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Turned On by Off-Label

By Tom Branna , Editorial Director | February 12, 2013

Dermatologists find novel uses for prescription drugs and even everyday household items.

Aspirin was used for decades as a treatment for aches and pains before doctors began recommending it as an inexpensive way to treat heart attacks. That’s just one example of how physicians recommend “off-label” use of drugs and other products, some more common than others.
“Pharmaceutical companies can’t promote their products for uses that haven’t been approved by FDA, by physicians can,” explained Dr. Mary Lupo, a board-certified dermatologist and clinical professor of dermatology at Tulane School of Medicine. Lupo pointed how that FDA drug approvals are very specific and that companies can only market and advertise drugs exactly as proven by drug trials.

At a press event last month that was sponsored by the Women’s Dermatologic Society, Lupo noted that in dermatology, most of the cosmetic treatments are considered off-label. Examples of common off-label treatments include the use of fillers in the temples, cheeks, periorbital regions or hands to counteract the signs of aging and the use of Botox in crow’s feet, upper lips or neck. In fact, Lupo said that reasonable physicians could use products legally in the US for any indication they deem effective.

Dermatologists have an array of prescription products at their disposal to treat a wide range of skin ailments.
But not every off-label recommendation from dermatologists is for pharmaceuticals. Inflammatory rashes such as eczema may benefit from bleach baths followed by petrolatum, according to Dr. Kristina Collins, New England Dermatology and Medical Center.

“Adding a quarter cup of bleach to a bathtub of water can have a dramatic effect on skin problems, even MRSA,” said Collins, who also pointed out that honey could even be used to treat skin ulcers due to its high sugar content. Experts suspect that the sugar draws water to the ulcer and out of bugs (via osmotic pressure) ultimately killing the critters. But sugar also contains glucose oxidase, an enzyme that produces hydrogen peroxide.
Other remedies from the home pantry include:
• Cottage cheese and pineapple mask for rosacea;
• Honey, egg white and turmeric mask for moisturization;
• Brown sugar and olive oil to hydrate and exfoliate; and
• Rose water, lemon juice and witch hazel to tone skin.
Of course, not every beauty problem can be solved with everyday pantry items. Drs. Lupo and Collins both recommend supplements such as biotin for nail and hair growth, probiotics to maintain a healthy system, and vitamins D, C, B3 and A, used topically and orally, to improve skin health.
Bleach, a laundry staple, has applications in skin care.

The Impact of Diet and Stress

They noted too, that the typical American diet is high in carbohydrates, which increases inflammation in the body and is a cause of psoriasis, acne and rosacea. Furthermore, psoriasis has been linked with the metabolic syndrome and some studies suggest that high fat foods and dairy trigger acne. On the flip side, omega-3 fatty acids and antioxidants may help reduce inflammation.

“High levels of sugar and carbohydrates are toxic to skin,” Collins asserted.
If a poor diet’s impact on skin health weren’t enough to worry about, the dermatologists noted that stress also has many negative effects on skin. For example, high stress levels can worsen the severity of eczema, psoriasis, rosacea, cold sores, dandruff/seborrheic dermatitis and acne. And, just like a pro-inflammatory diet that’s high in sugar, stress increases inflammatory hormones and chemicals. Both derms recommended exercise to reduce stress and pointed out that the use of cosmetics can help alleviate anxiety and improve interpersonal interactions.

But when diet, exercise and cosmetics aren’t enough, dermatologists use lasers to treat a variety of skin conditions including acne and acne scarring, rosacea, melasma, psoriasis and vitiligo.
Both dermatologists insisted that laser treatments should be administered by a board-certified dermatologist or plastic surgeon.