DermHelpCentral

Scleroderma

July 2010: The NY Times Journal of Medicine had an important section on Patient Voices dealing with Scleroderma (systemic sclerosis).  There was also a Question and Answer section for those who want more information.  The Patient Voices were really moving.

Erion Moore, II  26
Portland, OR

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ePatient Queries

 Towards a Virtual Office Visit and Patient-Centered Care

In an attempt to be of service, we are posting this page to allow you to tell me if you feel you need an immediate consult or visit.  You may have a worrisome new lesion, a bad rash or some other issue.  Some of these can be handled electronically -- but not all.  Here's how to go about this.

You may use the ePatient Visit Form (not yet, it's under construction)  or you can  copy the questions below and then paste them in an email, answer them and send to me at DJ Elpern:

1. How long have you had the problem?
2. Where is it located?  
3. What do you think caused it?  
4. Are you using any creams or other topicals already?  
5. What medications do you take and are any new?  
6. How uncomfortable are you?  
7. How worried are you?  
It is very helpful to attach some photos to the email if you if you can.

If possible, the photos are best taken in the "Macro" mode and daylight is better than artificial light (however some cameras will compensate if you know how to program them).  Please don't send huge format pictures.  7.5 x 10 inches is as large as you need.  Here's a good article on Digital Photography for Dermatology.

This is an  experiment: an attempt to create a Patient-Centered Home.  This idea was suggested to us by Dr. Rakesh Biswas, editor of the International Journal of User Driven Healthcare.

Thanks for joining me on this new path!  DJ Elpern

Jellyfish Stings (New Hampshire 7/2010)

Rye, New Hampshire.  July 21, 2010

About 150 people were stung by what officials said was a lion’s mane jellyfish weighing nearly 40 pounds, which turned the tranquil beach into a frenzied sea of screaming children and aching adults with red, sore feet and legs.  NY Times article.

The Lion's Mane jellyfish is purported to be the largest animal in the world, larger than even the sperm whale.

The following is taken from DermNet's section on Marine Wounds and Stings:

If you or a companion is stung by a jellyfish:

    * Avoid moving the affected limb.
    * Remove nematocysts and tentacles from the skin using gloves and forceps. Razor blades can be used to shave off nematocysts.
    * If stung by box jellyfish apply vinegar (5% acetic acid), or in its absence, salt water for 30 minutes. (B=Note Box Jellyfish are only in Australian and South Asian waters)
    * If stung by the Portuguese man of war, thoroughly rinse exposed areas with seawater (vinegar is not helpful).
    * Ice or an ice pack can help with pain while seeking medical attention.
    * Antivenin injections are available in some medical centres for specific jellyfish, and are particularly recommended for box jellyfish stings.

Do not rub with a towel or use fresh water as this may cause further damage by causing further nematocyst discharge. Contrary to popular belief urine and alcohol can exacerbate injury and are not recommended. 

Alopecia Areata, NY Times

WARNING: THIS IS NOT ABOUT PEOPLE WITH JUST A FEW BALD PATCHES - BUT DEALS WITH THE MUCH RARER UNIVERSALIS FORM. 

From the NY Times article: "Alopecia areata (AA) is an autoimmune disease that causes the body to attack its own hair follicles. AA, which is a different disorder than normal male-pattern baldness, affects nearly 2 percent of the global population and has no universally effective treatment. Its progression is unpredictable and can range from a few bald patches to a completely hairless scalp to the loss of every hair on a person’s body — known as alopecia universalis (AU). Sometimes the hair regrows, sometimes it does not, and sometimes it grows in only to fall out again years later." 

Only a small number of people with AA progress to total hair loss or the universalis variant.  The NY Times had an excellent intro to AA (with an emphasis on AU) in the July 6, 2010 issue. Times Article: A ‘Forest Fire of Hair Loss,’ and Its Scars. This has the link to the multimedia "Patient Voices" or you can link directly here at: Voices of Alopecia.

Preventing Lyme Disease

Prophylaxis with Single-Dose Doxycycline for the Prevention of Lyme Disease after an Ixodes scapularis Tick Bite
The Tick Bite Study Group

ABSTRACT

Background It is unclear whether antimicrobial treatment after an Ixodes scapularis tick bite will prevent Lyme disease.

Methods In an area of New York where Lyme disease is hyperendemic, we conducted a randomized, double-blind, placebo-controlled trial of treatment with a single 200-mg dose of doxycycline in 482 subjects who had removed attached I. scapularis ticks from their bodies within the previous 72 hours. At base line, three weeks, and six weeks, subjects were interviewed and examined, and serum antibody tests were performed, along with blood cultures for Borrelia burgdorferi.

Results Erythema migrans developed at the site of the tick bite in a significantly smaller proportion of the subjects in the doxycycline group than of those in the placebo group (1 of 235 subjects [0.4 percent] vs. 8 of 247 subjects [3.2 percent], P<0.04). The efficacy of treatment was 87 percent (95 percent confidence interval, 25 to 98 percent). Objective extracutaneous signs of Lyme disease did not develop in any subject, and there were no asymptomatic seroconversions. Treatment with doxycycline was associated with more frequent adverse effects (in 30.1 percent of subjects, as compared with 11.1 percent of those assigned to placebo; P<0.001), primarily nausea (15.4 percent vs. 2.6 percent) and vomiting (5.8 percent vs. 1.3 percent). Erythema migrans developed more frequently after untreated bites from nymphal ticks than after bites from adult female ticks (8 of 142 bites [5.6 percent] vs. 0 of 97 bites [0 percent], P=0.02).

Conclusions A single 200-mg dose of doxycycline given within 72 hours after an I. scapularis tick bite can prevent the development of Lyme disease.