Freckles January 21, 2009

What are freckles?

Freckles are flat, tanned circular spots that typically are the size of the head of a common nail. The spots are multiple and may develop randomly on the skin, especially after repeated exposure to sunlight. These are particularly common in people of fair complexion on upper-body skin areas like the cheeks, nose, arms, and upper shoulders. They may appear on people as young as age 1 or 2.

Most freckles on a person’s skin are usually uniform in color. On different people, freckles may vary somewhat in color — they may be reddish, yellow, tan, light brown, brown, or black — but they are basically slightly darker than the surrounding skin. They tend to become darker and more apparent after sun exposure and lighten in the winter months. Freckles are due to an increase in the amount of dark pigment called melanin and are not due to an increase in the total number of pigment-producing cells called melanocytes. The word freckle comes from the Middle English freken, which, in turn, came from the Old Norse freknur, meaning “freckled.” (Some speakers of Old English and Old Norse must have had a tendency to developing freckles.)

What types of freckles are there?

There are two basic types of freckles: simple freckles and sunburn freckles. Simple freckles are usually tan, round, and small — about the size of a common construction nail head. Sunburn freckles are often darker, have irregular jagged borders, and may be larger than a pencil eraser. Sunburn freckles are more common on the upper back and shoulders where people frequently get their most severe sunburns.

Ephelides (singular: ephelis) is the Greek word and medical term for freckle. This term refers to flat spots that are tan, slightly reddish, or light brown and typically appear during the sunny months. They are most often found on people with light complexions, and in some families, they are a hereditary (genetic) trait. People with reddish hair and green eyes are more prone to these types of freckles. Sun avoidance and sun protection, including the regular use of sunscreen, may help to suppress the appearance of the some types of freckles.

Lentigines (singular: lentigo) comes from the Latin word for lentil and is the medical term for certain types of darker freckles and sunburn freckles. Lentigines tend to be darker than the common freckle and do not usually fade in the winter. This kind of spot is referred to as lentigo simplex. Although occasionally lentigines are part of a rare genetic syndrome, for the most part they are just isolated and unimportant spots.

How do freckles develop?

Freckles are thought to develop as a result of a combination of genetic tendency (inheritance) and sun exposure. Two people receiving the same sun exposure may not have an equal chance of developing freckles. Natural sunlight and artificial suntanning lights emit ultraviolet (UV) rays. After exposure to ultraviolet rays, the outer layer of the skin (the epidermis) thickens and the pigment-producing cells (the melanocytes) produce the pigment melanin at an increased rate. (This production of melanin may in fact give some protection against future sun exposure.)

Of course, people differ a great deal in their reaction to sunlight. To take an extreme example, there is no pigmentation in the skin of an albino because of a defect in melanin metabolism. On the other hand, people with dark complexions are relatively less sensitive to sun exposure than fair-skinned people. However, people with dark skin are not entirely resistant to the effects of the sun, and they, too, can become sunburned with prolonged exposure. People with blond or red hair, light-colored eyes, and fair skin are especially susceptible to the damaging effect of UV rays.

Irrespective of skin color, freckling is caused by the uneven distribution of the melanin pigment in the skin.. A freckle is essentially nothing more than an unusually heavy deposit of melanin at one spot in the skin.

How important is heredity with freckles?

Heredity and skin type are very important factors for the tendency to develop freckles. Freckles tend to be inherited genetically and are most common in individuals with fair skin and/or with blond or red hair.

Research in twin siblings, including pairs of identical twins and pairs of fraternal (nonidentical) twins, have found a striking similarity in the total number of freckles found on each pair of identical twins. Such similarities were considerably less common in fraternal twins. These studies strongly suggest that the occurrence of freckles is influenced by genetic factors. In fact, the variations in freckle counts appear to be due largely to heredity.

Ongoing research in a rare disease called xeroderma pigmentosum has also confirmed the genetic tendency of freckles. Excessive freckles in dark-haired individuals are quite common in this disease.

Further, freckles are also found in skin folds like the underarms in another uncommon genetic disease called neurofibromatosis.

How can freckles be prevented?

Since we cannot change our own genetic component of freckling, our main prevention measures are aimed at sun avoidance and sun-protection, including

1. use of sunscreens with SPF (sun protection factor) 30,
2. use of wide-brimmed hats (6 inches),
3. use of sun-protective clothing (shirts, long sleeves, long pants),
4. avoidance of the peak sun hours of 10 a.m. to 4 p.m., and
5. seeking shade and staying indoors.

Ideally, freckle prevention is more effective than later trying to remove freckles that have already developed. Freckle-reduction treatments are more difficult and not always satisfactory.

People with known hereditary tendencies of freckling should start sun protection early in childhood. Much of the sun and UV skin damage occurs often while children are under age 18.

Fair-skinned people who are more prone to freckling and sunburns are also generally more at risk for developing skin cancers. Freckles may be a warning sign of sensitive skin that is highly vulnerable to sunburn and to potential skin cancer.

How can freckles be treated?

Several safe and effective methods are available to help lighten or reduce the appearance of freckles: Frequently, multiple or a combination of treatments may be required for best results. Not everyone’s skin will improve with similar treatments and freckles can easily recur with repeated UV exposures.

1. Bleaching or fading creams: Products containing hydroquinone and kojic acid can be purchased with and without a prescription. Higher concentrations of hydroquinone (over 2%) require a prescription. These products can help lighten freckles if they are applied consistently over a period of months. Bleaching or fading creams are most effective in combination with sun avoidance and sun protection.
2. Retinoids: Sometimes used in conjunction with other bleaching creams, tretinoin (vitamin A acid, Retin-A), tazarotene (Tazorac), adapalene (Differin) also may help lighten freckles when applied consistently over a period of several months.
3. Cryosurgery: A light freeze with liquid nitrogen in the physician’s office can be used to treat some types of freckles. Not all spots respond to freezing or burning.
4. Laser treatment: Multiple types of lasers may help lighten and decrease the appearance of freckles safely and effectively. Like cryosurgery, this is a simple and safe procedure with a high success rate and a low risk of scarring or skin discoloration.
5. Photofacials or Intense Pulsed Light treatments are another method to lighten and remove freckles. This is not a true laser technique but an intense light source.
6. Chemical peels can also help lighten freckles and improve irregular pigmentation.

 

Chicken Pox January 21, 2009

Chickenpox: A highly infectious viral disease also known medically as varicella — in many countries, this disease is always called “varicella” — that causes a blister-like rash, itching, fatigue and fever. The rash crops up first on the face and trunk and can spread over the entire body resulting in 250 to 500 itchy blisters.

Chickenpox is highly infectious. The virus spreads from person to person by direct contact or through the air by coughing or sneezing. It takes from 10-21 days after contact with an infected person for someone to develop chickenpox. People with chickenpox are contagious a day or two before the rash appears and until all blisters have formed scabs.

In children, chickenpox most commonly causes an illness that lasts about 5-10 days. Children usually miss 5 or 6 days of school or childcare due to their chickenpox. Their symptoms may include high fever, severe itching, an uncomfortable rash, dehydration, and headache. About 1 child in 10 has a complication from chickenpox — infected skin lesions, other infections, dehydration from vomiting or diarrhea, exacerbation (worsening) of asthma and pneumonia — that is serious enough to warrant a visit to the doctor.

Certain people are especially likely to have a serious illness from chickenpox. These at-risk groups include infants, adolescents, and adults and people with weak immune systems from either illnesses or from medications such long-term steroids or chemotherapy.

Chickenpox has nothing at all to do with chicken. The name was meant to distinguish this “weak” form of the pox from smallpox. “Chicken” is used here, as in “chickenhearted,” to mean weak or timid. The “pox” of chickenpox is no major matter unless it becomes infected (through scratching) or occurs in an immunodeficient person.

However, there can be very major problems from chickenpox including pneumonia and encephalitis and reactivation of the same herpes virus is responsible for shingles (zoster). Chickenpox is responsible for more deaths than measles (rubeola), mumps, whooping cough (pertussis) and H. flu (Haemophilus influenzae type B) meningitis combined. Contrary to what many people believe, chickenpox is by no means a mild disease.

A healthy person can die from the disease. From 1990 to 1994, before there was a vaccine available, there were about 50 chickenpox deaths in children and 50 chickenpox deaths in adults every year in the US. Most of these persons were healthy or did not have a medical illness such as cancer that placed them at higher risk of getting severe chickenpox. Most of the healthy adults who die from chickenpox contract the disease from their unvaccinated children.

The current aim in the US is to achieve universal (or come as close as possible to universal) immunization of children with the chickenpox vaccine. The rationale for childhood chickenpox vaccination is not just to protect the children but also to protect everyone with whom they come in contact, including adults (who can die from the chickenpox) and pregnant women (so that the unborn baby does not get chickenpox). Because chickenpox in children is usually not serious, some people think it is safe to let children get the disease. However, it is never possible to predict who will have a mild case of chickenpox and who will have a serious or even deadly case of disease. Now that there is a safe and effective vaccine available, it is not worth taking this risk.

A person can get chickenpox more than once but it is uncommon to do so. For most people, one infection is thought to confer lifelong immunity.

http://www.medterms.com/script/main/art.asp?articlekey=2702

Chickenpox is a common illness among kids, particularly those under age 12. An itchy rash of spots that look like blisters can appear all over the body and may be accompanied by flu-like symptoms. Symptoms usually go away without treatment, but because the infection is very contagious, an infected child should stay home and rest until the symptoms are gone.

Chickenpox is caused by the varicella-zoster virus (VZV). Kids can be protected from VZV by getting the chickenpox (varicella) vaccine, usually between the ages of 12 to 15 months. In 2006, the Centers for Disease Control and Prevention (CDC) recommended a booster shot at 4 to 6 years old for further protection. The CDC also recommends that people 13 years of age and older who have never had chickenpox or received chickenpox vaccine get two doses of the vaccine at least 28 days apart.

A person usually has only one episode of chickenpox, but VZV can lie dormant within the body and cause a different type of skin eruption later in life called shingles (or herpes zoster). Getting the chickenpox vaccine significantly lowers your child’s chances of getting chickenpox, but he or she may still develop shingles later.

Symptoms of Chickenpox

Chickenpox causes a red, itchy rash on the skin that usually appears first on the abdomen or back and face, and then spreads to almost everywhere else on the body, including the scalp, mouth, nose, ears, and genitals.

The rash begins as multiple small, red bumps that look like pimples or insect bites. They develop into thin-walled blisters filled with clear fluid, which becomes cloudy. The blister wall breaks, leaving open sores, which finally crust over to become dry, brown scabs.

Chickenpox blisters are usually less than a quarter of an inch wide, have a reddish base, and appear in bouts over 2 to 4 days. The rash may be more extensive or severe in kids who have skin disorders such as eczema.

Some kids have a fever, abdominal pain, sore throat, headache, or a vague sick feeling a day or 2 before the rash appears. These symptoms may last for a few days, and fever stays in the range of 100°–102° Fahrenheit (37.7°–38.8° Celsius), though in rare cases may be higher. Younger kids often have milder symptoms and fewer blisters than older children or adults.

Typically, chickenpox is a mild illness, but can affect some infants, teens, adults, and people with weak immune systems more severely. Some people can develop serious bacterial infections involving the skin, lungs, bones, joints, and the brain (encephalitis). Even kids with normal immune systems can occasionally develop complications, most commonly a skin infection near the blisters.

Anyone who has had chickenpox (or the chickenpox vaccine) as a child is at risk for developing shingles later in life, and up to 20% do. After an infection, VZV can remain inactive in nerve cells near the spinal cord and reactivate later as shingles, which can cause tingling, itching, or pain followed by a rash with red bumps and blisters. Shingles is sometimes treated with antiviral drugs, steroids, and pain medications, and in May 2006 the Food and Drug Administration (FDA) approved a vaccine to prevent shingles in people 60 and older.

Contagiousness

Chickenpox is contagious from about 2 days before the rash appears and lasts until all the blisters are crusted over. A child with chickenpox should be kept out of school until all blisters have dried, usually about 1 week. If you’re unsure about whether your child is ready to return to school, ask your doctor.

Chickenpox is very contagious — most kids with a sibling who’s been infected will get it as well, showing symptoms about 2 weeks after the first child does. To help keep the virus from spreading, make sure your kids wash their hands frequently, particularly before eating and after using the bathroom. And keep a child with chickenpox away from unvaccinated siblings as much as possible.

People who haven’t had chickenpox also can catch it from someone with shingles, but they cannot catch shingles itself. That’s because shingles can only develop from a reactivation of VZV in someone who has previously had chickenpox.

Chickenpox and Pregnancy

Pregnant women and anyone with immune system problems should not be near a person with chickenpox. If a pregnant woman who hasn’t had chickenpox in the past contracts it (especially in the first 20 weeks of pregnancy), the fetus is at risk for birth defects and she is at risk for more health complications than if she’d been infected when she wasn’t pregnant. If she develops chickenpox just before or after the child is born, the newborn is at risk for serious health complications. There is no risk to the developing baby if the woman develops shingles during the pregnancy.

If a pregnant woman has had chickenpox before the pregnancy, the baby will be protected from infection for the first few months of life, since the mother’s immunity gets passed on to the baby through the placenta and breast milk.

Those at risk for severe disease or serious complications — such as newborns whose mothers had chickenpox at the time of delivery, patients with leukemia or immune deficiencies, and kids receiving drugs that suppress the immune system — may be given varicella zoster immune globulin after exposure to chickenpox to reduce its severity.

Preventing Chickenpox

Doctors recommend that kids receive the chickenpox vaccine when they are 12 to 15 months old and a booster shot at 4 to 6 years old. The vaccine is about 70% to 85% effective at preventing mild infection, and more than 95% effective in preventing moderate to severe forms of the infection. Although the vaccine works pretty well, some kids who are immunized still will get chickenpox. Those who do, though, will have much milder symptoms than those who haven’t had the vaccine and become infected.

Healthy children who have had chickenpox do not need the vaccine — they usually have lifelong protection against the illness.

Treating Chickenpox

A virus causes chickenpox, so the doctor won’t prescribe antibiotics. However, antibiotics may be required if the sores become infected by bacteria. This is pretty common among kids because they often scratch and pick at the blisters.

The antiviral medicine acyclovir may be prescribed for people with chickenpox who are at risk for complications. The drug, which can make the infection less severe, must be given within the first 24 hours after the rash appears. Acyclovir can have significant side effects, so it is only given when necessary. Your doctor can tell you if the medication is right for your child.

Dealing With the Discomfort of Chickenpox

You can help relieve the itchiness, fever, and discomfort of chickenpox by:

• Using cool wet compresses or giving baths in cool or lukewarm water every 3 to 4 hours for the first few days. Oatmeal baths, available at the supermarket or pharmacy, can help to relieve itching. (Baths do not spread chickenpox.)
• Patting (not rubbing) the body dry.
• Putting calamine lotion on itchy areas (but don’t use it on the face, especially near the eyes).
• Giving your child foods that are cold, soft, and bland because chickenpox in the mouth may make drinking or eating difficult. Avoid feeding your child anything highly acidic or especially salty, like orange juice or pretzels.
• Asking your doctor or pharmacist about pain-relieving creams to apply to sores in the genital area.
• Giving your child acetaminophen regularly to help relieve pain if your child has mouth blisters.
• Asking the doctor about using over-the-counter medication for itching.

Never use aspirin to reduce pain or fever in children with chickenpox because aspirin has been associated with the serious disease Reye syndrome, which can lead to liver failure and even death.

As much as possible, discourage kids from scratching. This can be difficult for them, so consider putting mittens or socks on your child’s hands to prevent scratching during sleep. In addition, trim fingernails and keep them clean to help lessen the effects of scratching, including broken blisters and infection.

Most chickenpox infections require no special medical treatment. But sometimes, there are problems. Call the doctor if your child:

• has fever that lasts for more than 4 days or rises above 102° Fahrenheit (38.8° Celsius)
• has a severe cough or trouble breathing
• has an area of rash that leaks pus (thick, discolored fluid) or becomes red, warm, swollen, or sore
• has a severe headache
• is unusually drowsy or has trouble waking up
• has trouble looking at bright lights
• has difficulty walking
• seems confused
• seems very ill or is vomiting
• has a stiff neck

Call your doctor if you think your child has chickenpox, if you have a question, or if you’re concerned about a possible complication. The doctor can guide you in watching for complications and in choosing medication to relieve itching. When taking your child to the doctor, let the office know in advance that your child might have chickenpox. It’s important to ensure that other kids in the office are not exposed — for some of them, a chickenpox infection could cause severe complications.

Reviewed by: Larissa Hirsch, MD
Date reviewed: August 2006

http://kidshealth.org/parent/infections/bacterial_viral/chicken_pox.html

Acne January 21, 2009

What is acne? What are the different types of acne?

Acne (acne vulgaris, common acne) is not just a problem for teenagers; it can affect people from ages 10 through 40. It is not unusual for women, in particular, to develop acne in their mid- to late-20s, even if they have not had breakouts in years (or ever). On the positive side, those few individuals who have acne into their 40s may well grow out of it. Acne can appear on the skin as any of the following:

       congested pores (“comedones”),

       whiteheads,

       blackheads,

       pimples (“zits”),

       pustules, or

       cysts (deep pimples, boils). The pus in pustules and cysts is sterile and does not actually contain infectious bacteria.

These blemishes occur wherever there are many oil (sebaceous) glands, mainly on the face, chest, and back.

You can do a lot to treat your acne using products available at a drugstore or cosmetic counter that do not require a prescription. However, for tougher cases of acne, you should consult a physician for treatment options.

What causes acne?

No one factor causes acne. Acne happens when oil (sebaceous) glands come to life around puberty, stimulated by male hormones from the adrenal glands of both boys and girls. Sebum (oil) is a natural substance which lubricates and protects the skin, and under certain circumstances, cells that are close to the surface block the openings of sebaceous glands and cause a buildup of oil underneath. This oil stimulates bacteria (which live on everyone’s skin and generally cause no problems) to multiply and cause surrounding tissues to become inflamed.

Inflammation near the skin’s surface produces a pustule; deeper inflammation results in a papule (pimple); deeper still and it’s a cyst. If the oil breaks though to the surface, the result is a “whitehead.” If the oil accumulates melanin pigment or becomes oxidized, the oil changes from white to black, and the result is a “blackhead.” Blackheads are therefore not dirt, and do not reflect poor hygiene.

Here are some factors that don’t usually cause acne, at least by themselves:

       Heredity: With the exception of very severe acne, most people do not have the problem exactly as their parents did. Almost everyone has some acne at some point in their life.

       Food: Parents often tell teens to avoid pizza, chocolate, greasy and fried foods, and junk food. While these foods may not be good for overall health, they don’t cause acne or make it worse. Although some recent studies have implicated milk and dairy products in aggravating acne, these findings are far from established.

       Dirt: As mentioned above, “blackheads” are oxidized oil, not dirt. Sweat does not cause acne, therefore, it is not necessary to shower instantly after exercise for fear that sweat will clog pores. On the other hand, excessive washing can dry and irritate the skin.

       Stress: Some people get so upset by their pimples that they pick at them and make them last longer. Stress, however, does not play much of a direct role in causing acne.

       Hormones: Some women break out cyclically, but most women (and men) don’t. Some oral contraceptive pills may help relieve acne, but unless a woman has abnormal menstrual periods and excessive hair growth, it’s unlikely that hormones play much of a role in causing acne. Pregnancy has a variable effect on acne; some women report that they clear up completely, and others get worse, while many others see no overall change.

       Cosmetics: Most cosmetic and skin-care products are not pore-clogging (“comedogenic”). Of the many available brands, those which are listed as “water-based” or “oil-free” are generally a better choice.

In occasional patients, the following may be contributing factors:

       Pressure: In some patients, pressure from helmets, chinstraps, collars, suspenders, and the like can aggravate acne.

       Drugs: Some medications may cause or worsen acne, such as those containing iodides, bromides, or oral or injected steroids (either the medically prescribed prednisone or the steroids that bodybuilders or athletes take). Other drugs that can cause or aggravate acne are anticonvulsant medications and lithium, which is used to treat bipolar disorder. Most cases of acne, however, are not drug-related.

       Occupations: In some jobs, exposure to industrial products like cutting oils may produce acne

What can you do about acne on your own?

Think back to the three basic causes of acne and you can understand why the focus of both home treatment and prescription therapy is to (1) unclog pores, (2) kill bacteria, and (3) minimize oil. But first a word about…

Lifestyle: Moderation and regularity are good things, but not everyone can sleep eight hours, eat three good meals, and drink eight glasses of water a day. You can, however, still control your acne even if your routine is frantic and unpredictable. Probably the most useful lifestyle changes you can make are to apply hot compresses to pustules and cysts, to get facials (see below), and never to pick or squeeze pimples. Playing with or popping pimples, no matter how careful and clean you are, nearly always makes bumps stay redder and bumpier longer. People often refer to redness as “scarring,” but fortunately it usually isn’t in the permanent sense. It’s just a mark that takes months to fade if left entirely alone.

Open the pores

Cleansing and skin care: Despite what you read in popular style and fashion magazines, there is no magic product or regimen that is right for every person and situation.

       Mild cleansers: Washing once or twice a day with a mild cleansing bar or liquid (for example, Dove, Neutrogena, Basis, Purpose, and Cetaphil are all inexpensive and popular) will keep the skin clean and minimize sensitivity and irritation.

       Exfoliating cleansers and masques: A variety of mild scrubs, exfoliants, and masques can be used. These products contain either fine granules or salicylic acid in a concentration that makes it a very mild peeling agent. These products remove the outer layer of the skin and thus open pores. Products containing glycolic or alpha hydroxy acids are also gentle skin exfoliants.

       Retinol: Not to be confused with the prescription medication Retin-A, this derivative of vitamin A can help promote skin peeling.

Kill the bacteria

       Antibacterial cleansers: The most popular ingredient in over-the-counter antibacterial cleansers is benzoyl peroxide.

       Topical (external) applications: These products come in the form of gels, creams, and lotions, which are applied to the affected area. The active ingredients that kill surface bacteria include benzoyl peroxide, sulfur, and resorcinol. Some brands promoted on the Internet and cable TV (such as ProActiv) are more costly but not really any better than ones you can buy in the drugstore.

Benzoyl peroxide causes red and scaly allergic skin in a small number of people, which goes away as soon as you stop using the product. Keep in mind that benzoyl peroxide is a bleach, so do not let products containing benzoyl peroxide leave unsightly blotching on colored clothes, shirts, towels, and carpets.

Reduce the oil

You cannot stop your oil glands from producing oil (unless you mess with your hormones or metabolism in ways you shouldn’t). Even isotretinoin (Accutane, see below) only slows down oil glands for a while; they come back to life later. What you can do is to get rid of oil on the surface of the skin and reduce the embarrassing shine.

       Use a gentle astringent/toner to wipe away oil. (There are many brands available in pharmacies, as well as from manufacturers of cosmetic lines.)

       Products containing glycolic acid or one of the other alpha hydroxy acids are also mildly helpful in clearing the skin by causing the superficial layer of the skin to peel (exfoliate).

       Masques containing sulfur and other ingredients draw out facial oil.

       Antibacterial pads containing benzoyl peroxide have the additional benefit of helping you wipe away oil.

http://www.medicinenet.com/acne/page3.htm

Rosacea January 21, 2009

What is Rosacea?
Rosacea is a chronic and progressive disorder of the face, characterized by some or all of the following symptoms:
Extremely sensitive skin, blushing, flushing, permanent redness, burning, stinging, swelling, papules, pustules, broken red capillary veins, red gritty eyes (which can lead to visual disturbances) and in more advanced cases, a disfiguring bulbous nose. Men and women of all ages can be affected, with over 45 million estimated sufferers of Rosacea worldwide. http://www.irosacea.org/index.php
What is rosacea?
Rosacea (roz-ay-sha) is a very common benign skin disorder that affects many people worldwide. As of 2008, it is estimated to affect at least 14 million people in the United States alone. The main symptoms of this facial condition include red or pink patches, visible broken blood vessels, small red bumps, red cysts, and pink or irritated eyes. Most people with the disease may not even know they have rosacea or that it is a diagnosable and treatable condition. Many patients may just assume they blush easily or have gotten sunburned.
Rosacea is considered a chronic (long-term), non-curable skin disease with periodic ups and downs. As opposed to traditional acne, most adult patients do not “outgrow” rosacea. It characteristically involves the central region of the face, causing persistent redness or transient flushing over the areas of the face and nose that normally blush — mainly the forehead, the chin and the lower half of the nose. It is commonly seen in people with fair or light skin, and particularly in those of Irish and Scottish backgrounds. Some famous people with rosacea have included former President Bill Clinton and W.C. Fields.
The redness, often aggravated by flushing, may cause small blood vessels in the face to enlarge (dilate) and become more visible through the skin, appearing like tiny red lines (called telangiectasias). Continual or repeated episodes of flushing may promote inflammation, causing red bumps that resemble teenage acne. In fact, rosacea can frequently be mistaken for common acne.
What causes rosacea?
The exact cause of rosacea is still unknown and remains a mystery. The basic process seems to involve dilation of the small blood vessels of the face. Suspected causes of rosacea include but are not limited to genetic factors, genetics plus sun exposure, a mite sometimes found in hair follicles (Demodex folliculorum), the bacteria Helicobacter pylori (that is associated with stomach ulcers), gastrointestinal disease, and medications that cause blood vessels to widen. There seems to be a hereditary component in some people.
Rosacea tends to affect the “blush” areas of the face and is more common in people who flush easily. Additionally, a variety of triggers are known to cause rosacea to flare. Emotional factors (stress, fear, anxiety, embarrassment, etc.) may trigger blushing and aggravate rosacea. A flare-up can be caused by changes in the weather like strong winds or a change in the humidity. Sun exposure and sun-damaged skin is generally associated with rosacea. Exercise, alcohol consumption, emotional upsets, and spicy food are other well-known triggers that may aggravate rosacea. Many patients may also notice flares around the holidays, particularly Christmas and New Year’s holidays.
What are the signs and symptoms of rosacea?
Typical signs and symptoms include facial flushing, redness, burning, red bumps, and cysts. The symptoms tend to come and go. The skin may be clear for weeks, months, or years and then erupt again. Rosacea tends to evolve in stages and typically causes inflammation of the skin of the face, particularly the forehead, cheeks, nose, and chin.
When rosacea first develops, it may appear, then disappear, and then reappear. However, the skin may fail to return to its normal color and the enlarged blood vessels and pimples arrive in time. Rosacea may rarely reverse itself.
Rosacea generally lasts for years, and, if untreated, it tends to worsen.
How is rosacea cured?
Rosacea is currently not considered a curable condition. While it cannot be cured, it can usually be controlled with proper, regular treatments.
There are some forms of rosacea that may be significantly cleared using laser, intense pulse light, photodynamic therapy, or isotretinoin (Accutane). Although still not considered a “cure,” some patients experience long-lasting results and may have remissions (disease-free period of time) for months to years. http://www.medicinenet.com/rosacea/page4.htm

Allistair Johnson… November 10, 2008

…is the most wonderful, adorable, intelligent, funny, sweet, fantastic, unbelievable boy I have ever met in my entire life, and I can’t wait until I am in his arms again.

All my love,

Stephanie Paige Fischer

Stephanie Fischer… November 10, 2008

…is the love of my life.

Sincerely,

Allistair David Johnson

Whistles and Caramels November 30, 2007

Whistles and Caramels

            Oh, what joy!  What completely inexpressible, indescribable joy to float down the city street without a care in the world and a new shining penny in your pocket.  Laurie felt for the front of her apron again, lest her riches bounce out of her newly-sown pocket and into the gutter for a greedy child to steal.  Oh no, this penny was hers, all hers, and she was free to spend it as she wished.

            Who knew that Teacher would give a prize for the best-written composition in the class?  Laurie had stayed up late until the wicker candle burned low in the bowl and her eyes were red-rimmed.  But what did it matter now?  Teacher hadn’t cared that Laurie yawned while turning in the piece.  The other children certainly hadn’t faired much better, what with their faces dirty with soot having skipped the morning’s washing to complete their own compositions.  Laurie laughed in delight at the memory of Teacher sending Timothy to the washroom, complaining that she couldn’t tell which student he was for his face was covered in smuts.

            But, this was no matter.  Laurie’s braids were neatly pinned round her head and lay shining like the penny in her pocket.  Her dress was crisp, and her petticoat crisp underneath, and her bloomers fresh from the clothing line.  She paused for a moment on the sidewalk beside a rare shoot of grass, leaning over to examine her reflection in her brightly polished kid shoes.  Yes, she decided, she certainly looked more grown-up with money to spend and an award-winning composition sitting on Teacher’s desk in a place of honor.  She continued to skip merrily, hardly noticing the women with cheeks colored with dark rouge who stared enticingly at passing gentleman.  Laurie only had eyes for the small shop in the distance, its red and white awnings signaling an oasis in the gray that always seemed to encompass the afternoon of New York City. 

            She glanced behind her, barely seeing her classmates walking forlornly, dejectedly, toward the same candy paradise of Sweeney’s Candy Shoppe, run by a jolly fat man who was generally good-natured, especially toward the pretty things that entered his store to gape at the heaps of candy.  So often would a young girl stare at his colorful displays that he would pinch her cheek and give her a piece of stale chocolate.  And for this, the children were grateful, for they never had a coin of their own to spend, let alone time to make themselves pinching-worthy.

            But Laurie had a coin, oh yes, a coin of her own, and soon she forgot about the poor children with no money at all and dashed on toward Sweeney’s, fist clenching tight her apron and her dress flying up in the back.  “Such wonder,” she thought, of feeling so rich.  Why, I should feel this rich always,” repeating this as a rhythm and mantra to her steps across Eighth Avenue.  She did not give the other children another thought.

            Laurie reached Sweeney’s breathless, stopping for a moment to smooth the wrinkles out of her apron and tease a piece of hair back into place, for perhaps Sweeney was in one of his jolly moods and would give Laurie both a piece of free chocolate and candy for her penny.  She grasped the door handle, enjoying the feeling of smooth metal in her sweaty palm.  The indentation of the penny remained in her hand.  Pulling open the door, she listened for the sweet tinkle of the bell, alerting the robust storeowner of a customer’s presence.  Soon enough, Sweeney ambled from the back storage room, glancing at Laurie for a moment before settling his great girth down on the stool by the register. 

            “Ack, she’ll take her time looking,” he muttered to himself, “Why should I not allow the child a bit of pleasure by enjoying my shop when she has no money to purchase such things?”

            And so Laurie looked.  And she looked and looked and looked, hardly registering the constant tinkling of the bell as her classmates poured into the store in the hopes of a free chocolate, their only hope for candy.  Of course, they would endure the cheek-pinching for something so heavenly.  But Laurie had to endure no such thing.  She was rich, a queen, and she made the fellow children know it by lifting her nose when walking by, refusing the time to squeak out an “Excuse me!” when a little girl blocked an aisle she wished to peruse.  Oh, what a game it was.  What a fun, fun game that she wished to play for the rest of eternity.  The other children glared.

            Finally, Laurie’s eyes settled on something wonderful.  How could she have missed it before?  Chewy caramels, coated with both light and dark chocolate!  A candy with two different flavors that would last her a week at least!  They could be sucked delightfully at night, as she lay in her warm bed, toes stretching deliciously toward the flatiron Mama always placed at the foot of her coverlet.  Or she could chomp noisily while sitting on her stoop, legs crossed like the ladies in the moving pictures, and stare solemnly at the girls playing at hopscotch near the street.  Their hair would be windswept, eyes bright with excitement and energy like new marbles, but oh no.  Laurie would be the picture of an heiress.  She decided this as she scooped a handful of caramels into her bag, stepping carelessly around the hoards of children as she picked her way toward the register.

            “Oh, c’mon Laurie! Gimme half yur penny for a bit ‘er broken crackers, yeah?  Whatcha need all those car’mels for, anyways?”

            “You’ll give me a piece of your candy, oh won’t you, Laurie?” a classmate of hers pleaded, hands clasped and eyes wide.

            “I haven’t had a penny of my own in the longest time, and besides, it was my composition that won.  I’m going to get my own candy and eat it too.  It’s my prize.  Teacher said it was my prize!”  Laurie responded airly, shooing off the wave of boys snatching at her caramel bag.

            She, having finally reached old Sweeney, plunked down her caramels in front of the surprised man.  She then glanced up at him, preparing herself for a cheek-pinching.  But none came.  He was too shocked.

            “Say now, little lady,” he said finally, looking down at the little girl behind his spectacles.  “Where d’you suppose you got the money to buy these here candies?  Steal somethin’, did ya?”  He looked at her suspiciously, attempting to detect a shiftiness behind her long eyelashes.

            “No, sir,” Laurie replied truthfully, “I got this here penny as a prize from Teacher!”  She fished the shiny penny out of her pocket, still warm from her apron pocket.  “Isn’t it amazing?”

            Old Sweeney agreed that, indeed, it was amazing.  He took the penny from Laurie, and handed her a bagful of heaven in return.  Such a good trade, Laurie decided, staring at the mound of candy that was rightfully hers.  She was hardly wistful for the shining copper of the penny, the smooth indentation of the great seal of the United States.  She waltzed out the tinkling door without a second glance, singing a tune she had learned that day from weekly music class as she scrambled to her stoop to admire her prize.

            An hour or so later, judging by the sun’s progress across the gray sky, Laurie’s classmates ambled by her stoop, laughing and jostling eachother as they prepared a game of stickball.  Laurie raised her eyebrows at them, waggling her ears to produce a laugh that usually erupted from the group, but none came.  She cast her empty bag aside, having eaten two weeks’ worth of candy in one sitting, and jumped down the two steps leading toward the street.  She stood in front of the group, waving her hands idly, then faster and faster as the children neglected to produce a response.  They continued choosing their teams, and began to play in the street. 

            “What’s the matter with y’all?”  Laurie cried, running into the middle of the game.  “Didn’t y’all hear me?  I said I wanted to play!” 

            Having forgotten her earlier oath to sit serenely on the steps and watch the other children in disgust, Laurie marched up to each child in turn, each of whom promptly stuck their tongues out of their mouths and turned their backs on her.  Forlorn, Laurie made her way back to the stoop, hunched over with head in hands, and watched the children play.  She was an outcast, she realized, for celebrating her prize in front of the other children.  “How could I have been so foolish?” she wondered to herself in amazement.  “Perhaps this is what Papa meant about paying too much for a whistle.”  Now, she understood.

           

Technology paper September 20, 2007

InterActiveCorp, a multinational Web corporation owning business like Ticketmaster.com and Match.com plans to enter a new venture: InstantAction.com, a new level of gaming by means of using GarageGames.com, which is a game publisher and programmer.  Online gaming markets, averaging to about $2 billion dollars a year, are strong, albeit unstable investments.  Costing InterActiveCorp approximately $100 million dollars to produce, DFC Intelligence predicts that the ultimate revenue for this online gaming market will swell to over $13 billion in 2011.  IAC proposes, via InstantAction.com, a Website of game console quality, involving strategy, action, and advancement.  Because additional consoles or hardware is unnecessary, gamers can play through any offhand device, rather than expensive, specialized equipment.  Although other companies such as Cartoon Network, Sony’s Plastation 3, and Nintendo’s Wii have attempted to adapt games for online play, InterActiveCorp far exceeds these companies in originality, production, and sound ideas.  Although some fees will be charged to play these browser-based games, which do not require downloaded software or instillation, IAC intends to profit directly from advertising.  However, many technologically savvy insiders predict the fallback of such an industrious plan.  Advanced games via the computer, without installed or downloaded software, will probably lead to glitches and delays, as this field of technology is still unsteady.  If this company succeeds, the gaming market will be revolutionized, spreading games to more people and devices, therefore drastically hurting the console market and economies.   

http://www.businessweek.com/technology/content/sep2007/tc20070919_759130.htm

People September 18, 2007

People are so predictable. Have you ever just sat and observed a talking group of people? Kids, adults, they’re all the same. People are constantly playing the “status game”: altering their manner of speaking by determining how high of a rank they assume within the conversation. I usually play a lower rank, just for the heck of it. It gives me more opportunities to watch others, without being required to speak. People freak out when they realize I know much more about them than previously thought. Teenagers, especially, are all the same. They all have the same issues, the same problems, the same thoughts. Knowing what they’re thinking isn’t so difficult, especially when you’re aware of the game. Every single conversation is an example of the status game.

 I don’t like dodging subjects; I’m particularly blunt. This works to my advantage in the game, especially when people realize I know what they’re thinking. And once they figure this out, my rank skyrockets. It’s fantastic. People aren’t as smart as you think. It’s difficult to fight back the laughter when people stare at me, nonplussed and bewildered. Having this power is great, but frightening.

Who, exactly, is playing the game against me?

I hate. September 18, 2007

I hate blonde, annoying women.
I hate people who think they’re good at something and they suck.
I hate dragonflies.
I hate mushrooms and ferns.
I hate to turn the radio down as opposed to turning it off.
I hate the food residue on silverware fresh out of the dishwasher.
I hate that I have to wash dishes before putting them in the dishwasher.
I hate that my new puppy suddenly takes precedence over my old cat.
I hate that the good guys always live far away.
I hate that I’m not naturally good at something.
I hate that I can never keep my mouth shut.
I hate the awkward feeling of someone knowing my name, and my not knowing theirs.
I hate the date for the SATs.
I hate sea lice.
I hate finishing a good book.
I hate this hate list.