In fact the efficient and qualitative phoenix day spa could be highly refreshing and rejuvenating for the physique of such women. In result they get back their lost confidence with the revival of the sagging body. Feeling good is half way through to looking good and that exactly happens with a nice spa treatment for the body.

Numerous health benefits accrue by obtaining the services of a good day spa. It is not merely beauty treatment but also one of the most effective mind, body, and spirit healing and nourishing center. Usually spa packages are always designed to give the customer the best feeling and that too is offered at the most competitive prices. Services so offered by spas become even more desirable due to the relaxed, unhurried, and friendly and yet highly professional atmosphere in which they are rendered.

Best phoenix spas offer deep tissue massage with slow strokes or direct pressure applied on muscle grains. Other popular types of massage are Swedish massage and Hot Stone Massage. Women benefit most from the facial skin care and mircrodermabrasion in which gentle polish and exfoliation of the skin is applied and body treatment using scrubs, wraps, and cleansing.

Two retinoids, the cis form of retinoic acid (Isotretinoin, Accutane) and the aromatic retinoid (Etretinate, Tegison), are available for oral use in the United States. The former has shown remarkably good results in the treatment of acne, and both produce considerable improvement in some of the papulosquamous diseases such as psoriasis, lichen planus, pityriasis rubra pilaris, Darier’s disease, and ichthyosis. The retinoids also have an antioncogenic effect. Specifically, there is about a 40% response rate in patients with mycosis fungoides and other forms of cutaneous T-cell lymphoma. One can also temporarily delay the appearance of skin tumors in patients with xeroderma pigmentosum and nevoid basal cell carcinoma syndrome.

The dosage of isotretinoin used in acne patients is 0.5 to 1.5 mg/kg. For practical purposes a decision is usually made to use either 40 or 80 mg/ day. The lower dose is associated with£ewer side effects and thus has better patient compliance. Unfortunately, the interval until return of sebaceous gland function and the reappearance of acne is shorter (6 to 18 months) than it is when the larger dose is used. The beneficial effect in acne occurs as a result of dissolution of the follicular plug, reduction in sebaceous gland size and activity, and, possibly, antibacterial and anti-inflammatory effects.

Etretinate (Tegison) is the retinoid usually used for the treatment of psoriasis and other papulosquamous diseases. Usually, dosage is limited to 1.0 mg/kg (75 mg/day) because of the onset of unacceptable side effects above that level. Etretinate has a particularly good effect in pustular psoriasis, but for the other forms, PUV A therapy is sometimes added (RePUV A-retinoids plus PUV A) to obtain an optimal response.

Many toxic effects are associated with the oral use of retinoids. Patients taking isotretinoin for acne regularly develop severe xerosis and cheilitis. Less often, myalgia, arthralgia, conjunctivitis, epistaxis, and hair loss are experienced. Triglyceride levels increase in these patients and must be monitored. Cholesterol levels may also rise, and some disturbance in liver function studies may be noted. Long-term administration is accompanied by idiopathic calcification of the spine in an unknown percentage of patients.

Of greatest importance is the fact that the retinoids are among the most potent teratogens ever used in medicine. Retinoids may not be given until it is certain that a patient is not already pregnant, and pregnancy must then be prevented until 2 months after 13-ci,-retinoic acid is discontinued, The teratogenic risk with isotretinoin cannot be overemphasized; tragic birth defects have been reported all too often through careless prescribing and contraceptive failure. Etretinate, because it remains at detectable levels for years after its use has been stopped, cannot be given to women capable of conceiving.

Warts are common in teenagers, less so in children, and even less so in adults. There are no serious health risks associated with warts, but they can cause embarrassment because of their appearance.

What are the symptoms of Warts?

There are several different types of warts, each produced by a specific virus. The common wart, also called a verruca or a plantar wart, is a small, hard, horny, white or pink lump with a cauliflower-like surface. Inside are small, clotted blood vessels that resemble black splinters. The common wart can grow anywhere on your body but is most likely to develop on your hands. On the bottoms of your feet and palms of your hands, a common wart tends to become pushed in so that its surface is level with the rest of the skin. Several warts may appear next to one another on your foot, forming a mosaic-like area 25 mm (1 in) or more across.

Common warts on most parts of the body are usually painless. However, a wart on the underside of your foot can make you feel quite uncomfortable, as though you are walking with a stone in your shoe.

Among the other types of warts are plane warts, which are small, brown, smooth warts that occur most often on children’s faces .Another type of wart is called molluscum contagiosum. These are tiny, white, pearly lumps, each with a central depression. These are also most common in children. peline warts and vulval warts also occur.

What should be done?

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Most warts disappear naturally, often within a few months but sometimes over several years. You may prefer to wait for this to happen. But if you have any warts that you consider unsightly or annoying, carry out the self-help described below to remove them.

However, there are two cases in which you should consult a physician. One is if you penile or vulval warts. The other is if you develop any sort of wart and you are over the age of 45. In older people, what looks like” wart may be a more serious skin condition. such as skin cancer.

What is the Treatment of warts?

Self-help: There are many folk remedies for removing warts, but their apparent effectiveness is simply due to the fact that most warts eventually disappear of their own accord. The best way to treat unsightly warts is to apply a wart remedy in the form of paint. cream or plaster. These are available without a prescription at most drugstores. These preparations contain chemicals that destroy the abnormal skin cells. However, these chemicals will also damage surrounding healthy cells, so the preparations should always be applied carefully to minimize soreness.

Do not treat warts on your face or genitals with a wart remedy, because the skin on these areas is very sensitive. And never allow these preparations to get into your eyes.

If you have an unsightly or annoying wart that does not respond to this treatment, see your physician.

Professional help: Your physician may prescribe a more effective kind of wart preparation. If this fails, the doctor can remove the wart by freezing it with liquid nitrogen or burning it off with electricity. A few days after this rather painful treatment, the wart will probably fall off. If it does not, repeated treatment should remove it. As an alternative to freezing or burning, a wart can be scraped off (curettage) after first being numbed by a local anesthetic. Occasionally a wart seems to be resistant to all forms of treatment.

Benzodiazepines such as chlordiazepoxide (Librium), diazepam (Valium), and the shorter acting agent alprazolam (Xanax) are useful adjuncts in the treatment of associated anxiety. They are particularly helpful in the control of pruritus and will often work in situations where antihistamines alone have failed. As in the case with antihistamines, the usefulness of the benzodiazepines, particularly Librium and Valium, is often limited by the side effect of drowsiness. This can be partially circumvented by the administration of chlordiazepoxide (10 to 25 mg) or diazepam (5 to 10 mg) at suppertime and, if necessary, again at bedtime. These medications are particularly helpful in the control of the nighttime scratching that is so characteristically present in patients with atopic dermatitis. They are also worth trying in chronic urticaria unresponsive to conventional antihistamine therapy. Habituation, of course, is a problem of considerable importance. This risk can be lessened by avoiding the use of these agents in people with past drug-dependency problems, by limiting the number of pills prescribed, and by sharp restriction on refills.

Phenothiazines such as chlorpromazine (Thorazine) and trifluoperazine (Stelazine) are at least as effective as the benzodiazepines. They are used less often because of a greater frequency of side effects and because of a widespread belief that they are too potent to be used by clinicians other than psychiatrists. The phenothiazines have a chemical structure that is very close to that of some of the antihistamines. It is possible that the efficacy of both groups of drugs depends on their mixed antihistaminic and tranquilizing effect.

Recently, a new, nonsedating, non habituating anxiolytic agent (buspirone, Buspar) has become available. It differs from the above agents inasmuch as it acts on serotonin receptors rather than on y-aminobutyric acid (GABA) receptors. In my experience it is somewhat less effective than the benzodiazepines, but I use it fairly frequently because of its excellent safety profile. I generally start with a dose of 5 mg b.i.d. and increase to a final dose of 10 mg b.i.d.

Depression is a problem that is overlooked to an even greater degree than anxiety. I believe that it is present in at least 10% to 20% of patients with serious dermatologic disease. Mild depression often improves as the skin disease clears and, of course, requires no specific therapy. Depression of greater severity deserves greater attention. Patients should be offered the opportunity for psychotherapy or medical treatment or both. Endogenous depression is thought to be more amenable to treatment with medication than are other forms of depression, but many clinicians believe that a therapeutic trial is worthwhile regardless of diagnosis.

The tricyclics amitriptyline (Elavil) or doxepin (Sinequan, Adapin) given in a single daily dose at bedtime are used most often. The usual starting dose with either is 25 mg, but this can gradually be increased to 150 mg as necessary. The tricyclics are extraordinarily effective antihistamines and appear to be particularly effective in the treatment of resistan t chronic urticaria. Imipramine (Tofranil) is also effective and may be somewhat less sedating. Both physician and patient need to remember that the maximum effect of these medications is not apparent until they have been taken for 3 weeks. Side effects of drowsiness and confusion are fairly common, but other more serious cardiovascular and CNS side effects are only rarely seen.

Toxicity associated with the use of tricyclics often leads to a low level of patient acceptance. Several other alternative drugs are available and are well worth trying in certain circumstances. Alprazolam (Xanax) has antidepressant effects as well as the anxiolytic effects. Trazodone (Desyrel) is chemically unrelated to the tricyclics and appears to function as a serotonin antagonist. Fluoxetine (Prozac) is another serotonin antagonist that produces very little drowsiness. Recently, some concerns have been raised about its ability to potentiate suicidal ideation, but most doubt that this occurs. I have used it very effectively in a dosage of 20 mg each morning. Clomipramine (Clozaril) may have particularly good effect on obsessive-compulsive disorders such as trichotillomania, but high cost and concerns about safety have kept it from more widespread use.

In using topical preparations the clinician must make four decisions: what brand? what strength? what vehicle? and what quantity? lists a few of the most widely sold products. They have been grouped, on the basis of my experience, into rather arbitrary categories of low-potency, mid-potency, and high-potency preparations. A steroid from the low-potency group can be used for all acute and subacute eczematous diseases. A steroid from the mid-potency group can be used for chronic and resistant eczematous diseases and for most papulosquamous diseases. A steroid from the high-potency group can be used for eczematous diseases of the palms and soles and for resistant papulosquamous disease.

A special caveat applies to use of corticosteroids on the face and genitalia. In these two locations, only nonfluorinated, low-potency preparations such as hydrocortisone should be used. To do otherwise leads all too often to the development of a rosacea-like eruption on the face and striae formation on the upper inner thighs.

The choice of a vehicle for topical steroids depends on the distribution and extent of the disease to be treated. As a general rule, creams represent the best choice. Lotions and/or solutions, because of their ease of spreading, can be used in hairy areas. Ointments can be used where additional lubrication is desirable and can be substituted for creams when patients indicate that stinging on application has been a problem. In addition, for a given strength of steroids, ointments are slightly more efficacious than creams. This advantage is based on the fact that the partition coefficients for ointments allow for better transfer of the active ingredient from the vehicle into the lipid layer of the skin.

Most topical steroids come in a small and a large size. Generally, the small size is about 15 g, and the large size is 45 to 60 g. For limited disease, such as that which occurs on the hands and feet, the small size will be sufficient. For larger areas, or where it is anticipated that treatment will be carried out for weeks at a time, the large size will offer better economy.

Patients have generally been instructed to apply topical steroids 3 or 4 times daily. It is, however, becoming increasingly apparent that equally good results can be obtained with as few as one or two applications a day. One of these applications ought to occur directly after bathing, since penetration is slightly better and spreading occurs more easily on well-hydrated skin.

Patients are also usually uncertain how much should be applied and how thinly it ought to be spread. The amount to be applied can be stated in “fingertip units” (FTUs). A FTU is the amount of cream (expressed from the tube as a cylinder) that occupies the space from the skin crease overlying the distal interphalangeal joint to the tip of the finger. Each FTU contains about 0.5 g of cream or ointment. It takes about 1.0 FTU to cover the hand, 2.5 FTUs to cover the face and neck, and 3.5 FTUs to cover the whole arm. Generally, the product should be spread as thinly as possible; it is never necessary to leave an easily visible layer on the skin.

Penetration and thus the clinical efficacy of topically applied steroids can be enhanced by the addition of occlusive techniques. Such occlusion can be obtained through the use of plastic or latex gloves for disease of the hands, Baggies for disease of the feet, wrapped plastic film for disease of the arms or legs, and a vinyl sweat suit for disease of the trunk. In addition, it is possible to use occlusive dressings with adhesive backing (such as Actiderm or Duo-Derm) over small areas of disease. Unfortunately, occlusion, while enhancing efficacy, can lead to local problems, such as atrophy, miliaria, and folliculitis, as well as to systemic problems as a result of greatly enhanced percutaneous absorption.

Long-term use of topical steroids, whether there is occlusion or not, also raises a question about the potential risk of systemic absorption. This is not a significant problem when low-potency steroids such as hydrocortisone are used, even over large body surhlce areas. Mid- and high-potency steroids cause no trouble when used over small areas, but some detrimental effect on the pituitary-adrenal axis can be demonstrated when whole-body application is carried out. As might be expected, extra care should be taken when children are treated, since their large surface area-to-volume ratio increases the effective concentration of whatever amount is absorbed

Conventional wisdom suggests that all itching is qualitatively the same, but empirical observations suggest that this might not be so. For instance, patients with urticaria often complain extremely severe itching, but only rarely does this pruritus lead to excoriation. On the other hand, patients with dermatitis herpetiformis regularly scratch their lesions even when the pruritus is perceived as only moderately severe in intensity. Moreover, those individuals who are genetically atopic seem predisposed to vigorous excoriation at the slightest provocation, whereas nonatopics rarely scratch uncontrollably. From a practical standpoint, pruritus appears to depend on four major factors: (1) the type of disease-some conditions are inherently more pruritic than others; (2) the environmental condition on the skin-xerotic and sweaty skin favors itching; (3) genetic factors atopics have a lower threshold for itching than do non atopies; and ( 4) the psychologic set of the patients-itching is more severe in anxious and depressed patients. Those diseases that are, to a greater or lesser degree, inherently pruritic are listed, but the severity of pruritus experienced will be at the least partially dependent on other factors.

In examining the slide the condenser is racked to its lowest position, and the intensity of the light source is reduced. These two maneuvers increase the contrast between the fungal hyphae and the underlying epithelial cells. The medium-power objective is used for scanning the field, and the high-power objective is used to confirm the presence of suspected hyphae.

In pityriasis (tinea) versicolor, fungal hyphae are short, stubby, and vaguely” Y” shaped . Small round spores are numerous and are collected in clusters around the hyphae. The terms “grapes on a branch” and “spaghetti and meatballs” are often used to describe these hyphae and spores.

In dermatophyte and Candida infections the hyphae are thinner and longer. Few if any spores are present. Most observers cannot easily separate the pseudohyphae of Candida infections from the true hyphae of dermatophyte infections, and a decision as to which of the two infections is present usually depends on the clinical presentation or subsequent culture.

Artifacts are commonly present in KOH preparations and may be confused with hyphae. Cotton threads are thicker and lack parallel sides and branching. Hairs have parallel sides, but they too lack branching. The edges of epithelial cells sometimes overlap and appear to form a continuous, branching line. In such a situation, compression of the coverslip against the slide will cause the cells to change position and separate, thus breaking up the erroneous hyphae-like appearance of the cell outlines.

The unequivocal presence of hyphae on a KOH preparation identifies the disease in question as being of fungal origin. Therapy can be initiated on the basis of this finding without waiting for the report of a fungal culture.

The adult dosage of orally administered acyclovir for the treatment of active herpes simplex infection is 200 mg 5 times/day. It is given for 10 days in primary infection and for 5 days in recurrent infection. For patients with chronic, frequently recurring, oral or genital herpes, the drug may be given continuously in a dosage of 200 mg 2 or 3 times/day. The Food and Drug Administration (FDA) has approved continuous therapy for up to 1 year, but studies have indicated that it can be given safely and effectively for appreciably longer periods of time.

Acyclovir is also effective, at appreciably higher dosage, in the treatment of varicella and herpes zoster (“shingles”). The adult dose for herpes zoster is 5OO mg (an 5OO-mg tablet is available) 5 times/day for 7 to 10 days. Although the symptoms and signs of zoster are ameliorated, acyclovir treatment has not yet been documented as effective in preventing the development of postherpetic neuralgia. Dosages and indications for use are just not being established for patients with varicella.

Side effects rarely occur with the use of orally administered acyclovir in the dosages. Resistance of the herpes viruses to acyclovir occurs with some frequency, but this has not represented a clinical problem, so fur at least, in immunocompetent patients.

Patch testing can be carried out with a suspected contactant itself (“use test”) or with the chemical constituents of the contactant. The former is usually more practical, since it does not require the purchase and periodic updating of a patch test kit. Use tests are suitable for most nonindustrial contactants such as clothing, cosmetics, and medications where the item in question has been designed for direct application to the skin. Use tests may be considered inappropriate, when evaluating industrial and laboratory chemicals, because of the possible development of an unexpectedly severe reaction.

A use test is performed by taping the suspected contactant tightly against the skin for 48 hours. At the end of 48 hours (or earlier if the patient experiences severe itching) the bandages or tapes are removed, and the site of application is examined. Positive reactions will be red, raised, and pruritic. Flat, red reactions are interpreted as indeterminate and are not ordinarily considered clinically important. Negative reactions, of course, show no visible change at all. Care should be used so that irritant reactions to the tape are not misinterpreted as reactions to the contactant.

Patch test kits are available for more sophisticated types of testing. These kits contain appropriately diluted concentrations of the most commonly encountered contact antigens. They are generally used to screen either for possible contactants in eczematous disease of unknown etiology or for identification of a single, specific antigen in patients with positive use tests. The complexity of this type of testing together with the need to continually replace outdated material makes the use of patch test kits impractical for most generalists.

A positive patch test does not automatically confirm a diagnosis of contact dermatitis any more than a positive tuberculin skin test proves that a patient’s pulmonary disease is due to tuberculosis. Proof that a patient has allergic contact dermatitis requires both the presence of a positive patch test and improvement of the patient’s condition when the suspected contactant is removed from the patient’s environment.