Archive for the ‘Skin Care’ Category

How To Tackle an Ingrown Toenail

The last time I was at a family gathering, my sister asked me, “What’s your favorite over-the-counter product?”

That’s easy to answer: it’s New Skin®. Normally used to seal up cuts and scrapes, I love to recommend it for a completely different condition: ingrown toenails.

I ’ve spent years and years fighting the pain of getting ingrown toenails on both of my big toes. Then, as a pharmacy student sitting in class, one of my professors mentioned a product  called Outgrow® that he recommended for avoiding ingrown toenails. “It’s brushed onto the skin where an ingrown toenail likes to form and like magic, it will “toughen up” the tender skin and keep the nail from cutting into it. Eventually, the nail is forced to grow out straight.”

“Aha!” I immediately went out and purchased a bottle and used it very successfully for years, until I misplaced it somehow during a move out of state. I didn’t worry about it at first, thinking I could just buy another one. But alas, when I went to the pharmacy shelf to pick up another bottle, I couldn’t find it anywhere. Further research revealed that the manufacturer had discontinued their original formulation several years back. I was willing to try anything, so I ordered the new version. Unfortunately for me, the “new” formula proved totally useless, and I was again plagued with painful ingrown toenails.

Years and many ingrown toenails later, I renewed my search for something like the original version of Outgrow® that would  toughen up or protect my skin. I’d used New Skin® before on cuts, and wondered, “Could this work to prevent an ingrown toenail?” Another plus is that New Skin® contains an anti-infective compound called 8-hydroxyquinoline which can help heal your ingrown toenail! When I tried it, it worked so well that I happily recommend it to anyone else needing to avoid ingrown toenails.

Here’s how to use New Skin® to prevent or treat an ingrown toenail:

  1. You’ll need a bottle of New Skin®, a toothpick, a place to apply it that you can wipe up the mess if you spill or drip, and at least 15 minutes of drying time.
  2. Soak your toes in warm water to soften your toenail. You can also do this right after a warm bath or shower.
  3. Dry your foot well.
  4. Brush on a thin layer of New Skin® along the skin of the nail that tends to or which is already curling under your tender skin.
  5. While still wet, use the toothpick to lift up the edge of your toenail just a bit and work some of the liquid New Skin® underneath it so that the liquid is between your nail and your skin. You don’t need a thick coat, just enough to spread along the nail where it likes to curl.
  6. Let it dry for at least 5 minutes.
  7. Repeat if needed with a second “coat”, letting it thoroughly dry before putting on socks.

One 2-coat application lasts me several months. You’ll notice that your toenail will grow out nice and straight instead of cutting into your skin. Enjoy the freedom from the pain of pesky ingrown toenails!

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How To Get Rid of Toenail Fungus

Q:     My toenails are getting really thick and yellow. Are there any non-prescription products that can help?

When you have thickened, deformed toenails it’s not just how nasty they look but how they can cut through your socks, cause pain and prevent you from wearing your favorite shoes. All this misery, just from a fungal infection! Fungus that infects your feet through cracks in your skin, then spreading to the cells under your skin where your body forms new toenails, called the nail plate. Once the fungus invades your nail plate your nails start growing out ugly and deformed.

Fungus infection of the toenails, called onychomycosis often starts with one nail affected, usually with little white spots. As it spreads the entire nail becomes white and it spreads to other nails, eventually causing more severe symptoms, like  nails growing out thickened, yellow, discolored, even crumbly. As your toenails grow thicker it’s harder to keep them trimmed, and nails that grow sideways or slant upward wear holes in your socks and make it hard to find shoes that fit.

Treating onychomycosis is often lengthy, frustrating and disappointing. The prescription treatment considered the most effective only cures the infection in 50% of cases. Not only that, but 1 out of every 5 people who do get cured will have a recurrence within 2 years.
Infected toenails take 12 months to grow out, so any successful treatment of  onychomycosis takes a long, long time: a minimum of 3 months for oral treatment and 10-12 months for topical treatment. Topical treatments designed for athlete’s foot are not usually effective on toenail fungus because they only have to affect the skin. When treating a toenail infection you need the treatment to penetrate under the skin and to attack the fungus growing inside the nail plate.

What can you do?
Topical treatments are most successful in mild cases, such as only part of the nail on only 1-2 toes affected. If you have significant thickening and deformed nails, consider prescription strength antifungals. Sometimes the best way to treat severely deformed toenails is to remove them and let them grow back in while you are treating the infection with an oral antifungal like Lamisil® (terbinafine) for 12 weeks.

There are topical treatments for less severe cases of onychomycosis, but they have far less success than a prescription strength oral antifungal and they all need to be used consistently every day for at least 10 months. Filing off some of the nail may also help topical treatments penetrate better into the nail plate.

Some examples of topical remedies for nail fungus include prescription-only Jublia®, non-prescription tolnaftate solution, tea tree oil, and (believe it or not) Vick’s VapoRub®. Another option recommended by some of my fellow pharmacists is soaking your feet daily in full-strength white vinegar for at least 4-6 months.

Even when the fungus has been killed off, don’t be shocked if it comes back. That’s because the conditions that helped the fungus get a toehold on you are often still there: warmth, moisture and darkness.

Here are 5 tips For Fixing Nail Fungus:

1.     Get rid of athlete’s foot by treating it with topical creams or gels that kill off foot fungus. If you don’t eradicate the fungus from your skin, it will re-infect your toenails. Once your skin symptoms have disappeared keep on using the medication twice a day for at least another two weeks. This helps make sure the fungus gets completely shed out of your skin. If you leave any tinea fungus alive inside the skin layers of your feet it can easily multiply and spread, putting you right back where you started.

2.      Keep your feet as dry as possible. Wear loose shoes or sandals and change your socks frequently. Fungus thrives in warm, dark and moist places; your chances of beating the odds and getting a cure as well as avoiding recurrence are greater if you make it as difficult as possible for the fungus to multiply.

3.    When using a topical remedy, filing off some of the toenail on top seems to improve your changes for success.

4.     Apply the nail fungus remedy to the affected nails every day for a minimum of 10 months. If your symptoms don’t completely resolve or they become worse you should consult your doctor for other options. Sometimes removing the nail is the best option.

5.    Try daily vinegar soaks. Soaking your feet in full strength white vinegar every day for at least 6-10 months is an inexpensive option you can try.

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How To Fight Athlete’s Foot Fungus and Win

Q:        My husband has battled athlete’s foot for years. Is there something he can do or use to get rid of it for good?
Your husband has a lot of company out there. Nearly 1 out of every 5 Americans have some type of fungus infection of their skin or nails, and the most common type is athlete’s foot. Athlete’s foot is caused by a type of fungus called tinea. The medical name for the infection is determined by the affected area, for example, tinea of the feet is called tinea pedis or “athlete’s foot” and tinea of the groin is called tinea cruis or “jock itch.

Fungus like the tinea organisms love warmth, moisture, and darkness. People who wear tight shoes and whose feet sweat a lot make it much easier for tinea to get established and reproduce. Not drying between your toes after bathing or showering encourages tinea to spread across toes, nails and even from one foot to the other.

In order to contract athlete’s foot the tinea fungus has to find a way to get into your skin and set up camp. Getting blisters on your feet or cracks in the skin between your toes is an open invitation. Taking good care of your feet and keeping the skin of your feet intact can help keep you from getting infected in the first place.

If you already have athlete’s foot, what can you do? The most important thing is to make it as difficult as possible for the fungus to multiply, discouraging it to spread and making it easier for anti-fungal remedies to kill it off.

The biggest opportunity to make a difference in your husband’s athlete’s foot symptoms is to decrease the amount of moisture next to his feet. People who sweat a lot or who are in contact with wet clothing for long periods of time are much more likely to get fungal infections like athlete’s foot (tinea pedis) or jock itch (tinea cruis).

How can he keep his feet dry? One way is to wear sandals with open toes if at all possible. Feet that are open to the air don’t tend to sweat as much and the sunshine on their feet also discourages the growth of tinea.

Wearing loose shoes and changing his socks frequently will also help keep his feet drier. Some people prefer wearing running socks designed to wick moisture away and reduce getting blisters. Putting powder on his feet before he puts on his socks also helps absorb moisture.

Which remedies are best to treat athlete’s foot? There are several effective options that don’t require a prescription. My personal recommendation is terbinafine 1% gel. It used to be prescription only but now is available over-the-counter (OTC) as Lamisil AT® gel. You can also buy it as the cream, but I prefer the gel because it is less moisturizing than the cream.

When you go to buy an anti-fungal product because the company that sells Lamisil® AT gel has several anti-fungal agents sold under the Lamisil® name, not just terbinafine. Lamisil AF® cream contains the anti-fungal clotrimazole, Lamisil AF® powder aerosol contains the anti-fungal miconazole, and Lamisil Ultra® cream has butenafine. Another anti-fungal, tolnaftate, is available both as a generic and as the brand name Tinactin®.

Here are 4 Tips to treating Athlete’s foot successfully:

1.    Before applying the anti-fungal product, dry your feet well, especially between your toes.

2.    Apply the gel or cream to the affected area twice a day for a minimum of two weeks, until your symptoms completely go away. Don’t use powder by itself because it’s not powerful enough to eradicate the fungus. If your symptoms don’t completely resolve then continue treating twice a day and keep your feet as dry as possible. Wearing sandals without socks can be very helpful.

3.    Once your symptoms disappear continue treating twice a day for another two weeks. This is very important because it helps make sure the fungus gets completely shed out of your skin. If you leave any tinea fungus inside the skin layers of your feet they can start multiplying and before you know it you’ll be right back where you started.

4.    Once your athlete’s foot symptoms have gone and you’ve treated it for 2 MORE weeks, THEN switch to your maintenance program. Using a powder or spray powder 1-2 times a day helps control moisture as well as discourage the fungus from coming back.

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Does Drawing Salve Really Work?

Last week my phone rang as I was cleaning up the dinner dishes. Picking it up, I heard my neighbor’s voice on the other end. “Hi, Jerianne. How’s it going?”

“Fine, Louise. This is going to sound odd, but I was calling to see if you might happen to have some drawing salve I could borrow.”

“Actually, I DO. I found it when I was clearing out my Dad’s medicine cabinet a couple of years ago and kept it because I’d never seen a tube of drawing salve before. It has ichthammol in it. Is that what you’re looking for?

“Yes, exactly! Joe and I were in Mexico last week and today he noticed a red, swollen bump behind his left knee. It looked to me like some sort of tick embedded in his skin, so I used tweezers on it. I pulled some of it out but there are still some black things sticking out, maybe its legs? Ugh! We’re going to the doctor tomorrow but I wanted to put some drawing salve on it tonight to help the swelling and redness. Can I borrow your salve?”

“Sure. Come on down.”

Five minutes later I handed over my half-used tube of ichthammol, NF ointment. “Let me know how it works for you, okay?”

I’d kept that beat up tube of dark stinky ointment because you just don’t see that stuff much any more, and I wanted to find out more about it.

What does “drawing salve” do? The purpose of a drawing salve is to help a boil to come to a head so it can be drained. Another use is to “draw” splinters or other small foreign objects up to the surface of the skin where they can be removed by tweezers. Drawing salves are usually dark and often stinky. You put a small amount of a dark, stinky, and sticky ointment on a bandage then apply it to the area right over the splinter or boil, leaving it on overnight and reapplying if needed in the morning.

My neighbor was looking for ichthammol or ichthyol, which she was familiar with from her experience growing up around horses. Today when people talk about using drawing salve they mean an ointment containing ichthyol or ichthammol.

Ichthyol was discovered in the 1880s from shale deposits found around the Tyrol region of the Alps. Layered between the veins of this shale are layers of rock decorated with dramatic and detailed fossils of animals and fish. Called “oil-stone” or “stink-stone”, Rudolph Schroter found that when crushed and combined with steam, the shale, also called “oil-stone” or “stink-stone produced a distinctive oil high in sulfur. Schroter named the oil Ichthyol, or “fish oil” from ichthys, the Greek word for fish because of the beautiful and detailed imprints of fossilized prehistoric fish in the rock formations that surrounding the veins of shale.

Ichthyol became a major success. In the late 1880s Dr. Paul Gerson Unna, a famous German physician used ichthyol extensively in his remedies for skin problems. Ichthyol contains approximately 15% sulfur and has anti-inflammatory and anti-infective properties. Applied as an ointment, it softens the skin, allowing splinters and boils to come to the surface more easily.

Ichthyol is still mined and produced by the Ichthyol Company of Hamburg and used today, but under different names. The most common are ichthyol, ichthammol, ammonium bituminosulfonate and ammonium bituminosulfate. My old tube contains ichthammol USP, which is made by mixing ichthyol oil with a small amount of lanolin then combining that mixture with petroleum jelly or white petrolatum to make a 20% ichthammol ointment.

Jerianne called a couple of days later, thanking me for letting her borrow my ichthammol ointment. She’d put a dab of the smelly ointment on a Band-Aid® then applied it to the inflamed area behind Joe’s knee. When she peeked at it the next morning the redness was totally gone and the swelling had nearly disappeared. The doctor removed the rest of the mysterious bug parts and it was healing well.

You can find ichthammol ointment at your local veterinary supply or on the internet. Rite-Aid has its own house brand of ichthammol ointment, which also works well. It isn’t a commonly used product these days, so if you don’t see it on the shelf, ask the Rite-Aid pharmacist if he or she can special-order a tube for you.

Watch out for ointments from China. There is ammonium bituminosulfate from China that does not contain ichthyol or ichthammol and doesn’t seem to work as well, either. The real stuff is dark reddish brown and smells like fresh asphalt.

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Does Bag Balm® Get “Too Old”?

Q: Does BB (Bag Balm®) ever get too old? I’ve been working on this 10oz (I think) can for some time. It is darker than when new. Still smells the same… I hate to give it up! I was raised on the stuff, so were my kids, so are their kids and now a great grand daughter.

No, Bag Balm® doesn’t go “bad” but you may want to make sure your can of Bag Balm isn’t so old that it has the old formulation, which contained mercury compounds. It should state that it contains 8-hydroxyquinolone on the side of the can.

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Joyce’s Story

A nice lady named Joyce contacted me a couple of weeks ago. She had bought my book Why Dogs Can’t Eat Chocolate: How Medicines Work and How YOU Can Take Them Safely and it had given her the courage to ask some tough questions about the medicine she was taking for prevention of breast cancer.

A few years ago Joyce’s mammogram showed a lump that proved to be cancerous, and she underwent a lumpectomy, followed by 35 radiation treatments over the next 7 months.

After completing the surgery and radiation for her breast cancer, her oncologist started her on a medicine called anastrozole, the generic version of Arimidex® to help prevent a recurrence of her breast cancer. They planned for her to take it for 5 years and she had been taking it for almost 2 and half years with no problems.

“I had been doing just fine, until this spring. I thought my allergies were acting up. I’d sometimes see little red dots on the inside of my arms, which eventually faded away. Then something changed. The tips of my ears started to tingle, feel hot, and turn a fiery red color. But I could make that go away by taking an antihistamine, so I continued to think it must be just a bad year for my allergies.”

“By the first of August the rash had spread from my ear tips to my neck, though I still got relief by taking my antihistamine.  And when the rash spread to my thighs I was one week away from leaving on a wonderful trip to Scotland and I began to worry. What if the rash continued to spread? I didn’t want to cancel my special trip but I surely didn’t want to be miserable on it either.”

“I was reading your book Why Dogs Can’t Eat Chocolate and got to the part where  you encouraged us to Be A Squeaky Wheel and to SPEAK UP, not give up. I wondered, “Could my rash be related to my breast cancer medicine? I’ve taken it without any problems for over 2 years.”

As I listened to Joyce, with her on schedule to leave for Scotland in only 5 days, I advised her to go ahead and stop the medicine but also to call her doctor immediately and explain her situation. Her rash was getting worse, and yes, her Arimidex® could be the reason. If it was caused by the medicine she needed to stop taking it.

“Joyce, please call your doctor and make an appointment as soon as possible to discuss what has been happening, so she can advise you on what other options you have. She needs to know that you are having these symptoms, so she can help you. You did the right thing by speaking up.”

I heard back from Joyce a couple of weeks ago, after she returned from her trip. “The rash went away the day I stopped that medicine and has never come back. I had a wonderful time on my trip, and I didn’t need to take any antihistamines,” she wrote. “I saw my doctor the week after I got back and she told me I had done the right thing to stop the medicine. We discussed it and she started me on a different medicine that’s for the same thing, and I have had no problems taking it so far. Hopefully I can complete my last two and a half years of treatment with this new one”.

“I really appreciate you and your Why Dogs book because it gave me the courage to speak up about my symptoms instead of just putting up with them. You gave me the encouragement I needed to go talk to my doctor about my problem and ask for something else. Thank you.”

“By the way, I was interested in your article on skin treatment to prevent radiation burns and thought you might want to pass on this tip to your readers that I got from my radiologist in Seattle. He recommended I buy the purest aloe Vera juice I could find and to apply it to the skin area after each radiation treatment (never before, just after). I looked around and found some pure aloe juice at Trader Joe’s. I used it after every treatment and never had any discomfort after any of my treatments.”

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It’s the LEECH I Can Do For You

September 28th, 2015. Filed Under: Skin Care.
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I was reading an old article I saved from the newspaper about leeches used to treat medical conditions. It described a leech farm in Russia called the International Medical Leech Center in Moscow, which supplies leeches to medical clinics in Russia and nearby countries.

It brought back memories of my years as a hospital pharmacist with a very specialized responsibility: leech disposal.

My experience as a Leech Disposal Specialist began in 1987 in a 600-bed hospital in Dayton, Ohio. Our pharmacy manager started our staff meeting one Wednesday morning by clearing his throat. “We have a special request from nursing. The plastic surgeons are using medical leeches occasionally on some of their post-surgical cases. After being applied to the affected area, the leeches feed for several hours, are removed and new ones applied until the surgeon discontinues the treatment. After removing the leeches, the nurses want someone from pharmacy to come and take them away for disposal.”

“Eew!” was clearly on my face as well as my fellow pharmacists. Dead silence stretched on and on and on. About a year later, I raised my hand, hearing myself saying, “I’ll do it. When the nurses call, I’ll go and take the used leeches away.”

My next step was to learn more about these small creatures that could make the difference between a successful reattachment and permanent disfigurement. Plastic surgeons in the United States performing microsurgery had just started using medical leeches in cases of last resort when reattaching skin flaps or appendages such as fingers, ears and noses. In those cases, the tiny repaired arteries worked just fine at bringing in vital fresh blood into the reattached nose or finger but the even tinier veins had clotted off, blocking them from carrying fresh blood away from the surgical area.

The result was swelling that would doom the success of the reattachment if it wasn’t relieved.  I saw the miraculous difference that medical leeches made in these patients. The application of a leech opened up the clotted veins and “bled off” the excess blood that had accumulated, giving the body time to heal itself.

Our surgeons ordered the leeches directly from a company in South Wales called Biopharm Leech, which has farmed leeches for medical use since 1812. They raise these small worms with teeth in clean, carefully controlled conditions and ship them by air, arriving ready to apply immediately. Today, Biopharm uses Carolina Medical Supply as their US distributer, and you order your medical leeches directly from them.

Medical leeches arrive “hungry”, so they’re ready to use immediately. When applied, they attach 300 tiny “teeth” into the area, and the miracle starts. Leeches are living factories of pharmaceutical magic: leech saliva contains several amazing chemicals, including a clot-busting agent, a long-acting anticoagulant and an anesthetic.

Once a leech attaches, they secrete a clot-busting agent called hirudin, which goes to work to dissolve the clots blocking blood flow through the veins. At the same time, their anticoagulant ensures they can continue to feed without clots forming in the immediate area and the anesthetic makes the process practically painless. As they feed, they draw out from 15 to 30ml of blood each, nearly one ounce per leech. After removal, the leech anticoagulant continues to encourage bleeding for up to 10-12 hours, further relieving congestion from excess blood collecting in the reattached tissue.

Once a leech is “full”, and has either dropped off or been removed, what do you do with it? Ah, that was MY job. The nurses called me and I arrived to take away the “used” leeches. The recommended disposal process at that time was to put them into a 70% alcohol solution to immobilize them, and then flush them into the sewer system. So I carried them back to the pharmacy, drained out the water from their container, poured 70% rubbing alcohol over them and then flushed them down the toilet. Biopharm now sells a leech disposal kit on their web site,

In 2004, the FDA approved the commercial marketing of hirudo medicinalis (leeches) for medical use, and today some hospital pharmacies actually store “fresh” leeches in their refrigerators. More information about medical leeches is available at the Biopharm website, which has the motto, “The Biting Edge of Science.”

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