Terrasil (Thuja Occidentalis) Ointment: What It’s For

Recently, a patient asked me about using Terrasil for wart removal. Thuja Occidentalis Ointment, also known as Terrasil Wart Removal, is a homeopathic remedy for warts.  Natural ingredients include: organic beeswax, cedarwood oil, and jojoba.

Because Terrasil is a homeopathic remedy and not a drug, the FDA does not regulate non-drug substances for accuracy of the company’s claim of effectiveness. Thus, there is no scientific evidence yet to support the claim that homeopathy is an effective method of treatment. It may work, but the company doesn’t need to prove it.

But this patient’s question jogged my memory about an article in the New England Journal of Medicine in 2004. The article describes a clinical trial of human alpha-lactalbumin coupled to oleic acid that was highly effective for treating human warts. The substance, known as HAMLET, is purified from human breast milk and applied topically.

In an accompanying editorial, commenters expand the possibilities for HAMLET treating malignant tissue such as HPV induced cervical cancer and cutaneous squamous cell carcinoma (which may have HPV as a cofactor with ultraviolet light). HAMLET is used to treat cells causing apotosis (cellular death) and appears to be a leave normal cells alone. Thus, the side effects on normal tissue would be minimal.

Medications like HAMLET are no doubt in the pipeline. Additionally, I think it’s curious that breast milk may provide answers to some of our most pressing medical problems. There may be room for more research there.


Bavinck JNB, Feltkamp MC. Milk of Human Kindness? — HAMLET, Human Papillomavirus, and Warts. New England Journal of Medicine N Engl J Med. 2004;350(26):2639-2642. doi:10.1056/nejmp048086.

Label: TERRASIL WART REMOVAL- thuja occidentalis ointment. DailyMed. https://dailymed.nlm.nih.gov/dailymed/druginfo.cfm?id=119689. Published February 28, 2014. Accessed August 1, 2016.

Castor Oil Has Skincare Purposes I Didn’t Know About

A patient came to me having tried a number of remedies, including castor oil. I’ve heard of this, but I didn’t know if it had any relevance to dermatology. I decided to do some research on the topic.

The oil itself comes from the castorbean, which is native to areas of Eastern Africa and the Mediterranean. Specifically, the castorbean’s seeds contain the best source.

People know castor oil as a laxative ingredient, but it also treats skin ulcers and other wounds. It comes as an ointment or a spray, and its brand names are Granulex, TBC, Vasolex, and Xenaderm.

The oil is also found in cosmetic products like creams and lipsticks. When combined with Glyceryl Ricinoleate, it absorbs UV light. Overdoses and allergic reactions may occur if product is not used as directed.


Castor Oil/Peru Balsam/Trypsin (On the skin). National Institute of Health. http://www.ncbi.nlm.nih.gov/pubmedhealth/pmht0009483/?report=details#uses. Published July 1, 2016. Accessed August 16, 2016.

What is Mitchell’s Disease and How Can it Be Treated?

A patient said that I was “saddled with Mitchell’s disease,” which I had never heard of. After doing some research, I learned Mitchell’s disease is another name for Erythromelalgia. Erythromelalgia is a clinical syndrome that often goes unreported.

Erythromelalgia is a rare pain disorder characterized by a burning ache in the hands and feet. Severe redness and raised skin temperature are also symptoms. Erythromelalgia was called Mitchell’s Disease, named after Silas Weir Mitchell. Mitchell discovered and named the disease in the late 19th Century.

Presently, the cause of Erythromelalgia is unknown. There are a few theories floating around, but researchers think the underlying root is dilation and contraction abnormalities in blood vessels in the hands and feet.


Symptoms can manifest quickly or slowly. Some report a sudden, rapid onset of crippling pain over weeks. Others say that they’ve had relatively mild symptoms for years. Theories suggest that Erythromelalgia does get worse as it goes on. Some cases have even started in the feet, and spread up from the toes to the face and ears. Erythromelalgia is nonfatal, but it is chronic, which can cause interferences with a patient’s daily life.


Some suggest that patients relieve their symptoms by putting their extremities in a colder environment (e.g. ice water). However, in several cases, repeatedly immersing in ice water actually triggered an episode. Most doctors advise patients to stay in a cool environment, but that makes it more difficult for people who live in warmer areas. Topical medications appear to be more helpful, such as a local anesthetic like lidocaine.

As mentioned before, the disease is nonfatal, and most patients can live a normal life. Research into cause and treatment for Erythromelalgia is ongoing.


Erythromelalgia – NORD (National Organization for Rare Disorders). NORD (National Organization for Rare Disorders). http://rarediseases.org/rare-diseases/erythromelalgia/. Accessed August 12, 2016.

What Causes Skin Laxity and What Can We Do to Treat It?

A patient asked me what could be done for sagging skin in the upper arms. So, I decided to do some research into what causes it.

While excessive weight loss and pregnancy can be factors, the cardinal cause is age. As one gets older, skin relaxation occurs: the lean muscle in the body begins to deteriorate, and pockets of fat begin to show up. The amount of sagging depends on the individual, on factors such as body type and weight. As one ages, the skin around the stomach, upper arms, and legs begins to droop, creating a flabby, almost shapeless look to the body.

Though skin laxity is a natural process, it can have a negative impact on one’s body image. Fortunately, there are several treatments that can contour and tighten the skin.


While liposuction, abdominoplasty (tummy tuck), and brachioplasty (tightening of the arm skin) are the mainstream solutions, However, patients are looking for less invasive alternatives. Luckily, a new treatment method has been developed.

According to a study reported in Lasers in Surgery and Medicine, combining infrared light (IR), bipolar radio frequency (RF), and vacuum and mechanical massage has proven effective for skin laxity.

Though this looks promising, doctors and scientists have only conducted studies on the arms, legs, sides, and stomach. Researchers have yet to research this treatment method on other parts of the body. As a result, studies are ongoing.


ASDS — American Society for Dermatologic Surgery. Sagging Skin. http://www.asds.net/sagging-skin/. Accessed August 11, 2016.

Brightman L, Weiss E, Chapas AM, et al. Improvement in arm and post-partum abdominal and flank subcutaneous fat deposits and skin laxity using a bipolar radiofrequency, infrared, vacuum and mechanical massage device. Lasers Surg Med Lasers in Surgery and Medicine. 2009;41(10):791-798. doi:10.1002/lsm.20872.

Teimourian B, Malekzadeh S. Rejuvenation of the Upper Arm. National Center for Biotechnology Information. http://www.ncbi.nlm.nih.gov/pubmed/9703097. Published August 1998. Accessed August 9, 2016.

The Four Cosmetic Intervention Techniques Backed By Science

Cosmetic intervention is a hot-button issue in the dermatology industry. There is ongoing research into what works and what doesn’t. Everyone wants protect their facial skin from damage, and everyone wants to avoid wrinkles. As a practicing physician, I only use techniques that have been proven to work through scientific studies and trials.

Right now, there are only four cosmetic intervention techniques that fulfill that criteria.

  1. Sunscreen, daily: ultraviolet (UV) light and natural aging causes most damage to the skin. Protecting your fibroblasts from UV damage lessens their impairment. It also protects the epidermis, melanocytes, and skin-associated immune cells from UV damage.
  2. Retinoids: A retinoid (topical derivative of Vitamin A) applied to the skin helps fibroblasts “wake up.” The activation of fibroblasts produces more collagen. Since fibroblasts lose function with age, retinoids help restore fibroblasts and repair normal function
  3. Fillers: Adding volume to the dermis actively stretches the fibroblasts and wakes them up. As a result, fibroblasts begin to produce more collagen, much like the response to retinoids.
  4. Carbon Dioxide Laser Resurfacing: Usually a laser will remove a thin layer of tissue. Then stem cells from hair follicles resurface new dermis and epidermis.

I recommend that my patients use options 1-3. Resurfacing works, but it’s expensive, risky, and involves significant down time.

In conclusion, these four techniques are the only cosmetic intervention methods that scientific evidence can back.  Though this may seem limiting, there is ongoing research into other techniques, as people are eager to seek out alternative methods. But since there is nothing scientific to back up alternative methods, we’ll just have to wait and see.