Skin Care, Weight Control, and Feeling Good with Lupus

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A presentation by Amanda M. Sammut, MD and Sharon Isaac, MS, CDN

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  • Spf – 30 , will take 30 times longer to redden without sunscreen - UVB Thus, an spf 30 sunscreen 97% and spf 50 is 98%
  • Skin Care, Weight Control, and Feeling Good with Lupus

    1. 1. Skin Care, Weight Control andFeeling Good with LupusS.L.E. Lupus FoundationNew York City Hospital Tour 2013Harlem HospitalMay 7th, 2013Amanda M. Sammut, MD and Sharon Isaac, MS, CDN
    2. 2. Outline of Talk• Introduction– What is Lupus?• Skin– Lupus effects on the skin– Skin issues and concerns with steroid use– Skin care tips – acne care, sunscreen use, and smoking cessation• Weight Control– The effects of Lupus on weight– The effects of steroids on weight– Diet and exercise• Feeling Good– Key elements of feeling good with Lupus– Fighting fatigue– Sleep hygiene• Summary
    3. 3. What is Lupus?• Lupus is an inflammatory, autoimmunedisease• Lupus affects many different organ systems inthe body• Lupus can range from mild to severe in termsof its manifestations• It has a variable course and variable prognosis
    4. 4. Outline of Talk• Introduction– What is Lupus?• Skin– Lupus effects on the skin– Skin issues and concerns with steroid use– Skin care tips – acne care, sunscreen use, and smoking cessation• Weight Control– The effects of Lupus on weight– The effects of steroids on weight– Diet and exercise• Feeling Good– Key elements of feeling good with Lupus– Fighting fatigue– Sleep hygiene• Summary
    5. 5. Lupus and The Skin• The skin is often affected by lupus• Lupus may affect only the skin, withoutaffecting other organs, this is known as:“Cutaneous Lupus”• Lupus may affect the whole body, this isknown as: “Systemic Lupus Erythematosus”• Treatments for lupus may affect the skin
    6. 6. Common Skin Manifestations of Lupus• Butterfly/malar rash/acute cutaneous lupuserythematosus• Discoid lesions• Loss of hair – generalized or localized• There are many more skin manifestations oflupus that are less common (and notmentioned in this talk)
    7. 7. Common Skin Manifestations of Lupus
    8. 8. Common Skin Manifestations of LupusButterfly/malar rash/acute cutaneous lupus erythematosus
    9. 9. Common Skin Manifestations of LupusDiscoid lesions
    10. 10. Common Skin Manifestations of LupusLoss of hair –generalized orlocalized
    11. 11. Skin and Steroid Use• Acne• Stretch marks/Striae• Skin Thinning• Bruising
    12. 12. Acne• Acne is the medicalterm for pimples• Pimples occur whenpores get cloggedwith dead skin andoil, and bacteriabuild up• The skin getsinflamed and canturn red or swell
    13. 13. Acne: Home skin care recommendationsInstructions on skincleansing:•Apply a gentle cleanser withfingers•Do not scrub aggressively,massage skin gently withfingertips•Rinse with warm watertwice daily
    14. 14. Choosing Products• Water-based lotions, cosmetics,and hair products are lesscomedogenic (pimple-forming)than oil-based products• Seek out “non-comedogenic”skin care and cosmetic products• Do not pick acne lesions, as thismay worsen scarring• A number of treatments for acneare contraindicated inpregnancy, see a dermatologistfor further care
    15. 15. Tip:Avoid Minocycline!!!Minocycline is an oral antibiotic usedin the treatment of acne.It is generally recommended thatpatients with lupus avoidminocycline as minocyclinemay activate lupus orcause drug-induced lupus.
    16. 16. Stretch Marks/Striae• Seen in ~ 90% ofpregnant women, 70%of adolescent females,and 40% of adolescentmales• Striae from prolongedsteroid use are usuallylarger and wider, andinvolve widespreadareas, occasionallyincluding the face
    17. 17. Stretch Marks/Striae• Purple striae occur as thefragile skin stretches dueto the enlarging trunk,breasts, and abdomen• The striae appear as wide,reddish-purple streaksbecause the increasinglythin skin does not hide thecolor of venous blood inthe underlying deep skin
    18. 18. Stretch Marks/Striae• Avoid striae by avoiding rapid weight gain or weight loss• Striae are most likely to respond to treatment at an earlystage• Once they become white, only few treatments exist and theybecome quite difficult to treat• Intensive moisturization of the stretch marks has beenadvocated for the early treatment of striae• Tretinoins applied to the skin may improve the appearance ofearly striae (note: tretinoins can not be used in pregnant orbreastfeeding women; tretinoins increase photosensitivity)Tretinoins are prescribed by dermatologists
    19. 19. Sun Exposure• Increases risk of skin cancer• Cosmetic issues: wrinkles, freckles, sun spots• In patients with Lupus, sun exposureincreases the risk of Lupus activity or a Lupusflare
    20. 20. A Few Words on Tanning Salons…Tanning Salons are NOT recommendedThey emit UVA rays, which stillcontributes to activating Lupus (as wellas to increasing skin cancer risk)
    21. 21. Tips on Sunscreen Use• SPF 30 or higher• Look for “Protectionagainst both UVA and UVBrays”• Apply before makeup orbefore moisturizer• Apply at least 10minutesprior to sun exposure• Re-apply every two hoursif continued sun exposure
    22. 22. Tips on Sunscreen Use• Invest in sun-protectiveclothing and wide-brimmedhats• Certain medications mayincrease risk ofphotosensitivity, forinstance: antibiotics,diuretics, anti-inflammatorydrugs and birth control pillsand many more
    23. 23. Cosmetically…• Camouflage makeup, can often conceal skindiscoloration and scarring• Skin scars – filler and laser technology mayimprove scarring and skin discoloration –Buyer Beware!– Disease should be in full remission if this is to beperformed– See a dermatologist if you want more informationon filler and laser treatments– Shop around – get recommendations
    24. 24. Smoking Cessation• Smokers have more active lupus• Smoking increases rates of lupus flares• Hydroxychloroquine is less effective inpatients who smoke• Other reasons to stop smoking:• Smoking is associated with higher rates of cancerand of heart disease• Financial considerations• Cosmetic considerations
    25. 25. Skin Care Tips - Summary• For skin lesions caused by Lupus: control Lupusactivity, sun exposure avoidance, smoking cessation• For acne: wash face with gentle cleanser twice daily,see a dermatologist for medications, avoidminocycline• For stretch marks: In the early stage, keep them moistand see a dermatologist if you want to considermedications that can be applied to the skin• Sunscreen Use and Protection from UVA and UVB rays• Smoking Cessation
    26. 26. Outline of Talk• Introduction– What is Lupus?• Skin– Lupus effects on the skin– Skin issues and concerns with steroid use– Skin care tips – acne care, sunscreen use, and smoking cessation• Weight Control– The effects of Lupus on weight– The effects of steroids on weight– Diet and exercise• Feeling Good– Key elements of feeling good with Lupus– Fighting fatigue– Sleep hygiene• Summary
    27. 27. Lupus Activity and Weight• When Lupus is active, patients may haveactive inflammation and fevers and may loseweight from the body’s increased energyconsumption• People with active Lupus may feel fatigue andlose stamina, resulting in inactivity, whichresults in rapid muscle loss
    28. 28. Steroids and Weight• Steroids enhance appetite• This may result in significant weight gain• Some patients may lose weight on steroidsbut the majority gain weight
    29. 29. Tips to Battle Weight GainAssociated With Steroids• Keep mainly healthy food in your house• Grab healthy food when feeling hungry(cucumbers, baby carrots, etc.)• Have a bowl of fresh fruits and vegetablesavailable• Keep a food diary• Keep hydrated with plenty of water
    30. 30. Diet• Limited informative research on the effect ofdietary modification in Lupus• Balanced diet of carbohydrates, proteins andfats is generally recommended• Diet should be modified based on diseaseactivity and response to therapy
    31. 31. Healthy ways to add fruits andvegetables to your diet• Eat fruits and vegetables throughout the day• Add vegetables to your soups, sandwiches,and salads• Use fruits to make smoothies• Use fruit to your cereal and yogurt, also insalads, like asian salad• Choose fruits, or vegetables that are fresh, orfrozen
    32. 32. • Fill ½ of your platewith fruits/veggies• Fill ¼ of your platewith whole grains(i.e. brown rice orwhole-wheatpasta)• Fill ¼ of your platewith a protein (i.e.lean meat or fish)DietaryRecommendation
    33. 33. Special Dietary Considerations• For patients on steroids: a low-fat and low saltdiet is recommended (because steroids canincrease blood pressure and cholesterol)• For patients with kidney disease: a low-fat andlow sodium diet is recommended (becausekidney disease can increase fluid retention andincrease cholesterol)
    34. 34. Special Dietary Considerations• Patients who are dieting or not able to obtainan adequate diet should take a dailymultivitamin• Patients with hypertension or nephritis shouldrestrict salt intake• All dietary modifications should be discussedwith your physician
    35. 35. Watch out for…• Herbal remedies – these are of unprovenbenefit, may be harmful, may interact withmedications• “Natural” does not equal “safe”
    36. 36. Exercise• Walking, swimming, bicycling, low-impactaerobics, Pilates, stretching, or using anelliptical exercise machine– Strengthens bones and tones muscles withoutaggravating inflamed joints– Helps to lower the risk of developing osteoporosis• Avoidance of high-impact activity, ex. jogging,especially if joints are inflamed• Vary the exercises, so that different musclegroups all get a regular workout
    37. 37. Exercise• Pace yourself, especially if you tire easily• Don’t give up• Exercise should not be painful• Muscles that are not used may quicklybecome weak
    38. 38. Exercise• Regular exercise and even simple low-impactmovement will:– reduce or minimize stress– help to keep your heart healthy– increase muscle strength and your range ofmotion– help prevent osteoporosis– improve muscle stiffness
    39. 39. Outline of Talk• Introduction– What is Lupus?• Skin– Lupus effects on the skin– Skin issues and concerns with steroid use– Skin care tips – acne care, sunscreen use, and smoking cessation• Weight Control– The effects of Lupus on weight– The effects of steroids on weight– Diet and exercise• Feeling Good– Key elements of feeling good with Lupus– Fighting fatigue– Sleep hygiene• Summary
    40. 40. Key Elements of Feeling Good WithLupus• Control Lupus• Exercise and Diet• Fight fatigue• Rest and Good Sleep Hygiene• Support System – Don’t be afraid to ask forhelp• Managing stress, anxiety and depression• Smoking Cessation
    41. 41. Controlling Lupus• Ongoing patient-doctor communication• Compliance with medications and follow up• Alleviate symptoms• Prevent and treat relapses• Lessen side effects related to drug therapy• Coordinate care with your primary carephysician
    42. 42. Fatigue• Up to 80 percent of people withlupus experience fatigue• Fatigue may be the mainsymptom and can be debilitating• Contributing Factors:– Disease activity, pain, age, andmedications– Poor physical and mental health– Lack of good social support– Smoking
    43. 43. Fatigue• Other medical conditions may contribute tofatigue• A few examples include:– Anemia– kidney failure– Hypothyroidism– Depression
    44. 44. Tips to Help Manage Fatigue• Alternate activities with periods of restthroughout the day• Establish good sleep patterns• Plan ahead; for example, shop for giftsthroughout the year• Prepare meals in advance• Eat a healthy diet and exercise regularly• Stop smoking if you smoke
    45. 45. Rest• Especially important during periods of diseaseactivity• Inflamed or damaged muscles require rest to heal• Too little or too much sleep isn’t healthy• Napping during the day may be helpful duringperiods of lupus activity• Try to allow extra time in your daily schedule forrest
    46. 46. • Keep the same bedtime and waketime every day.• Limit liquids, heavy meals, tobaccoand alcohol within 3 hours of bedtime.• Limit caffeine at least 6 hours beforebedtime.• Exercise regularly, but not within 3hours of bedtime.
    47. 47. • Wind down for at least 1 hour beforebed in dim lights. Engage insomething quiet, calm and relaxing.• Keep the bedroom quiet, cool anddark.• Take a hot shower or bath 1.5-2hours before bedtime, not right beforebed.• Limit any screen time (TV, tablets,phone, computer) within an hour ofbedtime and during the nighttimehours.• Limit time in bed to 7½ to 8 hours at
    48. 48. Outline of Talk• Introduction– What is Lupus?• Skin– Lupus effects on the skin– Skin issues and concerns with steroid use– Skin care tips – acne care, sunscreen use, and smoking cessation• Weight Control– The effects of Lupus on weight– The effects of steroids on weight– Diet and exercise• Feeling Good– Key elements of feeling good with Lupus– Fighting fatigue– Sleep hygiene• Summary
    49. 49. Summary• Lupus is a complex autoimmune diseasecharacterized by symptom diversity and periods ofdisease activity and remission• Important principles of skin care, weight controland feeling good include:– Controlling Lupus – patients and physicians, together– Battling side effects of steroids– Protection against UVA and UVB rays– Smoking Cessation– Diet, Exercise, Rest, Sleep Hygiene– Recognizing need to seek help
    50. 50. Thank You• S.L.E. Lupus Foundation• Eric Mariuma, MD• Michelle Coombs• Harlem Hospital
    51. 51. References• Subramanyan K, Johnson AW. Role of mild cleansing in the management ofsensitive skin. Poster presented at the American Academy of Dermatology 61stAnnual Meeting, San Francisco, CA, March 21 to 26, 2004.• Draelos ZD. Cosmetics and cosmeceuticals. In: Dermatology, 2nd ed, Bolognia JL,Jorizzo JL, Rapini RP, et al (Eds), Elsevier, 2008. p.2301.• Images, if not otherwise mentioned, from google image• Acne treatment algorithm image from: www.uptodate.com• Draelos ZD. Cosmetic therapy. In: Comprehensive Dermatologic Drug Therapy, 2nded, Wolverton SE (Ed), Elsevier Inc, 2007. p.761.• Management of acne: a report from a Global Alliance to Improve Outcomes inAcne. Gollnick H, et. Al. J Am Acad Dermatol. 2003;49(1 Suppl):S1.• E-medicine article “Striae Distensae Treatment & Management” Author: SamerAlaiti, MD, RVT, RPVI, FACP; Chief Editor: William D James, MD• “Lupus Intangibles” slide borrowed from the Lupus Initiative• Fatigue, Rest and Exercise information from a variety of sources including patientinformation websites from the Lupus Foundation of America• Sleep Hygiene slides from Eric Mariuma, MD
    52. 52. The End

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