DermHelpCentral

Medicine for the 99%

"Can we incentivize pharmaceutical companies to produce much-needed drugs? In a Talk at TEDxCanberra, Thomas Pogge proposes a $6 billion plan to revolutionize the way medications are developed and sold.

An "Eczema" Story

In the Well section of the NY Times there is an excellent article on "Waking Up With Eczema" (December 25, 2011).  This essay will appeal to patients with "atopic dermatitis" as well as those who itch for other reasons.  There are well over a 100 comments, and some are very good, as well.  Itching, eczema, and atopic dermatitis are frustrating to live with and diffiuclt to treat.  This is a valuable introduction.

Intertrigo in Babies

Babies often get inflammation in skin folds.  This is especially common in neck folds and diaper area. See: Intertrigo on Dermnet, for an overview.

Brian Maurer, of Enfield, CT, is a pediatric practitioner.  Here is his easy approach for intertrigo in babies.

(1)     Cleanse the area 2 or 3 times daily with a mild soap (Dove unscented) and water.

(2)     Dry area with a hairdryer on low setting.

(3)     Apply a desiccant preparation.  Add cornstarch powder to an aluminum hydroxide antacid preparation (e.g. Mylanta, Maalox) to make a paste, which can be dabbed onto the area and allowed to dry.  Domeboro solution applied as a wet compress also works well.  Allow the area to air dry after application is complete.

(4)     Alternatively, if a fungal component is suspected, dust the area with Mycostatin powder. Caution: Take care when applying powder.  Shake a small amount onto finger and apply manually.  Avoid shaking powder directly onto skin at neck, as the infant might inhale the fine dust and develop a reactive pneumonitis.

 

Unnecessary MRIs

There was an important article in the NY Times on the overuse of MRIs in diagnosing sports injuries.  See: Sports Medicine Said to Overuse MRIs.  If you read this, it may save you time, money and unnecessary surgery!

Sweat and Tears: A First Person Narrative

Writer, Scott Keneally, shares his story about severe axillary hyperhidrosis in "Sweat and Tears."  The article is about a new treatment the Food and Drug Administration recently approved. MiraDry is a novel approach to axillary hyperhidrosis. aka sweaty pits. According to literature provided by Miramar Labs, the California company behind the technology, “The miraDry System non-invasively delivers precisely controlled electromagnetic energy to the region where the sweat glands reside, and destroys the sweat glands.”

This is an important narrative that deserves wide readership.

Here is the web site for the International Hyperhidrosis Society.  Sometimes, thse "societies" are fuunded by industry.  I can't tell is this is so for the I.H.S.

MRSA Guidelines

(These are notes taken at the New England Dermatological Society meeting of 12/3/11)

PDF of Guidelines: Download MRSA Guidelines

MRSA Guidelines: 
Talk BU Dept of Dermatology
December 3, 2011
Kalpana Gupta and Carol Sulis

One needs to consider the difference between Hospital Acquired and Community Acquired (CA-MRSA)

80% of CA-MRSA are soft-tissue infections. Usually are pustular
4% of household pets have CA-MRSA, often contracted from owners.

There is a question of how valuable decolonization really is.

If one has a CA-MRSA abscess it is clear that I &D is better than antibiotics.

For CA-MRSA the antibiotic of choice is Bactrim/Septra.  Second choice is doxycycline/minocycline and clindamycin is # 3.

Most CA-MRSA are now resistant to erythromycin.

Topical Antibiotics:
50% are now resistant to Bacitracin and Neomycin.
In the outpatient setting, at present, 0% are resistant to mupirocin.

If consider decolonization:
1) Mupirocin + chlorhexidine scrub for 5 = 10 days
2) Bactrim + Rifampin
There is poor data for the value of decolonization.