Thanaka: traditional Burmese sun protection.

Limonia acidissima or Hesperethusa crenulata is a common tree in Southeast Asia. It is indigenous to the Republic of Myanmar (formerly Burma) as well as India, Sri Lanka, Java, and Pakistan. In English, the common names for Limonia acidissima are sandalwood, wood-apple, elephant-apple, monkey fruit, and curd fruit tree. The plant has a number of different names in different languages including bal or bael in Assamese, bael in Bengali, kaitha in Hindi, belingai in Malaysia, and thanaka in Burmese. Unique to the Burmese people, thanaka has been used as a cosmetic product for over 2000 years. Mention of thanaka has been traced back to ancient Burmese lyrics, and relics of equipment used by ancient royalty to grind thanaka can be found in museums.

The management of antithrombotic medication in skin surgery.

BACKGROUND: Approximately one in four patients undergoing dermatologic surgery takes an antithrombotic medication. When approaching the management of antithrombotic agents, procedural dermatologists must balance surgical outcomes, bleeding risks, and cardiovascular protection. Continuing antithrombotics during surgery increases the risk hemorrhage, but discontinuation of these agents may increase the risk of thrombotic events. Despite increasing evidence for continuation of antithrombotics during dermatologic surgery, few official guidelines exist, and clinicians have been slow to integrate new evidence into clinical practice. A study in 2007 reported that more than 40% of dermatologic surgeons sometimes discontinue warfarin for surgery. OBJECTIVE: This article reviews antithrombotic agents in the United States and summarize perioperative management recommendations of antithrombotic agents in skin surgery. MATERIALS AND METHODS: A review of the literature was performed focused on antithrombotic medications commercially available in the United States, including the two newest agents, dabigatran and rivaroxaban. CONCLUSION: Although there are concerns regarding bleeding, there are no reports of life-threatening hemorrhage from continued antithrombotic therapy in dermatologic surgery. Furthermore, potentially fatal cardiovascular events after cessation of medically indicated antithrombotic medications are increasingly recognized, leading to the growing acceptance that the risk of stopping most antithrombotics may outweigh the risks of bleeding incurred by continuing antithrombotic therapy.