DermHelpCentral

Bed Bug

A patient recently brought in a bed bug she found on her chest one morning.  Here are the pictures of her arm with the "breakfast, lunch and dinner bites," the bug and a video taken of the creature with a digital camera through a Ziploc bag,

 Bed Bug Video:   

Dr. Hansen's "Ouchless Wart Treatment

Warts can be difficult and painful to treat to treat, especially in young children.  Some years ago, I saw a piece about a technique devised by Dr. Ronald C. Hansen, of the University of Arizona in a throwaway journal describing a painless wart therapy.  It explained office treatment, but can be modified for home therapy.

Please print out the document   or you can read it here: Download Ouchless

If the pain associated with wart cryosurgery (liquid nitrogen) or electrosurgery has made you or your child shy away from all forms of wart therapy, Dr. Hansen’s "Ouchless" alternative may be a great thing to try. The treatment is a 40% salicylic acid plaster that can remove even the largest of commons warts, he said.  "This is a terrific treatment for isolated warts on the fingers and toes," he said.  It is also one of the few skin treatments that call for multicolored duct tape. 

The 40% salicylic acid plasters are available over-the-counter.  Mediplast, Dr. Scholl’s Clear Away, and Salicylic Acid Wart Remover are commonly available brands.  Dr. Hansen had little success using the manufacturer's directions, andhe suggested you throw them out and follow his instructions:

• Soak the wart in warm water for a timed 15-20 minutes. 
• Using a 3-mm disposable curette, trim off close to two-thirds of the wart and the surrounding callus.  This procedure will be painless for the patient. 
• Cut the salicylic acid plaster to the size of the wart plus 2-3 mm.  Remove the backing, and stick it to the wart.  Without fail, the adhesive on the plaster will not be strong. 
• To counteract this, you can apply benzoin or athletic adhesive (Mastisol is what Dr. Hansen uses) to the adjacent area, and wrap the area in common duct tape.  Although some children like the classic silver duct tape, it is also available in a variety of colors that may appeal more to children. 
• Because you want the salicylic acid to digest the wart, leave the plaster on for 5-7 days before you apply a new one.  If the compress gets dirty, tell them to apply more duct tape to cover the dirt.  If it gets wet – no problem; maceration assists the action of the salicylic acid.  After three or four treatments, the wart will be asymptomatic at least and probably cured. 

Gilda Radner on Doctors

Gilda Radner was an amazing comedian who died of ovarian cancer in 1989 at age 43. During her illness, she wrote a poem that was published in the New England Journal of Medicine.

DOCTORS ARE WHIPPERSNAPPERS

Doctors are whippersnappers in ironed white coats
Who spy up your rectums and look down your throats
And press you and poke you with sterilized tools
And stab at solutions that pacify fools.
I used to revere them and do what they said
Till I learned what they learned on was already dead.

Radner G. Doctors are whippersnappers. New England J Med 1988; 319 (2): 1358.

Trichotillomania

There was a good article in the NY Times by a woman with trichotillomania.  It describes the anguish some of these people suffer and it hints at adverse events that may have triggered her disorder.

"The voice my suffering has taken through the years is not a voice filled with words, it is rather my trichotillomania, my O.C.D., the eating disorders I survived in high school, rising from attempted suicide with resilience as I realized on the floor of my room — I deserve better."

For more, see:

Surviving the Pain at the Roots by Alexandra Heather Foss.

Medical Photography

Patient images are used for many purposes in medical practice. They are placed in the medical record as an adjunct to clinical care, displayed to colleagues, students and other audiences in educational settings, and published in medical journals or other media as part of medical research. In each case it is not only prudent, but necessary for the patients’ protection and interest that appropriate consent be obtained. While medical journals invariably require written consent for photographs that may identify the patient, the format of the photograph consent form is usually not specified, nor is it always clear which images require consent. With the proliferation of published images on the Internet it has become particularly important to obtain permission for all uses that will be made of medical images, including worldwide distribution through various electronic media.

The above is the abstract from a good article on Consent for Medical Photography.  Download Informed_consent

Here is a consent form you can use: Download Consent for Medical Photography

Patient Handouts

Educational handouts are becoming routine in health care, helping to promote health literacy in patients and their caregivers. To be effective, handouts must be tailored to various target audiences. We will attempt to augment what is available for skin conditions with unique handouts that are informative and current.  Our handouts are not designed to scare patients or promote expensive treatments when there are more reasonable and safer alternatives.  This is a work in progress and will be added to over the coming months and years.  See: Derm Central's Patient Handouts.

Notalgia paresthetica

By Dr. Carolyn Ellis, Largo Medical Center, Largo, Florida

The 57 year-old woman pictured below has had episodic pruritus of the mid-back for six years.  She denied axny apparent cause for the pruritus.  At times there was an accompanying sensation of 'pins and needles'.   She also complained of heightened sensitivity in the area, which she noticed when putting on clothes or rubbing her back against the bed.  She located the affected area medial to the left scapula.  She could not identify anything that improved or worsened the symptoms.

Notalgia Paresthetica (NP) is an ecxeeding common disorder.  Dr. Carolyn Ellis has written a fine introduction to NP. See: Download NP edit

Typical Distribution of NP

Subtle Hyperpigmentation and Lichenification

 

Dr. Ellis' Teaching Points

 

CLICK IMAGE TO ENLARGE