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Foot Scrub in Skin Care Products Foot Scrub in Skin Care Products Price Range Under $10 $10 - $30 Over $30 More Brand Barielle St. Ives Masada Freeman Zia Natural Archipelago Botanicals L'occitane More Popular Skincare Products Origins Sole Searcher Skin Type Dry Skin Care Components Peppermint Apricot Tea Tree Eucalyptus Aloe Lavender Minerals More Skin Care Product Features Exfoliates Softens Natural Smoothes Moisturizes Nourishing Cleanses More Stores ABC-Pharmacy-Wholesale Drugstore.com Sephora.com Perfume Bay Bath and Body Works CosmeticMall.com The Body Shop More Products per page: 15 30 60 120 Sort by: Best Match Price Low-High Price High-Low Product Rating Store A-Z Store Z-A 1 2 3 4 Next > Product Title Store Price St. Ives Apricot Hand & Foot Scrub - 4 oz SKU NUMBER: 738872.The Mininimum EXP date on product: 1year.DESCRIPTION... ABC-Pharmacy-Wholesale This store is not yet rated. 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Pediatric Rheumatology Online Journal rcarter PEDIATRICS 2 17 2003-04-23T20:30:00Z 2003-04-23T20:30:00Z 3 1353 7715 University of Chicago 64 15 9474 9.2720 MicrosoftInternetExplorer4 Clean Clean In the current issue: Calinosis in Juvenile Dermatomyositis B isphosphonates in the Pediatric Rheumatic Diseases Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection Review for the Primary Care Physician: Kawasaki Syndrome CD154 and Lupus CASE DISCUSSION-JUVENILE DERMATOMYOSITIS CASE HISTORY A6 year old female child is brought to your clinic with a 3 month history of ared rash on her knuckles. It had beenseen 2 months before by a family doctor who diagnosed a contact allergy andprescribed a corticosteroid cream. Therash has persisted and recently worsened. She has stopped riding her bike and now is having trouble climbing thestairs at home. Her father has had tohelp her walk in the afternoon due to leg pains and has even carried her in hisarms. Her parents have noted a fever of38.5-39 degrees Centigrade on three occasions in the past month. She has developed a rash on her cheeks. She has choked on a piece of hamburgerrecently. Initialphysical examination reveals a child with a red macular rash on her cheeks andeyelids. She has red papules on all ofher MCP's and PIP's and abnormal nailfold capillaroscopy. Her right knee is swollen. She cannot do a situp or hold her head upagainst gravity. She has a nasal speechpattern and a positive Gower's sign. She is admitted immediately to yourhospital. She is noted to have troublewith her secretions and has a decreased tidal volume. Issues: 1) What workup would you perform? 2) What treatment would you initiate? 3) What prognosis would you discuss with the parents? 4) What tests and/or outcome parameters would you followto measure disease activity? 5) What would be your 2 year plan of treatment? DISCUSSANT #1 Onadmission, we would like to get an insight in the severity of thedermatomyositis of this six-year-old. Clinically, the skin manifestations are present, with the typical facialrash and the Gottron's papules, together with other signs of cutaneousvasculopathy. Muscle involvement is alsoprominent with progressive proximal and distal muscle weakness, difficultiesswallowing and an altered speech. In ourdepartment, the degree of muscle involvement is assessed by isometric handhelddynamometry (HHD), the Childhood Mysositis Assessment Scale (CMAS) andendurance, which is tested by a maximal exercise test using a motor-driventreadmill. Diseaseactivity is assessed biochemically by a full blood count, erythrocytesedimentation rate and especially by the elevation of muscle enzymes as CK,LDH, AST and APT. An immunologicalworkup includes determination of ANA, extractable nuclear antigens andmyositis-specific autoantibodies. There is an ongoing discussion about the needfor a muscle biopsy, performed under general anesthesia, to confirm thediagnosis, especially in patients with an impaired lung function. A STIR MRI with fat suppression can bescheduled in order to determine the degree of muscle involvement. To assess the involvement of other organsystems, a cardiac ultrasound is planned, together with an esophageal manometry,especially in the case of difficulties swallowing. Examination of stool, todetect occult bleeding, and a urine sedimentation has to be done. An abdominal ultrasound is performed todetermine the size of the liver and spleen and the state of the abdominalvessels. To exclude retinal vasculitis, a fundoscopy is scheduled. As soonas possible, treatment should be initiated. The symptoms of this girl are indicative for a more severe disease, withevidence of vasculopathy and decreased muscle strength. At present, the initial therapy is prednisone2 mg/kg/day orally in combination with calcium and vitamin Dsupplementation. For more severedisease, as in this patient, we should advise to give steroids intravenously inmultiple daily doses, because of the possibility of impaired abdominalabsorption due to vasculitis. In severe,life-threatening disease, intravenous methylprednisolone pulse therapy (15-30mg/kg/dose for 3 days) is thought to induce a rapid improvement of severedysphagia, myocarditis and in individuals who have rapidly worsening muscleweakness. As a cut-off value, weconsider a CMAS score below 24, being 45% of optimal performance, as a risk fortrauma such as tripping over, falling without protection of arms, aspiration,etc. When the initial treatment withsteroids appears to be ineffective after 4 weeks or if we are not able to taperoff the prednisone, a second line immunosuppressive agent should be added. Use of methotrexate (MTX) early in thedisease is currently first choice, with a dosage of 1mg/kg intravenously, onceweekly. We avoid subcutaneous orintramuscular administration because we consider this administration a risk forinducing ulceration or calcifications. When using MTX, potential adverse effects such as photosensitization,oral ulcers or opportunistic infections should be monitored. The initial response usually occurs between 4to 8 weeks after starting this therapy. Intravenous immunoglobulin has been reported to have benefit incombination with the ongoing treatment in resistant disease, however iv immunoglobulin therapy is very expensive and not evidence based . As important as the pharmacologicaltherapy, is the physical therapy program to preserve, and if possible, improveexisting muscle function, to prevent disuse atrophy, to avoid jointcontractures and to restore the aerobic capacity of the chronically illchild. In the early phase of thedisease, it is sufficient to encourage children and parents to maintain ADL,because of serious risk of inflicting trauma to an inflamed muscle whenstretching in an active phase. In ourPhysical Therapy Department, special programs, including aquatic training, areimplemented after the initial phase of muscle edema and general malaise with emphasis on muscle flexibility. Inthe discussion with the parents, the severity of the disease has to be stressed.We would explain that JDM is a rare, mostly chronic disease, with an unknownetiology. The prognosis has improvedsince the start of corticosteroids and other immunosuppressive agents. The course of the disease is difficult topredict, but is known to have a long course with remissions and exacerbationsor, in some cases, a chronic course with a severe debilitating morbidity. The presence of dysphagia, dysphonia,cutaneous vasculitis and severe decreased muscle strength are indicators ofserious disease. We would discuss thatthe use of immunosuppressive therapy is warranted and that this can haveconcomitant side-effects, which would be followed-up and treated ifnecessary. Finally, the possibility ofcalcifications should be discussed, with a decreased frequency due to earlyaggressive treatment. In thebeginning of the treatment, the girl will be admitted in order to assess theresponse to the treatment and to start physical therapy. The global assessments of the patient andphysician, which each integrate a number of facets of disease activity fromdifferent perspectives play a major role in assessing the therapeutic responsein combination with the more objective parameters as discussed before. In case of unsatisfactory response to thesteroids, second line agents will be added to the therapy. Prednisone dosage is tapered after 4 to 6 weeks, to avoidsteroid myopathy. In the course of thedisease, disease activity will be followed clinically on regular outpatientclinic visits, as well as by laboratory measures and assessment of the muscleparameters. It is well known that muscleenzymes and BSE can be normal even in active disease, so these are no perfectparameters during follow-up. It has beensuggested earlier to measure von Willebrand factor antigen to assess the degreeof endothelial inflammation, but we think it is not helpful in evaluating thedisease activity in an individual patient. Muscle strength, muscle function and endurance can be assessed in timein a quantitative manner. Whenindicated, the tests to exclude other organ involvement, discussed earlier, arerepeated. The aim is to taper the steroidsfurther, to a minimal dose. Then, in thecase of stable disease, the MTX treatment can also be diminished. Part 2 Two years later the rash is stillactive but the muscle strength and muscle enzymes are normal. The child has developed sheets of calciumdeposits in her forearms and arms. Issues: 1) In general, would you treat aggressively with immunosuppressives if the rash is active but the muscle strength isnormal? 2) How would you address the calcification problem? Answer First it is important that all themuscle modalities [muscle strength as well as (an-) aerobic performance] andmuscle enzymes are normal. Then, we would not treat the skin manifestationsaggressively if there is no indication of severe cutaneous vasculitis. Usually,we start with hydroxychloroquine at an oral dose of 5 mg/kg/day. Monitoring is needed for potential retinal toxicity. Regularlywe treat the skin locally with a cream based on corticosteroids but there are new interesting developments for local treatment like a cream based on FK-506(tacrolimus). Until now, there is not enough evidence for thislocal treatment. For the treatment of calcifications there are no controlledtherapeutic trials, and there can even be a spontaneous, unpredictable regression. We suggest to start treatment with the oral calcium antagonist Diltiazem, at a dose of 2 mg/kg/day,increased to 5 mg/kg/day after 3 to 4 weeks. The therapeutic effect is expected after several months. In case of severe calcinosis, a combinationtreatment with bisphosphonates is started. Oral alendronate (< 1 m 2 BSA: 10 mg/day; > 1 m 2 BSA: 20 mg/day) can be added to the therapy with control of serum levels ofcalcium, phosphorus, alkaline phosphatase and theurinary calcium/creatinine ratio. Elisabeth Elst 1 , Annet vanRoyen 1 , Janjaap van der Net 2 , Wietse Kuis 1 Departments of Pediatric Immunology 1 and Pediatric Physical Therapy 2 , Wilhelmina Children's Hospital University Medical Centre Utrecht , the Netherlands . References 1.Pachman LM. Juvenile dermatomyositis. Pathophysiology and disease expression. Pediatr Clin North Am 1995 ;42:1071 -98. 2.Ramanan AV, Feldman BM. Clinical features and outcomes of juveniledermatomyositis and other childhood onset myositis syndromes. Rheum Dis Clin North Am 2002 ;28 (4):833-57. 3.Takken T, et al. The physiological and physical determinants of functional abilitymeasures in children with juvenile dermatomyositis. Rheumatology 2003 ;42:158 -62. 4.Reed AM, Lopez M. Juveniledermatomyositis. Recognition and treatment. Pediatr Drugs 2002 ;4 (5):315-21. 5.Oliveri MB et al. Case Report : Regression of calcinosis during diltiazem treatment in juvenile dermatomyositis. J Rheumatol 1996 ;23:2152 -55. DISCUSSANT #2 INITIAL INVESTIGATIONS: To assess thedegree of muscle involvement, a formal muscle assessment is important. This centre uses the childhood myositisassessment scale (CMAS), as well as the MMT8 (eight muscle manual testing)pending validation of these scores. An MRI of thigh muscles will provideevidence of inflammatory changes in the fat, fascia and muscles. An open biopsyis performed in this hospital, though it may not be necessary for diagnosticpurposes if the MRI is abnormal. A needle biopsy is not advisable because ofthe small sample and, as the disease is often patchy, it may be normal. Musclebiopsies stained by conventional histopathology techniques may be normal inearly disease with very few/no inflammatory cellular infiltrates present. Sheshould also have a Child Health Assessment Questionnaire (CHAQ) to assess herfunction and quality of life(to be filled in by her parents). The blood work up should include full bloodcount, ESR, CRP, muscle enzyme such as creatinine kinase and LDH, U&E's,LFT's, ANA, ENA, and if possible specific auto antibodies (such as Jo 1 andRMP), to exclude overlaps and other rare muscle diseases. Her nasal speech may be associated withswallowing difficulties and a video fluoroscopy is advisable. Assessment of other organ involvementincludes pulmonary function and chest radiograph. If abnormal, a highresolution fine-cut CT scan is needed to delineate any inflammatory lungdisease (ILD). TREATMENT: IV m ethylprednisolone, at 30mg per kiloper dose on day one, two and three is our current practice to achieve animmediate and sizable anti-inflammatory response. This may be repeated thefollowing week. In between the IV m ethylprednisolone, she should have0.5-1mg per kilo orally of Prednisolone. If the child did not responddramatically to the IV MP, or there is evidence of malabsorption or GIvasculitis (symptoms such as abdominal pain), the equivalent dosage ofprednisolone should be given as MPIV. A switch to oral administration will belater, once the symptoms improve (usually after 1-2 weeks). For medium tolong-term control of disease activity, methotrexate is given sc afterdiscussion with the parents, the child, and the primary care physicians. Thestarting dose given here is 15mg per m 2 . If the CT scan showed any signs of lungabnormalities (alveolitis or fibrosis), IV Cyclophosphamide at 500-750/m2 andat monthly intervals for the first six months is advisable as well asmethotrexate. PROGNOSIS: With this child one should discuss thespectrum and the disease course for dermatomyositis (unicyclic, polycyclic orcontinuous). In this case, the possible ILD suggests a poorer prognosis, andshe is likely to be in the continuous or polycyclic group. The types of therapywill be discussed and in view of her poorer prognosis, the emphasis will bebiased towards more aggressive treatment. Controlling the disease is of paramountimportance, in order for the child to have no long-term sequelae once thedisease has gone into remission. MEASURES OF DISEASE ACTIVITY AND OUTCOME: To assess muscle disease activity, the CMASand MMT8, and CHAQ are used in this unit, MRI scans are done at 6 monthlyintervals or with a disease flare. Clinical observation of the presence ofarthritis, rash, or oedema is an indicator of disease activity. Calcinosis isan indicator of severe disease activity. CK and LDH are useful indicators ofinitial response to therapy, and of flares of disease. However CK may not be asgood a marker of muscle inflammation as LDH, especially later on in the diseasewith significant loss of muscle bulk. MRI is often useful in these cases.Video fluoroscopy and lung functiontest should be also used to monitorprogress of the lung disease, with a CT scan at appropiate intervals. PLAN OF TREATMENT at 2 years: The critical issue is whether there issubacute inflammation that has contributed to the sheets of calcinosis, despitethe normal CK. Disease activity is also suggested by the prominent rash. An MRIof the proximal muscle groups would be essential. If there is active muscleinflammation, as well as lung involvement, cyclophosphamide should be started.In this unit, IV is preferred as there are no concerns with compliance,absorption, or hydration, and there appear to be fewer long-term side-effects.A change to cyclosporin A orally is unlikely to be effective at this stage, butcombination therapy may be worth a try for a limited period. If the child's disease has progresseddespite 6 months' of cyclophosphamide, thenmore experimental treatments such as anti TNF should be considered. Pamidronate for the calcinosis isworth considering, and our unit has had 3 patients who have responded well tothis combination between 6 months and 1 year. ACTIVE RASH WITH NORMAL STRENGTH AND NOEVIDENCE OF MUSCLE INFLAMMATION: These children can pose a difficultproblem. The rash is indicative ofactive disease but does not always respond as well to the same medication asthe muscle inflammation. Ongoing disease is often seen in these children asthey are also often underweight and growth retarded. Different medications such as pulses ofIVIG, h ydroxychloroquine/mepacrine or Tacrolimus may be helpful. Clarissa Pilkington and Patricia Woo Great Ormond Street Hospital for Sick Children, London Table of Contents

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Amazon.com: Mario Badescu Kiwi Face Scrub: Beauty Your Store Beauty See All 32 Product Categories Your Account | Cart | Wish List | Help | Browse Brands & Products | Free Gifts & Special Offers | Fragrance | Makeup | Skin Care | Bath & Shower | Hair Care | Men's Grooming Search Amazon.com Beauty Skin Care Makeup Fragrance Bath & Shower Hair Care Men's Grooming Health/Personal Care Web Search This item is not eligible for Amazon Prime, but over a million other items are. Join Amazon Prime today. Already a member? Sign in . or Sign in to turn on 1-Click ordering. A9.com users save 1.57% on Amazon. Learn how . See larger image Share your own customer images Mario Badescu Kiwi Face Scrub Other products by Mario Badescu More about this product Price: $15.00 Availability: Usually ships in 1-2 business days. Ships from and sold by bluemercury, Inc. . Customers who viewed this item also viewed Mario Badescu Drying Cream Mario Badescu Enzyme Cleansing Gel Mario Badescu Seaweed Night Cream Mario Badescu Special Cucumber Lotion Explore Similar Items Product Description Product Description Containing Alpha Hydroxy Acid, Kiwi Face Scrub will help lighten skin discolorations and exfoliates. Exfoliating regularly with this scrub will prevent dulling build-up and blackheads that cause breakouts. This great new face scrub will give visible results in short term use. Product Details Product Dimensions: 4.0 ounces Shipping Information: View shipping rates and policies Note: Gift-wrapping is not available for this item. ASIN: B0007MYMW8 Amazon.com Sales Rank: #9,508 in Beauty (See Top Sellers in Beauty ) Yesterday: #9,350 in Beauty This page was created by a seller. Customers who bought this item also bought Mario Badescu Hylauronic Eye Cream Mario Badescu Seaweed Cleansing Soap Mario Badescu Oil-Free Moisturizer Mario Badescu Botanical Facial Gel Explore Similar Items Customer Reviews Be the first person to review this item . So You'd Like to... Fully Recover from a Stressful Day : A guide by Shandrala , ... always seeking a better way Create a So You'd Like to... guide Look for similar items by category Beauty > Products > Skin Care > Face > Exfoliators > Dry & Sensitive Skin Beauty > Products > Skin Care > Face > Exfoliators > Scrubs Beauty > Products > Skin Care > Face > Face Treatments > Dry Skin Beauty > Products > Skin Care > Face > Face Treatments > Exfoliating Beauty > Products > Skin Care > Face > Face Treatments > Normal Skin Beauty > Products > Skin Care > Face > Face Treatments > Oily Skin Beauty > Products > Skin Care > Face > Oil & Blemish Control > Cleansers, Scrubs & Face Washes Beauty > Products > Skin Care > Face > Oil & Blemish Control > Masks & Scrubs Beauty > Products > Skin Care > Face > Skin Lighteners This Item and You Write a Review | Write a So You'd Like To... Guide | Tell a Friend About This Item | Rate This Item Suggestion Box Your comments can help make our site better for everyone. If you've found something incorrect, broken, or frustrating on this page, let us know so that we can improve it. Please note that we are unable to respond directly to suggestions made via this form. If you need help with an order, please contact Customer Service . Please mark as many of the following boxes that apply: Product information is missing important details. Product information is incorrect. The page contains typographical errors. The page takes too long to load. The page has a software bug in it. Content violates Amazon.com's policy on offensive language . Product offered violates Amazon.com's policy on items that can be listed for sale. Comments or Examples: Examples: Missing information such as dimensions and model number, typos, inaccuracies, etc. bluemercury, Inc. Privacy Statement bluemercury, Inc. Shipping Information bluemercury, Inc. Returns & Exchanges Where's My Stuff? • Track your recent orders . • View or change your orders in Your Account . Shipping & Returns • See our shipping rates & policies . • Return an item (here's our Returns Policy ). Need Help? • Forgot your password? Click here . • Redeem or buy a gift certificate. • Visit our Help department . Search Amazon.com Books Popular Music Music Downloads Classical Music DVD VHS Apparel Yellow Pages Movie Showtimes Toys Baby Computers Video Games Electronics Camera & Photo Software Tools & Hardware Office Products Magazines Sports & Outdoors Outdoor Living Kitchen Jewelry & Watches Beauty Gourmet Food Musical Instruments Health/Personal Care Pet Supplies Travel Cell Phones & Service Outlet Auctions zShops Everything Else Automotive for Amazon.com Home | Directory of All Stores Our International Sites: Canada | United Kingdom | Germany | Japan | France | China Help | Shopping Cart | Your Account | Sell Items | 1-Click Settings Investor Relations | Press Room | Careers Conditions of Use | Privacy Notice © 1996-2006, Amazon.com, Inc. or its affiliates