Part 1

For the purpose of this article, I will concentrate on the most common type of eczema, atopic eczema. However, the treatment of atopic and non-atopic eczema is similar.

 Atopic dermatitis is a chronic inflammatory skin condition that involves a complex interaction between environmental and genetic factors. The Greek word atopy means “out of place” and describes the group of disorders including eczema, asthma and allergic rhinitis and which are genetically linked.  The terms “dermatitis” and "eczema" are often used interchangeably. When the term eczema is used alone, it usually refers to atopic dermatitis (atopic eczema).

Atopic eczema affects over 30 per cent of children before they reach school age and 1-3 per cent of adults in the UK. It is likely that its prevalence in Ireland is similar to the UK. It is often inherited.  There is very often a link with asthma and hay fever. Atopic eczema has become more common in recent years, the cause of this is uncertain. 

Triggers include specific allergies to foods, overheating, secondary infection, wool next to the skin, cat and dog fur, soaps, detergents, house dust mites and pollen.  Extreme hot and cold, humidity, and hormonal changes in women (caused by the menstrual cycle and pregnancy) can also cause a flare-up.

Prevention

The initial approach to treatment of atopic eczema involves the avoidance of exacerbating factors and hydrating the skin. Exacerbating factors in dermatitis disrupt the skin’s barrier function include excessive bathing, low humidity environments, dry skin, exposure to solvents and detergents and emotional stress. Avoiding these factors is beneficial for acute flare ups and long term management. A sleeping environment with minimal dust and upholstery reduces exposure to house dust mites and may potentially reduce the severity of eczema.

Diet

In adults, food allergies do not appear to be a factor in eczema. Using dietary exclusions for long term eczema in a large 2008 study did not improve the condition. In infants, avoidance of certain foods can help. Common food triggers include eggs, nuts, peanut butter, chocolate, milk, seafoods, and soya.

Maintaining adequate skin hydration

Evaporation of water on the skin leads to dry skin in patients with eczema; skin hydration is a key component of their overall management. Lotions, which have a high water and low oil content, can worsen dry skin via evaporation and trigger a flare of the disease. However, thick creams (eg, Eucerin^®, Diprobase^®) which have a low water content, or ointments (eg, petroleum jelly, Emulsifying Ointment), which have zero water content will better protect against dry skin.

A study in infants with atopic dermatitis who required moderate or high potency topical steroids (see more details later) found that infants treated with emollients had significantly decreased requirements for topical steroids compared with the group of infants who were not treated with emollients.  Emollients are best applied immediately after bathing when the skin is well hydrated.

Hydration can be improved by soaking in a bath containing a bath additive such as Oilatum^® for 10 to 20 minutes. Bath additives leave the skin and bath very slippy so take particular care when bathing. No well-designed studies have been published to determine whether showering or bathing is preferable in patients with eczema. To reduce microbial resistance, preparations containing anti-bacterials (eg.  antibiotic creams) should be avoided except where infection is present or is a frequent problem.

Clarity and quality of information on Diabetes was the theme at the Information event, hosted by Whelehans Pharmacy at the Greville Arms Hotel on Thursday June 30^th. With four speakers, all experts in their chosen field, giving excellent presentations on Diabetes and related issues from their own perspective, those that attended benefited greatly

Support

Prior to speaker presentations, attendees had access to excellent support and advice from a variety of information providers manning their own information stands. In addition, glucose checks were available so that attendees could “check their numbers”, a vital part in Diabetes management or prevention. Eamonn Brady from Whelehans Pharmacy would like to give a “A big thank you to the Order of Malta volunteers who provided this service and for giving up their time….hugely appreciated.”

Diabetes Ireland, both national and local, were present with their own info stands, the former supplying a wide range of information booklets with advice and support given by Pauline Dunne, Regional Development Officer, whilst the latter had local volunteers, Stephen Purcell and Orlagh Pettigrew giving the local perspective, whilst encouraging local diabetics and interested parties to join and add value to the group.

The National Diabetic Retina Screening programme had a table outlining the various screening programmes that they provide. The main interest was Diabetic Retina Screening. Fiona Treacey, Health Promotions Officer was on hand offer support and advice relating to this.

The Lifescan stand, hosted by Liz Kelly was extremely busy. Lifescan supply metering equipment measuring glucose levels in the blood. With changes in the metering systems, Liz was able to demonstrate how the new units work and supply people with equipment they could take away including new easier to read and use equipment including new amazing new Bluetooth technology. If anyone would like more info on the new One Touch Verio Metres our any Diabetic would like a free upgrade to a new metre, call Liz at 087 902 0803.

Whelehans Nutrition, with nutritionist Aisling Murray and Whelehans resident Chiropodist James Pedley were on hand to give advice. Checkout Aislings excellent article “Fat vs Sugar” elsewhere in this paper.  James was offering “Top Tips” on footcare for diabetics along with an offer to attend a dedicated Diabetic Foot Check day on 9^th July (only €15).

Speakers

The event then moved on to the presentations for the evening. First up was Pauline Dunne from Diabetes Ireland. Pauline’s talk gave a general overview of the condition and associated risk factors.  She then discussed different types of Diabetes, Type 1, which usually occurs in childhood, always needing treatment with insulin, Type 2, which is progressive, evolving slowly over time, especially from age 40. In many cases, Type 2 can be treated with improved diet and increased exercise, although, medication may also be required. Pauline went on to highlight a relatively new classification called “Pre-Diabetes”; this is a state where the individuals numbers are consistently high, but not high enough for a diabetes diagnosis. Again this “alert” status can prompt the changes the individual to take the necessary action to prevent onset.

With prevalence in Ireland (currently 225,000) rising (predicted increase of 50,000 by 2030) and an under resourced Health Service, Pauline highlighted the increasingly pressing need for people to take control and become more aware of the risks Diabetes presents, offering tips and strategies on how to identify and then reduce and minimise risk.

Next up was Fiona Treacey from Retina Screen. Fiona’s presentation took attendees through exactly how Diabetes causes Diabetic Retinopathy and can affect the retina and how, if left untreated can ultimately cause blindness. It is in fact a major cause of blindness in the working population. Fiona was able to provide graphic illustrations of how Diabetic Retinopathy effects the eye.

She then informed the assembly about the National Diabetic Retina Screening programme and how people with the condition can access it.  Indeed, she gave a thorough step by step outline of exactly how the service can be accessed, from initial contact- to securing a local screening appointment. In addition, Fiona discussed exactly what a screening consultation itself entails. Retina Screening is an extremely valuable service for any diabetic.  From the information provided, those that attended now have a firm understanding of next steps etc. If you need more information, go to www.diabeticretinascreen.ie

Following a short break, Eamonn Brady, Pharmacist at Whelehans took the audience through a presentation on Diabetes Medicine Management. After a brief overview of various lifestyle factors and their impact on Diabetes, Eamonn gave a comprehensive overview of the various types of medication available along with a step by step guide as to how to select a medication based on particular symptoms along with the pros and cons of each. Eamonn also explained different types of insulin management. In conclusion, Eamonn summarised that in the longer term, the older oral style drugs (ie Metformin) achieved the best overall outcomes for most.

The final speaker of the evening was Anne-Marie Keogh, Senior Diabetic Dietitian at Mullingar Hospital. Given the nature of the valuable work that Anne-Marie does every day, it was appropriate therefore that her talk focused completely of food. In particular, how much of it we consume and the myths around peoples’ perception of what “a portion size” is.

Using some fantastic illustrations, with a variety of pictures showing a full plate of a particular food type (ie pasta, potatoes, rice) and beside it the same plate for each showing “the correct” portion size (obviously considerably less, her point regarding “size” was then further emphasised by “hands-on” measurement indicators (cups of sugar) that the audience could see and touch. Anne-Marie’s final advice for the audience was to become more proficient about reading and understanding food labels to help identify exactly what they are consuming. The evening concluded with a short Q&A to the panel.

If you missed the event, call into Whelehans pharmacy for information from the night. You can contact Diabetes Ireland at 1890 909 909 for detailed information on Diabetes or check www.diabetes.ie .Keep an eye out in local media for more Diabetes and Sugar events with Whelehans and Diabetes Ireland in Mullingar.

 Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. If you have any health questions e-mail them to info@whelehans.ie

Do you suffer from any of the following symptoms?

Blurred vision, fatigue, lack of energy, extreme thirst, frequent trips to the bathroom (urination) especially at night, rapid and unexplained weight gain or loss, frequent infections, numbness, pain or tingling in your hands or feet.

If you answered yes to any of these questions you should get tested for diabetes. You may be one of the 50,000 people in Ireland have diabetes without realising it. Whelehans provide free Diabetes checks in store, no appointment is needed so simply call in for your two minute simple finger prick glucose test today.  

The problem of undiagnosed Diabetes?

Diabetes is hitting epidemic proportions as people are less physically active and more likely to be overweight than previously. People die needlessly or end up with debilitating conditions because they fail to get the simple diabetes tes. Undiagnosed or poor controlled diabetes can damage your heart, arteries, eyes, nerves and kidneys leading to serious health problems. Once diagnosed, diabetes is easily treated, and treatment is free for everyone in Ireland under the long term illness scheme.

Free Diabetes Talk and information event

Whelehans Pharmacy is hosting a free talk on Diabetes on Thursday May 30^th at 7pm in the Greville Arms Hotel. Pharmacist Eamonn Brady will speak about the medication used with Diabetes while experts including dieticians, eye screening specialists and other professionals will discuss diabetes management. More details to be announced; keep an eye on this column in the coming weeks for more details. This is expected to be a popular event so we advise booking in advance by calling Whelehans at 04493 34591.

To be continued....next week I will discuss more about diabetes

Disclaimer: Consult your healthcare professional before making any changes recommended. Whelehans Diabetes Check is not a substitute for your full assessment by your GP

Temporary hair loss (Telogen Effluvium)

Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. If you have any health questions e-mail them to info@whelehans.ie

I previously discussed male pattern baldness and alopecia areata in the Westmeath Examiner. This week I discuss telogen effluvium; a temporary type of hair loss which can occur for many reasons including sudden or severe stress. It is characterised by thinning of hair throughout the scalp. Therefore, patches of hair loss are not seen in this type of hair loss. It occurs more often in women. Causes include child birth, abortions, crash diets, starting or stopping contraceptives, drug therapy and severe emotional stress such as bereavement.

It is quite common for women to experience hair loss about 3 months after childbirth. During pregnancy, high levels of the hormones oestrogen and progesterone cause the body to keep hair that would normally fall out so the hair is fuller and thicker. After child birth, hormones return to pre-pregnancy levels, the excess hair falls out.

The contraceptive pill can cause hair loss as some pills contain a small amount of male hormones which can cause a mild form of pattern baldness in some women. In a similar way to after child birth, stopping the contraceptive pill reduces the level of oestrogen and progesterone in the blood, sometimes leading to a temporary hair loss.

About 3 or 4 months after an illness or a major surgery, some people suddenly notice the loss of a large amount of hair. This hair loss is related to the stress of the illness and is temporary.  Hormonal problems may cause hair loss. For example, if the thyroid gland is overactive or underactive, hair may fall out. Hair growth will return to normal once the thyroid disorder is successfully treated.

Some medicines can cause hair loss. Normal hair growth re-occurs when the medicine is stopped. Medicines that can cause hair loss include anticoagulants such a warfarin and heparin which are used to thin blood to prevent clots, gout medication such as allopurinol, some high blood pressure medication such as beta blockers, vitamin A (if too much is taken) and antidepressants such a SSRIs (eg) Fluoxetine, sertraline, citalopram. It is important to note that hair loss is rare with these drugs.

 More detailed information and leaflets is available in Whelehans

An old saying goes, “You cannot plough a field by turning it over in your mind”; the same is true for exams; worrying will not help but study will.

 With exams looming, stress levels are rising. Essentially it is time to clear the “desk” of guilt and regret for what appear to be many lost hours not devoted to study. It may very well be the situation; however it is essential to realise that there is still a considerable amount of time left to prepare for the looming exams. It is important not to lose hope or minimise expectations. There is still adequate time to brush off the study cobwebs and get stuck in to a study plan, so you have to stop procrastinating and get organised. Avoid getting overwhelmed; it is amazing how much you can learn in a short space of time

As Gandhi said, “You may never know what results come of action, but if you do nothing there will be no result”

Planning

Good planning and having your notes in order is key to exam success. File your subjects and gather all your written homework essays assignments. Pay particular attention to the suggestions/comments your teachers have made. Organise physical space to study and establish a routine of going there. Do not study on the bed, always use a study desk; bed might induce sleep and it can also impact on your sleep pattern during the night. 

Have study and a revision plan; if you have not done one, do one now. Following the plan and developing study patterns will enable you to study more productively. Avoid interruptions and start off with ten minutes revision of the subject in hand. Especially avoid having your mobile phone at hand or any such distractions as it will break your concentration. Everyone revises differently. Use headings, highlighting and revision cards, get revision guides. Make notes of the important points when revising. Use past exam papers and do model answers. Make sure to check past exam papers and familiarise yourself with the structure and format of each exam subject.  It is a good discipline to practice answering exam questions within the specified time limits. Check your answers against your notes to make sure you’ve got them right. Know the exam timetable and try to study in the same order. The night before the exam, leave cramming to one side and stick to what you already know. When studying the night before an exam, you run the risk of making yourself nervous if you try to learn new information. Review your notes or test yourself on key points.

Exam Day

On the day of the exam avoid talking to fellow students about the exam as it could confuse you or make you lose confidence in yourself. Similarly avoid talking to others about the exam after it’s done as you might start to doubt yourself, which may lead to stress and reduce your confidence in your next exam paper. During the exam remember to use your time strategy for reading the exam paper and the amount of time you need to allocate to each question. Read the instructions very carefully then scan the whole exam paper. Start with the questions you’re most confident with, break the questions down to make sure you really understand what you’re being asked.

Parental Support

As a parent guardian you can support your exam student through exam preparations and the actual exams by making home life as calm and pleasant as is possible. Some short term allowances may need to be made to alleviate the pressures and stress that come naturally with exams.

Benjamin Franklin once said, “By failing to prepare, you are preparing to fail“. Good luck with the exams!

Thanks to Finola Colgan Development Officer of “Mental Health Ireland (Midlands)” for her help with this article. Check out www.mentalhelathireland.ie and www.aisling.ie.