- by BGS Gleneagles Global Hospitals
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- Dec 21 2017
Hepatitis-know more-Dr Vinit Shah
2) What are the beauty treatments that will put you at risk of Hepatitis. For example we know about tattoos and manicures but do elaborate on how it may be possible. Also list other treatments in bullet form and cite how there is a possibility.
- Response : Treatments would include any modality which would breach your skin / mucous membranes (eyes , nasal mucosa , lips oral mucosa) , the instruments , consumables may not be properly disinfected and may be contaminated by the blood of potentially infected undiagnosed patient with Hepatitis B , Hepatitis C.
- Second is cosmetology procedures which involve administration of biological/ immunological products which may be contaminated during manufacturing process as they are from an infected hepatitis B/ C source , products such as (Botox , Colloid fillers , collagen derivatives ,growth factor derivatives , melanocyte transfer) .
- Cosmetology proceedures potentially at risk are :
- Botolinium Toxin injections
- Colloid Fillers
- Liposuction procedures for obesity
- Melanocyte transfer procedures for vitilligo
- Growth factore transfer procedures for dark circles
- Cosmetic plastic surgery procedures which use bioprosthetic grafts for skin/ tendons , muscles etc which may be contaminated
3) What is hepatitis? How many types are there? Please make us understand Hepatitis in the simplest of manner.
Response : Hepatitis is inflammation and damage of the liver by infective / non infective triggering factors. Most common non infective triggering factors are alcohol , fatty liver disease, hepatotoxic medications . (complimentary and alternative medications , dietary and herbal supplements coming up in a big way) . Infective sources are viruses , most commonly hepatotrophic (predominantly affinity for attacking liver – Hepatitis A , B , C , D , E ) or non hepatotrophic viruses (Generalised involvement of human body with liver as a target tissue which is involved (Dengue virus , Chikungunya etc). The most common mode of involvement is damage to the liver causing death of liver cells and inflammation (necrosis) and causing rise in liver enzymes (SGPT , SGOT) , rise in bilirubin (jaundice) picked up on liver function tests.
4) What are the symptoms?
Response : Common symptoms are low grade fever ,body ache , lethargy , anorexia , joint pain (Commonly called Prodromal symptoms preceding the phase of liver attack by a period ranging from 1-2 weeks.
Hepatitis A and E are the commonly transmitted hepatotrophic viruses transmitted by poor hygiene , sanitation mainly lead to acute hepatitis (Contaminated food , drinking water supplies) (Faeco oral route of transmission) causing epidemics. Pediatric age group is at risk for hepatitis A infection , in some cases liver damage may be very severe ( acute liver failure ) loss of liver function warranting liver transplantation. The other populations at high risk of hepatitis A infection include people with HIV infection , preexisting chronic liver disease due to any cause (where it can cause worsening of underlying liver disease), people undergone solid organ /bone marrow transplantation . Preventive measures include proper hygiene , sanitation , vaccination of high risk population groups. Hepatitis E virus infection also has similar way of transmission and pregnant ladies constitute the high risk group for this viral infection and is the most common cause of hepatitis / acute liver failure during pregnancy. This virus can also affect people with underlying chronic liver disease and cause sudden worsening and decompensation. In Western countries it is increasingly recognized as a cause of chronic liver damage especially in post solid organ transplant recipients, consumption of contaminated pork is incriminated as important source of transmission.
Regarding hepatitis B virus , it can most of the times remain dormant in body without any liver damage (asymptomatic carrier ) incidentally diagnosed during health check ups / preoperative check up before any surgery. In some people it can cause acute liver failure , chronic damage to the liver (chronic hepatitis) , progression to chronic liver damage (cirrhosis) , liver cancer (HCC). The virus has a tendency of suddenly returning to active multiplication from dormancy and causing severe liver damage ( reactivation of hepatitis B) , mostly commonly seen post chemotherapy / immunosuppressant post solid organ transplantation. Regarding Hepatitis C , it has same modes of transmission as hepatitis B and can similarly cause chronic liver damage , liver cirrhosis , decompensation ,liver cancer . However as against hepatitis B asymptomatic carrier state is very less and predominantly chronic hepatitis is the mode of liver injury.
5) Could you share few case studies of your patients who contracted Hepatitis after beauty treatments?
Response : Thanks to our very well informed and aware Dermatology community , at least in urban areas all the patients are screened for Hepatitis B and C by the dermatologists and strict precautions for proper disinfection of the instruments , quality control for biological products is followed , I haven’t encountered single patient who has contracted hepatitis B / C who’s causality I could track down to any dermatological procedures. Mainly it is the rural population where tattooing, skin branding is done by quacks in village fairs / festivals etc that the issue of poor instrument disinfection comes and risk of transferring viral hepatitis increases. Also tourist destinations with lot of tattooing centers is another potential risk for contracting viral hepatitis B and C
6) What happens to you if you contract Hepatitis?
Response : Hepatitis B : Hepatitis B virus infection is a very important cause of viral hepatitis, 3-5 % of Indian population is carrier for hepatitis B infection (HBsAg + ve) , some may be negative (HBsAg – ve) with virus damaging liver (Occult hepatitis B) pickup by viral DNA in blood/ liver tissue . The most common route of transmission incriminated in India is from mother to child, other routes of transmission are unsafe blood products, immunological products, sexual route, unsafe needles and syringes . Most of times the virus can remain dormant in body without any liver damage (asymptomatic carrier) incidentally diagnosed during health check ups / preoperative check up before any surgery. In some people it can cause acute liver failure, chronic damage to the liver (chronic hepatitis) , progression to chronic liver damage (cirrhosis) , liver cancer (HCC). The virus has a tendency of suddenly returning to active multiplication from dormancy and causing severe liver damage (reactivation of hepatitis B) , mostly commonly seen post chemotherapy / immunosuppressant post solid organ transplantation
Hepatitis C: Hepatitis C virus has same modes of transmission as hepatitis B and can similarly cause chronic liver damage, liver cirrhosis , decompensation ,liver cancer . However as against hepatitis B asymptomatic carrier state is very less and predominantly chronic hepatitis is the mode of liver injury.
7) How can one stay away from such risks?
Response : Hepatitis B : Screening of high risk groups (HBsAg) (pregnant ladies , health care professionals , sex workers , prior to proposed organ transplantation , chemotherapy administration) is of paramount importance . Once a patient is diagnosed he should be ideally referred to specialized liver care team , further investigations involve testing the replication state of virus , extent of liver damage at early stage ( specialized methods like liver stiffness testing) , screening for liver cancer by appropriate imaging modalities and regular surveillance so that return of virus to active multiplication / worsening chronic liver damage , liver cancer development are not missed. Prevention involves universal immunization against the virus by vaccination of the high risk groups , screening pregnant ladies managing their infection properly during pregnancy and breast feeding with appropriate oral medications , proper delivery of the baby with immediate dual vaccination (vaccine plus hepatitis B immunoglobulin) to the child , screening blood and immunological products , safe needle and syringe practices, active screening of family members of infected patients and vaccination of those who are negative . Treatment involves early identification of subset of people with liver damage and treating with oral antiviral medications / interferon, regularly checking them for adequate suppression of viral replication , worsening of liver disease , liver cancer . Liver transplantation is only cure for people with Decompensated liver disease patients.
Hepatitis C: No vaccine is available for hepatitis C so identifying infected patients and aggressively treating them to achieve complete viral response (SVR) is the only way to prevent progression to liver cancer and decompensation. With advent of highly potent directly acting anti viral oral medications (DAA’s) treating hepatitis C is very easy , cost effective, highly successful way of reducing the hepatitis C related Decompensated liver cirrhosis and liver cancers and should be done as soon as hepatitis C patient is identified by referring to liver specialist.
8) What are the myths and facts regarding Hepatitis?
Response: Facts : Highlighted above
Myths : Hepatitis B/C spreads by Physical contact / kissing , using utensils used by infected person : No
Extensive Dietary restrictions are required in viral hepatitis : No , in fact all high calorie items better because energy (glycogen , glucose metabolic cycles) in liver are at all time low in hepatitis and need to take significantly higher calories and proteins to support liver, no dietary restrictions recommended , everything healthy nutritious , prepared with proper hygiene and sanitation can be consumed.
Yellow colored items should not be consumed in jaundice : Completely wrong concept , all items which are healthy and nutritious can be consumed .
Complimentary and ayurvedic medication forms help resolve hepatitis and jaundice faster : Totally wrong and non scientific , on the contrary these things can worsen the liver damage due to potential hepatotoxic constituents
9) It was interesting to know that hepatitis can be contracted because of ink and not just needles, do let us know how and precautions to take before getting inked.
Response : Research has shown it is the contaminated needle which is definitely much more risky than the ink , precautions are doing the procedure at a place with good quality control for needles , instruments , ink , avoid doing it at places with lot of crowd segregation like college festivals / fairs , rural festivals etc.
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