The Clinician's Handbook of Natural Medicine E-Book

Joseph E. Pizzorno, Michael T. Murray, Herb Joiner-Bey

• Editorial: Churchill Livingstone
• Año: 2016
• ISBN:
  9780702055133
• Edición: 3
• Categoría: Medicine
• Categoría: Alternative & Complementary Medicine

Written by leading authorities in complementary and integrative medicine, this convenient, quick-reference handbook provides clear and rational directives on diagnosing and treating specific diseases and disorders with natural medicine. You'll get concise summaries of diagnostic procedures, general considerations, therapeutic considerations, and therapeutic approaches for 84 of the most commonly seen conditions, 12 of which are new to this edition, plus naturopathic treatment methods and easy-to-follow condition flowcharts. Based on Pizzorno's trusted Textbook of Natural Medicine and the most current evidence available, it's your key to accessing reliable, natural diagnosis and treatment options in any setting.

• Expert authorship lends credibility to information.
• Scientifically verified content assures the most reliable coverage of diagnostic and natural treatment methods.
• Over 80 algorithms synthesize therapeutic content and provide support for your clinical judgment with a conceptual overview of case management.
• The book's compact size makes it portable for easy reference in any setting.
• A consistent organization saves you time and helps you make fast, accurate diagnoses.

• 12 NEW chapters enhance your treatment knowledge and understanding with information on important and newly emerging treatments and areas of interest, including:
• • Cancer
  • Endometriosis
  • Fibromyalgia
  • Hair Loss in Women
  • Hyperventilation Syndrome
  • Infectious Diarrhea
  • Intestinal Protozoan Infestation
  • Lichen Planus
  • Parkinson's Disease
  • Porphyrias
  • Proctological Conditions
  • Uterine Fibroids
• Each chapter is fully updated to reflect the content of the latest edition of Pizzorno's Textbook of Natural Medicine and keep you current on the safest and most effective natural interventions.

TitleChap

Chapter 1

Acne vulgaris and acne conglobata

Diagnostic summary

• Open comedones: dilated follicles with central dark, horny plugs (blackheads)

• Closed comedones: small follicular papules with (red papules) or without (whiteheads) inflammatory changes

• Superficial pustules: collections of pus at follicular opening

• Nodules: tender collections of pus deep in dermis

• Cysts: nodules that fail to discharge contents to the surface

• Large, deep pustules: nodules that break down adjacent tissue, leading to scars

General considerations

Most common skin problem. A key factor is genetics; acne is inherited autosomal dominant pattern with incomplete penetrance. If both parents had acne, three of four children will have acne. If one parent had acne, then one of four children will have acne. Lesions are mainly on the face, but also back, chest, and shoulders. More common in males; onset during puberty but later for conglobata. Acne vulgaris onset from increased size of pilosebaceous glands and sebum secretion by androgenic stimulation. Severity and progression arise from interactions of hormones, keratinization, sebum, and bacteria.

• Progression: hyperkeratinization of upper portion of follicle, blockage of canal, dilation and thinning, formation of comedones (open or closed based on degree of keratinization and blockage of duct), purulent exudate in pustules and cysts.

• Bacteria: normal skin species (Propionibacterium acnes [Corynebacterium acnes] and Staphylococcus albus). P. acnes releases lipases, hydrolyzing sebum triglycerides into free fatty acid lipoperoxides, promoting inflammation.

• Inducing compounds and habits: corticosteroids, halogens, isonicotinic acid, diphenylhydantoin, lithium carbonate, machine oils, coal tar derivatives, chlorinated hydrocarbons, cosmetics, pomades, overwashing, and repetitive rubbing.

• Endocrinologic aspects: androgen-dependent condition. Androgens control sebaceous secretion and exacerbate follicular hyperkeratinization. Endocrine disorders producing excess androgens induce acne development: idiopathic adrenal androgen excess, 21-hydroxylase, polycystic ovaries, free testosterone (T), dehydroepiandrosterone (DHEA), DHEA sulfate, deficient sex-hormone binding globulin. Skin of patient with acne has greater activity of 5-alpha-reductase, elevating more-active male hormone dihydrotestosterone (DHT) locally in skin tissue. Receptors for growth hormone and insulin-like growth factor 1 (IGF-1) reside on sebaceous gland; these hormones stimulate sebum production. Conditions of growth hormone excess (e.g., acromegaly) are associated with increased sebum production and acne. Insulin at high levels can interact with IGF-1 receptors. IGF-1 promotes expression of enzymes responsible for androgen biosynthesis and conversion. Elevated cortisol from chronic stress thickens sebum. The stress of acne compounds this problem.

Therapeutic considerations

Nutrition

• Diet/incidence ratio: linked to Western diet. Recommend high-protein diet (45% protein, 35% carbohydrate [CHO], 20% fat) to decrease 5-alpha-reductase activity and increase cytochrome p450 degradation of estradiol. High CHO diet (10% protein, 70% CHO, 20% fat) has opposite effect. Limit foods high in iodine and milk. Milk contains estrogens, progesterone, and androgens as well as glucocorticoids and IGF-1. Eliminate trans fats and high-fat foods.

• Sugar, insulin, and chromium: insulin efficacy in treating acne suggests cutaneous glucose intolerance and/or insulin insensitivity. Impaired skin glucose tolerance suggests that acne may be called “skin diabetes.” Eliminate concentrated CHOs to minimize immunosuppression. High-chromium yeast improves glucose tolerance and may help acne. A diet that encourages high insulin response chronically could promote acne by elevating IGF-1.

• Vitamin A: retinol reduces sebum production and hyperkeratinization of sebaceous follicles. Effective at toxic dosage of 300,000-400,000 international units (IU) q.d. × 5 to 6 months. Toxicity: cheilitis (chapped lips) and xerosis (dry skin), especially in dry weather; headache then fatigue, emotional lability, and muscle and joint pain. Laboratory tests are unreliable to monitor toxicity—serum vitamin A correlates poorly with toxicity, whereas serum glutamicoxaloacetic transaminase (SGOT) and serum glutamicpyruvic transaminase (SGPT) are elevated only in symptomatic patients. Massive doses are teratogenic—women of child-bearing age must use birth control during and for at least 1 month after treatment. Reserve massive doses for intractable cases, in which it should not be used alone. Contraception counseling is mandatory, and two negative pregnancy test results are required before initiation of vitamin A therapy in women of child-bearing potential. Baseline laboratory examination should include cholesterol and triglycerides, hepatic transaminase, and complete blood count. Conduct pregnancy tests and laboratory examinations monthly during treatment. Vitamin A at 150,000 IU daily in emulsified form for short duration is reliable and safe in bringing acne under control.

• Zinc (Zn): vital to acne treatment. Involved in production of local hormones and retinol-binding protein, wound healing, tissue regeneration, and immune function. Absorption characteristics of Zn salts used may affect results; requires 12 weeks to show good results. Prefer Zn picolinate, acetate, or monomethionine. Zn is essential to normal skin function (e.g., Zn-deficient syndrome acrodermatitis enteropathica). Zn is essential for retinol-binding protein and serum retinol levels. Low Zn levels increase 5-alpha reduction of T, and high Zn inhibits this reaction. Serum Zn is lower in 13- and 14-year-old boys than in any other age group.

• Vitamin E and selenium: vitamin E regulates retinol levels. Male patients with acne have decreased red blood cell (RBC) glutathione peroxidase, which normalizes with vitamin E and selenium. Acne of men and women improves with this treatment—inhibiting lipid peroxide formation—suggesting use of other free-radical quenchers.

• Pyridoxine: helpful for women with premenstrual acne because of effect on steroid hormone metabolism. B₆ deficiency causes increased uptake and sensitivity to T. In some patients, thyroid therapy markedly improves acne.

Topical treatments

Goal is to reduce bacteria and inflammation.

• Tea tree oil (Melaleuca alternifolia): from leaves of small trees in New South Wales, Australia; antiseptic properties; ideal skin disinfectant. Effective against wide range of organisms (including 27 of 32 strains of P. acnes); good penetration without skin irritation. Therapeutic uses are based on antiseptic and antifungal properties; prefer strong solutions (up to 15% tea tree oil) for best results; occasionally produces contact dermatitis.

• Azelaic acid: natural 9-carbon dicarboxylic antibiotic against P. acnes. Twenty percent azelaic acid cream has an effect in all forms of acne. Must be applied b.i.d. to affected areas for 4 weeks and must be continued for 6 months. Twenty percent azelaic acid cream is as effective as 5% benzoyl peroxide, 4% hydroquinone cream, 0.05% tretinoin...