DermHelpCentral

Skin Cell Gun

From Wikipedia:  "The skin cell gun is an experimental device for the treatment of second degree burns developed by Jörg C. Gerlach and colleagues at Stem Cell Systems GmbH in Berlin. With this technique, individual adult stem cells from the patient's uninjured skin are applied to the wound site, where they differentiate into normal skin. (The conventional methods use solid layers of tissue, not disaggregated cells.) The hope is that with the skin cell gun, damaged skin tissue can be regenerated more quickly than with traditional methods."

Yoon -- pls add Nat Geographic link

A big question is whether the Skin Cell Gun is real or a hoax.

 

Lyme Tick Geography

This important article which appeared on the NPR Blog "Shots" is worth reading.  Especially if you reside in the Northeast, the Mid-Atlantic states, the upper Midwest and other endemic areas:

"Tick Tally Reveals Lyme Disease Risk."

 

Cliff Analogy and Health

This is an important paper that presents a “Cliff Analogy” illustrating three dimensions of health intervention to help people who are falling of of the cliff of good health: providing health services, addressing the social determinants of health, and addressing the social determinants of equity. In the terms of the analogy, health services include an ambulance at the bottom of the cliff, a net or trampoline halfway down, and a fence at the top of the cliff. Addressing the social determinants of health involves the deliberate movement of the population away from the edge of the cliff. The paper is worth studying if one is interested in equity of health care services.  Download Cliff Analogy and Health

Mediplast for Plantar Warts

(Taken from the University of Wisconsin Dermatology Web Site)

Here's a pdf:  Download Mediplast for Plantar Warts This is a great treatment since it is not painful. It is at least as effective as other treatments; but takes a bit longer.

The doctor would like you to use Mediplast® for your child’s warts.  Mediplast® is a plaster that is soaked with 40% salicylic acid.  When wearing the plaster, the acid slowly and painlessly leaches out onto the skin below.  This kills the skin cells that harbor the wart virus.  This is a very good way of getting rid of warts.  Even if another treatment is being used (for instance, the pulsed dye laser), using this plaster speeds the process of thinning the wart and any callus that has formed around it.

Where do I get it?
Mediplast® does not need to be prescribed.  You can find it at any local drugstore.  Often, you will need to ask the pharmacist for the product.  It may be kept behind the counter instead of on the shelves.  If they do not have any Mediplast, ask them to order it for you.  You may wish to call ahead to see if it is in stock.

How do I use it?
Mediplast® comes as a sheet, wrapped in paper.  When you remove the sheet from the wrapper, you will notice that one side is fuzzy and the other is paper.  Cut a circle just slightly bigger than your child’s wart, remove the paper backing, and place the sticky side down on the skin.  If there are a group of warts, cover the entire area with a larger piece of Mediplast®.  You should then take a sturdy, water-resistant tape, such as duct tape, and wrap around the toe, foot, finger, etc.  You can also use black electrician’s tape if the warts are on the toes or fingers.  This tape is thinner and slight stretchy.  Trainer or athletic tape is ok to use as well, but it tends to get soggy after showers.

Apply the Mediplast® and tape on Monday morning and leave it in place until Friday afternoon or night.  It is okay to shower, etc.  If the tape falls off, it is okay to keep using the original Mediplast® piece and just replace the tape.  Although the package says to change the Mediplast® daily, we’ve found that it works best if left in place for 4 to 5 days. You may shorten the treatment to 3 days if it causes too much irritation.  When you remove the plaster, the skin below will be very white and soft.  File the area of white, soft skin with a nail file or a pumice stone.  These can be bought in the nail care aisle at the drug or grocery store.  File the area until all the white, dead skin is removed or until it is painful. Sometime over the weekend, soak the wart in warm water for 5-10  minutes and repeat the same filing process as described above.

Monday morning, re-apply a new piece of Mediplast® covered with tape.  Repeat the process for the next week.  Do this weekly until your next visit, or until the wart is gone.  Follow up with your dermatologist  in 4 weeks or as instructed to check your progress.

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.