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Wednesday, 07 April 2010 21:27 |
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There is a rash that has gotten the nickname of the "Christmas Tree Rash" and though it usually doesn't happen in December, the name fits. This rash is a response to a viral infection and the pattern of the rash can have red patches on the back that appear at the same angles of a christmas tree's branches. Not every patient will have this pattern, but it is unique finding for this rash. I saw a gentleman from Ballantyne with a perfect pattern of the rash and his wife had also noticed the funny orientation of his rash.
The rash often starts with a larger lesion that we call the "Herald Patch" because it heralds the arrival of the many smaller lesions that can follow. The rash may have only a handful of lesions or over 100. Some people have itching that is unbearable while others have come in simply to find out what is growing on their skin. I sam a woman from Matthews recently who was asymptomatic, but had nearly 50 lesions on the trunk and arms. She didn't want treatment, she just wanted to know how she got it and when it would go away. Many different viruses can cause this rash and we don't do any bloodwork as the virus is likely gone by the time the rash has appeared. The rash may last weeks, but I have already seen a gentleman from Steel Creek who had the rash come and go over nearly four months.
Most people only get this rash once in a lifetime. One percent of people are susceptible to repeated cases of pityriasis rosea. Yesterday I saw two people in one day that have become repeat PR rash victims. One was from Fort Mill and one from the South Park area. They are both bothered by their rash and unhappy campers.
The treatment usually is a topical steroid and in severe cases oral steroids are needed. The good news is that PR is harmless and easily treated. The seasons for PR tend to be in the spring and fall, when more viruses tend to cycle, not christmas. Ho Ho Ho.
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Wednesday, 14 October 2009 00:31 |
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There is a true epidemic of skin cancer in America. One million cases of skin cancer will occur this year in America. Lifelong sun exposure is increasing for Americans as we spend more time outdoors and the sun's rays are becoming more intense with our loss of ozone. The use of tanning booths is a new way to further damage our skin and raise our risk for skin cancers. There are three common forms of skin cancer and we are seeing dramatic annual increases in the number of these skin cancers. Melanoma, which is the most aggressive form of skin cancer, is now the most common cause of cancer deaths in American women under forty years old.
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Read more: Skin Cancer : Epidemic From The Sun [Skin Cancer : Epidemic From The Sun]
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Tuesday, 22 September 2009 13:53 |
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The tanning booth industry has a problem. Their product causes cancer. You don't have to take my word for it, trust the World Health Organization. It is officially on their list of known carcinogens. This is an issue which patients have actually argued with me about. Young women especially often believe that there is no danger to tanning booth usage and this is because the people who own and operate these machines tell them so. Nobody promotes a product by telling you it causes cancer. Many states have now passed laws that do not allow underage teens to visit a tanning booth without the consent of a guardian. I recently had a teen from Fort Mill,South Carolina who admitted to using tanning booths since she was 15. She has many scary moles and "only" went to the booths once a week, while many of her friends were going three times per week.
I have had patients that own tanning salons and they usually do not go into the booths. They know the dangers and the severe photo-damage that comes with tanning. They usually tell me that they are smarter than their clients. The problem is that people falsely believe that they are safe and they often develop an addiction to the tanning rays. This addiction is well documented and many patients will readily admit to it. This tends to be more of a winter issue and is likely related to Seasonal Affective Disorder. I even had a young woman from Ballantyne recently trying to convince me that she is doing the smart thing going to indoor tanning. She was not very convincing.
As a dermatologist their is no doubt in my mind that younger and younger patients are developing scarier moles and melanoma. I had a patient in my New York practice who had a melanoma at the age of 18. She was a frequent visitor to the tanning booths and had even worked at one. She had used the booths DAILY as they were free for employees. Happily she had an early melanoma and is one of the lucky melanoma survivors. But the lesson was learned and she tried spreading the word to her friends. Most went less frequently, but still kept tanning. Even seeing a scar on their pals couldn't change their minds completely.
So if you tan or care about someone who does, just ask them not to. Have them Google "Tanning" and "World Health Organization". They might learn a lesson that could save their lives. |
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Tuesday, 22 September 2009 13:51 |
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More on Zoster and Vaccines
Zoster is an eruption of the skin that is one of the most dreaded conditions that a person can have. Shingles and zoster are the same condition, and they come up as an eruption of an old chicken pox virus travelling down a nerve root. The area affected may have pain that starts days before there are any visible lesions of zoster. The pain is often thought to be orthopedic or even cardiac depending on the location that the virus is coming up in. The first visible sign of shingles may be a red patch or patches and these are typically in a line that traces the nerve root. The skin area of a nerve root is called a dermatome and on the trunk a dermatome extends from the spine to the center of chest or abdomen. On the extremities or head dermatomes are also linear, and in areas there is usually a near perfect cut off of lesions at the mid-line. After redness, the next thing that is typically seen is a cluster of vesicles and blisters. These blisters are the classic picture of zoster and when a patient states that they have a line of blisters it is likely that they have zoster.
Most people who have zoster can remember that they had chicken pox. I saw a gentleman from Fort Mill, South Carolina who remembers all of siblings having the pox together, nearly 80 years ago. You cannot "catch" or "get" zoster from another person, it is an old infection that has resurfaced in the dermatome. The virus has remained dormant in the nerve root, often for decades. A person with zoster can give the chicken pox virus to others and this has been well documented. One reason I have seen so many people from Fort Mill with zoster is that there is a growing population of those over fifty years old retiring to the area. The older one gets, the more likely zoster is to occur. It may be difficult to get an emergency dermatolgy visit in Fort Mill and hopefully a person in need can find the right care quickly because the faster that medicine is started, the more it can help.
The pain of zoster can be a nightmare. The pain may begin before the rash and can last for months and even years. The long term pain is called post-herpetic neuralgia. There are many treatments for this but the best treatment is likely vaccination or early treatment of the infection. The areas of zoster may scar and this is especially significant on the face. The upper face can get zoster and the real danger there is that the virus can involve and damage of the eye.
The older a person is the more likely that zoster occurs. I have seen cases younger than five, but most often see people over fifty. The zoster vaccine, Zostavax, is a new option to try and prevent cases of zoster. It is the same vaccination as that given to children for preventing chicken pox. Just as children may still get an eruption of chicken pox after getting vaccinated, adults can still have an outbreak of zoster even though they have been vaccinated. The vaccine does lower the odds for an eruption, and the zoster that does happen appears to be less severe. The vaccine is approved for those over fifty and people with certain medical conditions. It is definitely something worth considering to try and prevent the pain of zoster. I recently saw a woman from Fort Mill, South Carolina with Zoster who had been vaccinated. There were only a few months between vaccination and her zoster and happily she had only a mild eruption and minor pain.
So, remember to think of zoster if there are painful blisters, especially in a linear pattern. The medications for treating zoster are excellent, but they need to started early to be effective. So if you see linear blister and feel pain, please get seen.
David Schulman
Pineville Dermatology, South Charlotte Dermatology. Matthews Dermatology
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Saturday, 19 September 2009 00:54 |
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Molluscum Contagiosum. The name says much about this iproblem. That second word is the key. These are a viral growths that are highly contagious. It is common for these bumps to spread through a classroom or preschool and sometimes even spread to parents. They are viral in nature but our bodies do develop an immune response to these lesions, unlike their distant viral cousins the wart. The immune response is rapid for some and they only have the lesions for days or weeks. Other people have no immediate response and their molluscum grow and multiply. I have seen many patients with dozens of molluscum and even some with over one hundred. What we do is try and wake the immune system to the foreign nature of these growths and when this happens the mollusum will be cleared by the body, usually forever.
Not a day goes by without a patient coming in with molluscum. Patients are often told the diagnosis by a healthcare professional and then told to not do anything. Wait for the body's response is the frequent recommendation. Wait. While they are waiting, patient's molluscum may multiply. They are by definition contagious, not just from person to person, but also from one area on the body to another. The growths are often clustered in creases and private areas and often get picked at.
Molluscum can grow inwards and form a cyst or abscess. These tend to be tender red nodules and can leave behing scars. A molluscum abscess may need to be drained due to the pain and pus at the site.
The standard of care for molluscum is freezing them with liquid nitrogen. Though cold, this treatment has been used for decades and tends to have an excellent response without scarring. Freezing helps to show the umbilication, or belly button, of molluscum. This central pore in the papules is a cute and unique feature of molluscum. By freezing the lesions, they are left there for the body to learn that they are foreign, and often one round of freezing will bring about the desired immune response. Many doctors still will "scrape" off the molluscum papules with a sharp instrument. This is likely to be accompanied by pain, bleeding and scarring.
I have seen a recent wave of children from Rock Hill and Fort Mill, South Carolina with molluscum. The back to school spread and now the early winter's eczema have led to a small epidemic of the virus.
Molluscum can be a sexually transmitted disease. Usually this is in the high school and college age population and the lesions are grow at the genitalia. The treatment is the same and there are no long term complications like there can be with genital warts or genital herpes. The recent spring break brought me two different college students from Ballantyne with molluscum. MArch and April seem to be the time of year when I have seen the most adults with molluscum.
Though they are often a problem with spreading, molluscum are no danger and they are only likely to get infected when they are picked at. Most adults are immune from a long forgotten exposure and children do need to get their molluscum treated if they don't clear the infection on their own.
Matthews, Ballantyne
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