In the first of our Medical Miracles Questions and Answers, Judy Siegel-Itzkovich, our new Medical Miracles Reporter responds to medical queries.
I am a 23-year-old woman. When I was 10 years old, I fell from my bicycle onto rough pavement and suffered a large cut on my cheek and chin. It left me with a scar that even today is disfiguring and causes me much embarrassment. Are they any treatments for scars – years after they appear – that can cause then to fade or disappear? M.A., Jerusalem, ISRAEL
Dr. Yoav Gronovich, director of the plastic surgery department at Jerusalem’s Shaare Zedek Medical Center, replies:
Facial scars are a significant aesthetic problem that affects many people’s self-image and daily functioning. Acne, incisions and burns cause inflammation and a high bacterial load that damages the arrangement of collagen fibers in a crisscross form, thus damaging the skin’s appearance.
There are two types of scars: those that are fresh, up to a year or two, and old scars. As a rule, the scar passes several stages until it stabilizes over the course of a year or two; during this period, there are significant things that can be done. Therefore, when someone’s skin is hurt, it should be treated as immediately as possible.
Old scars are more difficult to correct, but there are things that can be done to influence the quality of the final scar and make them look much better.
Proper closure of the incision or wound by a surgeon will allow good initial conditions for the formation of a “good” scar. Other factors include genetics, exposure to the sun, location of the scar relative to the facial muscles and their movement. Exposure to the sun is one of the most important factors for worsening pigmentation and hardening of the tissue. Avoiding sun exposure as much as possible can maintain the level of collagen fibers in the scar; as a result, the scar will be more elastic and flexible.
Unfortunately, there is no way to eliminate a scar completely. But with existing technologies, the condition of the scar can be significantly improved and blurred until it is almost indistinguishable. Silicon gel has been shown to be an effective method for smoothing and healing the scar. Transparent and easy to apply, it is, however, expensive, especially when one has a large scar on the skin. A silicone sticker achieves a similar and even more efficient effect (thanks to the mechanical pressure it provides) and is significantly cheaper. Its major drawback is the discomfort and the embarrassment that the stickers can temporarily cause, especially if they are used on the face.
Laser devices are suitable for treating scars without exfoliating or damaging the epidermis, the outer layer of the skin, and improves the appearance of the scar. In this method, the laser beam penetrates the dermis (the skin layer in which the collagen fibers are found.
Laser treatments are performed over a period of several months and have a gradual effect. While these treatments do not involve side effects, they are very expensive. Lasers are also used to remove tattoos.
Another advanced treatment is the injection of hyaluronic acid into the scar to improve it. Hyaluronic acid promotes the formation of collagen and elastin, which contribute to the formation of volume in the area where it is lacking and the elasticity of the skin. This method is suitable for the treatment of sunken scars.
We have also found that using laser therapy and injecting fat from other parts of the person’s body, such as the abdomen, is very effective in treating scars. This method is based on fat grafting and stem cells from a source of fat.The plastic surgeon separates the scar tissue fibers that form the scar’s characteristic depression, thus creating a space into which the fat and stem cells are injected. The fat creates instant filling; the stem cells differentiate later into skin cells and improve the way the skin looks.
In the second stage, five laser treatments are performed at a wavelength that penetrates into the dermis layer and causes heating and release of collagen fibers. Facial scars, including those from acne as well as cuts, can improve significantly from such a procedure and make patients very satisfied. The result in cases treated so far due to facial scars, some as a result of acne injuries, has been high satisfaction in patients.
My husband, who is now 58 years old, recently started to hiccup. From my experience, this phenomenon stops after a few minutes of its own accord. But in his case, it went on for over a week and was very annoying, worrisome and embarrassing. What causes a person to hiccup for so long, as is there anything that can be done? E.F., Haifa, ISRAEL
Judy Siegel-Itzkovich answers:
Indeed, everyone get hiccups, but a small number of people suffer from “persistent hiccups” that can go on for a few days and “intractable hiccups” that can persist for much longer. Two neurologists – Dr. Stasia Rouse and Dr. Matthew Wodziak of Loyola University School of Medicine in Chicago – recently wrote in the journal Current Neurology and Neuroscience Report about this condition. “Intractable hiccups can occur more often than we realize. Hiccups typically occur between four and 60 times a minute. Acute hiccups are common. They start without any specific reason and go away in a few minutes. They often can be stopped by holding the breath or breathing into a paper bag.
Persistent hiccups (lasting longer than two days) and intractable hiccups (lasting longer than a month) generally are associated with underlying medical conditions. They interfere with eating, socializing and sleeping and can significantly impair a patient’s quality of life. The longest recorded case was an Iowa farmer who hiccupped continually for 69 years and nine months, according to the Guinness Book of World Records.
About 4,000 people in the U.S. are hospitalized each year for hiccups. Ninety-one percent of people who suffer intractable hiccups are men, most of whom are over age 50.
Drs. Rouse and Wodziak describe a hiccup as an involuntary, spasmodic contraction of the diaphragm and sometimes the intercostal muscles (tiny muscles between the ribs). This causes inhalation to be cut short by closure of the glottis (the opening between the vocal chords).
Hiccups are usually triggered by drinking carbonated drinks or eating a large meal. Anxiety or stress also can trigger hiccups, along with alcohol, spices, smoking or other irritants to the gastrointestinal or respiratory tracts.
Intractable hiccups usually have underlying causes. In one patient, for example, hiccups were traced to arthritis in the sternoclavicular joint (the joint connecting the collar bone to the breast bone). In another patient, hiccups were linked to pulmonary embolisms (blood clots in the lungs). Certain drugs also can trigger hiccups.
In addition to treating the underlying cause, if known, physicians can treat hiccups with various medications, including baclofen, gabapentin, metoclopramide, chlorpromazine and haloperidol, Drs. Rouse and Wodziak wrote.
Nerve blocks within or near the phrenic nerve (involved in breathing) also are being studied. Other reported remedies include swallowing granulated sugar, hypnosis and acupuncture.
Treatments for hiccups cross multiple disciplines, including neurology, gastroenterology, pulmonology and primary care, the Chicago doctors wrote. As there are no formal guidelines for treating intractable hiccups, many treatments are based merely on a physician’s own experience or anecdotal evidence. “here is a lack of good quality evidence to recommend specific treatment for hiccups,” they concluded.
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