Cutaneous mastocytosis is one of two types of mastocytosis, a rare disorder in which too many mast cells — a type of white blood cell that helps the immune system function properly — accumulate in the body. In cutaneous mastocytosis, mast cells build up in the skin, causing skin changes or lesions, while in systemic mastocytosis, mast cells multiply abnormally in the bone marrow, digestive tract, liver, spleen, or other organs. Cutaneous mastocytosis usually occurs in infants and toddlers but may affect adults, whereas systemic mastocytosis is found mostly in adults.e60dc2a1-f33c-4a05-9b50-8e3e8e59762928608ee1-b7c2-4f1c-8ad6-eb54833ac23f
Types of Cutaneous Mastocytosis Types There are three variants of cutaneous mastocytosis:e60dc2a1-f33c-4a05-9b50-8e3e8e5976291ae66eef-5229-4f17-b191-543decf92df8 Maculopapular Cutaneous Mastocytosis/Urticaria Pigmentosa This is the most common form of cutaneous mastocytosis and looks like small reddish-brown or brown spots on the skin that can be flat or elevated. At first, these may be mistaken for freckles. Plaque-like lesions — lesions greater than 1 centimeter in size — can also occur. The bumps can be classified into two types, monomorphic (all spots look similar) and polymorphic (the spots vary in appearance). Cutaneous Mastocytoma Usually present at birth, cutaneous mastocytoma involves an isolated mastocytoma (mast cell tumor) that’s about 2 to 5 centimeters in diameter. It usually goes away on its own, but it can be surgically removed if needed. Four cutaneous mastocytomas or more may become a diagnosis of maculopapular cutaneous mastocytosis. Diffuse Cutaneous Mastocytosis (DCM) In diffuse cutaneous mastocytosis, rather than individual lesions, there is an overall thickening and slight darkening of the skin; all the skin may become inflamed, rather than discrete areas. This is the most severe form of cutaneous mastocytosis and is more common in infants and babies under 2 years old.e60dc2a1-f33c-4a05-9b50-8e3e8e597629d6e19315-99ad-4bcf-954f-2bcb50bc053e
Signs and Symptoms of Cutaneous Mastocytosis Symptoms Cutaneous mastocytosis can cause a variety of symptoms, both on the skin and in other systems of the body. Skin Symptoms Skin symptoms of cutaneous mastocytosis can vary depending on the type and severity of the disease. They include:e60dc2a1-f33c-4a05-9b50-8e3e8e597629bfee0ee8-1bb6-4340-9574-f8541abb6bba Itchy or Inflamed Skin The skin can develop red, itchy patches or hives , or other changes, as described above. Rashes Maculopapular cutaneous mastocytosis often results in dark spots or bumps that may itch or swell when scratched. Flushing Some people experience redness or flushing of the skin, especially after exposure to heat, eating certain foods, or stress. Blistering In more severe cases, especially in diffuse cutaneous mastocytosis, the skin may blister and become painful. This only happens in babies and young children. Systemic Symptoms Even though mast cell overaccumulation occurs only in the skin in cutaneous mastocytosis, it can cause symptoms in other parts of the body, particularly the gastrointestinal system. Children with cutaneous mastocytoma may also have:e60dc2a1-f33c-4a05-9b50-8e3e8e597629e50fe0a6-5556-44c1-9e98-3f2649df9a95 Diarrhea Abdominal pain Peptic ulcers Children with diffuse cutaneous mastocytosis may experience:e60dc2a1-f33c-4a05-9b50-8e3e8e597629bfee0ee8-1bb6-4340-9574-f8541abb6bba Diarrhea Gastrointestinal bleeding Decreased blood pressure
Causes and Risk Factors for Cutaneous Mastocytosis Causes In many cases, mastocytosis is caused by several mutations in a gene called KIT, which is responsible for regulating the growth and function of mast cells. This change in the KIT gene is usually not inherited.e60dc2a1-f33c-4a05-9b50-8e3e8e597629cf9cbd35-256f-41af-9377-d31956b92767 Risk factors for cutaneous mastocytosis include: Age Cutaneous mastocytosis most commonly appears in childhood, often before the age of 2. Environmental Triggers External factors like temperature changes, stress, infections, and certain medications may trigger symptoms.
How Is Cutaneous Mastocytosis Diagnosed? Diagnosis Depending on the age of the person and the suspected type of cutaneous mastocytosis, diagnosis may involve a combination of the following: Physical Exam The skin will be examined to check for characteristic lesions like urticaria pigmentosa. Darier’s Sign If maculopapular cutaneous mastocytosis/urticaria pigmentosa lesions are found, the provider may lightly rub or scratch a small area of the affected skin. The development of redness or hives over or around the lesion within about five minutes is called Darier’s sign and suggests the presence of mast cells within the lesion.e60dc2a1-f33c-4a05-9b50-8e3e8e59762954c10eb4-acf4-43a1-910f-8f675ce2ea3d Skin Biopsy A small sample of skin may be taken and examined under a microscope to confirm the presence of excessive mast cells. Blood Tests Measuring the levels of tryptase, a protein released by mast cells, can help confirm the diagnosis, though it’s primarily used to assess systemic mastocytosis. Genetic Tests In some cases, additional tests, such as genetic testing, may be used to check for mutations in the KIT gene.e60dc2a1-f33c-4a05-9b50-8e3e8e597629328d3d6a-15da-457d-a0c0-dc7c63fb40a2 Bone Marrow Biopsy In adults, this may be used to look for unusual numbers of mast cells in the bone marrow. Because pediatric mastocytosis is usually limited to the skin and spontaneously improves as children get older, most infants and children don’t have to have a bone marrow biopsy performed.
Treatment and Medication Options for Cutaneous Mastocytosis Treatment While there is no cure for cutaneous mastocytosis, there are treatments available to manage symptoms and improve quality of life. Epinephrine for Anaphylaxis Although the risk of anaphylaxis is small compared to people with systemic mastocytosis, people with cutaneous mastocytosis (or their caregivers) should have at least two doses of epinephrine in self-injectable form or nasal spray available at all times. Medication Options The following medications may help relieve symptoms in cutaneous mastocytosis:e60dc2a1-f33c-4a05-9b50-8e3e8e5976296deaf5da-9e82-44c3-aa17-bddfd158c7d3 Antihistamines These are the mainstays of treatment to control symptoms like itching, flushing, and rashes. Cromolyn Sodium This medication can help stabilize mast cells, preventing the release of histamine and other chemicals. It can help with gastrointestinal symptoms. Leukotriene Modifiers These drugs help control symptoms like itching and abdominal discomfort when antihistamines alone aren’t enough. Proton Pump Inhibitors These drugs are helpful for treating stomach acid issues. Steroids Systemic glucocorticoids may be used for severe symptoms, but they aren’t recommended for routine or maintenance management. Short-term use of topical steroids may help reduce inflammation and itching in some patients. Surgery Removing mastocytomas (if possible) may cure cutaneous mastocytosis, but it isn’t recommended unless the symptoms can’t be controlled in any other way.e60dc2a1-f33c-4a05-9b50-8e3e8e59762914a65a25-1491-4c6c-9b2a-86d4a6f2afa5 Phototherapy In severe cases, ultraviolet light therapy (UVB) or psoralen plus ultraviolet A (PUVA) may be used to reduce the number of mast cells and control symptoms.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295b777b24-45ff-46d0-8653-b9cb72190d42
Prevention of Cutaneous Mastocytosis Prevention While there is no known way to prevent cutaneous mastocytosis, managing triggers can help prevent flare-ups and keep symptoms under control.e60dc2a1-f33c-4a05-9b50-8e3e8e59762946074a06-97ec-44f8-b404-d224b8d31fb1
Lifestyle Changes for Cutaneous Mastocytosis Lifestyle Changes Although prevention of cutaneous mastocytosis isn’t possible, there are ways to limit exposure to factors that can activate mastocytosis symptoms or trigger an anaphylactic reaction. Avoiding Triggers Many potential triggers for cutaneous mastocytosis have been identified, but not everyone with the condition reacts in the same way. Potential triggers include the following:e60dc2a1-f33c-4a05-9b50-8e3e8e5976299753b548-593e-4b0a-ace2-cf2c12d8665b Friction on the skin caused by touching or rubbing Being stung or bit by an insect, especially ants , wasps , and bees Alcohol Heat and humidity Physical exertion and stress Spicy foods, alcohol, and certain medications Dietary Changes Current guidelines don’t recommend a specific diet, but identifying food triggers can help manage symptoms or allergic reactions. Foods that are more reactive include monosodium glutamate (MSG), alcohol, shellfish, artificial food dyes and flavorings, preservatives, pineapples, tomatoes and tomato-based products, and chocolate. However, these foods might not be an issue for everyone, and some people may have problems with other foods. Consulting a nutritionist or allergist can be helpful in identifying specific triggers through an elimination diet . It’s also important to eat a healthy, balanced diet.e60dc2a1-f33c-4a05-9b50-8e3e8e59762908308c10-c2b8-477f-a7e6-6e5c4843a205
Cutaneous Mastocytosis Prognosis Prognosis and Outlook The most common type of cutaneous mastocytosis, maculopapular cutaneous mastocytosis/urticaria pigmentosa, goes away by puberty in about half of the children who have it. Symptoms usually get better in others as they become adults.e60dc2a1-f33c-4a05-9b50-8e3e8e5976294e998aa3-f57a-44b5-a3d5-14fff4819bf9 Overall, the prognosis for all types of cutaneous mastocytosis is excellent for children who experience the onset of skin lesions within the first two years of life, because it usually goes away. When cutaneous mastocytosis develops after age 2 or in adulthood, it tends to persist. Late-childhood onset of the disease is associated with an increased risk of developing systemic mastocytosis.e60dc2a1-f33c-4a05-9b50-8e3e8e597629381199d1-fbda-47e0-9151-22d2d6024fe8 A high percentage of adults with skin lesions have systemic mastocytosis, with the majority having indolent systemic mastocytosis.e60dc2a1-f33c-4a05-9b50-8e3e8e597629f255c827-774d-4192-9eb1-7554a1836608
Complications of Cutaneous Mastocytosis Complications Though rare, some individuals with cutaneous mastocytosis may be at risk for severe allergic reactions (anaphylaxis), especially if they have high levels of tryptase, or if they experience systemic involvement.
Research and Statistics: How Many People Have Cutaneous Mastocytosis? Research and Statistics Cutaneous mastocytosis usually affects infants and toddlers but may affect adults. The global prevalence of any type of mastocytosis, including cutaneous mastocytosis, is about 1 in 10,000 to 20,000 people, though some experts believe the condition is underdiagnosed.e60dc2a1-f33c-4a05-9b50-8e3e8e59762971748869-ba44-440d-9e8e-4127893f3f14
Support for People With Cutaneous Mastocytosis Support The Mast Cell Disease Society This advocacy group offers online and Facebook-based support groups and an online forum. It also has an online physician finder and a variety of downloadable reference guides for patients.
The Takeaway Cutaneous mastocytosis is a rare condition in which abnormal mast cells accumulate in the skin, causing symptoms like rashes, itching, and flushing. It primarily affects infants and young children, though it can develop in adults. Medical treatments and lifestyle changes won’t cure the disease, but they can help manage symptoms.
Resources We Trust Cleveland Clinic: MastocytosisLeukemia & Lymphoma Society: MastocytosisNational Organization for Rare Disorders: MastocytosisThe Mast Cell Disease Society: Cutaneous Mastocytosis VariantsAmerican Academy of Allergy, Asthma & Immunology: Mast Cell Disorders and Mastocytosis Videos
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Understanding Migraine-Related Brain Fog and Memory Loss
People with migraine often report problems with memory loss, but the link remains unclear. Factors relating to both migraine and brain fog, such as pain, fatigue, and difficulty focusing, may help explain patterns of memory loss with migraine, although experts are still unsure.
Elizabeth Seng, PhD, a psychology and neurology professor at Yeshiva University in New York City, who will speak about cognitive issues during the 2025 Migraine World Summit, says people are more likely to report memory loss interictally (between migraine episodes), but it’s not clear why.
Memory Loss or Something Else?
“It is … common to misattribute attention issues to memory loss,” Begasse de Dhaem says. “If someone isn’t able to pay attention or concentrate during or around a migraine attack and then doesn’t recall the information they learned, it’s not that they forgot or experienced memory loss; it’s that they had difficulty paying attention.”
Cogniphobia
During her Migraine World Summit interview, Dr. Seng also proposes cogniphobia as a possible cause of difficulty thinking, especially between attacks.
Cogniphobia is when a person is afraid to think or reason too much in case it triggers an attack. This fear of thinking “too hard” between attacks may result in losing the habit of thinking hard over time. What appears to be long-term cognitive decline may in fact be an avoidance strategy.
In a study published in 2022, people who met the criteria for cogniphobia found it hard to remember images in the short and longer term, suggesting a link between cogniphobia and memory loss.
The links between migraine and cognitive impairment are complex. However, the relationship between migraine and memory loss may become clearer as scientists learn more about migraine and its underlying mechanisms.
How to Get Through a Spinal Tap to Confirm an MS Diagnosis
Like any invasive procedure, a spinal tap comes with certain risks, and doctors have to weigh those risks against the potential benefits.
Some people develop a headache — called a “spinal headache” — after a spinal tap. Spinal headaches usually start within a day or two after a lumbar puncture but can occur several days later. They are thought to result from an internal leak at the puncture site, which is believed to cause pressure changes in the cerebrospinal fluid that can be sensed by the dura mater, the tough membrane that surrounds the spinal cord.
You’ll know it’s a spinal headache if the pain goes away when you lie down but reappears when you sit or stand.
Home remedies for a mild spinal headache include:
- Lying down in a comfortable position
- Drinking liquids
- Taking an over-the-counter analgesic, such as acetaminophen (Tylenol)
- Studies have shown that caffeine can also be helpful.
Let your doctor know if you develop a headache following a spinal tap, particularly if your pain or any other symptoms, such as nausea, are severe or get progressively worse.
According to Orhun Kantarci, MD, a professor of neurology at Mayo Clinic in Rochester, Minnesota, spinal headaches usually last no longer than three days, and they usually go away on their own.
Research also shows that 2 to 40 percent of people experience a headache post spinal tap.
Other potential complications of a spinal tap include infection and bleeding, but both are rare. Contact your physician immediately if you experience signs of infection such as fever, severe neck stiffness, and pain or redness at the puncture site.
Beef Organ Supplement Benefits: Is the Hype Justified?
While organ meats are nutritionally rich, there’s little to no published research on how beef organ supplements affect health. That hasn’t stopped some manufacturers from making numerous claims about beef organ supplement benefits.
“Supplements can be sold as if they are good for your health even if there has never been a study of the supplement in humans,” says Pieter Cohen, MD, an associate assistant professor of medicine at Harvard Medical School in Boston, who studies dietary supplements with the Cambridge Health Alliance.
“So, we can’t trust that animal-organ supplements will have any health benefits,” he says. “Even more concerning, none of these products [are required] to be tested in humans for safety before they appear on the market. Even if it appears [from the label] that they might be safe and effective, it is unlikely that there is good evidence to support these claims.”
To that end, below is a breakdown of some of the health benefits you might see advertised by beef organ supplement companies and where the research currently stands.
Boosts Your Immune System
Meat and offal can be natural sources of antioxidants, including vitamins A and C, as well as immune system supporting minerals, such as zinc.
Research supporting beef organ supplements as immune system boosters is currently lacking.
Promotes Healthy Skin and Muscles
Many producers of beef organ supplements advertise the inclusion of peptides to support skin and muscle health — noting, for example, that collagen peptides may help with recovery when combined with resistance training.
But while peptides exist in food and supplements, “We don’t absorb peptides well,” says Victor J. Bernet, MD, the chair of the division of endocrinology at Mayo Clinic Florida in Jacksonville and a former president of the American Thyroid Association. Dr. Bernet has studied supplements containing animal thyroid tissue and animal adrenal gland tissue. “They’re broken down in your stomach and never get to your bloodstream,” he says. “That’s why a peptide like insulin is delivered by injection or inhalation, and not as a pill.”
Increases Energy Levels and Reduces ‘Adrenal Fatigue’
While not technically a diagnosable medical condition, adrenal fatigue describes symptoms of long-term physical and mental stress that people might self-diagnose and erroneously aim to remedy with supplements.
In one study, Bernet and others found that adrenal-support supplements, including two made from animal adrenal-gland tissue, contained thyroid hormone; most supplements in the study also contained steroid hormones.
Bernet says extra hormones could be useless for suspected adrenal fatigue or even cause problems, like prompting your adrenal glands to become less active.
“It’s like oil in your car,” he explains. “You need enough hormones, which your body generally produces. But too much isn’t helpful.”
If you’re feeling unusually fatigued, a visit to your doctor is a better idea than beef organ supplements. “People who are seeking treatments for symptoms by taking supplements may be missing something like sleep apnea or chronic fatigue syndrome,” Bernet says. “We have treatments and strategies that can really help those conditions.”
Improves Digestive Health
Some beef organ supplements are specifically formulated for digestive health. These often contain enzymes, aimed at helping your body break down nutrients, such as fats, proteins, and carbohydrates.
Sometimes doctors prescribe digestive enzymes to people who have medical conditions that might cause enzyme insufficiency. But it’s not clear whether any over-the-counter supplements, including beef organ, work the same way.
Boosts Brain Health
Beef liver is an excellent source of choline, an essential nutrient that helps improve memory and cognitive function, and it can also help to regulate your mood and nervous system. But there is no clinical evidence that shows you can obtain these benefits from beef organ supplements. (Sometimes healthcare professionals recommend choline supplements to people who are deficient in this nutrient.)
Promotes Heart Health
In general, beef liver can be a good source of heart-healthy vitamin B12 and iron. There is no research to suggest that beef organ supplements offer the same benefits.
Is It Always a Heart Attack?
While many doctors like Becker urge the public to err on the side of caution and get immediate medical attention when chest pain appears to be serious, some types of discomfort in the chest may be the symptom of a less serious problem.
Adriana Quinones-Camacho, MD, a cardiologist with NYU Langone Health, suggests that if chest pain occurs only when pushing on the chest, it is more likely to be a musculoskeletal issue related to muscles or bones. “If you touch the area and elicit pain, it may be due to something in the muscles in the chest wall,” she says. “Still, even if it’s less likely to be a heart attack, people present in very different ways.”
GERD
“Most common but less dangerous causes of chest pain that are often mistaken for heart attack are indigestion, acid reflux, or gastroesophageal reflux disease,” says Dr. Quinones-Camacho, adding, however, that severe heartburn can be hard to tell apart from a heart attack, even for some physicians.
The Cleveland Clinic estimates that gastroesophageal reflux disease (GERD, otherwise known as chronic acid reflux) accounts for 50 to 60 percent of non–heart related chest pain cases.
Typically, heartburn feels like a burning in the chest that is actually in the esophagus (the muscular tube through which food passes from the throat to the stomach), and it often occurs after eating or while lying down or bending over, according to the Mayo Clinic.
Getting relief from an antacid (or even burping) suggests that the discomfort is from heartburn, but if the burning is accompanied by sweating and trouble breathing, it may be more likely that it is a sign of heart trouble.
“If the discomfort comes only when the person is eating certain foods — whether it’s spicy chili or something else — and never at other times, then it is most likely indigestion,” says Dr. Quinones-Camacho.
Angina
Angina can cause a feeling of tightness or squeezing in your chest; the pain may radiate to your arms, neck, back, shoulders, or jaw. Angina is caused by narrowing of the arteries, which can temporarily reduce blood flow to the heart. With a heart attack, blood flow is reduced for a longer period and can cause permanent damage to the heart muscle.
With angina, rest or medication (nitroglycerin) can quickly stabilize the heart, but if you’re having a heart attack, rest or medication does not ease symptoms.
Angina can sometimes be a warning sign of heart attack, so if the condition does not improve quickly or worsens, call 911.
Costochondritis
Costochondritis is a condition caused by inflammation of the cartilage that connects your breastbone (sternum) to your ribs. The pain can closely mimic a heart attack or other cardiac problems, but costochondritis is not life-threatening and usually doesn’t cause any complications.
The sharp, aching pain can worsen with upper-body movement or with deep breaths because it involves joints that flex when you inhale. And the pain is often felt on the left side, notes the Mayo Clinic.
Costochondritis is typically caused by some kind of mechanical stress — coughing too hard or reaching too far and straining your body. Costochondritis can happen to people with rheumatic diseases like rheumatoid arthritis and psoriatic arthritis, in which inflammation affects your rib cartilage. But it can also be partially caused by noninflammatory conditions, such as fibromyalgia.
Pneumonia
Chest pain, particularly if it develops suddenly and is on one side, is a common sign of pneumonia. But if you have pneumonia, you’ll likely also be experiencing other symptoms, such as chills and fever (higher than 100.4 degrees F), a cough lasting more than three weeks, shortness of breath or rapid breathing, bloody mucus, and drowsiness or confusion.
Panic Attacks
When you have a panic attack, stress hormones like adrenaline and cortisol flood your body, leading to a sudden and overwhelming physiological and emotional response. Chest pain, along with a rapid heart rate and hyperventilation, can be part of a panic attack. As with a heart attack, sweating and nausea may occur. But unlike a heart attack, during a panic attack you may experience other symptoms like trembling, a choking sensation, feelings of intense terror and fear, or feeling detached from reality.
While there can be a number of noncardiac causes of chest pain, it’s always worth getting chest pain checked. The bottom line: When in doubt, check it out and seek medical attention.
What Is Addison’s Disease? Symptoms, Causes, Diagnosis, Treatment, and Prevention
The only treatment for Addison’s disease is medication to correct levels of cortisol and aldosterone in the body. Cortisol is replaced with a synthetic version, such as hydrocortisone (Cortef), prednisone (Prednisone Intensol, Rayos) or methylprednisolone (Medrol). Aldosterone is replaced with a synthetic version called fludrocortisone acetate.
Addison’s disease is a lifelong condition, so you’ll need to take these medications for the rest of your life.
Dosages of these medications vary from person to person, and your doctor may tell you to take more or less of them during certain times in your life. For example, if you are sick or scheduled to have surgery, your doctor may tell you to take more of these medications because more of these hormones are needed when your body is under stress.
You may also need to up your sodium intake while taking these medications, especially during heavy exercise, hot weather, or if you’re having digestive issues such as diarrhea.
It’s important for your healthcare team to closely monitor the dosages of your medication to ensure you’re not taking too much or too little. Too much hydrocortisone, for example, can lead to type 2 diabetes, obesity, or osteoporosis over time. Too much fludrocortisone can lead to high blood pressure.
As mentioned, an Addisonian crisis or adrenal crisis is a medical emergency. Treatment may involve intravenous medication or solutions such as corticosteroids, saline solution, or sugar.
What Is T-Cell Lymphoma?
T-cell lymphoma (TCL) is a rare form of cancer that affects the lymphatic system.e60dc2a1-f33c-4a05-9b50-8e3e8e5976292896150b-d635-48a6-b6ad-cc018b935444 It develops from the abnormal multiplication of T cells, or T-lymphocytes, a type of white blood cell essential for immune system function. The specific treatment course and prognosis for T-cell lymphoma depends on the subtype — of which there are many — and how advanced the cancer is.
Types of Lymphoma Types There are two types of lymphoma:e60dc2a1-f33c-4a05-9b50-8e3e8e597629b4d560a8-e488-4a2c-a4c7-eb5c1da4a423 Hodgkin lymphoma (formerly Hodgkin disease) non-Hodgkin lymphoma Hodgkin lymphoma involves a type of cancer cell called Reed-Sternberg cells. Unlike Hodgkin lymphoma, the non-Hodgkin varieties look different under the microscope and don’t contain Reed-Sternberg cells. T-cell lymphoma is a type of non-Hodgkin lymphoma. Non-Hodgkin lymphomas either begin in B cells or T cells — T-cell lymphomas account for less than 15 percent of all non-Hodgkin lymphomas.e60dc2a1-f33c-4a05-9b50-8e3e8e5976293aac0bd9-f138-4999-b731-3048cb367629 Types of T-Cell Lymphoma The two main categories of T-cell lymphoma are:e60dc2a1-f33c-4a05-9b50-8e3e8e597629684e47d5-ec15-4a45-91b6-5432dd54912a Cutaneous T-cell lymphoma Peripheral T-cell lymphoma Typically slow-growing, cutaneous T-cell lymphoma (CTCL) is the most common form of T-cell lymphoma.e60dc2a1-f33c-4a05-9b50-8e3e8e59762981af462d-724d-4e20-8301-b10e7381bd8f It mainly affects the skin — though they’re not classified as skin cancers — but can also affect lymph nodes, blood, and internal organs.e60dc2a1-f33c-4a05-9b50-8e3e8e5976296412dd5a-d2c3-46a3-9384-a19ac04e1592 Peripheral T-cell lymphomas are a diverse group of cancers that primarily affect lymph nodes and other lymph tissues. There are 19 different subtypes that are usually aggressive.e60dc2a1-f33c-4a05-9b50-8e3e8e59762983211dfd-e911-4223-85c1-aac7c5e979d8
Signs and Symptoms of T-Cell Lymphoma Symptoms Given its many different subtypes, T-cell lymphoma can present with a wide range of signs and symptoms, and its manifestations may vary from person to person. For instance, the first signs of a type of T-cell lymphoma called mycosis fungoides is often a skin rash, while other forms may present with swollen lymph nodes. Common symptoms for cutaneous T-cell lymphoma include:e60dc2a1-f33c-4a05-9b50-8e3e8e5976296ce652ff-0de4-49eb-bf18-337bd98aff6e Red rash that may look like a sunburn and is intensely itchy Round scaly patches of skin that may be raised Light or white patches of skin Thick, raised plaques Skin lesions, including ulcers or nodules, that may break open Skin tumors that may be bluish or reddish brown Changes to nails and hair, including hair loss Thickened skin on the palms of hands and soles of feet Skin peeling Insomnia (from itching) Aggressive forms of T-cell lymphoma may include symptoms like hypercalcemia (too much calcium in the blood), bone pain, and confusion.e60dc2a1-f33c-4a05-9b50-8e3e8e59762901cd370c-57f6-4dd7-a194-a624bd66652b Signs and symptoms for other types of T-cell lymphoma include:e60dc2a1-f33c-4a05-9b50-8e3e8e597629f484d4bf-b467-4075-a222-e5b5d4a8788ce60dc2a1-f33c-4a05-9b50-8e3e8e59762938e41dab-1317-4b17-8903-3c1b6116d93de60dc2a1-f33c-4a05-9b50-8e3e8e597629a639dcfb-0580-42cc-80c1-49a3fd8d796a Swollen lymph nodes, particularly in the neck, armpit, or groin Fever or chills Unexplained fatigue Unexplained weight loss Night sweats Respiratory issues such as coughing, shortness of breath, or chest pain Gastrointestinal symptoms such as abdominal pain, nausea, vomiting, constipation, or diarrhea Frequent urination Enlarged liver or spleen Bleeding or bruising easily Recurrent infections If the cancer spreads to the brain, it may also cause:e60dc2a1-f33c-4a05-9b50-8e3e8e5976290af220e3-8ad2-43f7-9a69-bda99e400cfd Headaches Concentration problems Personality changes Seizures
Causes and Risk Factors for T-Cell Lymphoma Causes The causes of the majority of T-cell lymphomas are unknown.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e54ce6b8-b486-4c31-8301-3fe78196edab Acquired genetic mutations usually have a role to play, but external factors — including viruses and chemical exposure — may also contribute to causing T-cell lymphomas.e60dc2a1-f33c-4a05-9b50-8e3e8e597629c1a6be7c-3a74-4eaa-bbdb-6177c7cd5619 You have an increased risk of developing T-cell lymphoma if you:e60dc2a1-f33c-4a05-9b50-8e3e8e5976291216bea5-e0e1-4832-975d-0c83940d0bc6 Are age 55 or older Are male or assigned male at birth Are white or Asian Have a weakened immune system due to conditions like HIV/AIDS or immunosuppressive therapies following organ transplantation Have a family history of lymphoma or other blood cancers Have prolonged exposure to carcinogens such as ultraviolet light, chemicals, pesticides, or environmental toxins Have certain viral infections, such as Epstein-Barr virus and HTLV-1 (human T-lymphotropic virus 1) Have certain autoimmune diseases, such as celiac disease
How Is T-Cell Lymphoma Diagnosed? Diagnosis Diagnosing T-cell lymphoma involves a combination of medical and family history review, physical examination, and various diagnostic tests.e60dc2a1-f33c-4a05-9b50-8e3e8e5976293e5ff3c9-5457-4e4f-bf26-f981e5e52224 During the physical examination, your healthcare provider will look for evidence of lymph nodes that can be felt through the skin, skin abnormalities, or other signs indicative of T-cell lymphoma. Tests that may be used to diagnose T-cell lymphoma include:e60dc2a1-f33c-4a05-9b50-8e3e8e597629819f353c-cf41-46ac-b136-d43a005a4798 Blood tests to evaluate the number and types of blood cells, and to assess organ function and overall health Peripheral blood smear, an examination of blood cells and platelets under the microscopee60dc2a1-f33c-4a05-9b50-8e3e8e5976291a1331b0-22b8-4464-91fe-000af0add2bf CT, PET, or MRI scans to identify enlarged lymph nodes or organs affected by lymphoma and areas with abnormal cell growth Biopsy of any enlarged lymph nodes or involved skin (to confirm lymphoma and determine its subtype) Immunophenotyping, a lab test that helps diagnose specific lymphoma typese60dc2a1-f33c-4a05-9b50-8e3e8e5976294b9db24b-8c23-47c5-9d79-c22404bc06ff Bone marrow aspiration (a procedure that removes a small sample of bone marrow) and biopsy to determine if the disease has spread to the bone marrow Flow cytometry, a test used to identify specific types of lymphoma cells Collection and testing of cerebrospinal fluid to determine if the lymphoma has spread to the central nervous system Tests for various viruses including HIV, HTLV-1, and Epstein-Barr virus Your healthcare provider may also run tests to identify specific genetic mutations or molecular markers to further characterize the lymphoma and guide treatment decisions. Accurately diagnosing T-cell lymphoma often takes time. Given that cutaneous T-cell lymphoma shares symptoms with many other benign conditions, it takes an average of 6 years from disease onset to reach a correct diagnosis.e60dc2a1-f33c-4a05-9b50-8e3e8e597629944abeb3-0972-4a42-acdb-5afc46bce1d1 During diagnosis, your healthcare provider will also determine the stage of your disease, which is crucial for developing an effective treatment plan. Stages of T-Cell Lymphoma T-cell lymphoma is typically defined as being stage 1 through 4, which indicates the extent of the cancer.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b1b1fe2d-b1f1-413f-a534-d1c66c56b7d0 Stage 1 The cancer is limited to a single lymph node region or a single lymphoid organ, which includes the thymus, spleen, and bone marrow. Stage 2 The cancer involves two or more lymph node regions on the same side of the diaphragm, a major breathing muscle located below the lungs. Stage 3 The cancer involves lymph node regions on both sides of the diaphragm, above or below it, or your spleen. Stage 4 The cancer has spread to organs beyond the lymphatic system, such as the liver, lungs, or bone marrow. Cutaneous T-cell lymphoma has a different growth pattern than other types of lymphoma, and staging may be based on the presence of various symptoms:e60dc2a1-f33c-4a05-9b50-8e3e8e5976295e6cc76a-e107-4011-9859-664ddbcdd97a Stage 1A Limited patches, papules, or plaques covering less than 10 percent of the skin surface. No tumors are present, and lymph nodes, blood, and internal organs are not involved. Stage 1B Same as stage 1A but skin issues cover more than 10 percent of the skin surface. Stage 2A Lymph nodes are abnormal but not cancerous. Stage 2B One or more tumors 1 centimeter or larger develops on the skin. Lymph nodes are not cancerous. Stage 3 At least 80 percent of the skin surface is reddened and covered with patches, papules, plaques, or tumors. Stage 4A There is a high number of Sézary cells, or cancerous T-cells, in the blood. Stage 4A2 There may be a high number of Sézary cells in the blood, and the lymph nodes are very abnormal or have developed cancer. Stage 4B The cancer has spread to other organs, such as the spleen or liver.
T-Cell Lymphoma Treatment Options Treatment Treatment plans are tailored to each patient, considering factors such as age, overall health, the specific characteristics of the T-cell lymphoma subtype, and stage of the disease.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e933ac96-0587-43d7-b975-5a5c246c426f Options for treatment cover a wide range of medications, procedures, and therapies. Medication Options Medication options may include: Topical corticosteroids, like clobetasol propionatee60dc2a1-f33c-4a05-9b50-8e3e8e597629ee9595f0-a367-4efc-8497-fd4a040a4db9 Retinoids (drugs related to vitamin A), like bexarotenee60dc2a1-f33c-4a05-9b50-8e3e8e5976293c533594-389f-4b7a-987d-f23de377dde1 in the form of creams, gels, and ointments to help control redness and itchiness Topical chemotherapy drugs like mechlorethaminee60dc2a1-f33c-4a05-9b50-8e3e8e5976293f6ac0e9-452d-48d1-a041-58fa3c544576 Intravenous chemotherapy drugs like doxorubicin (Adriamycin) and pralatrexate (Folotyn)e60dc2a1-f33c-4a05-9b50-8e3e8e597629824c331c-0446-4e9c-8943-5c05b1283fc1 Antiviral drugs such as zidovudine (Retrovir), if there is a viral infectione60dc2a1-f33c-4a05-9b50-8e3e8e59762939863263-d4ac-4aef-9597-7042f852e7bd Immunotherapy medications that stimulate or boost the body’s immune system to recognize and attack cancer cells, including alemtuzumab (Campath, Lemtrada) and denileukin diftitox (Ontak), imiquimod (Zyclara), and pembrolizumab (Keytruda) Targeted therapy medications that focus on specific molecular changes or proteins in or on cancer cells Surgery Surgery options include:e60dc2a1-f33c-4a05-9b50-8e3e8e597629e9c068c3-e61e-4f1e-b1fb-b35387edfc9b Tumor resection to remove tumors Stem cell transplantation, a procedure to replace damaged bone marrow cells with stem cells (immature blood cells), which may require general anesthesia Other Treatments and Procedures Nonmedication treatment options may include:e60dc2a1-f33c-4a05-9b50-8e3e8e597629ac3967ec-dd15-4386-85ce-ecb6ddec357be60dc2a1-f33c-4a05-9b50-8e3e8e5976294f936960-af79-469f-988f-83ce9c7c2ab6 Extracorporeal photopheresis, a procedure in which your blood is removed and treated with UV lights and light-activated drugs before being returned to your body Radiation therapy to eliminate cancer cells, particularly when the disease is localized Phototherapy, or using ultraviolet (UV) light to kill cancer cells in the skin Lifestyle Approaches While T-cell lymphoma requires thorough medical treatment, there are things you can do to encourage positive treatment outcomes. These include: Light exercise to maintain physical strength and reduce fatigue A nutrient-rich diet of lean meats, fruits, and vegetables, especially cruciferous vegetables like broccoli and cauliflowere60dc2a1-f33c-4a05-9b50-8e3e8e597629eaafde43-b22b-45e8-9fee-1573fbdc4270 Palliative care for emotional and psychological support Complementary therapies for symptom relief with the support of your doctor In the case of cutaneous T-cell lymphoma:e60dc2a1-f33c-4a05-9b50-8e3e8e597629cec16dd6-e9d7-4e76-a192-17190d4a8f6c Use mild, unscented soaps to prevent skin irritation. Keep skin moisturized to prevent itching and infection. Discuss bleach baths with your healthcare provider to reduce infection. Clinical Trials Researchers may be testing new therapies to help with conditions like T-cell lymphoma. If you’re interested in participating in a clinical trial, speak with your doctor or visit ClinicalTrials.gov to search for studies in your area.
T-Cell Lymphoma Prevention Prevention There is no definite way to prevent T-cell lymphoma. Most often, people with T-cell lymphoma have no risk factors that can be changed. But a level of awareness and certain lifestyle choices can reduce some risks, contribute to early detection, and lead to better overall prognosis. These include:e60dc2a1-f33c-4a05-9b50-8e3e8e59762987c1c7f2-fcf0-4632-b08d-90da5bea122d Routine health checkups and screenings to aid in the early detection of lymphoma. Awareness of potential symptoms, and medical advice for persistent issues A healthy weight, physical activity, and a healthy diet Minimal exposure to environmental challenges, such as certain chemicals or pollutants Avoidance of risk factors for HIV (which increases the risk of T-cell lymphoma) and HTLV-1, including intravenous drug use and unprotected sex
T-Cell Lymphoma Prognosis and Survival Rates Prognosis and Outlook T-cell lymphoma prognosis varies widely based on the specific subtype, stage at diagnosis, and individual patient factors. Generally, T-cell lymphomas tend to have a more aggressive course than some B-cell lymphomas.e60dc2a1-f33c-4a05-9b50-8e3e8e597629d6adc933-5675-4092-b43f-c644576f433b Younger people, those diagnosed early, and those with localized disease that hasn’t spread through the body tend to have better outcomes.e60dc2a1-f33c-4a05-9b50-8e3e8e5976296524b216-f4a1-4d65-915f-b8765445e59ee60dc2a1-f33c-4a05-9b50-8e3e8e597629b632295a-c4d6-4a69-9298-38529abe0c63 Survival rates can be influenced by: Subtype: Different subtypes have distinct prognoses, with some being more responsive to treatment than others. Stage at diagnosis: Early-stage T-cell lymphomas often have a more favorable prognosis than those diagnosed at an advanced stage. Age and overall health: Younger patients and those in good overall health may respond better to treatment. Response to treatment: How well the cancer responds to initial treatment can significantly influence the prognosis. The overall five-year relative survival rate for non-Hodgkin lymphoma is 74.3 percent.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291cb0f295-5e92-46fc-86aa-78cb98fa23a5 It accounts for 3.3 percent of all cancer deaths. The survival rate for early-stage cutaneous T-cell lymphoma over 10 years is roughly 90 percent, while late stage CTCL survival rates are about 53 percent.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a876abb2-dbd1-41a9-929b-904862c6dde3 For peripheral T-cell lymphoma, the five-year survival rate is between 30 and 40 percent.e60dc2a1-f33c-4a05-9b50-8e3e8e59762987c1705e-9adf-4c71-bf0b-f378b6d4a26f It’s crucial for you to discuss prognosis and potential treatment outcomes with your healthcare provider, as individual cases can vary widely.
Complications of T-Cell Lymphoma Complications T-cell lymphoma can lead to serious complications, including organ damage or life-threatening infections.e60dc2a1-f33c-4a05-9b50-8e3e8e5976296f467061-8491-4aa8-8d68-0e6bc495b53c Organ damage can occur when tumors penetrate areas like the spleen, liver, or bone marrow.e60dc2a1-f33c-4a05-9b50-8e3e8e5976296365a8fd-e6ea-441a-bb96-193fda72ffe5 Immune suppression or immune system reactions to tumors can lead to infections.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b3df4516-2c27-4a97-826d-2140c43c3b50
Research and Statistics: Who Has T-Cell Lymphoma? Research and Statistics T-cell lymphomas are rare, making up 10 to 15 percent of all non-Hodgkin lymphomas. They are slightly more common in men or people assigned male at birth.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a533dab7-0c31-4554-95ca-e705a195caeb T-cell lymphomas occur more often in locations like Japan, China, the Caribbean, South and Central America, and West Africa, where HTLV-1 infections are more common.e60dc2a1-f33c-4a05-9b50-8e3e8e597629f44ef915-b2b9-4555-a0fb-6e13d7aedf38
Related Conditions to T-Cell Lymphoma Related Conditions Related conditions include:e60dc2a1-f33c-4a05-9b50-8e3e8e59762941e3881a-3a37-45eb-8d07-b4937bfc43f7 Other non-Hodgkin lymphomas, like B-cell lymphoma Skin conditions mimicking cutaneous T-cell lymphoma, like psoriasis and eczemae60dc2a1-f33c-4a05-9b50-8e3e8e597629634795f3-cb0a-4311-b52f-a635737fda83 Autoimmune disorders like hemophagocytic syndrome Leukemia Some extracutaneous lymphomas, like systemic T-cell lymphomae60dc2a1-f33c-4a05-9b50-8e3e8e597629c4b17b54-7e90-49c9-9356-dccee939e1bb T-cell lymphoma may present as inflammatory skin diseases like psoriasis or dermatitis in the early stages, sometimes making diagnosis more complicated.
Support for T-Cell Lymphoma Support People with T-cell lymphoma can support each other and share effective ways to manage the disease. One of these organizations may offer the resources you need. Leukemia & Lymphoma Society (LLS) LLS is the largest nonprofit dedicated to curing blood cancers, including leukemia, lymphoma, Hodgkin’s disease, and myeloma. It provides patient education, offers financial assistance, and advocates for policies to improve access to care and encourage treatment development. Lymphoma Research Foundation (LRF) The Lymphoma Research Foundation is the largest U.S. nonprofit focused exclusively on lymphoma. It funds innovative research to advance treatments and cures while providing education, support services, and resources for patients and caregivers. LRF also connects people with lymphoma through its peer-to-peer Lymphoma Support Network. CancerCare CancerCare is a national nonprofit offering free professional support services for individuals affected by cancer, including counseling, support groups, educational workshops, and financial assistance. The T-Cell Leukemia & Lymphoma Foundation (TCLLF) The TCLLF supports patients with rare T-cell cancers by funding research, hosting educational forums, promoting clinical trial participation, and raising awareness about these rare diseases.
The Takeaway T-cell lymphoma is a rare cancer that affects the lymphatic system. It develops from the abnormal multiplication of T cells, a type of white blood cell. Treatment and prognosis for T-cell lymphoma depends on the subtype and how far the cancer has progressed. The overall five-year relative survival rate for non-Hodgkin lymphomas like T-cell is 74.3 percent.
Resources We Trust Mayo Clinic: Hodgkin’s vs. non-Hodgkin’s lymphoma: What’s the difference? Cleveland Clinic: T Cells: Types and Function Leukaemia Foundation: Optimal Care Pathways for Lymphoma American Cancer Society: Treating T-Cell Non-Hodgkin Lymphoma Cancer Care: Peripheral T-Cell Lymphoma Resources and Support
Additional reporting by Crystal Hoshaw .
What Are Ultra-Processed Foods?
It’s not hard to tell the difference between an unprocessed ear of corn and an ultra-processed bag of corn chips. But it can be challenging to determine how much processing goes into foods that come boxed, bagged, canned, or frozen.
“Food manufacturers are not required to label if food is ultra-processed, and anything boxed, canned, or frozen does not automatically mean they are ultra-processed,” says Dr. Glenn. “Some foods that people may assume are ultra-processed foods are not actually ultra-processed foods — like canned or frozen fruits and vegetables,” she adds.
One quick way to sort this out at the grocery store is to think about how closely the products you’re buying resemble the whole foods they might originate from. Here are some examples Harvard Health Publishing offers to distinguish between processed and ultra-processed packaged foods:
- Canned corn (processed) versus corn chips (ultra-processed)
- Apple juice (processed) versus apple pie (ultra-processed)
- Baked potato (processed) versus french fries (ultra-processed)
- Flour (processed) versus cookies (ultra-processed)
Ultra-processed foods are typically prepackaged products, and they often contain lots of sodium, added sugars, and saturated fats. If you’re an adult, aim to get less than 10 percent of your daily calories from added sugars and saturated fats, or no more than 200 calories out of a 2,000 calorie daily diet and limit daily sodium intake to less than 2,300 milligrams, according to the U.S. Dietary Guidelines.
Focusing on these items is a good, if imperfect, way to identify ultra-processed foods, Glenn says.
“Consumers can examine the label and check out the ingredient list to get a sense if a product is ultra-processed or not,” Glenn says. “Ingredients are listed by weight in the ingredient list, so if you see a lot of ingredients you typically would not use in the kitchen at the beginning of the list then the food is considered ultra-processed.”
Ingredients Commonly Used in Ultra-Processed Foods
If you see these ingredients near the beginning of the ingredient list, the food is probably ultra-processed, Glenn says:
- Isolates (specifically, sources of protein such as hydrolyzed proteins, soy protein isolate, gluten, casein, whey protein, and “mechanically separated meat”)
- High-fructose corn syrup, as well as other varieties of sugars including fructose, “fruit juice concentrates,” invert sugar, maltodextrin, dextrose, and lactose
- Hydrogenated oils and interesterified oils
- Additives on the label like colors and sweeteners
Beyond this, Mozaffarian says there are some other things to look for on labels and try to avoid:
- Refined Sugar and Starch Use a 10:1 rule when you look at how much carbohydrates and fiber you see on the label. You want to have at least 1 gram of fiber for every 10 grams of carbohydrates.
- Sodium Choose products with the lowest amount of sodium on the label.
- Saturated Fat Total fat listed on the label should be much bigger than the amount of saturated fat. This means you’re getting products made with healthier fats.
- Shelf Life Before you pick up a food product, check the expiration date — it shouldn’t be too far away. Products that don’t expire for many months, or longer, have to be heavily processed to extend their shelf life.
Healthy Ultra-Processed Foods
As for items within the ulta-processed category as per Nova, ideally people want to minimize these as much as possible, but some of these foods may be healthier than others, says Glenn.
“For example, some soy milk products would be considered ultra-processed, or foods like breakfast cereals or fruit yogurts, where in research studies the data looks okay so far, although I would love to continue to see more research on this topic and on these specific products,” she says.
What Is an Anal Fistula?
An anal fistula is a tunnel that develops from the inside of the anus to the skin outside. It usually starts near blocked or infected anal glands and forms an abscess (a pus-filled pocket). Pus and fluid collect in this space, which then tunnels to the outside, where it drains.e60dc2a1-f33c-4a05-9b50-8e3e8e597629d46585f3-e129-4c9a-928e-b5c45c3bf066 From the outside, an anal fistula (also called a fistula-in-ano) looks like a small hole in the skin close to your anus.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295f1c9d80-32f9-4af3-81c1-9e4b5b6a4fe2 You may notice pus, blood, or stool draining from it.e60dc2a1-f33c-4a05-9b50-8e3e8e59762928dd0482-1869-4acf-b738-381926398d93 The most common symptoms of an anal fistula are anal pain, swelling, redness, and fluid drainage from the opening.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b6a199f3-ff88-4499-a04d-d78ea536dfd2 Treatment options vary, but most anal fistulas require surgery.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e1ce61f6-5fce-48f2-996a-ae3f2a596a62
Types of Anal Fistulas Types Healthcare providers categorize anal fistulas based on their location. Each type relates to its proximity to your anal sphincter muscles, which control your bowel movements.e60dc2a1-f33c-4a05-9b50-8e3e8e5976296d046e8b-26c3-465f-99b5-f758cc6396ce Intersphincteric anal fistula : A fistula that forms in the internal anal sphincter muscle, then leads out between the internal and external sphincter muscles. Transsphincteric fistula : A fistula that forms in both layers of anal sphincter muscles. Suprasphincteric fistula : A fistula that forms in the internal sphincter, then leads around the external sphincter. Extrasphincteric fistula : A less-common fistula that forms around both sphincter muscles. Superficial anal fistula : A fistula that bypasses all muscles. Extrasphincteric fistulas and superficial anal fistulas don’t come from blocked anal glands but are still called anal fistulas based on their location.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291670d3dc-22cd-4c02-8f79-d8e426a78ff0
Signs and Symptoms of an Anal Fistula Symptoms One of the most common symptoms of an anal fistula is pain in and around the anus. Swelling and inflammation associated with an anal fistula can cause intense discomfort. The pain usually gets worse when you apply pressure to the area by sitting, coughing, or pooping.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295ecbfd3b-f54b-4780-8c56-b7ba251db11c Besides anal pain, symptoms of an anal fistula include:e60dc2a1-f33c-4a05-9b50-8e3e8e597629e95eb845-e237-43b6-a2ef-a7b65bb39709e60dc2a1-f33c-4a05-9b50-8e3e8e597629f985a117-6b8f-4650-b9fe-93f0e4054ae0 Fluid drainage (including pus, blood, or stool) from the fistula A visible opening on the skin near the anus Redness, inflammation, and itching around the opening Fever and chills Fatigue Feeling generally sick Pain with urination Trouble holding stool in Fistula symptoms may ease temporarily but tend to come back in the same area every few weeks.e60dc2a1-f33c-4a05-9b50-8e3e8e597629aa51f157-d8b4-4536-86e3-c9f2b1019fe5
Causes and Risk Factors of Anal Fistulas Causes Most types of anal fistulas are caused by a perianal abscess (the blockage, inflammation, and infection of the anal glands). These small glands sit inside your body near the anal opening and typically cause no trouble. But certain medical conditions and risk factors can make them more likely to get clogged and infected.e60dc2a1-f33c-4a05-9b50-8e3e8e5976290fa4c509-61c3-4db7-ab7c-781fbc284ba9e60dc2a1-f33c-4a05-9b50-8e3e8e5976298540a2d9-11f4-4fb4-96c7-d4ffe0b06278 Risk factors for anal fistulas include:e60dc2a1-f33c-4a05-9b50-8e3e8e5976294fd31325-7b71-4db5-9d0c-bc8242383e80e60dc2a1-f33c-4a05-9b50-8e3e8e597629044d2ec8-4323-4054-bf55-8d8242033e58e60dc2a1-f33c-4a05-9b50-8e3e8e597629dec24c83-879a-4b46-9113-6d2486c2f500 Being male Having a current or prior history of perianal abscesses Having an inflammatory bowel disease (IBD) like Crohn’s disease Having had surgery in the anal region Having had radiation treatment for rectal cancer Experiencing a traumatic injury Having an infection in the anal area Having chronic sexually transmitted infections Having tuberculosis Having hidradenitis suppurativa Having obesity Having diabetes Having high cholesterol
How Is an Anal Fistula Diagnosed? Diagnosis Anal fistulas are diagnosed by a gastrointestinal specialist ( gastroenterologist ) or a colorectal surgeon. They’ll perform a physical examination, ask about your medical history and symptoms, and order diagnostic tests.e60dc2a1-f33c-4a05-9b50-8e3e8e597629f5a8f71f-a289-49e7-8638-98140564ea0c Common tests used to diagnose an anal fistula include:e60dc2a1-f33c-4a05-9b50-8e3e8e5976295a9276b4-37b7-4aa9-8724-8e9d0fc93834e60dc2a1-f33c-4a05-9b50-8e3e8e5976298c28d11e-6c56-4d0f-95cf-16dcfd86d7d4 Anoscope, a small tube with a light and camera that helps see the anal canal. Magnetic resonance imaging (MRI) , an imaging scan that produces detailed images of the fistula and sphincter muscles. Fistulography, which involves a contrast injection (dye) to show the path of the fistula on an X-ray. Fistula probe, a tool that’s inserted into the fistula to map its tunnel. It may be difficult to find the fistula opening inside the anus. Sometimes, providers inject hydrogen peroxide into the outer opening to help locate the infection at the source of the fistula. The hydrogen peroxide will form bubbles or foam at the site of the infection.e60dc2a1-f33c-4a05-9b50-8e3e8e5976293aac6926-5a0a-47ee-aeee-cb970c3d5eff For persistent and very painful anal fistulas, your provider may recommend diagnostic surgery to examine it and identify any potential complications. If your provider suspects you may have an IBD like Crohn’s disease, they may order a colonoscopy to diagnose this related condition.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b1d6217b-949a-49dd-b137-3b8f495aefee
Treatment and Medication Options for Anal Fistulas Treatment In most cases, treating an anal fistula involves surgery. But if your fistula is caused by Crohn’s disease and isn’t infected, it may heal with medical treatment for Crohn’s. Sometimes, both medicine and surgery are used for fistulas among people with Crohn’s.e60dc2a1-f33c-4a05-9b50-8e3e8e597629d11f1568-7ced-4253-acec-f22b82fd8954 All treatment options aim to repair the fistula while protecting the important sphincter muscles nearby.e60dc2a1-f33c-4a05-9b50-8e3e8e5976292e712d9d-ca8e-4e03-a48d-a62601b304e6 Medication Options As mentioned, if you have an IBD like Crohn’s disease, the medications used to treat it may help resolve your fistula if it’s not infected.e60dc2a1-f33c-4a05-9b50-8e3e8e597629dde6b76c-88e4-4519-bfb4-7796239724ab Your provider may also prescribe antibiotics to be used alongside surgery in some cases, but these drugs will not repair a fistula on their own.e60dc2a1-f33c-4a05-9b50-8e3e8e5976290e8852fa-5916-4dd7-835a-9a5659a226fc Surgery Since medication alone typically cannot heal an anal fistula, surgery is the most common treatment. Surgical options to treat anal fistula include:e60dc2a1-f33c-4a05-9b50-8e3e8e59762924f05034-fe5e-42e0-9032-12547e45e48de60dc2a1-f33c-4a05-9b50-8e3e8e597629b8ef70cc-a367-42ce-8bb2-e50d25b107c3 Fistulotomy This surgery opens the fistula further so it can heal from the inside out. Glue and plug A newer treatment option, this procedure closes the inner fistula opening. Then, your provider fills the tunnel with a special type of glue and seals the outer opening with a collagen plug. Seton placement During this procedure, the surgeon places a suture or rubber band (seton) inside the fistula, which keeps it open and allows it to drain and heal from the inside out. Endorectal advancement flap (ERF) In this procedure, a surgeon removes the fistula’s internal opening, then covers it with a flap removed from the rectal wall. This procedure preserves more sphincter muscle than other options. Ligation of the intersphincteric fistula tract (LIFT) A two-stage treatment, the LIFT procedure works best for deep or complex fistulas. A surgeon places a seton into the tunnel, which gradually helps widen it. Then, weeks later, the surgeon removes any infected tissue and closes the internal tunnel opening. Muscle flap Also for complex fistulas, this procedure fills the tunnel with healthy muscle removed from the thigh, buttocks, or labia. Ostomy and stoma For persistent fistulas that haven’t healed with other methods, your provider may recommend bypassing your anus altogether until the fistula can fully heal. This is done via a procedure called an ostomy. This involves creating a temporary opening (called a stoma) in your abdomen to temporarily divert your intestines away from your anal canal. After surgery, you’ll wear an ostomy pouch over the stoma to collect waste. This process can be reversed once the fistula has healed.
Prevention of Anal Fistula Prevention To prevent an anal fistula, you must first prevent anal abscesses from forming around your anal glands. Lifestyle changes that can help prevent anal fistulas include:e60dc2a1-f33c-4a05-9b50-8e3e8e59762914fdf2a5-eec1-47a0-9108-c42fc6348dbe Healthy dietary habits with an adequate fiber intake Daily exercise Safe sex practices Regular cleaning of the area around your anus, including through daily showering or washing the area when soiled If you have any symptoms of an IBD, like weight loss, abdominal pain, blood in your stool, or chronic diarrhea, let your healthcare provider know right away. Early diagnosis and treatment of Crohn’s disease or other IBDs can help reduce risk of anal fistulas.e60dc2a1-f33c-4a05-9b50-8e3e8e597629ec395395-59c8-4be4-95be-22b468ab80e2
Lifestyle Changes for Anal Fistulas Lifestyle Changes After surgery for an anal fistula, these lifestyle and self-care strategies can help your body recover:e60dc2a1-f33c-4a05-9b50-8e3e8e5976296b5263ff-c146-41aa-a331-601e2f48da58e60dc2a1-f33c-4a05-9b50-8e3e8e597629fe8f08be-ce03-44be-ac30-e78b250bbed4 Soak in a warm bath three to four times a day. Wear a pad over your anal area during healing. Increase fiber in your diet. Drink plenty of fluids to prevent constipation. Use a provider-approved stool softener. Avoid straining during a bowel movement. Wait until your surgeon clears you to resume your usual activities.
How Long Do Anal Fistulas Last? Prognosis and Outlook The prognosis of an anal fistula depends on how simple or complex it is. It typically takes three to six weeks to heal from one or more surgeries. Recovery from more extensive surgeries may take up to 12 weeks.e60dc2a1-f33c-4a05-9b50-8e3e8e5976298fd8284f-708e-440d-b82d-a93e1bd11d29e60dc2a1-f33c-4a05-9b50-8e3e8e59762978dc723a-1518-4c0d-8f56-be2662ba9234 Once an abscess or fistula exists, it can come back even after treatment.e60dc2a1-f33c-4a05-9b50-8e3e8e59762938d4e816-b062-4792-8dcf-4d44ccfa40ed The symptoms of an anal fistula left untreated may come and go every few weeks, but most anal fistulas recur without surgery.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e5b529d1-f347-405b-82ef-78ad0c25794a
Complications of Anal Fistula Complications The most common complication of an anal fistula is recurrence, meaning it comes back after healing.e60dc2a1-f33c-4a05-9b50-8e3e8e59762916c84d31-7e58-471c-8779-4a6f0eaedf37 Other potential complications include:e60dc2a1-f33c-4a05-9b50-8e3e8e59762984fbefd6-9991-40bc-9bb0-2654df2bef00e60dc2a1-f33c-4a05-9b50-8e3e8e597629fc2523e5-6574-48c1-a7b8-eee6172dfd77e60dc2a1-f33c-4a05-9b50-8e3e8e597629cc7f2bf5-ab5b-4b1a-8fba-2a02b66bf5d1 Inability to hold in stool (fecal incontinence) Chronic infection Fistula extension to new areas Anal cancer Chronic draining of fluids at the opening Anal stricture (a narrowing of the anal canal which can make it difficult to pass stool)
Research and Statistics: How Many People Have Anal Fistulas? Research and Statistics Anal fistulas occur in as many as 8 out of every 10,000 people each year. In the Western Hemisphere, a small minority of cases are associated with Crohn’s disease.e60dc2a1-f33c-4a05-9b50-8e3e8e59762931ce98f2-94ba-4e80-b125-42d71b6a0c75 Anal fistulas happen twice as often in men than women. They’re most common in adults around age 40, but they can occur in younger people, especially those with Crohn’s disease.e60dc2a1-f33c-4a05-9b50-8e3e8e59762933ef7400-19d8-4a36-846d-65fbbe0a5709e60dc2a1-f33c-4a05-9b50-8e3e8e597629e706fb56-f219-4c7a-bb93-2f8c911c4a71
Related Conditions Related Conditions Some conditions cause symptoms that are similar to the symptoms of an anal fistula. They include:e60dc2a1-f33c-4a05-9b50-8e3e8e597629f5a9707d-486d-4555-9244-acdd468cd297 Anal fissure Anogenital warts ( Condyloma acuminata ) Hemorrhoids Rectal ulcers Crohn’s disease Hidradenitis suppurativa Anal cancer STIs
The Takeaway Anal fistulas happen when an infection of the anal glands causes an abscess that tunnels through anal tissue to the skin outside the anus. Common symptoms of anal fistulas include pain, redness, and swelling around the outer opening, as well as drainage of pus, blood, and stool from that area. Most anal fistulas can only be repaired through surgery, though fistulas caused by Crohn’s can sometimes resolve with IBD medication.
Resources We Trust Cleveland Clinic: Anal FistulaMayo Clinic: Anal Fistula: Symptoms and CausesJohns Hopkins Medicine: Anal FistulaAmerican Society of Colon & Rectal Surgeons: Abscess and FistulaCedars Sinai: Anal Fistula
What We Know and What We Don’t
With a measles outbreak in Texas currently nearing 200 cases and claiming at least two lives, public health officials are strongly encouraging vaccination.
At the same time, some public health officials, including U.S. Department of Health and Human Services (HHS) Secretary Robert F. Kennedy Jr., are touting vitamin A therapy for the reduction of severe measles symptoms.
While research supports the benefits of vitamin A for general health, doctors stress that it is no substitute for measles vaccination and it is not a cure.
Parents of young children, who are especially vulnerable to measles infection, are urged to check that their kids are up to date with their immunizations, and ask their healthcare provider if they should be concerned if their child is getting sufficient vitamin A.
The Claim: Vitamin A Can Reduce the Risk of Dying From Measles
In an op-ed for Fox News this month, Secretary Kennedy highlighted research showing that vitamin A can dramatically reduce measles mortality.
In an interview with Fox, Kennedy said that the federal government was shipping doses of vitamin A to Gaines County, Texas, the epicenter of the outbreak.
What We Know About Vitamin A as a Measles Treatment
There is no antiviral medication currently available for measles treatment, and vitamin A has primarily been used as a management approach for malnourished children in developing countries.
The National Foundation for Infectious Diseases endorses vitamin A supplementation in measles patients who are severely ill to reduce the risk of extreme complications such as blindness.
In the systematic review that Kennedy cited, of studies concerning the measles vaccine and vitamin A treatment, scientists found that two doses of vitamin A had the potential to reduce the risk of dying by up to 62 percent in children with measles — but it did not prevent the spread of the illness.
Lead study author Christopher Sudfeld, ScD, an associate professor of global health and nutrition at the Harvard T.H. Chan School of Public Health, noted that most randomized controlled trials of vitamin A treatment for measles were conducted in sub-Saharan Africa in the 1980s and early 1990s — in places like Ghana, South Africa, Tanzania, and Zambia, where children might not get enough vitamin A.
For most children in the United States, however, vitamin A deficiency is not an issue, Dr. Sudfeld says.
“The National Health and Nutrition Examination Survey has suggested that less than 1 percent of the U.S. population is vitamin A-deficient based on lab tests,” he says.
Vitamin A-rich foods include eggs (specifically the yolk), green leafy vegetables, carrots, fish, milk, butter, and sweet potatoes.
“The nice thing about vitamin A is you don’t have to take it every day, because your body stores it. So you don’t have to worry if your kid only eats vitamin A-rich foods two or three times a week, because that may be enough,” says Amy Edwards, MD, an infectious disease expert and associate professor in the department of pediatrics at Case Western Reserve’s School of Medicine in Cleveland.
Vitamin A, along with the array of key nutrients found in a balanced diet, can support a healthy immune system.
What We Don’t Know About Vitamin A and Measles
It’s not clear if vitamin A supplementation is helpful if you are not deficient in this nutrient, says Dr. Edwards.
“Published papers don’t show if additional supplementation in children who are not deficient is helpful,” says Edwards. “We generally recommend only giving vitamin A to children who are hospitalized with measles, because that way, if there’s even just a smidge of benefit, we want to correct that deficiency, if it exists.”
She adds that more research is needed to see how beneficial vitamin A may be in milder cases and in people who are already getting enough vitamin A.
Should You Try Vitamin A for Measles Management?
Parents of children sick with measles and adults with measles should never decide to take vitamin A supplements on their own, says Patsy Stinchfield, NP, the immediate past president of the National Foundation for Infectious Diseases (NFID).
“When prescribed by a knowledgeable provider — usually for hospitalized children on the day of diagnosis and a second dose on day 2 — vitamin A is considered supportive management, much like giving oxygen to someone with pneumonia,” says Stinchfield. “It doesn’t cure or treat the virus, but supports immune function while the patient is in the acute stage of the illness.”
Sudfeld emphasizes that a doctor’s supervision is vital, because the doses of vitamin A used in measles treatment are very high and can cause serious health problems if taken incorrectly.
“Too much vitamin A can cause serious side effects like liver damage,” he says. Excessive amounts can also lead to dizziness, nausea, headache, coma, and even death, according to NFID.
The bottom line is vitamin A supplements may be part of supportive care for some individuals with measles, and research suggests they may help reduce mortality in certain populations. But “supplements will not prevent people from getting measles,” Sudfeld says. “Only vaccination does that.”