Tuesday, November 21, 2017
Health

Mayo Clinic Q&A: Getting rid of sunspots; preventing celiac disease?

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THERE ARE WAYS TO STOP SEEING (SUN)SPOTS

How effective is laser resurfacing for removing sunspots? Are there creams or other products that work to treat sun-damaged skin?

Laser resurfacing and other forms of laser and light therapy can effectively reduce or eliminate sunspots. Certain creams also can be useful. Keep in mind, though, that if you don't protect your skin from the sun, the spots will almost always return, or new ones will form.

The medical term for a sunspot is lentigo (or lentigines for multiple sunspots). You also may hear them called age spots or liver spots. These spots on the skin are flat and round, or oval in shape. They are uniform in color, ranging from light brown to black. Because they are a result of sun damage to the skin, the spots are most common on areas of the body that have frequent sun exposure, such as the face, shoulders and hands.

Laser therapy, as well as a treatment called intense pulsed light, can treat pigmented skin lesions, including sunspots. Before you move forward with any treatment, however, it is important to be evaluated by a health care provider who is experienced in diagnosing and treating skin conditions. Your health care provider can review factors that could affect your treatment, such as your skin type, medical history, family history and any medications you take.

He or she also will perform a thorough physical exam to confirm that the spots you want treated are sunspots. That's a key step because not all brown spots are lentigines. For example, brown patches on the face could be another skin disorder called melasma. Using laser treatment on melasma may worsen that condition. In some cases, the skin cancer melanoma also can look similar to sunspots. Identifying and treating melanoma as quickly as possible is critical to curing it.

If laser therapy is right for you, you may need more than one treatment to achieve the best outcome. It's usually done in a health care provider's office and doesn't require hospitalization. The length of the procedure and the time it takes to see results vary, depending on the specific type of treatment you receive. Potential side effects include redness, swelling, itching, changes in skin color and scarring. Because laser and light treatments are considered cosmetic, they typically are not covered by insurance. After laser treatment, to protect your skin and keep spots from returning, you need to use a broad-spectrum sunscreen with a sun protection factor, or SPF, of 30 or higher. To prevent sunspots, always use sunscreen, or wear protective clothing when outdoors.

Topical creams can be an alternative to, or used in addition to, laser or light therapy to fade sunspots. Effective options include topical retinoids and a bleaching cream called hydroquinone. These creams are available by prescription from your health care provider or in lower-potency nonprescription forms in retail pharmacies and drugstores. There also are many other topical agents available over the counter, such as antioxidants that may improve the appearance of sunspots.

As you consider treatment options for sunspots, review the benefits and risks with your health care provider. He or she can help you determine which approach is best for you. Whatever you decide, to protect your safety, ensure the health care provider you work with has training and experience with the therapies you're considering.

Rachel Miest, M.D., Dermatology, Mayo Clinic, Rochester, Minn.

IT'S GOOD TO IDENTIFY CELIAC DISEASE RISK EARLY

Is there anything I can do now to prevent my 1-year-old from getting celiac disease?

There is no proven way to prevent celiac disease, but if your child is considered to be at high risk for the disease due to family or medical history, there may be steps you can take to lower that risk or to identify the disease early. If your child isn't in a high-risk category, there's no need to be concerned, as the possibility he or she will develop celiac disease is low.

Celiac disease is an immune reaction to eating gluten, a protein found in wheat, barley and rye. For people with celiac disease, eating gluten triggers an immune response in the small intestine. Over time, that response damages the lining of the small intestine and prevents it from being able to absorb some nutrients. The intestinal damage can lead to diarrhea, fatigue, weight loss, bloating and anemia. In children, celiac disease also can affect their growth and development.

Anyone can get celiac disease, but it is much more common in people who have a family history of the disease or who have a medical condition that predisposes them to celiac disease. For example, the prevalence of celiac disease in the United States is about 1 percent for people who don't have any risk factors. If a child has a parent or sibling with celiac disease, that number rises to around 5 to 10 percent. Some autoimmune disorders, such as Type 1 diabetes, also are associated with a higher risk of celiac disease. Genetic disorders, including trisomy 21 and Turner syndrome, can raise a child's risk, too.

Two studies published in the New England Journal of Medicine in 2015 showed that the timing of gluten introduction into the diet of children at higher risk didn't lower the incidence of celiac disease. The studies found that delayed introduction of gluten actually may increase the risk. Some research suggests that the amount of gluten at the time it is introduced into a child's diet may play a role, but there is no clear data on what is the right amount.

Based on those findings, the current recommendation is for parents of children at high risk for celiac disease to follow the guidelines issued by the American Academy of Pediatrics for food introduction.

If you have a family history of celiac disease, you could have your child tested to see if she or he has the permissive genotype for celiac disease, known as HLA DQ2/8. If the child doesn't have it, you don't need to worry about celiac disease.

If the child has that genotype, you should still introduce foods, including those that contain gluten, according to the American Academy of Pediatrics guidelines. Then, you could consider having the child screened for celiac disease three to five years after gluten introduction — or sooner if you notice symptoms that could be related to celiac disease.

If you're concerned about celiac disease, talk to your child's health care provider. He or she can answer your questions and provide more information on the American Academy of Pediatrics guidelines for when to introduce new foods into your child's diet.

Imad Absah, M.D., Pediatric Gastroenterology, Mayo Clinic, Rochester, Minn.

Mayo Clinic Q & A is an educational resource and doesn't replace regular medical care. Email a question to MayoClinicQ[email protected] For more information, visitmayoclinic.org. © 2017 Mayo Foundation for Medical Education and Research. Distributed by Tribune Content Agency, LLC. All rights reserved.

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