DermHelpCentral

Epistotherapy

Epistotherapy is the act of writing letters that are therapeutic for a person who finds herself in a challenging situation. This short article, written by a South African G.P., was published in the BMJ in 1999. It made an impression on me then and continues to be of value. These are excerpts. I can send a pdf of the entire essay to you if you are interested.

Abbreviated Excerpts

See pdf of BMJ article. Download Epistotherapy

Why We Won't Cure Cancer

The Catch-22 of Oncology

"The growing cancer epidemic is not a problem that medical science is about to solve. In fact, it is a problem we are about to make worse. the main reason for our shortcoming is much simpler: Cancer is closely linked to the very process of aging. The longer we live, the more cancer there will be. Every time we cure a person of cancer, we produce a person with an increased probability of getting cancer again. It is the Catch-22 of oncology.

We should be mindful that although cancer research is producing astonishing science, many more lives can be saved by doing the boring stuff, like getting people to stop smoking, eat healthfully, exercise and put on sunscreen.

See full Op-Ed piece from the NY Times by Jarle Breivik.

Early Prostate Cancer

"The treatment of men with early-stage prostate cancer has undergone a sea change. Five years ago, nearly all opted for surgery or radiation; now, nearly half are choosing no treatment at all.

The approach is called active surveillance. It means their cancers are left alone but regularly monitored to be sure they are not growing. Just 10 percent to 15 percent of early-stage prostate cancer patients were being treated by active surveillance several years ago. Now, national data from three independent sources consistently finds that 40 percent to 50 percent of them are making that choice."

See NY Times Article by Gina Kolata.

This is an important article.  Another concept is that PSA tests are done unnecessarily which leads to  to unnecessary biopsies which leads to diagnosis of early prostate cancer and then surgery or radiation.  Patients travel down this slippery slope.

Areola and Nipple Eczema

Breast eczema is an itchy and occasionally painful problem.  When it affects breast feeding (or pumping) women, there is an added frustrating and maddening component.  Eczema, staph and Candida (yeast) can be implicated.  For the latter two, cultures and wet mounts are diagnostic tools.

Drs. Barankin and Gross have written a useful and comprehensive guide to nipple and areola dermatitis. Download Nipple and Areolar Eczema i 

This will be of help to clinicians and patients alike.

Patients in Pain, and a Doctor Who Must Limit Drugs

This is a fine article about the frontline of opioid prescribing: the physician’s office. “The management of chronic pain has had a long, fractious history in the United States. In the 1990s, doctors were admonished for undertreating pain. Opioids, they were told could be safely prescribed and bring life-changing relief. Now the pendulum has swung sharply back and doctors have been scrambling for alternatives.”

Full article.  The May 16, 2016 NY Times article features a family physician from a small town in Nebraska.  It is true to life and worth reading.

GAD-7 Questionnaire

This easy-to-use self-administered patient questionnaire is used as a screening tool and severity measure for generalised anxiety disorder (GAD).

 

 

Dr. Rademaker's Guide to Isotretinoin Dosing

Making sense of the effects of the cumulative dose of isotretinoin in acne vulgaris
Marius Rademaker, BM, FRCP, FRACP, DM   Int. J. Dermatol. 25. 518-23;2016

More complete notes.

Of 1453 patients treated with isotretinoin, 326 (22.4%) received a second course of treatment (study population). The remainder served as controls (n = 1127). Dosage varied from 10 mg/week to 1.1 mg/kg/d, cumulative dosage from 1 to >300 mg/kg, and duration of treatment from 8 weeks to 5 years. Compared with controls, patients who received a second course were more likely to be women (61 vs. 47%; P < 0.001) and received higher daily (0.71 vs. 0.58 mg/kg/d; P <0.001) and cumulative (126 vs. 101 mg/kg; P < 0.001) doses. Patients treated with very low doses (e.g. 10 mg three times per week) and/or low cumulative doses (e.g. 25–50 mg/kg) did not appear to relapse more often than controls. In Conclusion, neither daily nor cumulative dosages influenced relapse of acne patients treated with varying doses of isotretinoin as long as treatment was continued for ≥2 months after the acne had completely resolved.

Full article:  Download Rademaker Isotretinoin

Rare Diseases Guide

What do you do if you are diagnosed with a condition your doctor has not come across before. If you are a health care provider how do you deal with such a patient?

About one in 17 people will develop a rare condition at some point in their lives. Because many rare conditions are currently incurable, some guidelines may be helpful to patients, their families, and care givers. It is worth being aware of some potential pitfalls and how to avoid them.

This short BMJ essay, written by a patient with a rare disorder, offers encouragement for overwhelmed doctors and frustrated patients: Download Healthy approaches to rare conditions

Paper Tape Can Prevent friction Blisters

I learned this 40 years ago on Kauai from the, then, track coach, David "Duke" Wellington.  It took a scientific study to prove what athletes and coaches have known for decades!!

Almost everyone who regularly trains or competes in any sport has experienced blisters. A new study* provides the first reliable, field-tested evidence about how to prevent blisters during prolonged exercise. It found that the tape had reduced the incidence of blisters by at least 40 percent.

he process is simple. Cut or tear a single narrow strip of the paper tape and wrap it over whichever part of your foot has been prone to blisters. For most people, the toes and ankle are the spots most vulnerable to blisters.  NY Times Article.

*Paper Tape Prevents Foot Blisters: A Randomized Prevention Trial Assessing Paper Tape in Endurance Distances II (Pre-TAPED II).
Lipman GS, Clin J Sport Med. 2016 Apr 11.
Abstract
RESULTS: One hundred six (83%) participants developed 117 blisters, with treatment success in 98 (77%) runners. Paper tape reduced blisters by 40% (P < 0.01, 95% confidence interval, 28-52) with a number needed to treat of 1.31. Most of the study participants had 1 blister (78%), with most common locations on the toes (n = 58, 50%) and heel (n = 27, 23%), with 94 (80%) blisters occurring by the end of stage 2. Treatment success was associated with earlier stages [odds ratio (OR), 74.9, P < 0.01] and time spent running (OR, 0.66, P = 0.01).

CONCLUSION: Paper tape was found to prevent both the incidence and frequency of foot blisters in runners.

Intertrigo: Prevention and Treatment

Intertrigo, an inflammatory dermatosis involving body folds that develops through friction of skin to skin is influenced by moist conditions. It is found primarily in the area under the breasts, groin, abdominal and perianal skin folds. Besides these large skin folds, intertrigo may also affect minor skin folds (such as the armpits). Intertrigo has been defined as 'an erythematous eruption in a skin fold, caused by warmth, moisture and chafing; it occurs most often in the skin folds under the breasts and in the groin or as “a cutaneous inflammatory process on opposing skin surfaces” or “an inflammatory dermatosis involving body folds.”

The moist damaged skin may become secondary infected by bacteria, yeast or fungi. Visual symptoms of intertrigo are redness in mirror format and moist skin. Patients may complain of itching, burning feeling, pain and odor.

This good article about intertrigo will provide a thorough understanding of the problem and is available free full-text online. BMC Nurs. 2010; 9: 12.
Prevention and treatment of intertrigo in large skin folds of adults: a systematic review.