DermHelpCentral

Imiquimod Cream

This valuable tool used predominantly for actinic keratoses and some skin cancers.  (It may also be used for genital warts and molluscum.) Presently, in the U.S., it is available as Zyclara and as a generic (both are equivalent).  We find it especially useful in the treatment of large superficial skin cancers. 

How to Use.  The following is taken from DermNet:

Wash your hands before and after applying imiquimod cream.

Pierce the sachet with a needle and squeeze out a tiny amount of cream onto your fingertip. Apply this to the affected areas.

Although the information on the packet states that the sachet is for single use, you could seal it using a paper clip or tape and store in a closed container to prevent the cream drying out.

Imiquimod may be used at any time of year, as it is not photosensitising. However, when outdoors, you should protect yourself from the sun with clothing and sunscreen as usual.

What to expect

Areas treated with imiquimod will be come inflamed. The effects include itching, burning, redness, ulceration (sores), scabbing, flaking and pain. These reactions indicate that the cream is likely to be effective - if there is no inflammation, imiquimod is unlikely to clear the lesions. An exaggerated response may clear the skin lesion sooner than expected - sometimes after as few as three or four applications. In some patients, surrounding untreated areas also become inflamed but this will settle when treatment is discontinued.

If you develop a severe reaction with black scabs and ulceration, stop applying the cream and arrange to see your doctor as soon as possible.

For more information see: DHC  and DermNet.

 

5 Fluorouracil Cream (5 FU)

5 FU is a commonly used modality for the treatment of actinic keratoses (AKs).  It is a "field treatment" not a spot treatment, and is employed when a large area is affected.  Cryotherapy with liquid nitrogen is used for spot treatment, and many AKs can be just left alone if they do not bother you.

An excellent article on how to use 5 FU can be found on DermNet. If you use 5 FU it will be an invaluable guide.

Sun Poisoning

When I practiced dermatology on Kauai, I was impressed with the large numbers of patients I saw with a distinctive photodermatitis.  It was seen mostly in the months of December to May, and almost all were tourists.  This reaction to sunlight followed the first few exposures of the year.  After a few weeks, by history, it would disappear and would not return until the patients had been out of the sun for months and were then re-exposed.  Gradually, my colleagues and I realized that this is a common problem,  Indeed, upwards of 10% of the public may suffer from this.

(These images were taken from the article we published and show typical findings in typical areas.) 

Sunscreens do not prevent it.  They may potentiate it because they allow individuals to stay out long enough to absorb enough radiation.  For prevention, graded small exposures work for most patients.  That can be achieved by going to a tanning parlor three or four times before a winter or spring trip to sunny areas.  These exposures should be short and are not intended to tan but to "harden" the skin to light.  Most people gradually harden in their home setting since their natural exposure is graded.

Dr. Yoon Cohen, a recent medical school graduate, found a copy of the 1985 article which I wrote with Morison and Hood and you can read the pdf here thanks to her: Sun Poisoning Article.

Treatment:  Cool tap water compresses for 20 minutes followed by a moderate to potent topical steroid cream for four to five days will help most patients.  For more severe cases systemic steroids for four to fice days will give relief and allow a patient to enjoy their vacation or the beach. Hydroxizine affords some relief of itching. Of course, these treatments should be administered by one's personal physician.

Babesiosis

"A potentially serious infection caused by tick bites has gained a foothold on the East Coast, particularly in the Lower Hudson Valley and in coastal areas of the Northeast.

The condition, called babesiosis, is a malariua-like illness that results from infection with Babesia microti, a parasite that lives in red blood cells and is carried by deer ticks. Though far less common than Lyme disease, babesiosis can be fatal, particularly in people with compromised immune systems.

So. In addition to Lyme Dissease, one can contract Ehrlichiosis and Babesiosis from tick bites.  The NT Times had a reasonably good introduction to babesiosis in the June 21 issue:  "Once Rare, Infestion Spreads By Tick Bites."  We will post something on Ehrlichiosis soon.

For more on Babesiosis see:  eMedicine.com (although you may need to register for a free account. 

Explaining Sunscreen and the New Rules

by Jane Brody, NY Times June 21, 2011.

This is a fine article about sunscreens with reference to the new regulations.  If this is a topic that you ponder please Read "Jane Brody's Sunscreen Primer."

 

New Rules for Sunscreens in U.S.

"After 33 years of consideration, the Food and Drug Administration took steps [this week] to sort out the confusing world of sunscreens, with new rules that specify which lotions provide the best protection against the sun and ending claims that they are truly waterproof. Click on the image to read these. Read NY Times article "F.D.A. Unveils New Rules About Sunscreen Claims."

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S.P.F.

‘Going Natural’ -- Pointers for Black Hair

The NY Times "Skin Deep" section has some informative articles on the broad area of cosmetic dermatology.  The June 9, 2011 edition had a useful piece on 'Going Natural' with black hair.  It has helpful pointers and lists a number of blogs and web sites.

"'Going natural' is the term used by many African-American women who decide to stop chemically processing, or relaxing, their hair. It’s a move that can be fraught with confusion, missteps and sometimes pain, as the 2009 Chris Rock documentary "Good Hair" attested." Rock's film is entertaining and educational and well-worth watching.

There are many problems associated with "relaxing" black hair and other common grooming practices, not to mention the significant expense which can run to 1000s of dollars per year.  The Times article and Chris Rock's film are good introductions to this area.

Drug Side-Effects

"The average drug label lists 70 possible side effects and some drug labels list more than 500."  This should come as no surprise to anyone who takes a medication.  Gina Kolta has a short, lucid article about why so many side-effects are listed for the drugs we take in the Sunday, June 5, 2011 NY Times.  "Side-Effects:  These Drugs Have a Few"  .

Pores

"Like home renovators who overhaul the kitchen only to then find fault with the master bath, some dermatology patients feel that, once their wrinkles are relaxed and their brown spots treated, their pores stand out. Such is the level of worry that doctors have nicknamed the condition “porexia.”

Most days, one or two patients come in with questions about large unsightly pores.  Most dermatologists, myself especially, have little formal training in "porology"  A recent article in the NY Times "Skin Deep" section "Do My Pores Look Big?" covers this area well.  If you have concedrns about your pores or questions about what to do for them, this article will help you and save you time and money.