Understanding chronic urticaria (hives) and how to treat it

One of the most frustrating skin conditions to have (and treat) is chronic urticaria. Urticaria, commonly known as hives, can be classified as either acute (an episode lasting less than 6 weeks) or chronic (symptoms daily or almost daily for more than 6 weeks). Specific triggers (e.g. pressure, cold) may induce symptoms of urticaria, but often there is no specific external trigger for chronic urticaria. In Canada and the U.S. this chronic condition is labeled Chronic Idiopathic Urticaria (CIU) while the rest of the world refers to it as Chronic Spontaneous Urticaria (CSU). Despite the different terminology it is the same disease.

It is estimated that CIU affects up to 1% of the population at any given time, with peak incidence in patients between 20-40 years of age. CIU generally persists in patients for 1-5 years, with 50% of cases resolving within 6 months of onset and only about 5% lasting more than 10 years.

One of the most serious adverse effects of CIU is impairment of quality of life. Diagnosis and treatment is key to helping improve quality of life for patients.

The diagnosis of CIU is a two-step process. The first step is to gather relevant history from the patient regarding time of disease onset and frequency / duration of symptoms. The second step is a physical examination and diagnostic provocation test. Following diagnosis, your doctor will likely assess the severity using the Urticaria Activity Score (UAS), looking at the number of hives and itch intensity over a 7-day period (UAS7).

The goal in treating CIU is rapid and complete symptom control. The first line of treatment is the use of H1 antihistamines. These are over the counter drugs like Claritin, Allegra and Aerius. If symptoms persist after two weeks the second line treatment is to increase the dosage of antihistamines up to four times. If symptoms are still unresolved then third line treatments include cyclosporine and montelukast (Singulair). Most recently omalizumab (Xolair) was added to the treatment arsenal.

Omalizumab was approved in Canada for treatment of moderate to severe CIU in August 2014, following approval in the US and EU earlier last year. Omalizumab is very well tolerated and has been shown to lead to rapid and sustained improvement in UAS7.

If you or someone you know is dealing with chronic urticaria and are unable to control it with the recommended dosage of antihistamines, you should speak to your doctor to review other options.

New Treatment to Get Rid of Your Double Chin

You may have heard that there is a new injectable treatment to eliminate the dreaded “double chin.” The product is known as KYBELLA in the U.S. and BELKYRA here in Canada. BELKYRA was recently approved by Health Canada for the treatment of submental fullness, or fat below the chin.

This is the only FDA and Health Canada approved non-surgical treatment to reduce submental fat. The active ingredient in BELKYRA is deoxycholic acid, which is a naturally occurring molecule in the body that helps with the breakdown and absorption of fat. When injected, it causes the destruction of fat cells so that those cells can no longer store fat.

Because BELKYRA destroys fat cells, once the desired aesthetic appearance is achieved it is not expected that any re-treatment will be needed. However, the initial treatment regimen will be tailored based on your profile and the desired contouring of the chin. It may require up to six treatments each one-month apart, though results have been seen in as few as two treatments.

Many adults, both men and women, have expressed unhappiness with the appearance of a double chin. That is why it is very exciting to be able to offer a non-invasive treatment that can provide patients with significant results in a short amount of time. The procedure has minimal patient downtime and common side effects are similar to other injectables, including possible swelling, bruising and pain at the site of injection.

I am thrilled to be a part of the practice at Carruthers & Humphrey, which will be the first practice in Vancouver to offer BELKYRA (available in late August or September 2015). If you are interested in a consultation for BELKYRA or other cosmetic procedures please contact the office. 

2015 ASDS Survey on Cosmetic Dermatology

This week new survey data was released by the American Society for Dermatologic Surgery. The 2015 ASDS Consumer Survey on Cosmetic Dermatologic Procedures reflects overall consumer views on cosmetic medical treatments.

According to the results, half of consumers are considering a cosmetic medical procedure and the specialty in which the physician is board-certified is the single most important factor when selecting a practitioner for a cosmetic procedure.

The top cosmetic concerns for consumers are:

• Excess weight, 88 percent
• Skin texture and/or discoloration, 72 percent
• Lines and wrinkles around and under the eyes, 69 percent
• Excess fat under the chin/neck, 67 percent
• Sagging facial skin, 67 percent

Highlights of the survey are summarized in the infographic below.

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What You Need to Know About Fillers

One of the topics I get asked about most often by patients who are curious about cosmetic procedures is the use of fillers. Many people don’t really understand what filler is or they may have negative association of people being “over done” with filler.

When injected by a professional filler is very safe* and can serve as a key part of an overall program to restore a more youthful appearance by replacing volume in the face that is lost through aging.

In 1981 bovine collagen became the first FDA approved substance for soft tissue augmentation. Collagen remained the only commercially available filler until 2003, when the first hyaluronic acid (HA) dermal filler was approved. This was a breakthrough because HA fillers are easier to use and demonstrate longer-lasting results than collagen.

HA is a sugar that occurs naturally in the body and the effects of HA filler can be reversed (dissolved) simply by injecting a substance called hyaluronidase. In recent years HA fillers have continued to evolve and data suggests that HA fillers can stimulate a biological response to induce production of the patient’s own collagen.

The majority of the fillers I use in my practice are HA based. Commonly I will use the newer cross-linked fillers for their volumzing properties. These products are often used to address deeper wrinkles that cannot be treated with Botox alone. They are also used to bring back contours of the face, especially in the cheeks and chin, which flatten as we age.

The use of too much filler, especially when placed incorrectly, can begin to create an unnatural look. However, when an appropriate amount is used in carefully selected areas, filler provides an essential foundation to minimize the effects of aging. In general filler treatment can last for up to 12 months, but depending on the type of filler used and location of injection the duration may vary.

If you are interested in learning more about filler or booking a consultation to discuss cosmetic options please contact my office.

*Note on safety: In May 2015 the FDA issued a warning about serious complications if filler is inadvertently injected into blood vessels. I have researched and authored two papers on complications that can arise from the use of fillers. With a solid understanding of facial anatomy and proper protocols in place the risk is very low.