If you have been following this column, you would have realized by now the importance of your skin and the need to consult a properly- trained dermatologist for your skin problems.

At this point, if you do not know of any dermatologist, you can call Tel. No. (632) 723-0101 loc 2015 (office of the Philippine Dermatological Society) and the person who will answer can give you the name of one or more member dermatologists whose office is near your residence or place of work.

When you finally go for consultation, expect your doctor to ask you in detail the nature of your complaint, how long it has been, what you have applied as topical treatment, who else has the same problem in your household, and several more questions including your state of health and if you are on regular medications.

She will also ask you about your family history, your hobbies, your social activities, plus other relevant information that she feels will help elucidate your problem. In examining your skin, she then may ask you to strip down to your undergarments and with the help of a bright light and a magnifier, record your skin findings on your chart. Thoroughness is a hallmark of a good physician, and the dermatologist is no exception to this rule.

Once a diagnosis or an impression is made of your skin problem, the dermatologist then proceeds to explain what the problem is and how best to manage it. At this point, you have every right to ask all the questions that are in your mind including your apprehensions and your doubts.

Discuss options for treatment and be very clear on the advantage of one over the other. A dermatologist appreciates a patient who is interested and who desires to be properly informed.

If a surgical procedure is contemplated, know what it is for, how experienced your doctor is, what to expect by way of pain or discomfort and how to care for it afterwards. If you feel that you need time to think it over or would like to get a second opinion, feel free to express this to your doctor. But be aware that putting it off indefinitely may compromise you.

Supposing the management of your skin problem only requires the application of a topical medication, as in mild acne for example. The dermatologist will probably prescribe a gentle cleanser, a topical antiseptic or antibiotic, and a cream which will remove your blackheads and whiteheads.

The instructions on how to use theses products must be very clear to you and must be properly followed to ensure their effectiveness.

Do not think that if the medications are applied thickly they will work better; indeed, this is a waste of money and may even cause irritation.

You must also realize that if the medicines work for you, you should not freely recommend them to your relatives and friends. Treatment is highly individualized and best done under the care of a physician. It is also true that you must not try other people’s medications even if you see how well it improves their skin.

A frequent source of apprehension encountered in a dermatological practice is the use of oral steroids for skin diseases.

Most of the negative reactions of patients are often rooted in hearsay because of a friend who died while taking steroids or because they have read that steroids are bad which is why they are banned in sports.

While it is easy to correct the latter statement in that the banned steroids in sports are the anabolic varieties, not the anti-inflammatory ones, the earlier statement may have arisen because the patients receiving steroids who died were very sick in the first place. In fact, properly-used steroids have saved hundreds of lives. What is important is that you must be under the care and supervision of your doctor while on steroid therapy.

The use of topical steroids also deserves to be mentioned here as they remain the mainstay of treatment for numerous inflammatory skin diseases.

The amount and duration must be followed faithfully as specified by your doctor. Remember that if used on localized areas of the body for a very short period of time, the danger of the steroid being absorbed is very minimal if it exists at all.

If your skin lesions do not respond as expected given a certain period of use, you must return to your doctor and have her re-evaluate your skin problem. You may have developed a complication like a secondary bacterial infection and your doctor is the best person to address this new development. Trusting your doctor and communicating with her freely is your best guarantee of getting well.

Before I end this article, may I say a few words about creams and lotions or any medications bought from a dermatologist’s office.

These must be properly labeled at all times in their generic formulations and the instructions for their use clearly indicated in your prescription. If this is not done, insist on it.

You have the right as a consumer to know what you are buying, what it is for and how to use it. You also have the right to ask if other drugs may be substituted for these that can be bought at the local drug-store. Remember that a good dermatologist will always place your best interest over and above her financial gain. Be aware of your rights and go and exercise them.

When one mentions leprosy — one of the oldest and most feared diseases known to mankind — we invariably imagine afflicted persons during the biblical times or two centuries ago when they were ostracized by society. Lepers then were considered outcasts and “untouchables,” or worse as “living corpses.”

However, this mildly communicable disease (also called Hansen’s disease) caused by a slow growing bacteria, Mycobacterium leprae, can be cured. In fact, it is more curable than chronic diseases such as diabetes and hypertension. One does not take medicines for leprosy for a lifetime.

The disease mainly affects the skin and nerves. Although it is transmitted primarily through coughing and sneezing by afflicted individuals, a patient who gets afflicted with leprosy may have had prolonged exposure to an untreated patient, or has a weak immune system. In fact, approximately 95% of us have a natural immunity to leprosy.

The e arly signs of Hansen’s disease include discolored or light patches on the skin with loss of feeling. Leprosy patches can be pale, reddish, or copper-colored, flat or raised. They do not itch. They usually do not hurt. They lack or lose sensation to heat, touch or pain. They can appear anywhere.

If left untreated, leprosy can cause deformity, crippling and blindness. This is because when nerve trunks in the arm are affected, part of the hand becomes numb and small muscles become paralyzed, leading to curling of the fingers and thumb. When leprosy attacks nerves in the legs, it interrupts communication of sensation in the feet. The feet can become subject to erosion through untended wounds and infection. If the facial nerve is affected, a person loses the blinking reflex of the eye, which can eventually lead to dryness, ulceration, and blindness. Bacilli entering the mucous lining of the nose can lead to internal damage and scarring which in time causes the nose to collapse.

But today, have no fear. Leprosy is no longer incurable and life-threatening.

Afflicted persons can now be successfully treated using multi-drug therapy (MDT), making use of three antibiotics: rifampicin , clofazimine and dapsone . Treatment can take from six months to a year, sometimes longer, depending on severity of infection. Alternative treatment is also available for those who will not be able to tolerate these antibiotics.

In the Philippines , MDT was successfully employed in field trials in 1985. Since then, it has remained the mainstay of leprosy control in the country.

In fact, the Department of Health (DOH) maintains that leprosy is not anymore a major public health concern, as prevalence rate in 2004 was at 0.38 per 10,000 individuals, way below the international threshold of one per 10,000, which is the criterion of the World Health Organization (WHO) for an effective leprosy control.

While the Philippines has achieved a considerable headway in leprosy prevention and treatment, compared in 1986 when the prevalence rate was 7.2 per 10,000, there is still a lot to be done. For the last three years, we still detect an average of 2000 to 2500 cases per year. Areas of concern with a prevalence rate of 1,0-1.9 per 10,000 include Ilocos Norte and Sur, Laoag, Candon, Vigan, Ormoc, Siquijor, Cagayan de Oro, Oroquieta, Iligan, Basilan and Sulu. Moreover, the percentage of children (below 15 years old) among the new cases has not reached the benchmark of <5%. For the last two years, approximately 5.6 to 6.1% of the new cases are children. We also have not reached the target of reducing the number of patients who suffer from deformities, that is, there are still a large number who have not been given early treatment because of lack of awareness, resulting to delayed detection. To date, approximately 4.5% suffer from severe deformities.

Thus, the Philippine Dermatological Society (PDS) — in cooperation with the National Leprosy Control Program of the DOH Communicable Disease Service and the World health Organization — continues to wage a sustained campaign to help detect all patients and cure them. We need to remove the fear of leprosy, at the same time, improve people’s awareness of its early signs.

“The stigma of leprosy, one of the oldest scourges of man, should no longer exist. Patients afflicted with leprosy should be able to lead completely normal lives,” noted the PDS, the oldest and largest organization of trained and accredited skin specialists in the country. Now on its 53 rd year, the PDS spearheads the observance of February as “Leprosy Month.”

On February 20 to 27, the PDS institutions will have poster display, conduct daily lectures, and film showing to help disseminate information about Hansen’s disease. On February 25, 2006, the Philippine Leprosy Mission and the PDS will hold the Walk for a Cause for patients afflicted with leprosy. The group will gather at 6:30 a.m. – 12:00 nn at the North Avenue Gate of the Quezon City Circle .

Coinciding with Valentine’s celebration, Leprosy Month should be an opportune time for all Filipinos, young and old, to be aware of Hansen’s Disease, and participate in its total elimination.

The PDS said that this February let us show how much we care for our loved ones — relatives, friends and co-workers — especially those who have suffered from the stigma people had placed on leprosy.

The best way to eliminate the disease is early detection. The best way to prevent deformities is early treatment. If you think you have any of the symptoms mentioned, visit the nearest Barangay or Municipal Health Clinic, or better yet consult a certified dermatologist.

To sustain leprosy prevention over the long term, the PDS recommends maintaining a sanitary environment, avoiding overcrowding, and eating nutritious food.

People, young and old, with medical and skin problems that require surgery have now a better choice: quicker, bloodless, painless, and high-tech laser treatment.

Before its discovery, however, laser was popularized in novels and movies as a weapon of destruction. Now, it has myriad of uses, foremost of which is that it serves as a potent and effective instrument for curing and healing ailments and diseases.

It is interesting to note that dermatologists were among the first in the medical world to use lasers. They seized it as a tool for treating skin problems such as unsightly moles, freckles, tattoos, scars, wrinkles and birthmarks. With this technology, it has now become possible to get rid of some of these skin conditions without going under the knife, thus minimizing the risk of infection, the degree of bleeding, swelling and pain, and eliminating the need for general anesthesia. These advantages have made laser treatment an increasingly appealing option for patients. A sign of the emerging popularity of laser treatments is the fact that lasers can now be found not only in hospitals and skin clinics but even in spas and beauty centers. Furthermore, we are bombarded with so many ads of lasers, genuine or otherwise. In extreme cases there has been an abuse of the word laser by some establishments that advertise any form of light emitting equipment as a laser in order to draw in clients. As the quest for the perfect body and the flawless face continues, the Philippine Dermatological Society (PDS) seeks to make the necessary clarifications regarding laser treatments in order to enlighten the general public and assist potential patients in making an informed decision.

Laser Facts

Laser is an acronym for Light Amplification by Stimulated Emission of Radiation. Unlike sunlight, which produces various colors of the rainbow when passing through a prism, the laser beam is made up of only one color of light that travels in a single direction, making it pure, intense and concentrated. The beam’s color differs for each laser, depending on the substance put inside the laser chamber. When activated, the chamber emits a specific light with a corresponding wavelength, which breaks down, dissolves or destroys a specific target, with minimal damage to surrounding structures.

In addition to laser, dermatologists also use a similar technique, known as “Intense Pulsed Light” or IPL. It differs from laser, as it is made up of a blend of various wavelengths emitted by a flashlamp. IPL beams a gentler and more diffused energy, which is absorbed by various skin components, creating a full and subtle improvement, particularly of photo-damaged skin.

There is no single laser that can target and remedy all skin conditions. Each condition has a specific laser employed — as in vascular laser, pigment laser, hair removal laser, epidermal resurfacing laser, and sub-surfacing or non-ablative laser.

Vascular birthmarks such as hemangiomas and port-wine stains, and spider veins are eradicated using the pulsed dye laser, which targets the hemoglobin.

Tattoos, age spots, freckles and some pigmented birthmarks can be lightened with melanin-specific, short-pulse and high energy, Q-switched Nd:YAG laser. Permanent hair reduction is best accomplished with long-pulsed lasers such as alexandrite, diode and Nd:YAG.

Wrinkles, photo-damaged skin and depressed scars due to acne or chickenpox may be improved with resurfacing lasers such as short-pulsed carbon dioxide and erbium-YAG laser. The newer subsurfacing lasers such as long-pulsed diode, Nd:YAG and infrared lasers offer less downtime.

Wrinkles, photo-damaged skin and depressed scars due to acne or chickenpox may be improved with resurfacing lasers such as short-pulsed carbon dioxide and erbium-YAG laser. The newer subsurfacing lasers such as long-pulsed diode, Nd:YAG and infrared lasers offer less downtime.

IPL is best used for photo-rejuvenation, and in eliminating age spots, redness and large pores.

PDS Advice: Be Cautious!

As more people are enticed to undergo treatment via laser or IPL — either for hair removal, skin rejuvenation, or removal of other skin problems — they should be cautious, the Philippine Dermatological Society (PDS) warns.

In fact, in the United States, where the skin laser treatment industry is now a $2-billion-a-year business, complaints are cropping up, with a number of patients being injured by laser treatments done in spas and beauty salons by individuals with inadequate training, the PDS reported.

It is therefore highly advisable that before undergoing any laser treatment, interested persons should first consult a board certified dermatologist. The dermatologist, after thoroughly evaluating the patient, will give the proper diagnosis and discuss all the treatment options available. If laser is the ideal treatment, the dermatologist will also discuss what the patient should expect from the treatment and any possible complications.

The patient should not be afraid to ask questions and to check the credentials of the person who will be performing the treatment. That person should not merely be able to operate the laser machine but should also know which laser would be best suited for a particular skin problem and a particular skin type. Keep in mind too that not all establishments with the latest laser equipment will also have the qualified people to use these machines.

Anybody who claims that laser or IPL treatment is 100 percent guaranteed and with zero percent adverse side effects is lying, the PDS said.

Multiple sessions are usually required, and improvement may not be 100 percent or permanent for some skin conditions.

At least two to four weeks before treatment, PDS advises that patients should avoid tanning — be it obtained naturally through sunbathing or artificially in beauty parlors — as it increases the risk of darkening and burning..

The time spent for actual treatment depends on the type of laser or IPL used, and the extent of skin to be treated.

For instance, facial photo-rejuvenation via IPL can be done in just an hour, or during lunch break. Right after treatment, the patient can immediately work, as if nothing happened. Removing unwanted hair is also quick.

Vascular and pigment laser treatments, however, take longer. One hour before treatment, a cream is applied to numb the skin.

The longest treatment is the carbon dioxide resurfacing laser, as it entails administering anesthesia and possibly, sedation. Thereafter, it takes two weeks to heal the raw skin. After the skin heals, there will be some redness for about six months, when strict sun avoidance is advised, especially for dark-skinned and tanned individuals.

Pigment lasers may also cause darkening of the treated skin. However, it is often temporary, lasting three to four months. The reverse is also true-that is, treatment with pigment lasers can also cause hypopigmentation.

In dark-skinned patients, blisters may occur due to excessive absorption of laser beam by the target (usually melanin), but it usually heals within a week or two.

Further, bruising due to leakage of red blood cells from zapped vessels, which may occur with the use of vascular lasers, usually disappears within a few weeks.

Major complications include infections, 2nd and 3rd degree burns and scarring. However, in the hands of a properly trained physician, these complications are rare.

In all, the PDS noted, the ideal person to perform IPL or laser treatment for skin problems is a doctor who is board certified in dermatology, or another specialty with equivalent training. S/He should have at least three years of residency in a reputable medical center, where s/he has been exposed to a variety of skin problems and has passed a rigorous specialty board examination.

In addition, s/he should have undergone further training in laser surgery, and familiar with the different types of laser machines, their indications and proper usage. As not all skin disorders can be treated with laser or IPL, the dermatologist should therefore use them only when they are the best or only option.

Founded in 1952, the Philippine Dermatological Society (PDS) is the only recognized affiliate professional group for dermatology of the Philippine Medical Association and the Philippine College of Physicians.

The PDS Secretariat is at Rm. 1015, Front Tower, Cathedral Heights Building Complex, St. Luke’s Medical Center, E. Rodriguez Avenue, Quezon City, with telephone number, 727-7309; and website, www.pds.org.ph.

People often encounter changes in their nails. Some just ignore them while others find themselves not knowing what to do. Nail changes can be very important since it may be a sign of a major medical illness. It could also mean a very minor cosmetic problem causing major psychological trauma. Oftentimes, nail problems are misdiagnosed as fungal infection and treated as such.

Nail problems may manifest in a number of ways. A nail may show changes like thickening, thinning, abnormal curvature, discoloration, separation, of the nail plate from the nail bed, pitting, formation of grooves, dystrophy, and total destruction of the nail apparatus while the surrounding nail fold (the skin around a nail) may show inflammation. Some of these may be seen in several disorders while some specific conditions like onychomycosis may present two or three of these changes at the same time.

Thickening of the nail plate may be caused by repeated trauma, psoriasis and fungal infection while thinning of the nail plate may be caused by repeated immersion in water, impaired peripheral blood circulation, wearing of artificial fingernails, lichen planus and twenty nail dystrophy.

In very young children, it is common to have flattening of the nails. This condition may be hereditary or it may also be due to iron-deficiency anemia. Correction of the low iron levels will result to normalization of nail. For the fingernails, it usually takes six months for the nail to return to normal while for the toenails, it takes about one year. On the other hand, overcurvature of the nail is usually due to hereditary pincer nails.

Separation of the nail from the underlying nailbed is called onycholysis. It is usually caused by trauma, psoriasis, or fungal infection. It may also be a result of a photosensitivity reaction. Appropriate management for this condition is to cut the nails short, apply medical tape around the finger to cover the nail to prevent it from catching dirt and to avoid cleaning the underside of the nail with a pointed piece of stick or metal as this causes further trauma.

Clubbing of the nail is also considered an important nail change as this may signify chronic lung, liver or heart disease or may be hereditary. Pitting of the nails may be seen on the hand in cases of alopecia areata, psoriasis and eczema. These usually disappear in time once the dermatological problem has resolved, although some persist.

A myxoid cyst, glomus tumor or a growth under the nail may cause longitudinal grooves. Horizontal grooves on the other hand, may be due to an eczema around the nail, habitual ticking of the nail, a severe illness, malnutrition, or a severe form of stress.

Discoloration of the nail can vary from white, red, black, green, and blue to yellow. This may indicate a systemic disease affecting the liver or kidneys, skin cancer or melanoma, bacterial, or fungal infection, hematoma, racial pigmentation, side effect of intake of oral medications or it may mean nothing at all.

Ingrown toenails are common and often very painful. This condition can be due to several factors including hereditary overcurvature of the nail, convex cutting of the nail, wearing pointed toe and high-heeled shoes, fungal infection and occasionally, intake of oral retinoids.

A portion of the nail burrows under the skin surrounding the nail producing swelling, inflammation and pain. Treatment involves antiseptic soaks, topical or oral antibiotics if needed. Patients should be advised to cut the nails in a straight manner and not too short. For recalcitrant cases, simple nail removal can be done but has a 60-70 percent recurrence rate.

Melanoma usually presents initially with a longitudinal pigmented streak on the nail plate gradually involving the surrounding skin before destruction of the nail plate occurs. This rare condition is usually fatal and accounts for 1.5 to three percent of all melanomas. This occurs with equal incidence in blacks, Asians, and Caucasians.

Diagnosis if often made late and the mortality rate is more than 50 percent. Since there is lack of public awareness, mortality remains high. All cases suspected of being nail melanoma should be biopsied. If the streaks affect multiple nails, biopsy may not be performed as this may be due to racial pigmentation. If melanoma is confirmed on biopsy, standard treatment for early disease is digital amputation of the distal phalanx.

In summary, before starting treatment of any nail problem, an accurate diagnosis has to be made. It is important to identify trauma as the root of the problem or as a complicating factor. Protecting a damaged nail from further injury will help in the healing process.

It is important to do a biopsy on any suspicious-looking nail as this is the only tool that could lead to early detection of melanoma. Thus, with all these things in mind, it is important that one sees a dermatologist for any nail problem so that proper evaluation and management can be given.

Rationale : In response to the growing concern regarding the safety and efficacy of GLUTATHIONE, the Philippine Dermatological Society is issuing this position paper

I. Philippine Dermatological Society

The sole authority in the field of dermatology recognized by Philippine Medical Association is the Philippine Dermatological Society. It is composed of members who underwent the prescribed standard training in the specialty of dermatology. There are currently ten training institutions affiliated with the Philippine Dermatological Society. The Society through the Philippine Board of Dermatology certifies the Fellows and Diplomates as specialists in dermatology.

II. Evidence-based Medicine

The universal standard in health care delivery is Evidence-Based Medicine . It seeks to define the practice of Medicine using the best available scientific evidence on any particular health-related issue. Evidence is further classified and ranked according to strength, with testimonial evidence (“this drug works because it cured me and will work for you too”) as weak, while the randomized clinical trials (RCTs) which are controlled, standardized, unbiased studies, rank strongest. Thus, good medicine is defined by good evidence.

III. Glutathione Facts *

What is glutathione?

Glutathione is a compound composed of three amino acids: glutamine, glycine, and cysteine . It is primarily found in body cells. The liver generates most of the body’s glutathione supply.

Glutathione is also naturally found in many food sources. Fresh fruits and vegetable provide high levels of glutathione, but cooking and processing destroy most of it. Glutathione supplements are not normally required because glutathione is so widely distributed in common foods.

What is the role of glutathione in the human body?

Glutathione participates in several cellular and body functions such as antioxidant defense, metabolism, and regulation.

The most well known role of glutathione is as an antioxidant. Glutathione is an efficient scavenger of free radicals and other reactive oxygen species through enzymatic reactions. It is an extra cellular antioxidant, and it is also the main intracellular antioxidant against protein, lipid or enzymatic oxidation.

Glutathione reacts with harmful xenobiotics (synthetic chemicals) and pollutants. It forms soluble compounds with harmful substances, rendering these excretable via the urine, thus detoxifying our body (Guoyao et al., 2004). It is no wonder that diseases such as cancers, neurodegenerative diseases, and AIDS have been associated with depleted intracellular glutathione levels.

What are the commonly available ways to increase glutathione levels in the human body?

Glutathione found in foods are efficiently absorbed in the human intestines. Vitamin C, dietary sources of glutathione and several other nutritional compounds including N-acetylcysteine (NAC), alpha-lipoic acid, glutamine, methionine, and undenatured whey protein can help increase glutathione levels in the body.

In the Philippines, oral and intravenous glutathione are readily available. Researches found no increase in blood glutathione levels after a single oral dose of up to 3,000 mg glutathione to seven healthy subjects (Witschi, 1992). High dose IV glutathione was found to be safe in a study by Bianchi et. al. that evaluated the reduced form (GSH) glutathione kinetics in normal subjects compared to cirrhotic patients (Valencia, 2002)

What are the claims of glutathione distributors?

Claims related to the skin were: whitening, anti-aging, skin rejuvenation. All glutathione distributors claim that their products had whitening effect on the skin. Ninety-five percent (95.5%) had antioxidant effects. Others claimed anti-aging effects by ninety-one (91%).

What is the evidence behind the claims?

Claim No.1: Glutathione supplements or skin products whiten the skin

Glutathione oral supplements and its intravenous form have become very popular because of their reported “side effect – the ‘whitening’ of skin”. Based on animal and human studies (Villarama and Maibach, 2005), glutathione may act by:

• Direct inactivation of the enzyme tyrosinase, necessary in melanin (pigment) production
• Conversion of pigment to the lighter phaeomelanin
• Quenching free radicals and peroxides that contribute to tyrosinase activation and melanin formation
• Modulation of depigmenting abilities of melanocytotoxic agents

However, regarding the efficacy of glutathione supplements, there are:

• No published controlled clinical trials
• No published randomized controlled trials (RCTs)
• One unpublished RCT (Philippines) – company-sponsored clinical trial using IV glutathione; unable to retrieve copy of the study, results unknown
• Numerous anecdotes and testimonials (lowest level of evidence)

Hence, good quality evidence is NOT found

Claim No. 2: Glutathione supplements are anti-aging

• No cohort studies
• No published controlled clinical trials
• No published randomized controlled trials (RCTs)

Claim No. 3: Glutathione supplements rejuvenate the skin

• No published reports

Are glutathione supplements safe?

• No reported adverse effects found
• One review (Uretsky, 2005) stated as a precaution – ‘ sensitivity to any of the inactive ingredients in the preparation of glutathione or the products used to stimulate glutathione levels’

There are anecdotal reports of IV glutathione adverse effects (dermatologist, endocrinologists):

• Erratic blood sugar levels in diabetics
• Recurrence of arthritic pains
• Recurrence of hypothyroidism/hyperthyroidism

The precautions of IV glutathione (distributors’ advice)

• Not for pregnant women
• Not for patients with acute liver problems
• Patients must have eaten prior to infusion

IV. SUMMARY

• The current evidence behind the claims made by distributors is based on
  weak evidence: anecdotal evidence, testimonials, animal studies for efficacy and safety
• Poor quality, published reports of human clinical trials or case reports.

V. RECOMMENDATIONS:

• Glutathione oral (tablet) supplements and intravenous (IV) injection of glutathione currently do not have scientifically proven skin whitening, ‘ anti-aging’ or skin rejuvenating effects. Beware of retailers and distributors who make such claims.
• Intravenous glutathione is considered a drug and should only be purchased and administered upon advice and supervision of a physician.

References

1. * Dofitas BL. Glutathione supplements and the skin. Oral Presentation. UPPGH Postgraduate Course ‘Women’s Dermatology’ March 2008.

2. Guoyao Wu, Yun-Shong Fang, Sheng Yang, Joanne R Lupton, and Nancy D Turner. Glutathione metabolism and its implications for health. J Nutr 2004 Mar;134(3):489-92.

3. Villarama, CD & Maibach HI. Glutathione as a depigmenting agent: an overview. Int. Journal of Cosmetic Science 2005 June; 27 (3): 147-153.

4. Valencia, Erik and Gil Hardy. Practicalities of glutathione supplementation in nutritional support. Curr Opin Clin Nutr Metab Care 2002; 5:321-326.

5. Witschi A, Reddy S, Stofer B, Lauterburg BH. The systemic availability of oral glutathione. Eur J Clin Pharmacol 1992;43(6):667-9.

6. Miko Enomoto T, Johnson T, Peterson N, Homer L, Walts D, Johnson N. Combination glutathione and anthocyanins as an alternative for skin care during external-beam radiation. Am J Surg 2005 May;189(5):627-30; discussion 630-1.

Prepared by:

Lonabel A. Encarnacion, MD, FDPS
Member, PDS Board of Directors

Resource Persons:

Nora R. Cortez, MD, FPDS
Chair, PDS Task Force onTruth in Commercial and Product Advertising

Belen L. Dofitas, MD, FPDS
Chair, PDS Task Force on Health Information & Disease Registry

Approved by the PDS Board of Directors:
Arnelfa C. Paliza, MD, FPDS
President

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