Anabolic Steroids and Weight Gain in HIV Patients

People with HIV suffer from a condition referred to as HIV wasting. This condition is characterized by involuntary loss of about 10% of the total body weight, often coupled with prolonged diarrhea, fever, or weakness. In HIV wasting, the weight loss is attributed to the loss of lean body mass or muscle mass.anabolic steroids

HIV wasting is caused by several factors, one of which is reduced food intake. HIV patients usually consume less food because they have low appetite. Furthermore, the medicines they take also have side effects that make them eat less.

Another factor that causes wasting in HIV patients is that their small intestine, affected by infections brought about by the disease, does not absorb nutrients effectively anymore. Finally, HIV patients experience wasting because their body's metabolism is altered. The disease affects the way their body processes food and builds up protein.

A study conducted in 2005 showed that HIV patients have a chance to gain the weight they lost to wasting. This can be made possible by treating them with anabolic steroids.
The study involved HIV patients with ages ranging from 24 to 42. A total of 294 individuals were given anabolic steroids, which they took for 6 weeks, while 238 individuals were given the placebo. At the end of the study, those who took the anabolic steroids showed weight gain of almost three pounds.

According to medical experts, this amount of weight gained because of steroid intake is clinically relevant. This positive result has birthed the hope that more of the weight lost because of wasting can be regained by longer treatment of anabolic steroids.

Although more research is needed to establish this principle, the result of the study definitely brings good news to HIV patients. Scientists and medical experts have been trying for a long time to reverse the effect of HIV wasting, which can lead to extreme muscle loss and weakness. Wasting can even cause organs to fail and make the patient die more quickly. People with HIV or AIDS suffer from reduced testosterone levels, and their bodies are unable to build muscle mass.

So what are anabolic steroids? These are synthetic steroids that have the same characteristics as testosterone, which is the male sex hormone. They help the body to grow skeletal muscles.

Anabolic steroids have been made largely unpopular primarily because athletes misuse and abuse these products. However, they do have important medical applications and are being used to treat certain medical conditions like low testosterone level for men and anemia. Now this study involving the use of anabolic steroids for the treatment of HIV wasting proves once again that these substances have a significant role in the field of medicine.

In this study, the patients either took the anabolic steroids orally or through an injection. The side effects reported include acne, mood swings, slight increase in growth of body hair, aggressiveness, abnormal liver function tests, and irritability, which are all common manifestations of using anabolic steroids.

More study is needed to confirm if the weight gain caused by anabolic steroid intake will bring about an improvement in the patient's quality of life. Experts also still need to determine how much gain weight translates to a successful result of treatment with anabolic steroids.

Steroid Abuse

What is steroid abuse? Depending on who you ask you will find the answer to this question can vary quite a bit. Defining steroid abuse can actually be very difficult compared to other types of abuse. For example, alcohol abuse is very easy to spot. An individual who drinks all day is going to stick out like a sore thumb, and while some can get away with it for a time eventually the abuse shows through. This is not the case with steroid abuse. Anabolic steroids do not have the ability to alter our mind or perception like alcohol or other drugs.  There is no scientific or medical evidence to support the idea of roid rage. In fact, there is strong evidence that supports it doesn’t exist.

When defining steroid abuse there is really only one definition that makes any sense. If the supplementation of anabolic steroids causes you no harm or anyone around you this is not steroid abuse. If the supplementation of anabolic steroids causes you harm or anyone around you this is steroid abuse. This is the only definition that makes any sense, but unfortunately we have not reached the point to where such sanity prevails.

Signs of Steroid Abuse:
The signs of steroid abuse are more or less the possible side effects of use itself. There are many possible side effects but they are dependent on the steroids being used, the individual’s genetic response as well as on the total dosing. You cannot say if you supplement with X steroid you will in fact fall prey to Y effect. It does not work that way. Internal side effects can include high blood pressure, high cholesterol, and liver damage; however, there’s more to say. A healthy adult who supplements responsibly while putting in some effort to controlling his blood pressure and cholesterol can do so without any adverse effect. This is assuming healthy readings existed before use was undertaken. As for liver damage, only certain anabolic steroids can promote liver stress, but this can also be avoided with educated use.

Beyond the internal effects, there are direct outward side effects that are possible such as gynecomastia (male breast enlargement), water retention, acne, hair loss and body hair growth. Again, gynecomastia and water retention can be avoided even with supraphysiological doses if proper supplementation practices are followed. If the individual avoids such effects as well as maintains a healthy blood pressure and cholesterol reading can this be labeled as steroid abuse? Of course not, and there is no argument to support it being actual abuse. As for the other effects mentioned, such as acne, hair loss and body hair growth, these are largely dependent on genetic response due to the use of steroids with high levels of androgenic activity. Many will not see such effects occur. Others, such as in the case of hair loss may very well find hair loss accelerated if they are predisposed to male pattern baldness. They were going to lose their hair anyway, but the use of steroids may speed it up. When we look at the issue of steroid abuse, any argument or discussion must include this type of relevant information.

How to use Aromasin with Steroids

Estrogen is an unwanted by-product of steroid use. In some tissues of the male body, there is a nasty little enzyme called the aromatase enzyme. This enzyme is responsible for turning testosterone and other male hormones into female ones like estrogen, and estradiol or other girly-like hormones. An abundance of female hormones in the male body can cause a whole list of bad side-effects, like male breast tissue growth and water retention. Bodybuilders use a lot of different drugs and compounds to combat these bad side effects. The best way to keep estrogen from causing problems is to make sure it is never created in high amounts in the first place. Using a compound that inhibits the aromatase enzyme is a sure way to make sure testosterone and other steroids are never converted into side-effect causing estrogen by enzymatic conversion.

A compound that inhibit the aromatase enzyme from creating estrogen is called an aromatase inhibitor, or AI for short. There are a lot of options out there when it comes to AI's (aromatase inhibitors), and Aromasin is certainly one of the most popular options for bodybuilders that cycle steroids for a number of reasons.

Aromasin is a suicidal aromatase inhibitor, which makes it a better choice than other AIs. Exemestane binds with aromatase enzymes and then subsequently permanently disables the enzyme by destroying it.

Aromasin is a steroidal AI which keeps it from negatively affecting your lipids like other non-steroidal AIs. It is also not liver toxic, and can be ran for longer lengths of time without negative effect. This makes it a better option to run on cycle from a pure health standpoint. Aromasin will not hurt your gains on cycle like other AIs, but may actually help them. Another benefit on cycle is that steroidal AIs lower SHBG which increases the ratio of free to bound testosterone. What that means during your cycle is a very positive impact on your gains. This (in a sense) makes your anabolic androgenic steroids more bio-available.

The half-life of Aromasin is only about 9 hours, and clears quickly. However, because of how effective Exemestane is at eliminating aromatase enzymes (80-90% after administration), estrogen levels will remain low up to 72 hours after a single dose of 25mg. This is why Aromasin is very effectively dosed every other day. In one study, users were still 40% below baseline estrogen values 72 hours after their dose. This makes Aromasin very versatile for dosing and not require more frequency.

Now, the place where Aromasin really shines is in post cycle therapy (PCT). There is simply no other Aromatase inhibitor that can compare in terms of its effects on recovery. We already mentioned how Aromasin lowers SHBG, which increases free testosterone. What does that mean? In a study, Aromasin dosed at 25mg per day increased total testosterone by 60% in only 10 days. Even better than that, is the fact that free (useable) testosterone increased over 100% in the same time frame! In addition, Aromasin also increases IGF-1 levels. There is no estrogen rebound from Aromasin, and it is also a very powerful and effective treatment for gynecomastia. All of this makes Aromasin a no-brainer for post cycle therapy as well as on cycle estrogen control.

Could Steroids and HGH end Male Menopause?

As many of us know, ‘getting old’ sucks and although many advancements have been made to prolong our lives in a more functional sense, factually speaking, it would be nice to be twenty five forever. Male menopause is caused when men lose testosterone. As men age, this condition can get worse, varying in different men, but most if not all men, will see a dramatic drop in testosterone. The side effects are horrific and essentially, these effects such as loss of sex drive and fatigue, are why the getting old thing is so awful. So the questions many men may have is it possible to maintain youthful testosterone levels? Currently, the answer to that question is a mixed one varying between yes, maybe, but not quite sure.

 Some obvious solutions could be scheduled injections of anabolic steroids and/or HGH- Human Growth Hormone. Currently, many people have heard of these two examples because of the controversy surrounding the recent major league baseball scandal. Sure, the competitive advantage that such embattled stars such as Roger Clemens and Barry Bonds received because of their use of some of these performance-enhancing drugs is not only unfair, but also ethically challenged. However, should society as a whole look at the use of steroids and HGH as a criminal act, if it can possibly improve the lives of millions, especially aging men? These questions are somewhat difficult to answer because further studies are needed for both of these substances to prove not only efficiency, but also what are the associated risks of ingesting such drugs.

 Some case studies have proven anabolic steroids to be quite dangerous and even if positive results could be acquired from use, it may not be worth it. Some confirmed side effects of steroid use include; “change in behavior “roid rage”, acne, deepening of voice-if ingested by females, muscle damage, heart failure and liver cancer. ” But most of the aforementioned problems have developed while people have been issuing their own personal therapy schedule. It is quite possible, steroid therapy could not only be effective, but healthy even, if done under the proper supervision of a licensed physician.

 Although, this topic, like many others in the unknown medical arena can produce fierce and emotional opinion, it is the belief here that more studies should be conducted on the effectiveness’ of HGH and anabolic steroids. Despite all opinions and observations of case studies, it will be impossible to conclude what benefits maybe derived from such substances if only hypothesized and simple conclusions are allowed to become conciliatory fact in public opinion. There must be a push from organizations such as the AARP-, which “is a nonprofit, nonpartisan membership organization for people age 50 and over or more bluntly ‘aging men’”, for federal research of the possible hormonal benefits these drugs can have. It is quite likely that this research will prove factual some of the already examined case studies and end the debate about steroid and HGH use as a possible positive. However, without a conclusive study that examines in exact detail certain dosages and trials with actual people, then the possible benefits of these drugs for aging males, will never be realized.

 So, like social security, finding a suitable testosterone replacement will become necessary for us males as we age. Therefore, we should demand more research into drugs such as anabolic steroids and/or HGH, or otherwise good luck getting me excited about retiring and “getting old!”

What Are Medical Steroids?

Medical steroids may have a couple of differing definitions. First, they may refer only to steroids that are anabolic or that are similar in composition to hormones like testosterone, which is primarily produced in the male body. In this context, the adjective "medical" is used to differentiate between prescribed steroids and unauthorized steroid use for things like body building or performance enhancing, which are discouraged by the medical community. Alternately, medical steroids could refer to all steroids including corticosteroids that may be used to treat medical conditions.

In this second definition, medical steroids include corticosteroids, which may be used as anti-inflammatory drugs. A number of conditions are treated with corticosteroids including severe asthma, allergies, autoimmune diseases, transplant rejection, and inflammatory bowel or intestinal conditions like Crohn’s disease. Medications like prednisone and budesonide (Entocort®) are some of the most common corticosteroids used and they may be taken orally, injected, or inhaled depending on the condition they treat.

Another common member of the medical steroids that is a corticosteroid is hydrocortisone or cortisol. Hydrocortisone is available in weak strength preparations over the counter and might be used in ointment form to treat minor skin irritations. Higher strengths of this steroid are available by prescription and could be used as skin ointment or in different preparations for many medical purposes.

Sometimes the term medical steroids addresses testosterone based steroids that may be abused. Continued concern about doping with anabolic steroids plagues many types of professional sports leagues and there are some severe consequences that may result from using anabolic steroids without medical need. It is just as important to remark that anabolic steroids have many legitimate uses worth exploring.

Different formulations of anabolic steroids might be prescribed to address conditions where males have low levels of testosterone that creates perpetual problems with energy, mood and/or sexual dysfunction. Some conditions arrest puberty in young males and can be treated with testosterone. Diseases that create body wasting or significant weight loss might also be treated with medical steroids; this is particularly the case when people can’t gain weight due to ongoing illnesses like cancer or HIV.

Administration of any form of medical steroids has risks and benefits. Doctors plan use very carefully so that people do not constantly take either anabolic steroids or corticosteroids, unless it's absolutely needed. Using limited doses may help minimize side effects that in corticosteroids include greater likelihood of infections and in anabolic steroids hazard significant changes in mood, adverse effects to the cardiovascular system, and other side effects. Given these risks, many argue that steroids should always be used medically, and never in non-medical settings.

What Are the Medical Uses of Steroids?

There are two classes of steroids used in medicine. Corticosteroids are drugs derived from the adrenal sourced hormones, cortisol and corticosterone. These hormones affect the immune system by suppressing inflammation. Therefore, drugs such as prednisone affect inflammation. Additionally, anabolic or androgenic steroids are those commonly associated with weight-lifting. These steroids are derived from testosterone-like hormones and cause the body to accumulate muscle mass and rebuild tissues. In medicine, anabolic steroids can be used after a serious injury, like a burn or chronic illness.

Reduce Inflammation
Corticosteroids are used to treat a variety of inflammatory conditions, including but not limited to, chronic asthma and osteoarthritis. The inflammation occurring in these diseases leads to tissue damage, deterioration and increased sensitivity. In the case of asthma, this sensitivity promotes the airways to become over-reactive to allergens, exercise and other stimulants. Increased activity promotes increased bronchoconstriction and asthma attacks. The inflammation of arthritis causes the lining of the joint to become further damaged and speeds the rate of wear and tear. Professor Barnes of the Imperial College of London found that chronic conditions such as asthma unwinds portions of DNA that signal inflammation. Barnes discovered that steroids work by reversing this process, putting unwound DNA back into it wound form.

Pain Treatments
As a result of the powerful anti-inflammatory effects of corticosteroids, they are commonly used to treat pain conditions. The four cardinal signs of inflammation are heat, redness, pain and restricted movement. Therefore, by treating inflammation decreases in pain will result. Generally, when prescribed for pain corticosteroid will be given in low doses and for short terms, as long term steroid use is associated with many side effects. Interestingly, The American Osteopathic College of Dermatology notes that one of the side effects of long term oral steroid use is osteoporosis and a condition known as avascular necrosis. Both conditions can lead to extreme joint pain and an increased risk for fractures.

Treat Autoimmune Disease
Oral corticosteroids are also used in conditions of autoimmunity. These conditions can include inflammatory bowel diseases, scleroderma, lupus or rheumatoid arthritis. In autoimmune diseases, the white blood cells and other immune cells attack the body's own tissues. A 1999 article from the "Australian Prescriber" journal notes that steroids are usually used in high doses for a short period of time to causes a remission or reduce the progression of the disease. The steroids create a short-term reduction in white blood cell counts by either interfering in the way they are recycled or directly killing them.

Weight Gain
Anabolic steroids increase protein building and skeletal muscle mass. A 2000 Annuals of Internal Medicine article notes that wasting syndromes identified in conditions such as HIV/AIDS and end-stage cancer are defined by the word cachexia. Cachexia was described as being an inflammatory event that ultimately leads to muscle breakdown, weight loss not countered by increased food consumption, fatigue, malaise, altered consciousness and bone marrow suppression among many other changes. These changes were described as a hypoanabolic state and the author states that anabolic steroid use may be helpful. When taken with a high protein diet, anabolic steroids increased weight gain.

Prevent Anemia
Anemia results from a deficiency of or inability of red blood cells to properly bring oxygen to the tissues. The production of new red blood cells occurs in the bone marrow and this process is monitored by the kidneys. The kidneys produce the hormone, erythropoietin to signal increased red blood cells production when it senses that the oxygen level in the blood is too low. The 2000 article states that anabolic steroids have been used when the kidneys begin to fail in chronic kidney disease to help stimulate red blood cell production and prevent anemia.

The Mental Side Effects of Steroids

Steroid usage affects not only the body but the mind as well. The mental effects of using the drug can be just as dangerous and even more serious than the side effects that are physical. There is a lot of emphasis on the physical changes associated with steroid usage, and the mental aspects of the drug use is often overlooked.

Psychosis
Psychosis is a break with reality. The steroid user doesn't feel connected with the real world and is instead living and thinking in his own world. In this reality he is all-powerful, invincible and capable of anything. It is in the psychosis state that the violence associated with "roid rage" comes into play. When the power or strength of the steroid user is challenged he will do what he can to defend his honor. The steroid user may not even understand or know what he is doing.

Depression
Depression is a common side effect and can be so severe that it even leads to suicide. Steroid users often use other drugs to combat the many side effects that accompany the use of steroids, like depression. Insomnia is a common side effect, so the steroid user may abuse sleeping pills. Knowing that she is abusing a drug can then lead to depression, which can just deepen the cycle of drug abuse.

Mania
Mania is a feeling of complete euphoria similar to psychosis. During a manic state the user may feel as though he is high. He may also be prone to violence and rash, impulsive decisions. This can negatively effect the social life of the steroid abuser, which can lead once again to depression and abuse of other drugs. In the manic stage, the steroid user may become extremely paranoid about anything and everything. He may feel challenged when no challenge is present. This can lead to violence and loss of social relationships.

Anabolic Steroids may Affect Future Mental Health

The main conclusion of a new study on elite male strength athletes finds that there is a link between use of anabolic-androgenic steroids and reduced mental health later in life. Twenty per cent of the subjects in the study admitted steroid use.

The study is published by CERA, which is the University of Gothenburg's centre for education and research on addiction. Together with colleagues from Sahlgrenska University Hospital, they found a connection between abuse of anabolic-androgenic steroids (AAS) and mental health problems many years later.

The study included almost 700 former Swedish wrestlers, weightlifters, powerlifters and throwers who competed at the elite level sometime between 1960 and 1979. Twenty per cent of them admitted using steroids during their active careers. The purpose of the study was to look for links between AAS use and mental problems.

'We found a clear link. AAS users were more likely to have been treated for depression, concentration problems and aggressive behaviour,' says Claudia Fahlke, director at CERA.

The researchers also found that AAS users were more likely to have abused other illicit drugs and alcohol. However, it remains unclear whether the steroid use actually caused the mental health problems or the mental health problems rather caused the steroid use.

'What we were able to show, though, is that psychiatric symptoms and use of steroids and other drugs tend to reinforce each other in a vicious cycle. This suggests that the anti-doping efforts remain very important, both in and outside of sports,' says Fahlke.

Anabolic steroids global boom in cosmetic use

A competitive spirit is an indispensable aspect of human life, where it could be argued that a failure to compete only results in participating in a competition to fail. Over a very long period of time, humans have relied on various kinds of performance-enhancing substances. It has been suggested, for example, that the ancient Greeks turned to potions to improve performance.

Today, these substances range from “soft” or legal substances such as energy drinks to “hard” substances such as steroids and amphetamines, and other more “natural” methods, including blood doping to increase the number of rich red blood cells in the bloodstream.

In the exercise or athletic world, anabolic-androgenic steroids or anabolic steroids are a very popular performance-enhancing substance. But over the past 40 years they have increasingly been used for aesthetic or “beauty” reasons. This is what we found in a recent study, published in Annals of Epidemiology, that suggested that 3.3% of the world’s population have used anabolic steroids at least once, most of whom were male (around 6.4% of males and 1.6% of females).

The biggest users were in the Middle East, followed by South America, Europe, North America, Oceania, Africa, and Asia. Use was highest among recreational sportspeople followed by athletes, prisoners and arrestees, drug users, high school students, and non-athletes.

Our finding suggests that use of anabolic steroids is now a serious global public health problem. Not confined to athletes, the spread of their use into the general population means millions of individuals across the world, many of whom have no athletic ambitions, are using them to increase and improve their physical strength and appearance.

A recent Australian survey suggested that two thirds of young men who began injecting drugs in the past three years were using steroids (rather than methamphetamine or heroin).
Previous work

Anabolic steroids are a group of hormones that include the natural male sex hormone testosterone and a set of synthetic versions. Early scientific forays into the effects of testosterone included one Harvard professor injecting himself with a “rejuvinating elixr” that included extract from dog and guinea pig testicles in 1889. It wasn’t until the mid-1930s, however, that human testosterone was first “discovered” and then synthesised by Adolf Butenandt and Leopold Ruzicka (independently of each other) in 1939. Both were awarded the Nobel Prize for their work.

All anabolic steroids – natural and synthetic – have two essential results: a “muscle building” effect that results in muscle growth, and an androgenic or virilising effect that results in masculinising characteristics such as deepening of the voice. Anabolic steroids increase the production of protein within cells, which decreases body fat as well as increasing muscle growth beyond natural limits.

Steroids are used in medicine for several purposes including the treatment of male hypogonadism, a condition where the body doesn’t produce enough testosterone and which can limit the production of sperm. It is also used to treat delayed puberty, enhance appetite and stimulate growth.

Many “steroids” prescribed by medics are not anabolic, but corticosteroids which have neither anabolic nor addictive potential. But other people who use these steroids for fitness or aesthetic purposes clearly do it outside of these health reasons.
Spread to general population

Around the 1960s and 1970s, anabolic steroids were mainly used by elite athletes and bodybuilders motivated by the desire to develop bigger muscles and enhance their athletic performance. In the past three or four decades however, millions of non-competitive athletes such as recreational sportspeople and adolescents have been using them, motivated by the desire to look more attractive. This means their use has spread from the athletic community into the general population. While it has been suggested that athletes comprise the smallest group of anabolic users, in our study they were the second biggest.

Until recently, several questions over the global use estimates were largely unanswered. The aim of our study was to estimate the global prevalence of use. Putting together findings from 187 studies (and subject to some limitations such as the paucity of anabolic steroid prevalence research in especially Africa and Asia), we estimate the problem is gradually increasing. Between 1990 and 1999 prevalence was about 2.9% but post 2000, this has risen to 3.2%.
Harmful effects

These findings should attract the attention of global public health officials because of the associated serious harmful effects of long-term use. These include high blood pressure, heart attack, stroke, acne and skin infections, liver damage, tendon rupture, premature baldness, stunted bone growth in adolescents, syringe exchange infections such as HIV and hepatitis, and death. There are psychosocial implications too. Users can become violent or aggressive, cause mood syndromes, and addiction.

There are also other gender-specific effects. In males, these include low sperm count, shrunken testicles, infertility and growth of breasts. In females, these include roughening of the skin, decreased breast size, deepening of the voice, growth of body hair, changes to the menstrual cycle and enlargement of the clitoris.

It has to be noted that the effects and harms of anabolic use are dose-dependent. So higher and longer term use leads to bigger muscles but more harmful effects.
Laying down the law

Since the 1990s there has been increasing legislation to combat the problem. Anabolic steroid use is illegal in the US, the UK, Australia, Argentina, Brazil, Portugal, and Saudi Arabia. Though the US passed their Anabolic Steroid Control Act in 1990, and Sweden the Act Prohibiting Certain Doping Substances in 1991, other countries have been a bit slower – Norway only banned use in 2013. In many places they are unregulated and can be bought in some pharmacies.

An amendment to the US act in 2004 also added prohormones to the list of controlled substances. These substances, a kind of precursor to a hormone (rather than a hormone itself), can amplify the effect of existing hormones.

But as the internet makes obtaining substances easy, even if illegal, it’s clear that better ways of dealing with the problem – and the probable harmful effect on population health – will need to be found.

Anabolic Steroid Treatment In People With HIV

Anabolic steroids are artificial (synthetic) versions of the male hormone testosterone that help build muscle. They also enhance masculine characteristics.

Because they can help the body to form lean muscle, they are sometimes used to treat wasting and weight loss caused by HIV, and doctors sometimes prescribe anabolic steroids to people experiencing fat loss from the limbs because of lipodystrophy. Testosterone supplements are also used to treat low testosterone levels which can develop in people with HIV due to HIV infection, some other infections, anti-HIV drugs and other medicines.
Anabolic steroids are also widely used by body builders and by many people who weight-train at the gym.

Anabolic steroids treatment in people with HIV

The anabolic steroids have been studied as a treatment for wasting caused by HIV, and have been shown to be safe and effective, helping the formation of lean muscle mass. To be most effective, anabolic steroid treatment should be combined with an exercise programme of resistance (weight) training.

Studies have mostly been restricted to men because of concerns about the side-effects of steroid treatment for women.

Anabolic steroids can increase levels of LDL (bad) cholesterol and other side-effects, so their use should be closely monitored particularly if you are taking a protease inhibitor or have any risk factors for heart disease.
Testosterone replacement therapy in people with HIV

It is estimated that as many as 40% of HIV-positive men who are ill because of HIV have low levels of testosterone (hypogonadism). Low testosterone can result in decreased appetite, depression, poor metabolism of food, and sexual problems, including the inability to obtain and maintain an erection.

A blood test can show if you have low levels of testosterone and your doctor may prescribe either a short course of oral testosterone replacement therapy, testosterone patches, or testosterone gel.

Although testosterone is usually considered to be the male sexual hormone, it also occurs naturally in women. Testosterone patches have been examined as a treatment for wasting caused by HIV in women. It was found that weight and quality of life improved for some of the women, and the development of male characteristics was not reported.

Side-effects from testosterone replacement therapy are rare, but can include the shutting down of natural testosterone production, shrinking of the testicles, hair loss, increased sexual desire, and aggression. In women, male characteristics, such as the deepening of the voice, and facial hair may develop.

Types of Steroids – A Complete Guide

No one with a television or Internet access in USA is a stranger to the term steroids or what it means to professional athletes. Major league baseball, professional football, pro wrestling, and professional cycling have all come under the microscope. But what are steroids? What do they do? How do they work? In this guide, we’ll go through the types of steroids that occur naturally in our bodies, what they’re used for when they are synthesized for prescription drugs, and how they work as illegal performance enhancing drugs. We’ll look at a few famous cases of steroid use and abuse, and we’ll also touch on the subtle difference between “doping” and using steroids.

So what are steroids, and what do the different types of steroids do? According to Dr. Benjamin Wedro, MD, two types of steroids occur naturally in the body. Corticosteroids, produced in the adrenal gland, include aldosterone, which helps the body manage sodium content, and cortisol, which aids in our stress response and in controlling inflammation. Corticosteroids are often synthesized and prescribed for topical, aural, or intravenous use to treat inflammation, asthma, rheumatoid arthritis, inflamed bowel disease, and other disorders.

Corticosteroids v. Anabolic Steroids
The other type of steroids, androgenic or anabolic, are testosterone-controlling hormones. They regulate the levels of hormones in the testicles or ovaries. Androgenic steroids control the development of male sex traits, while anabolic steroids control and contribute to the growth of muscle mass. This is why patients undergoing female to male sex reassignment are often prescribed androgenic steroids, but not necessarily anabolic steroids. Anabolic steroids are the most known and most controversial steroids, as they are often synthesized and used illegally by athletes to gain more muscle mass for performance enhancement. Some examples of anabolic steroids are Metribolene, Androstenediol, Methyltestosterone, and 1-Androstenediol, but there are many, many more synthesized anabolic steroids in use both legally and illegally.

Now let’s talk about problems with steroid use and professional athletes. The most recent scandal in the news with an athlete using performance-enhancing drugs is the case of Alex Rodriguez. The famous New York Yankees’ third baseman, known for his amazing record and his brief relationship with Madonna, is now known for his alleged involvement in the Biogenesis doping scandal. According to Michael Schmidt of The New York Times, the anabolic steroid in use in this case was Human Growth Hormone, or HGH. Rodriguez is facing a suspension and penalty fees, but anabolic steroid use can land you in a lot more trouble than that. Sprinter Marion Jones won five gold medals in the 2000 Sydney Olympics, only to have them all stripped from her, and then do subsequent jail time, in 2007 when it was found that she had been doping with EPO (Erythropoietin) and a designer cocktail of anabolic steroids.

It should be noted that EPO is not a steroid, but a blood oxygenator. Athletes who use EPO are said to be “blood doping,” a different form of performance enhancement than steroid use. We have refrained from mentioning the famous scandal surrounding Lance Armstrong and his seven consecutive Tour de France victories because Armstrong was an alleged blood doper, using EPO rather than anabolic steroids. One drug test, however, in 1999 came back with a positive for steroids. Armstrong and his team claimed that this was a false positive, as he’d been using a corticosteroid topical cream to treat skin irritation, which was legal in the sport but could create a false positive.

So, there are two general types of steroid. Both corticosteroids and androgenic/anabolic steroids are produced naturally in the body. Corticosteroids are often synthesized and used for inflammation, while anabolic steroids affect muscle growth. So, when you hear about a friend taking steroids for a bad case of poison ivy, don’t expect her to bulk up and lift a car for you. All performance-enhancing steroids are anabolic steroids. There is a whole range of designer anabolic steroids, but they all boil down to increasing the levels of muscle-building hormones in the body.

Performance Enhancing Drugs

From anabolic steroids to human growth hormone; from SARMS and Diuretics to stimulants and painkillers the world of performance enhancing drugs runs deep and within it there are truly limitless possibilities. Although as most individuals who are familiar with performance enhancing drugs in-terms of real life application, most all will agree it is anabolic steroids and human growth hormone that carry with them the highest level of importance.
Common Performance Enhancing Drugs:

Although there are many and we cannot possibly list them all, there are some performance enhancing drugs that are used far more commonly than others and some that for the most part are mainstays in the enhancing world. This list would include:

    Testosterone
    Stanozolol
    Nandrolone Decanoate
    Methandrostenolone
    Human Growth Hormone

All though many other performance enhancing drugs could have easily made the list the above five are the most commonly used, they carry with them the longest history regarding their use in sports and are generally viewed by the athlete as not only safe options but highly efficient as well.
Why People Use Performance Enhancing Drugs:

On its surface this should be a fairly easy question to answer; they enhance performance. Athletes use them to perform at a higher level, to perform at levels otherwise unattainable. This is pretty easy to understand but it is not what we consider standard athletes that make up the majority of users. Increasingly as the years have past performance enhancing drugs have found a new welcomed home in the hands of the everyday gym rat; the individual who simply wants to look better. They do not compete in any sport, they do not have a contest they are preparing for; they simply enjoy the look performance enhancing drugs can help them obtain.
The Dangers of Performance Enhancing Drugs:

You’ve seen the news, you’ve read the thousands of editorials but sit back and think for a moment; have you ever been given a real piece of information, have you ever heard or seen truly unbiased reporting on the subject? More than likely you haven’t and that is a shame because lies even when painted with good intentions are still lies and they help no one.

The truth is simple, the abuse of performance enhancing drugs can cause health problems; how we define abuse is a difficult measure and is often defined in the eye of the beholder, but too much can be a problem. With most performance enhancing drugs there are risk, as we increase the use by increasing doses or duration we increase the risk. Let’s be clear these risks are possible, they are not guaranteed by any means; many individuals have used performance enhancing drugs their entire lives problem free. Further, and this may be the most important fact of all, as it pertains to the most common group of performance enhancing drugs, anabolic steroids, in the history of their use there has yet to be one single death attributed to their use; no, not one, go for it, try to find one, you’ll be looking until your eyes bleed.

It is without question the legality of performance enhancing drugs that is the main issue. Most all sporting organizations prohibit their use and if you are a member of one of those organizations and you use them then yes, on paper you cheated; we say “on paper” because many of these same sporting organizations really don’t care, their rule is there for show only. The most important aspect of legality surrounding performance enhancing drugs is their actual legal standing in a particular country. In many countries these items are prohibited unless obtained with a prescription for a viable medical reason. Then again, in some countries they are not, if you live in a country where it is legal you can walk right into the pharmacy and walk right out with testosterone in hand. The point, know and understand the law as it pertains to where you live, not doing so will not enhance your performance.

HIV and Weight Loss Treatment

Weight loss in people with HIV has many possible causes. If you lose weight fast, it may be because you have another infection along with HIV. This type of illness is called an opportunistic infection.

Gradual weight loss may be due to problems with nutrition. You may lose weight if you cannot eat enough food or if your body cannot absorb all the nutrients from the food you eat.

HIV Viral Load Testing

The HIV viral load is the number of copies of the human immunodeficiency virus in your blood and other parts of your body. The HIV viral load test involves taking a blood sample from a vein in your arm. The amount of HIV in your blood is then measured. Along with other tests, the HIV viral load test helps monitor your disease, guide HIV therapy, and predict how your disease may progress. Keeping your viral load low can reduce complications of HIV disease and extend your life. Two common test numbers...


Pain in your mouth, from sores or a yeast infection called thrush, can make it hard to eat.

You may not feel like eating because you are sick to your stomach or food just doesn't appeal to you. HIV itself or HIV medicines can cause you to feel this way.

You may not feel like eating because you are depressed. Depression can make you lose your appetite. If you have lost interest in activities you used to enjoy or have other depression symptoms, tell your doctor.

If you have diarrhea, your body may not be able to absorb all of the nutrition from your food.

If you are a man and you have a low level of the hormone testosterone, your body may not be able to turn your food into muscle tissue.

When you lose weight, you lose muscle, fat, or both. Exercising to build muscle and eating healthy foods are part of treatment. Your doctor also may change your medicines or add new ones.

Marijuana has been shown to stimulate the appetite. Talk to your doctor if you're interested in trying it.
Eating healthy

Eating a healthy, balanced diet with enough protein and calories may help you keep weight on. It also can help your immune system stay strong to fight infection.

Your doctor or a registered dietitian can help you make a plan that works for you.

Here are a few tips:

    If you are sick to your stomach or don't feel like eating, discuss your medicines with your doctor. It may be possible to change medicines. Do not change medicines on your own. Always discuss changes in medicines with your doctor, and make those decisions together.
    If you don't feel like eating, eat your favorite foods. Eat smaller meals several times a day instead of a few large ones.
    Drink high-calorie protein shakes between meals. Try nutritious drinks, such as Ensure. Protein or energy bars are another good way to get extra calories between meals.
    If you have diarrhea, eat bland foods like rice, bananas, or bread. Avoid high-fiber foods. Milk products can cause diarrhea for some people who react to the sugar or lactose in the milk. If you have this problem, try lactose-free or soy-based products.
    If you have mouth sores, avoid spicy foods, hot or cold foods, oranges, grapefruit, and other citrus fruits. Stay away from hard or crunchy foods. Use a straw when you drink.
    If you are sick to your stomach, try drinking peppermint or ginger tea.

Exercise may help you feel better and strengthen your muscles. It also may improve your immune system, which can help you fight infection.

Make sure to talk with your doctor before you start your exercise program, especially if you haven't been active for a long time.

Exercise:

    Is safe.
    Improves strength and endurance.
    Improves heart and lung fitness.
    May help you feel less tired.
    Enhances your sense of well-being.

Walking is a good way to get aerobic exercise. Start slowly if you haven't been active. Try 20 minutes a day or two 10-minute walks. Slowly increase your time. Try to walk as often as you can.

Weight lifting also can build your strength. Again, talk to your doctor first, and ask how to start a program that works for you. If you can't get to a gym, you can use soup cans or other things around the house as weights.

Competitive sports do not pose a risk of spreading HIV to other athletes or coaches. In sports in which exposure to blood can occur, the risk of spreading HIV is very small. But if a person, HIV-infected or not, starts to bleed, he or she should leave the game, and the wounds should be covered before the person returns.

Medicines

If you are not already taking antiretroviral medicines, your doctor may want you to start. You may need medicines that increase your appetite or help with nausea.

Hormones, such as testosterone, and anabolic steroids, such as nandrolone, may be used to help build muscle. Growth hormone also may be used.

Steroid Use and Liver Cancer

Although well-documented reports linking steroids to liver cancer are rare, as more athletes use drugs to improve their performance or build their bodies, many types of dangerous side effects from the abuse of anabolic steroids are becoming known — and events are becoming more frequent.

Recently, there have been many instances in the news about famous athletes and performance-enhancing drugs, sometimes referred to as "doping." In most cases, the drugs that are being used are anabolic steroids. These drugs are manufactured steroids that behave like the male hormone testosterone.

Anabolic steroids are male-related hormones that can be used to increase muscle mass. When these drugs are abused they can have many side effects, including liver damage.

Liver Cancer: What Anabolic Steroids Can Treat

Anabolic steroids, under a doctor's prescription, will treat certain conditions in which increasing bone strength and muscle mass are required for health reasons. These medications can be helpful in the following types of cases:

    Delayed puberty
    Testosterone deficiency
    AIDS-related weakness

Liver Cancer: Anabolic Steroid-Related Liver Damage

Liver damage from anabolic steroids can cause a condition called cholestasis. With this condition, bile, a digestive fluid made in your liver, cannot get to where it needs to go and leaks out into your blood. Symptoms include:

    Itching
    Nausea
    Loss of appetite
    Dark urine
    Jaundice — the yellow discoloration of your eyes and skin

Damage to the liver is evident when enzymes called aminotransferases leak out of damaged liver cells into your bloodstream.

Another important point about anabolic steroids: They can be addictive. These steroids can cause steroid craving that leads to the need for more frequent and higher drug doses. Liver damage has been shown to be related to the cumulative effects of higher and more frequent use.

Liver Cancer: Can Anabolic Steroids Cause It?

Dr. Wu says that reports exist showing a slightly increased risk of developing liver cancer with long-term use of high-dose anabolic steroids. However, he says, “the scientific evidence supporting a cause-and-effect relationship is weak.”

But these steroids are known to cause tumors that form in your liver. Called hepatic adenomas, these tumors are not cancerous. However, they are dangerous because they can rupture and cause serious bleeding in the liver. There have been several reported deaths caused by bleeding from ruptured hepatic adenomas. The link between hepatic adenomas and anabolic steroid use in athletes is increasing. Recently, a case of a hepatic adenoma turning into liver cancer was reported.

Liver Cancer: Anabolic Side Effects

While there is not a strong link between liver cancer and anabolic steroids, there is strong evidence for serious liver damage. Other side effects of anabolic steroids include:

    High blood pressure
    Increased levels of bad cholesterol
    Mood swings
    Aggressive behavior
    Infertility in men
    Menstrual abnormalities in women

If you are an athlete or a body-builder and you are tempted to use anabolic steroids, consider that besides the legal and social risks involved, these drugs can and do cause life-theatening medical complications.

How Safe Are Steroids for Psoriasis?

Chances are that steroids for psoriasis have been part of your treatment plan for relieving scaling and inflammation and improving cell turnover, at least at some point in time. Doctors commonly recommend steroid sprays, lotions, ointments, and creams to help when psoriasis flares. Topical steroids remain a mainstay of treatment for inflammatory skin conditions, including psoriasis. However, as effective as they may be for some people, there are risks associated with long-term use, especially if the medications are not used properly.

Corticosteroid Safety: Potential Side Effects
As helpful as they are, corticosteroids for psoriasis do come with a lot of baggage in the form of side effects. Your health care provider can help you weigh the risks versus benefits for your individual needs.

Side effects are dependent on the potency of steroid being used — low potency, medium potency, high potency, highest potency — as well as the site of application.

Possible side effects include:

Resistance to treatment. Steroid treatments that work initially may lose their effectiveness over time as your body develops a resistance to them.

Skin damage. Topical corticosteroids can wreak havoc on your skin. An ultrasonographically detectable decrease in skin thickness can occur after a single application of a very potent topical steroid. Thinning of skin, called atrophy; loss of elasticity resulting in stretch marks; easy bruising; and dilated surface blood vessels are potential risks associated with steroid use. These side effects can occur even when low-potency topical steroids are used. Skin changes that are mild typically reverse when you stop using steroids, but more visible changes in skin texture can be permanent.

Systemic side effects. When steroids are absorbed into the skin, you run the risk of them affecting internal organs. This can occur when steroids are applied to large areas of skin, are used for long periods of time, or involve excessive use of occlusion -- covering the affected area with a dressing after applying medication to increase its effectiveness and absorption. According to Michocki, potential systemic side effects include salt and water retention resulting in increased blood pressure, edema, worsening heart failure, hypokalemia (low potassium in the blood), glucose intolerance with worsening diabetes, osteoporosis, aseptic necrosis (localized death of a portion of bone caused by poor blood supply to the bone), increased risk for infection, and ultimately development of Cushing’s disease from too much cortisol and adrenocorticotropic hormone (ACTH). Cushing’s disease has a long list of complications of its own, such as diabetes; high cholesterol; increased risk for heart attack; osteoporosis; and damage to eyes, kidneys, and nerves from high blood sugar.

Anabolic steroids help people with HIV put on weight and muscle mass

People with HIV who are treated with anabolic steroids to prevent AIDS wasting may realize modest gains in weight and muscle mass, a new review shows.

The review covered 13 studies of adults age 24 to 42 with HIV, 294 of whom received anabolic steroids for at least six weeks and 238 of whom received placebo. The average weight increase in those taking anabolic steroids was nearly three pounds.

“The magnitude of weight gain observed may be considered clinically relevant,” said lead author Karen Johns, a medical assessment officer from the agency Health Canada. “One hopes there would be greater weight gain with the long-term use of anabolic steroids; however, this has not been proven to date in clinical trials.”

The review appears in the most recent issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

AIDS wasting, which leads to significant weight loss in people with HIV, causes severe loss of weight and muscle and can lead to muscle weakness, organ failure and shortened lifespan. Researchers have long sought to reverse this common, destructive effect of HIV with mixed success.

The wasting stems from loss of the body’s ability to grow muscle and from low levels of testosterone.

Anabolic steroids are synthetic substances similar to the male sex hormone testosterone that promote growth of skeletal muscle and the development of male sexual characteristics.

Although most recently in the news for their misuse by professional athletes, anabolic steroids have legitimate medical application for men with low testosterone and people with certain types of anemia. Two anabolic steroids available in the United States, nandrolone decanoate and oxandrolone, have been used to help increase weight and muscle mass in small studies of people with wasting.

Conversely, anabolic steroid use has been associated with increased rates of HIV in those who share needles or use nonsterile needles when they inject steroids.

In the review studies, anabolic steroids were administered to patients either orally or by injection. The main side effects were mild and included abnormal liver function tests; acne; mild increase in body hair; breast tenderness; increased libido, aggressiveness and irritability; and mood swings — all common side effect of anabolic steroid use.

“The risks and side effects of taking anabolic steroids long-term are certainly of concern,” Johns said. “We were unable to assess these risks in our review due to the short duration of treatment in the studies.”

Wayne Dodge, M.D., the HIV/AIDS program director at the Group Health Cooperative in Seattle, suggests that clinicians should obtain blood testosterone levels, “if an HIV-infected individual has had significant weight loss, significant fatigue or muscle wasting, and particularly if associated with a significant decrease in libido and erections. If [testosterone] is in the low or low-normal range then a trial of [steroids] could be tried. The individual and the clinician should decide what result would constitute a successful trial: weight gain of 15 pounds, a 30 percent improvement in sense of well-being [or] a successful erection once a week.”

The reviews authors conclude that further studies are needed to determine if increase in weight leads to improved physical functioning and quality of life, and ultimately increased survival, as well as the potential for serious side effects, especially with prolonged use. 

Anabolic steroids and HIV

Anabolic steroids are artificial (synthetic) versions of the male hormone testosterone that help build muscle. They also enhance masculine characteristics.

Because they can help the body to form lean muscle, they are sometimes used to treat wasting and weight loss caused by HIV, and doctors sometimes prescribe them to people experiencing fat loss from the limbs because of lipodystrophy. Testosterone supplements are also used to treat low testosterone levels which can develop in people with HIV due to HIV infection, some other infections, anti-HIV drugs and other medicines.

Anabolic steroids are also widely used by body builders and by many people who weight-train at the gym.

Anabolic steroid treatment in people with HIV
The anabolic steroids have been studied as a treatment for wasting caused by HIV, and have been shown to be safe and effective, helping the formation of lean muscle mass. To be most effective, anabolic steroid treatment should be combined with an exercise programme of resistance (weight) training.

Studies have mostly been restricted to men because of concerns about the side-effects of steroid treatment for women.

Anabolic steroids can increase levels of LDL (bad) cholesterol and other side-effects, so their use should be closely monitored particularly if you are taking a protease inhibitor or have any risk factors for heart disease.

Testosterone replacement therapy in people with HIV
It is estimated that as many as 40% of HIV-positive men who are ill because of HIV have low levels of testosterone (hypogonadism). Low testosterone can result in decreased appetite, depression, poor metabolism of food, and sexual problems, including the inability to obtain and maintain an erection.

A blood test can show if you have low levels of testosterone and your doctor may prescribe either a short course of oral testosterone replacement therapy, testosterone patches, or testosterone gel.

Although testosterone is usually considered to be the male sexual hormone, it also occurs naturally in women. Testosterone patches have been examined as a treatment for wasting caused by HIV in women. It was found that weight and quality of life improved for some of the women, and the development of male characteristics was not reported.

Side-effects from testosterone replacement therapy are rare, but can include the shutting down of natural testosterone production, shrinking of the testicles, hair loss, increased sexual desire, and aggression. In women, male characteristics, such as the deepening of the voice, and facial hair may develop.

Anabolic steroid use for non-medical purposes
Anabolic steroids are often used by people who weight train to improve the effects of training and for aesthetic reasons. They are usually used in four-week cycles, followed by a period off 'treatment'.

The use of anabolic steroids in this way is rarely medically supervised, and this may involve health risks.

Health risks of anabolic steroid use
Anabolic steroids, and testosterone, can damage the liver, and severe liver problems including liver fibrosis, cirrhosis and cancer have been seen in long-term users of anabolic steroids. If you are being prescribed them by your doctor, your liver function will be closely monitored.

Acne, male pattern baldness, sexual dysfunction, shrinking of the testicles, and the shutting down of natural production of testosterone can also be caused by anabolic steroids. Aggression, mood disturbances, stomach pain, an enlarged prostate and water retention can also develop as a consequence of steroid use. Breast enlargement in men, and the development of male characteristics in women have also been observed.

It you are buying steroids on the 'black' market it’s unlikely that you can verify if they are genuine or be certain of their quality. Counterfeit steroids are common and may contain impurities that cause infections or abscesses.

When used in a non-medical context, anabolic steroids are often injected. Sharing needles to inject steroids involves the same health risks as sharing needles to inject recreational drugs, including HIV transmission, and infection with hepatitis C virus and hepatitis B virus.

Legal status of anabolic steroids
Anabolic steroids are a prescription-only medicine. Although possession of anabolic steroids is not illegal, selling them is and can involve a fine and even a prison sentence.

If you take part in any form of competitive sport, then it’s likely that the use of anabolic steroids will be banned, even if you are taking them for legitimate medical reasons.

Infected eczema: Diagnosing, Treating, Prevention of Infection

What does infected eczema look like?
Infected atopic eczema looks red and angry, and is usually ‘weepy’ with a yellowish crust. Yellow pus-filled spots may also be present and small red spots around the body hairs (folliculitis). The skin feels hot, itchy and sore, which leads to more scratching. Scratching damages the outer layers of the skin and creates cracks allowing more bacteria to grow.

Occasionally the glands may swell and there may be an enlargement of lymph nodes in the neck, groin and armpits. Lymph nodes filter out bacteria and stop them from entering the bloodstream. Swollen lymph nodes can be tender to the touch. Infection should always be suspected if the eczema suddenly worsens or does not respond to emollient or topical steroid treatment.

Candida appears red, itchy and sore and there may also be tiny yellow pustules.

Eczema herpeticum produces small blisters, containing clear fluid or yellow pus, which break open and ulcerate the skin. Mild attacks are fairly common but in more serious cases, the virus spreads quickly on first infection. A high temperature and a general feeling of being unwell usually accompany it.

This form of eczema herpeticum is very dangerous and it is essential to contact a doctor immediately and to ask him or her if the symptoms could be eczema herpeticum.

Diagnosing Infection
Dermatologists, dermatology nurses and general practitioners with a special interest in dermatology may be able to tell if eczema is infected just by looking at it. Patients who have already experienced infection are also likely to recognize the signs and symptoms.

However, it is not always clear if eczema is infected, which can make diagnosis difficult. Your doctor may take a swab from the skin to be sent to the microbiology laboratory. This is a quick, painless procedure and can help to confirm what is causing the infection and can also show what antibiotics should be effective as treatment. Skin swabs frequently show the presence of Staph. aureus on the skin, but may also reveal additional bacteria called streptococci.

Treating Infected Eczema
Treatment depends upon the type of infection. Staph. aureus can be treated in several ways. For mild infections emollients and topical steroids, together with a bath oil containing an antiseptic may be sufficient. Sometimes a combination cream or ointment may be prescribed.

Combination creams and ointments contain both a topical steroid to help combat inflammation and an antibiotic to fight the infection. If the eczema is heavily infected, oral antibiotics may be prescribed that help to quickly bring the infection under control, but it is important to continue to use emollients to help restore the skin barrier.

Antiviral drugs such as acyclovir are used to treat eczema herpeticum orally, by injection or in the form of a cream or ointment. If the eczema herpeticum is severe, a few days in the hospital may be needed to get the infection under control.

Candida is usually treated with an antifungal cream that can be prescribed by your doctor or dermatology nurse or bought over the counter from a pharmacist.

Using a medicated shampoo or an anti-yeast shampoo can treat Pityrosporum ovale on the scalp but will depend on the severity of the eczema. These shampoos are available from pharmacies. Several antifungal creams, with or without a mild steroid, are available to treat seborrheic eczema on other parts of the body.

There is no specific medicine to clear molluscum contagiosm. It is up to the body’s own immune system to get rid of the infection and unfortunately this can take months.

Infection and Your Other Treatments
Eczema patients who are using the topical immunomodulators Protopic and Elidel should not continue to use them if their eczema becomes infected. Speak to your doctor if you are using these products and suspect that your eczema may be infected.

Never use wet wrap bandages with infected eczema, as the moist, warm environment created by wet wraps is a perfect breeding ground for bacteria.

If your eczema is infected and you normally use emollient ointments, it may be worth asking your doctor to consider prescribing in addition an emollient cream to use some or all of the time while the infection persists. This is because in some people the ointment – which is occlusive – can also ‘trap in’ the infection.

Whatever emollients you are using, remember that it is easy to spread infection – both on your own skin and your child’s skin – and also to pass it from one person to another.

Pump dispensers reduce the risk, as does good hand hygiene before and after putting on emollients. If you do not have a pump dispenser, use a clean spoon to take the emollient out of the pot, rather than using your fingers.

Prevention of Infection in Eczema
Restoring the skin’s barrier to infection, be reducing dryness and cracking will help to reduce the entry points for bacteria. Intensive emollient therapy, with moisturizing creams and ointments, soap substitutes and emollient bath oils are essential. Daily baths and showers can help to prevent infection.

If someone in the family has a cold sore, it is important to refrain from sharing towels and face cloths. Ensure that you change bed linen regularly and wash it in a hot wash.

Even if you take preventative measures it is not always possible to stop eczema becoming infected. However, by treating with the most appropriate medication, the infection can be cleared and the eczema can be kept under control.

Infection and Eczema

We all know that eczema is not infectious – one of the UK National Eczema Society’s messages for very many years. Damaged skin is vulnerable to infection, however, and infected eczema is one of the most common issues raised with the UK National Eczema Society’s helpline. In this article our information team looks at why this might be and what we can do about it.

Broken skin provides an environment where micro-organisms can flourish. As a result, skin infections are not uncommon. Infections may be bacterial, fungal or viral.

Bacterial Infection
Atopic eczema is most often infected by a bacterium called Staphylococcus aureus, which makes the eczema worse and slower to heal. Staph. aureus is found on the skin in less than 10% of healthy individuals.

By contrast, almost everyone who has atopic eczema will have Staph. aureus on their skin somewhere, even thought their skin may not show signs of infection. It is not clear whether the bacteria migrate from the active eczema to areas of skin without eczema or whether people with atopic eczema are simply more susceptible to Staph. aureus colonization than those without eczema.

Colonization is not normally a problem unless the skin is broken. Infection occurs only when the bacteria penetrates the skin’s barrier.

It is likely that people with atopic eczema have an impaired ability to deal with infection. In addition, as we know all too well from practical experience, eczema itches and the natural responses to itch is to scratch. This in turn causes the skin to crack and split and become red and inflamed, warm and moist – a perfect home for bacteria.

This is made worse by the itch-scratch-itch cycle and the vicious cycle that follows. It is also possible that the dry skin of atopic eczema is deficient in certain fatty acids, which may encourage the growth of bacteria.

Viral Infection
The major virus that causes problems in people with eczema is the herpes simplex or cold sore virus. Many people who do not have eczema catch herpes simplex in childhood. It is usually very mild, causing a few mouth or gum ulcers that may not even be noticed.

Our bodies become immune after a first infection by herpes simplex – you tend not to catch it from anyone a second time.  However, your own initial virus can become active again causing small, itchy blisters that quickly form a cold sore. This is how herpes simplex usually affects people who do not have eczema.

Herpes simplex is highly contagious and can appear as genital inflammation or conjunctivitis as well as cold sores. For people with eczema, the herpes simplex virus can be much more serious, probably because they have a lowered resistance to viruses. People with eczema should avoid skin-to-skin contact with anyone who has herpes simplex as this virus can infect eczema, giving rise to a condition called eczema herpeticum, which can cause serious illness.

Many children get molluscum contagiosum, but it may be slightly more common in atopic eczema sufferers. Molluscum contagiosum appears as small, smooth, red or flesh-colored bumps, each with a tiny dimple in the center. They often develop on eczema-prone areas such as skin folds behind the knees.

The condition often becomes red and crusted when the body’s immune system is starting to fight against it. This can look alarming, especially if surrounded by eczema, but is in fact a good sign and means that the molluscum contagiosum will clear up soon.

Fungal Infection
Candida or ‘thrush’ is a yeast or ‘fungal’ infection that may develop on skin with eczema, but can also appear on the skin of people without eczema. Candida likes warm, moist folds of skin such as the groin, under the arms and breasts or around the diaper area in babies.

Pityrosporum ovale is also a fungal infection, from the yeast pityrosporum, and can be found on the skin of people with seborrheic eczema. It likes to live where a lot of sebum (the body’s natural grease) is produced – for example, scalp, chest, ear folds and groin. Pityrosporum ovale may well be responsible for seborrheic eczema developing in many people. 

Fungal Meningitis and Steroid Injections

A new disease has been identified by the U.S. Centers for Disease Control and Prevention (CDC). The disease is fungal meningitis caused by fungal-contaminated steroid injections. The disease is linked to a treatment known as epidural steroid injections, a treatment designed to reduce pain and inflammation in a person's back.

Fortunately, fungal meningitis is not contagious. However, in September, the CDC reportedly suspected many more individuals would be detected with fungal meningitis because of the potentially long period of time before some symptoms develop and the large number of exposed patients. This has proven to be accurate because the number of people who have been diagnosed or died has approximately tripled since the CDC first stated its suspicions about detectable infections and deaths. In addition, 10 patients have had peripheral joint infections develop (for example, knee, shoulder, hip, and elbow) but no deaths have been associated with these joint infections to date.

There are now five aspects of fungal meningitis infection that are concerning. First, the infection may take a long time (from two to 28 days; some may take even more time) to begin to develop the symptoms listed above. Second, several of the patients developed strokes due to the infection; and third, the steroid medications suppress inflammation and may make the individual more susceptible to infectious agents. Fourth, fungal meningitis is difficult to treat and usually requires at least two antifungal drugs given intravenously over an extended time period (months). The last or fifth aspect is that a number of patients treated for fungal meningitis may return with an epidural abscess. Consequently, compounded drugs, especially those containing steroids that are contaminated with fungi or bacteria, are likely to be difficult to both diagnose and treat.

Drug compounding centers are not regulated by the high standards that drug producers must meet. Most compounding centers are regulated by state agencies and not by the stricter FDA rules that are applied to drug producers. This current outbreak of fungal meningitis, joint infections, and other infections such as epidural abscesses related to products used to treat patients is likely to change this "oversight or regulation" situation. Currently, several high-ranking politicians are demanding stricter regulations be set up for drug-compounding companies. The FDA commissioner, the NECC cofounder, and the director of the Massachusetts Board of Registration in Pharmacy are scheduled to meet with a congressional panel on Nov. 14, 2012. Confidence in compounded drugs can be brought back to the many doctors and patients who need to use them only if such incidences of contaminated drugs from compounding centers are substantially reduced or eliminated.