is less harmful than medicines that are swallowed, that’s a misconception, Green said.

“When you put something on a large enough surface of your skin, it can be absorbed into your bloodstream,” he warned. “You then can have all the potential permanent damage not only of putting cream too often on the same place on your skin, but also the potentially dangerous side effects of taking a pill form of the cream.”

So, what’s the safest approach to take for a skin rash that doesn’t resolve in a few days with nonprescription-strength creams?

Make an appointment with a doctor, suggested Dr. Erin Warshaw, a professor of dermatology at the University of Minnesota, who was also involved in the study.

Warshaw urged patients to take any skin creams they may be using with them to their appointment, to show the doctor. These creams may very well yield valuable clues about what’s causing a skin irritation or preventing it from healing.

More information

Learn more about proper skin care from the American Academy of Dermatology.

Copyright 2020 HealthDay. All rights reserved.



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Study finds differences in heart failure trends between former East, West Germany

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July 1 (UPI) — Differences in heart health between people in the eastern and western parts of Germany show a long-term effect of the Berlin Wall on the country, according to new findings presented Wednesday on HFA Discoveries.

Germany was divided in the aftermath of World War II, and different healthcare structures developed in East and West Germany. The country became unified again in 1990, but new research shows effects of the decades-long separation persist, researchers say.

From 2000 to 2017, the absolute number of hospital admissions due to heart failure throughout Germany increased continuously by nearly 94 percent — to approximately 465,000 from just under 240,000 — researchers said.

However, the increase was much higher, at 119 percent, in the region that once encompassed East Germany, compared to just over 88 percent in the region once known as West Germany, they said.

Study co-author Marcus Dörr, a professor at the University Medicine Greifswald in Germany, said differences between the two regions in prevalence of heart failure risk factors may explain the findings.

“In fact, previous research has shown that, for example, hypertension, diabetes and obesity are much more common in East than in West Germany,” Dörr said in a press release.

In addition, lingering differences in patient care, as well as in the management of healthcare systems between the two regions, still might exist, Dörr said.

In general, heart failure is the most common reason for hospital admissions in the United States, Germany and much of the world, he said.

For their research, Dörr and his colleagues analyzed data from the Federal Health Monitoring project, an annual census of routine health data in Germany, for 2000 through 2017.

Heart failure was the leading cause of disease-related hospitalization in Germany in 2017, they found.

However, heart failure hospitalization rates nearly doubled in the former East Germany — to 2.9 percent from 1.5 percent — from 2000 to 2017, while it increased to 2.2 percent from 1.4 percent in the former West Germany over the same period, the researchers said.

While the overall length of hospital stays decreased continuously over the same period, the total number of heart failure-related hospital days increased by 51 percent in East Germany, compared to 35 percent in West Germany.

In 2017, heart failure was by far the leading cause of in-hospital death across Germany, accounting for 8.2 percent of deaths, they found.

However, in the region that once was East Germany, heart disease caused 65 deaths per 100,000 inhabitants in 2017, compared to 43 deaths per 100,000 inhabitants in the former West Germany, they said.

The differences may have to do with the average age of people in East Germany — four years older than it is in the West — but the differences in heart failure-related parameters were similar after standardization, the researchers said.

Before reunification in 1990, East and West Germany had distinct healthcare systems, Dörr said. The system in East Germany was essentially run by the state, with less than 1 percent of physicians working in private practice, and there were often shortages of technical equipment, he said.

“Since 1990, both regions have the same federal healthcare system with more physicians in private practice and similar clinical care pathways” Dörr said. “More research is needed to explain the huge differences observed between East and West Germany.”



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Discrimination increases hypertension risk by 49 percent in black Americans, study finds

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July 1 (UPI) — Facing racial discrimination increases risk for high blood pressure among black Americans, according to a study published Wednesday by the journal Hypertension.

Black people who reported “medium levels” of lifetime discrimination had a 49 percent increased risk for high blood pressure, or hypertension, compared to those who indicated low levels of lifetime discrimination, the researchers found.

The study was based on nearly 2,000 black Americans who participated in The Jackson Heart Study, which focused on cardiovascular disease among residents in the tri-county region of Jackson, Mississippi.

“African Americans continue to be disproportionately affected by hypertension, making it imperative to identify the drivers of hypertension in this population,” co-author Allana T. Forde, said in a statement.

“Greater lifetime discrimination was associated with an increased risk for hypertension among African Americans in this study, which reflects the impact of cumulative exposure to stressors over one’s lifetime and the physiological reactions to stress that contribute to deleterious health outcomes,” said Forde, a postdoctoral research fellow at the Urban Health Collaborative at Drexel University.

Forde and colleagues reviewed data on 1,845 black Americans, aged 21 to 85, who were enrolled in The Jackson Heart Study. None of the participants had a history of hypertension at the start of the research, the authors said.

Participants self-reported their discrimination experiences through in-home interviews, questionnaires and in-clinic examinations, researchers said.

For the purposes of the study, having hypertension was defined as taking blood pressure-lowering medication, having a systolic blood pressure of 140 mm Hg or above or having diastolic blood pressure higher than 90 mm Hg at follow-up visits, according to the authors.

During the follow-up period, more than half of the participants — 954, or 52 percent — developed hypertension.

The study results, Forde said, “suggest how social determinants such as racism and discrimination affect health in measurable ways.”

Strategies to reduce health inequities and improve health are needed to address these broader social determinants, she added.

Although the study included experiences of discrimination among a large sample of black Americans, discrimination was measured at a single point in time, which limited the researchers’ ability to capture changes in discrimination experiences over the entire follow-up period, according to the researchers.

In all, nearly 80 million American adults are living with high blood pressure, including more than 40 percent of black Americans, according to the American Heart Association.

“Previous studies have shown that discrimination affects African Americans’ health,” Forde said.

“Traditional risk factors, such as diet and physical activity, have been strongly correlated with hypertension, yet important psychosocial factors like discrimination, which also have the potential to negatively impact health, are rarely considered,” she said.



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Official COVID-19 count may underestimate deaths by 28 percent

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July 1 (UPI) — Official counts of COVID-19 cases in the United States may underestimate deaths by as much as 28 percent, according to an analysis published Wednesday by JAMA Internal Medicine.

From March 1 through May 30, an estimated 122,300 Americans died after being infected with the new coronavirus, SARS-CoV-2, the researchers said. That’s higher than the Center for Disease Control and Prevention’s tally of 95,235.

The difference is based on the researchers’ assessment of “excess deaths” across the country — the actual number of reported deaths compared to figures from the same period for the previous five years.”

There have been questions about whether the reported statistics overcount COVID-19 deaths, but our analyses suggest the opposite,” study co-author Daniel Weinberger, an associate professor of epidemiology at Yale University School of Medicine, told UPI.

“The number of reported COVID-19 deaths likely represents an undercount of the true burden caused by the virus.”

Analyses of “excess deaths” have been used to estimate deaths caused by infectious diseases in the past, including pneumonia, the flu and HIV, according to Weinberger and his colleagues.

As of Wednesday morning, nearly 2.7 million people in the United States have been diagnosed with COVID-19, and more than 127,000 have died, according to figures from Johns Hopkins University.

CDC officials acknowledged last week that the total number of people actually infected with COVID-19 may be 10 times higher than official estimates because many who are infected don’t experience symptoms and don’t know they have it.

For the study, researchers reviewed mortality data from the CDC’s National Center for Health Statistics.They compared the “expected” number of deaths for the period — based on an average of totals for 2015-19 — and compared it to the total for 2020. The period covers the peak of the COVID-19 outbreak so far in parts of the United States.

The excess deaths for the three-month period in 2020 could be attributed to COVID-19, but may also be influenced by “people avoiding care for emergency medical conditions, like heart attacks,” as well as declines in certain categories of deaths, like car accidents, Weinberger said.

“Excess deaths can provide useful information in addition to the traditional statistics that are based on laboratory testing, [but] the data need to be interpreted with caution,” Weinberger said. “Looking at changes in deaths due to any cause provides a more complete picture of the epidemic.”



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