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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
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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 Rock Hill 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. 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. 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.
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 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 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. 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. |
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Saturday, 19 September 2009 00:50 |
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Few things are as annoying as hives. Patients are often desperate from the itch and the accompanying lack of sleep. The medical name for hives is urticaria. Hundreds of things can cause hives and nearly every medicine ever used will lead to someone somewhere getting hive. The most common medicines are the penicillen antibiotics, along with sulfa antibiotics. The opiate family of pain medications, which includes morphine, demerol, and codeine are also major causes of hives. Imagine being in pain and then having the added joy of a new insanely itching rash. That is an unhappy person. Foods can be another cause of hives, and peanuts have become public enemy number one at many schools. Many nuts and berries bring on hives. There are also hives that are from viruses. Instead of getting a cold, your skin may get the reaction.
Hives are an inflammatory reaction in your skin with the release of histamine causing swelling and redness in the skin. The itch gets worse with itching and this can lead to a snowball effect of increasing itching. The most important thing to be aware of is that what is happening in the skin can also affect breathing. ANY challenge with breathing needs to be treated immediately as a medical emergency. Dial 911 and don't take any chances if there is any question about a respiratory emergency. I recently gave Epipens to two patients in one week with severe hives. A man from Tega Cay and a woman from Ballantyne both had reported that they had had minor trouble breathing when their hives began. An Epipen is a dose of adrenaline that is carried for respiratoy emergencies and can be given to help open the airways. If a pen is needed, the next step is getting to an emergency room because the medication does not have a long term effect.
How do I know if it's hives? If it is an itching rash that moves from place to place that's likely what you have. If you scratching your skin and it welts up in the scratch line that's an easy way to confirm. That is a finding called dermatographism- the ability to write on the skin and get it to welt. A small percent of people always have dermatographism and I recently saw a woman from Lake Wylie who has been suffering from this for years. Without daily anti-histamines she has hives from nearly any skin contact.
So if it is hives you have, I hope it doesn't last long and that you aren't suffering too much.
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