Category: Health

Breaking The Chains Of ‘Bacne’

March 19, 2020 Return

WORDS HANNAH MAY-LEE WONG

Dr Ch’ng Chin Chwen

Consultant Dermatologist

It’s certainly no fun when it seems only pimples have got your back. Want to get rid of them? Take the advice of a dermatologist.

Having acne can really ruin one’s confidence and having them on your back is no less embarrassing. Back acne or ‘bacne’ is particularly frustrating as they appear in places that are hard to reach. Thankfully, according to consultant dermatologist Dr Ch’ng Chin Chwen, there are things you can do to alleviate back acne. In this article, Dr Ch’ng debunks some common myths about back acne and gives us helpful dermatologist-approved tips on how to get rid of them the right way.

What causes back acne and why do only some of us get them?
Acne, no matter which part of the body it appears in, is mostly triggered by genetic and hormonal factors. There is some recent evidence pointing to high sugar foods and milk/dairy products as key contributing factors to acne breakouts as well.

A variety of medications are known to be associated with acne breakouts. These include oral corticosteroids, hormones (such as anabolic steroids, certain contraceptive pills, and testosterone), certain antiepileptic medications, antibiotics or antidepressants, and some chemotherapeutic medications.

Why is the skin on our back particularly prone to acne?
This area has more sebaceous glands. The formation of acne on our skin involves sebaceous glands, which are more abundant over our face, upper chest and back. Areas without sebaceous glands don’t develop acne (for example, the palms).

What worsens back acne?

Using harsh skin care items like antibacterial soaps, astringents and abrasive scrubs can disrupt the skin’s natural protection layer, irritate the skin, and worsen acne. Hence, excessive washing, scrubbing or use of drying skin care products can also exacerbate back acne.
Use of oily/thick textured skin care products that clog the pores can worsen back acne. For people with acne-prone skin, it’s best to stick to oil-free or non-comedogenic skin care products.
Back acne may be more common in our country because of our hot and humid weather. Sweating, wearing thick or tight clothing, or working in an oily environment can clog pores and worsen back acne.
Stress has long been known to be a contributing factor to acne breakouts.

What should we do to get clear skin on our backs? Any medication or topical treatment options available?

Avoid trigger factors as mentioned earlier in this article.
Practice good skin care habits: no excessive washing/ cleansing, diligently use sun protection, avoid hot and humid places, shower immediately after sweating, wear loose and airy clothing made of cotton, and regularly moisturize your skin.
Topical acne medicines (similar to those that treat facial acne) are available in most pharmacies. Perhaps look for products that can cover large surface areas easily, such as products specifically formulated for body acne or spray-on products.
Your dermatologist may prescribe oral medicines such as antibiotics, spironolactone, and isotretinoin to treat your acne.
Light and laser treatments provided by your dermatologist may also help treat back acne. Do you recommend those with back acne to use a loofah/ back scrubber? Gentle scrubs can help clear clogged pores, but harsh scrubs can disrupt skin barrier and cause more inflammation—the balance may be difficult to strike. If you want to use loofah, use it softly, and remember to wash and dry the loofah properly after each use for hygiene reasons.

It’s easier to opt for a chemical exfoliator rather than physical scrubs for a gentler effect. Use products with AHA (alpha hydroxy acid), BHA (beta hydroxy acid) or salicylic acid. Note that salicylic acid is stronger and may not be suitable for those with dry skin to use regularly.

Are those ‘special acne body wash’ the best option for those with back acne?
Yes. Body washes that contain AHA, BHA or salicylic acid may help with back acne.

When should we see a dermatologist?
If you have tried changing your diet, lifestyle, skin care products, and have regularly used over-the-counter acne gels but still have uncontrolled acne, you should see your dermatologist.

It’s hard to care for our backs as some areas are hard to reach. Are there any products that can help us solve this problem?
Some products come in a spray form for difficult-to-reach areas. HT

A Fascinating Story Of Vaping, Popcorns & Lung Troubles

March 19, 2020 Return

WORDS LIM TECK CHOO

In 2019, many news outlets featured the story of a 17-year-old in Canada who was treated for a condition called popcorn lung disease, which can be life threatening. It was alleged that his condition was due to his regular vaping and marijuana habit.

The incident actually happened a while back, and it became news only after the medical team published a paper on the case in the Canadian Medical Association Journal. The case was considered noteworthy because of two reasons:

popcorn lung disease itself is a rare disease, and
this is a case that indicates a link between vaping and popcorn lung disease.
Before we go on, first let’s review the incident based on the medical team’s account in the paper.¹

POPCORNS IN THE LUNG?
The teenager suffered from severe and prolonged coughing fits. His coughs are wet (there is phlegm produced) and he also suffers from fever and prolonged, laboured breathing (dyspnoea).

He was first admitted into the emergency department when he developed pneumonia. Five days after he was discharged, he was back again, this time for severe dyspnoea, malaise, and nausea.

The healthcare team diagnosed his condition as bronchiolitis obliterans, also called obliterative or constrictive bronchiolitis. This rare condition is more popularly known as popcorn lung disease.

What’s that?
What happens is that the smallest airways in the lungs, called the bronchioles, become inflamed and even damaged. This causes constant irritation to the lung tissues, hence the chronic coughs and phlegm formation.²

Furthermore, when the areas of damage heal, scar tissues can form at those areas. Extensive formation of such scars can cause the air passages to become narrow or even completely blocked altogether.²

As a result, over time, the affected person will find it increasingly harder to breathe, and their body becomes deprived of much-needed oxygen. If this condition is left unchecked, death will eventually follow.²

Can this be treated? Unfortunately, to date we don’t have any treatment that can reverse the damage in the lungs.

However, the progress of the disease can be kept in check with medications such as antibiotics, corticosteroids, and immunosuppressants.²

Additionally, cough suppressants may be useful to manage coughing fits, and oxygen therapy can help those affected by this disease to breathe more comfortably.²

As for the teenager, the report shares that, at the time of its publication, he still had issues with movement and carrying out physical activities, but the medical team was optimistic about his chances of recovery.

Wait, so despite its name, the disease has nothing to do with popcorns?
Illustrations of the alveolus in the lung may resemble a popcorn at times, but the term ‘popcorn lung’ stems from how this disease affected a significant number of workers in American popcorn factories.

When it comes to popcorns, most Malaysians consider it a delicious snack to be enjoyed at the movies. In the US, it is big business—the country, in fact, is the top producer of ready-to-eat or microwave popcorns in the world, with the average US citizen consuming 45 quarts (about 1.4 kilogram) of popcorns every year!³

I can’t believe it’s not butter! To cut costs, many microwave popcorn manufacturers use artificial flavouring instead of butter. A commonly used ingredient in artificial butter flavouring is the alpha-diketone, 2,3-butanedione or diacetyl. ^4,5

In 2000, it was reported in the US that eight former microwave-popcorn factory workers had developed bronchiolitis obliterans. Of the eight, four were very sick, awaiting lung transplant. Researchers of the US National Institute of Occupational Safety and Health (NIOSH) eventually identified the culprit to be vapours that were produced when butter flavourings were added to the popcorn. More specifically—diacetyl. The fact that the same disease was also observed among workers in coffee plants and in plants that manufacture diacetyl corroborated this finding.^5,6

Out with diacetyl! A flurry of lawsuits from ex- and current workers were quickly filed against manufacturers of microwave popcorns in the US. As it always happens when it hit where it hurts the most (their pockets), the popcorn industry was pretty quick to take action. Today, diacetyl is no longer used in the manufacture of microwave popcorns.

“TODAY, DIACETYL IS NO LONGER USED IN THE MANUFACTURE OF MICROWAVE POPCORNS.”

THE LINK BETWEEN POPCORN LUNG & VAPING?

“The teenager in the study had been vaping regularly in the past 5 months. He regularly added tetrahydrocannabinol (THC) to his vape juices. THC is an extract obtained from marijuana; it can trigger a ‘high’ similar to that of taking marijuana itself. The teenager also occasionally inhaled marijuana via a bong.”

Hence, it is understandable that people begin linking his vaping habit to his popcorn lung disease.

Well, it’s not so straightforward …
It is very important to note that the medical team that published the paper made the following conclusion:¹

This case of acute, life-threatening bronchiolitis resulting in fixed, chronic airflow obstruction in a previously healthy youth highlights the need for further research on the epidemiology of e-cigarette use, its addictive potential, and the short- and long-term risks and mechanisms of injury associated with vaping.

Wait, the paper said ‘further research’—does this mean we still aren’t sure about the link?
A study conducted by Harvard, published in 2016, found that diacetyl was present in 47 out of the 51 e-cigarette flavours studied.⁷

However, various research to date has still not found any conclusive evidence that the levels of diacetyl present in vape juices can indeed cause popcorn lung disease.⁸

Now, science is all about making evidence-based conclusions, so without the conclusive evidence, researchers will hesitate to give absolute statements about this link.

Does this mean that we can vape in peace?
Well, it’s not so simple. We should keep in mind that, unlike cigarettes which have decades of research demonstrating conclusively how bad they are for our health, e-cigarettes are comparatively new. It may take a while to get confirmation as to how they can affect our health.

Not that we have been complacently sitting on our thumbs waiting for research to uncover the evidence, though!

In the US. The US Food and Drug Administration (FDA) would require e-cigarette companies to submit their product ingredients for review from 2022. For the time being, therefore, there is a likelihood of vape juices produced in the US that still contain potentially harmful amounts of diacetyl.⁸

In the EU. The EU Tobacco Products Directive (TPD) banned the use of diacetyl in e-cigarette liquids in 2016.⁹ Hence, all vape juices originating from EU countries should be free of that substance.

What does this mean for us?
Well, one thing most health authorities all over the world agree on is that vaping is not a positive alternative to smoking. There are many red flags to suggest that vaping may have negative long-term effects on our health. Quitting smoking by taking up vaping is like leaping from the fire into a deep sea—who knows what is lurking beneath that sea?

Why take chances? Don’t vape, and if you are vaping, talk to your doctor or pharmacist on how you can successfully quit the habit! HT

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References: 1. Landman, S.T., et al. (2019). Life-threatening bronchiolitis related to electronic cigarette use in a Canadian youth. CMAJ.;191(48):E1321— E1331. 2. Genetic and Rare Diseases Information Center (US). Bronchiolitis obliterans. Retrieved on 27 December 2019 from https://rarediseases.info.nih. gov/diseases/9551/bronchiolitis-obliterans. 3. The Popcorn Board. Industry Facts. Retrieved on 27 December 2019 from https://www.popcorn.org/Facts-Fun/IndustryFacts. 4. Centers for Disease Control and Prevention (US). Flavorings-Related Lung Disease. Retrieved on 27 December 2019 from https://www.cdc.gov/niosh/ topics/flavorings/exposure.html. 5. Krishna, R., et al. (2019). Bronchiolitis Obliterans (Obliterative Bronchiolitis, Constrictive Bronchiolitis) [Updated 11 November 2019]. Retrieved on 27 December 2019 from https://www.ncbi.nlm.nih.gov/books/ NBK441865/. 6. Centers for Disease Control and Prevention (US). “We Were There” – Diacetyl and Popcorn Lung Disease. Retrieved on 27 December 2019 from https://www.cdc.gov/od/science/wewerethere/diacetyl/index.html. 7. Allen, J.G., et al. (2016). Flavoring Chemicals in E-Cigarettes: Diacetyl, 2,3-Pentanedione, and Acetoin in a Sample of 51 Products, Including Fruit-, Candy-, and CocktailFlavored E-Cigarettes. Environ Health Perspect;124(6):733–739. 8. American Lung Association. (2016, July 7). Popcorn Lung: A Dangerous Risk of Flavored E-Cigarettes. Retrieved on 27 December 2019 from https://www.lung.org/about-us/ blog/2016/07/popcorn-lung-risk-ecigs.html. 9. Medicines and Healthcare Products Regulatory Agency (UK). Advice on Ingredients in Nicotine-Containing Liquids in Electronic Cigarettes and Refill Containers. In: Discussion Paper on Submission of Notifications Under Article 20 of Directive 2014/40/EU. Retrieved on 27 December 2019 from https://content.govdelivery.com/attachments/UKMHRA/2016/05/20/file_attachments/554116/Ingredient%2
Bguidance%2Bdraft%2B120516.pdf

5 Facts About Obstructive Sleep

March 13, 2020 Return

WORDS LIM TECK CHOON

Dr Mangayarkarasi M Ramanathan

Consultant Physician & Respiratory Physician Assunta Hospital

#1 Obstructive sleep apnoea (OSA) is NOT a snoring problem.
Like its name would suggest, OSA is a condition in which there is an obstruction in your airway that interrupts your breathing while you are asleep. Possible obstructions include tonsils and adenoids in children or muscles at the back of the throat that can become too relaxed during sleep, narrowing the airway as a result.

When you have OSA, your body interrupts your sleep to get you to breathe each time oxygen levels fall below normal. As a result, you never truly reach deep sleep, and you wake up still feeling very tired.

Snoring is one possible sign of someone with OSA, but someone who snores may not necessarily have OSA.

OSA can also be ‘silent’—the person with OSA may not snore at all. Dr Mangayarkarasi shares that people with ‘silent’ OSA often have high blood pressure because of their condition; often their OSA is detected only after the doctor begins investigating the cause of their high blood pressure.

#2 OSA is linked to many serious issues and poor quality of life.
Additionally, lack of proper sleep can lead to daytime sleepiness, which in turn puts you at risk of reduced workplace productivity and/or academic performance as well as accidents. Accidentally falling asleep while driving due to OSA is a main cause of road accidents.

#3 Among children, hyperactivity may be a symptom of OSA.
Studies found that children with OSA are more likely to have problems paying attention or concentrating, and they also tend to develop attention deficit hyperactivity disorder (ADHD). As a result, their academic performance will suffer, and they will also have behavioural problems.

Children with OSA are also at increased risk of health problems listed in the previous point.

#4 OSA can be managed for better daily sleep and quality of life.
There is no cure for OSA. Dr Mangayarkarasi points out that, fortunately, it can be managed using continuous positive airway pressure (CPAP) therapy.

If you have OSA, your doctor may advise you to use a CPAP device each time you sleep. You need to wear a sleep mask attached to the device via a rubber tube, and once you’ve switched on the machine and go to sleep, the device will continuously deliver air via a steady, constant pressure. That way, your body will never be deprived of oxygen and you can achieve true sleep.

What about surgery? While surgery to widen the airway is certainly possible, Dr Mangayarkarasi reveals that among adults, this option is considered only after CPAP therapy fails to yield the desired positive results. This is because there is still a high possibility of someone developing OSA again some time in the future after a surgery.

For children with OSA, however, surgery is often the first option. Such surgery typically involves the removal of the tonsils to make more room in the airway.

#5 CPAP therapy is more convenient than before.
Don’t be put off by the above photo— that’s a typical image associated with the use of a CPAP device, but it’s an old school one!

These days, the device is smaller, lighter, and sleeker, thanks to improved technology. There are even portable versions that will be most suitable for people who travel often,and these portable versions may even come with slots to charge your mobile phone! Furthermore, the rubber tubes are thinner, longer, and more flexible to allow for more mobility, while the masks are also smaller and more comfortable to wear.

Aren’t CPAP devices expensive?
They do cost quite a bit, but in Malaysia, you can withdraw from your EPF funds to purchase the device. Furthermore, you may be able to pay in installments. Some government hospitals may offer CPAP devices at a subsidized cost as well. Therefore, don’t immediately assume that you cannot afford a CPAP device.Talk to your ENT specialist—they can advise you on how you can best afford CPAP therapy within your budget. HT