According to skin influencers on TikTok, topical steroid creams are being ‘illegally sold’ in some black Afro hair and beauty supply stores, affecting black women in particular. Angela Mavalla, a pharmacist and skincare educator, has been sharing TikTok videos garnering thousands of views, encouraging black women to stop purchasing topical steroid creams from these shops – as they are meant to be prescription-only treatments used with appropriate guidance from a doctor. When used incorrectly, the creams can make potentially make skin symptoms worse and harder to manage. “Though these creams tend to address issues like acne and eczema very quickly, because of their potent nature, the skin becomes addicted to it and will flare up badly once you stop using them,” said Mavalla. “A lot my clients – [who are black women] – that I consult privately, were coming to me with issues relating to topical steroid use, such as having terrible flare-ups because they had stopped using the cream, and needed help with tapering off them. “I began making content based on these creams, mainly to warn people of them, and found that these TikTok’s would go viral in a short space of time, with lots of people relating to it, and giving their own testimonials of how the creams damaged their skin,” Mavalla added. “I have seen instances of accidental skin bleaching, worsened eczema and hyperpigmentation, topical steroidal withdrawal and addiction, and worst of all, a crippling low self-esteem and self image. It’s awful. “The first point of call when it comes to steroidal creams should always be a pharmacy. Pharmacists are always willing to help, advise and where necessary, signpost to the most appropriate medical profession, such as a dermatologist.” Dr Unnati Desai, the national GP lead, as well as safeguarding lead for GP services and dermatology lead at Nuffield Health, acknowledged that it can take sometimes take time to correctly diagnose these conditions, and might require a biopsy. It might also take a longer period of time to get symptoms under control, as skin conditions may require trying multiple different treatment regimes to find the one that suits each individual person, as well as getting to grips with individual triggers. What are topical steroid creams and what should they be used for? Doctors prescribe topical steroid creams to treat a wide range of skin complaints – but it’s important to have proper assessments first. “They are topical medications (synthetic corticosteroids) that have an anti-inflammatory action on the skin, by suppressing the skin immune system and constricting the blood vessels of the skin where applied,” Desai told the PA news agency. “They are used for dermatological conditions that result in inflamed, itchy or irritated skin – e.g. eczema, psoriasis, lichen simplex, lichen planus, lichen sclerosus and other autoimmune dermatoses.” Why do people experience topical steroid withdrawal after using steroid creams? When used incorrectly, topical steroids may have potentially significant side-effects. And as Desai warned: “Stopping any steroid treatment suddenly can often result in a flare-up of the condition, which may be worse than the original presentation.” There are some obvious signs and symptoms to look out for to figure out if you are experiencing topical steroid withdrawal, such as red, burning skin and a lumpy, papulopustular rash. “When using a steroid cream to get a dermatitis flare-up under control, especially when a more potent steroid cream has been used for a prolonged period of time, it is necessary to slowly come off the steroid cream and wean your skin off treatment by either reducing the potency of the cream, or the frequency [of application],” said Desai. “This gives the skin time to adjust to coming off the steroid cream slowly, but also clarifies whether the skin condition is coming under control with treatment. “Sometimes, severe dermatoses require long-term use of a medication to be controlled, in which case your doctor will consider alternative treatment modalities.” What damage can it do to your skin?Desai added: “Long-term use of potent steroid creams is not recommended, as there may be some systemic absorption, which can result in suppression of your body’s natural cortisol hormone at the worst. “In most cases, it is the long-term impact on the skin itself that is the concern, as regular or long-term use of steroid creams can impact the skin integrity and thickness, resulting in thinning of the skin, stretch marks, increased hair at the site of use, enlarged skin blood vessels and bruising. “Using a steroid cream when there is an underlying infection present on the skin will make the infection worse, or using steroid creams on the face can result in other chronic skin conditions, such as perioral dermatitis or other acneiform eruptions. “Occasionally, an allergy can develop to components within the cream that can make the dermatitis worse.” How can people remain safe? Desai stressed the importance of only using topical steroid treatments under the appropriate supervision of a qualified clinician. “In addition, as most chronic inflammatory skin conditions tend to result in drier skin, self-care at home with soap substitutes and emollients is important,” she said. “This includes gently cleansing the skin one to two times daily maximum (over-washing will negatively impact the skin barrier function, as will long hot bubble baths), and using unscented emollients (medical grade skin creams designed to gently hydrate the skin), which will better protect the skin and may, depending on the skin condition, make a flare-up less frequent or less severe. “If a steroid cream is needed, a doctor will recommend the amount of cream to be used according to the size of the area affected. We use the ‘Finger Tip Unit’ (FTU) – one FTU is the amount of topical steroid that is squeezed out from a standard tube along an adult’s fingertip – as a method of advising each patient how much cream they need to use with each application.” Read More House of the Year 2023 shortlist revealed by Royal Institute of British Architects Fatima Whitbread supporting new fostering campaign, as research finds ‘misconceptions put people off’ 5 key coat trends to complete your autumn/winter wardrobe 12 ways to weave some woodland wonder into your home Hibernation mode: 5 small self-care adjustments to make before the clocks change 13 possible cancer symptoms you should get checked out

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Debt limit talks between the White House and House Republicans stopped, started and stopped again heading into a weekend where President Joe Biden and world leaders watched from afar, hoping high-stakes negotiations would make progress on avoiding a potentially catastrophic federal default. In a sign of a renewed bargaining session, food was brought to the negotiating room at the Capitol on Saturday morning, only to be carted away hours later. No meeting was likely Saturday, according to a person familiar with the state of the talks who was not authorized to publicly discuss the situation and spoke on condition of anonymity. Biden's administration is reaching for a deal with Republicans led by House Speaker Kevin McCarthy, R-Calif. The sides are up against a deadline as soon as June 1 to raise its borrowing limit, now at $31 trillion, so the government can keep paying the nation’s bills. Republicans are demanding steep spending cuts the Democrats oppose. Negotiations had came to an abrupt standstill Friday morning when McCarthy said it was time to “pause” talks. Then the teams convened again in the evening, only to quickly call it quits for the night. Biden, attending a meeting of global leaders in Japan, tried to reassure them on Saturday that the United States would not default, a scenario that would rattle the world economy. He said he felt there was headway in the talks. “The first meetings weren’t all that progressive, the second ones were, the third one was,” he said. The president said he believes "we’ll be able to avoid a default and we’ll get something decent done.” Negotiators for McCarthy said after the Friday evening session that they were uncertain on next steps. “We reengaged, had a very, very candid discussion, talking about where we are, talking about where things need to be, what’s reasonably acceptable," said Rep. Garret Graves, R-La. Rep. Patrick McHenry, R-N.C. was asked if he was confident an agreement over budget issues could be reached with the White House. He replied, “No.” As the White House team left the nighttime session, Biden counselor Steve Ricchetti, who is leading talks for the Democrats, said he was hopeful. “We're going to keep working,” he said. McCarthy had said resolution to the standoff is “easy,” if only Biden's team would agree to some spending cuts Republicans are demanding. The biggest impasse was over the fiscal 2024 top-line budget amount, according to a person briefed on the talks and granted anonymity to discuss them. Democrats contend the steep reductions Republicans have put on the table would be potentially harmful to Americans, and they are insisting that Republicans agree to tax increases on the wealthy, in addition to spending cuts, to close the deficit. Wall Street turned lower as negotiations came to a sudden halt. Experts have warned that even the threat of a debt default would could spark a recession. Republicans argue the nation's deficit spending needs to get under control, aiming to roll back spending to fiscal 2022 levels and restrict future growth. But Biden's team is countering that the caps Republicans proposed in their House-passed bill would amount to 30% reductions in some programs if Defense and veterans are spared, according to a memo from the Office of Management and Budget. Any deal would need the support of both Republicans and Democrats to find approval in a divided Congress and be passed into law. Negotiators are eyeing a more narrow budget cap deal of a few years, rather than the decade-long caps Republicans initially wanted, and clawing back some $30 billion of unspent COVID-19 funds. Still up for debate are policy changes, including a framework for permitting reforms to speed the development of energy projects, as well as the Republican push to impose work requirements on government aid recipients that Biden has been open to but the House Democratic leader Hakeem Jeffries of New York has said was a "nonstarter." McCarthy faces pressures from his hard-right flank to cut the strongest deal possible for Republicans, and he risks a threat to his leadership as speaker if he fails to deliver. Many House Republicans are unlikely to accept any deal with the White House. Biden is facing increased pushback from Democrats, particularly progressives, who argue the reductions will fall too heavily on domestic programs that Americans rely on. ___ Associated Press writers Zeke Miller and Josh Boak in Hiroshima, Japan, and AP Congressional Correspondent Lisa Mascaro contributed to this report. Read More Ukraine war’s heaviest fight rages in east - follow live Charity boss speaks out over ‘traumatic’ encounter with royal aide Will Biden's hard-hat environmentalism bridge the divide on clean energy future? Russia warns of ‘colossal risks’ if F-16 fighter jets sent to Ukraine G7 'outreach' an effort to build consensus on global issues like Ukraine, China, climate change

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The former Italian prime minister Silvio Berlusconi has died at the age of 86. Berlusconi, who amassed a fortune after founding Italy’s largest media company, had been suffering from leukaemia and recently developed a lung infection. He died at the San Raffaele hospital in Milan. The former prime minister suffered from a range of health conditions in recent years, including prostate cancer, heart ailments and a spell in hospital with Covid-19 in 2020. He was readmitted to the same hospital in Milan on Friday where he recently spent almost six weeks for treatment for the lung infection. Doctors said he had chronic myelomonocytic leukaemia, a rare type of blood cancer but not one that is considered to be acute. His personal physician Dr Alberto Zangrillo had said the lung infection diagnosis was linked to his leukaemia. Italian defence minister Guido Crosetto expressed “great, enormous pain” over the news of his death. “He leaves a huge void, because he was a great,” he wrote. “It’s the end of an epoch, the closing of an era. I loved him very much. Goodbye Silvio.” Berlusconi dominated Italian politics for almost 20 years, leading the centre-right party Forza Italy from 1994 to 2009, before taking the helm of successor party The People of Freedom until 2013. The right-wing populist led four governments across three spells as prime minister of Italy – from 1994 to 1995, from 2001 to 2006 and again from 2008 to 2011. His last few years in the country’s top job were marred by allegations of corruption and tales of “bunga bunga” sex parties at his lavish villa outside Milan. He was accused of unlawful sex with 17-year-old nightclub dancer known only as “Ruby the Heartstealer” – but he was acquitted on appeal in 2014, after several women testified that his bung bunga parties were merely “elegant dinners”. Berlusconi made his name and the bulk of his huge fortune beginning with his business dealings in the 1980s. He was the controlling shareholder of Italian media giant Mediaset, and owned the football club AC Milan from 1986 to 2017. The tycoon was convicted of tax fraud in 2012 and was sentenced to four years’ imprisonment, later shortened to one year of community service. In 2019 he staged an unlikely political comeback by winning a seat in the European parliament. Italian national news channels ran sombre coverage of the news of Berlusconi’s death, with Sky News’ foreign editor Andrew Connell noting that coverage on Sky TG24 was “something akin to the death of a royal”, describing him as a “unique politician known well beyond Italy”. Forza Italia forms part of far-right prime minister Giorgia Meloni’s coalition government, but Berlusconi held no position in her cabinet and the two clashed over the 86-year-old’s friendship with Russia’s Vladimir Putin – Ms Meloni has voiced her strong support for Ukraine since the war broke out in February 2022. On his 86th birthday, while the war raged, Mr Putin sent Berlusconi best wishes and vodka, and the Italian boasted he returned the favour by sending back Italian wine. Matteo Salvini, Italy’s deputy prime minister and leader of the far-right League party, penned a lengthy tribute on Twitter to “one of the greatest ever, in all fields, from all points of view, without equal”. Former centre-left prime minister Matteo Renzi referred to Berlusconi’s divisive legacy in his own tribute on Monday. “Silvio Berlusconi made history in this country. Many loved him, many hated him. All must recognise that his impact on political life, but also economic, sport and television, has been without precedence,” he wrote. Political blogger Dario D’Angelo tweeted: “Whether you loved him or you hated him, it matters little today. With Silvio Berlusconi goes a part of your life. Of our life.” Berlusconi controlled his business empire through Fininvest, a family holding company with assets worth €4.9bn (£4.19bn) at the end of 2021. Before his death, Silvio owned 61.3 per cent of Fininvest, while Pier Silvio and Marina Berlusconi, his two children from his first marriage, each owned a 7.65 per cent stake. The future of his business interests will likely depend on how he has chosen to distribute his 61 per cent stake between his five children from two marriages. Eldest daughter Marina is expected to play a prominent role, though Berlusconi never publicly named a successor to take charge of the company. Read More Silvio Berlusconi, scandal-scarred ex-Italian leader, dies at 86, according to his TV network Former Italian premier Silvio Berlusconi was also successful in soccer at AC Milan and Monza Former Italian prime minister Silvio Berlusconi dies aged 86 Reports: Former Italian Premier Berlusconi readmitted to hospital 3 weeks after release Four villages ‘liberated’ in Ukraine’s first gains of counteroffensive How much has the Madeleine McCann investigation cost?

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