Health Tips - Skin/Bites/Stings/Dermatology

Animal Bites - The most common complication associated with bite wounds is wound infection. One of the best methods of reducing the risk of infection is to adequately irrigate the wound with sterile water under high pressure. This high pressure will dislodge and wash away any bacteria commonly found in the animal’s mouth that can cause infection. Also important is whether animal bites should be closed (sutured) and this depends on the type of animal, age and location of the wound. Under no circumstances should a wound that is infected be closed. Dog bites may be safely closed if they are not more than 8-12 hours old and are not located on the hand. Cat bites which are usually puncture wounds should not be closed because they cannot be adequately cleaned. Cat bites however, that are lacerations rather than puncture wounds may be closed if they are not on the hand. In most cases wounds on the hands and wounds more than 8-12hours old should be left open because of the possibility of infection.

Antibiotics are used to prevent infection as well as to treat wounds that have evidence of infection. Finally, the patient should receive a tetanus booster if they have not received one in the previous 10 years.

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Atopic Dermatitis/Eczema - Often begins between ages 2 to 6 months. Initially a very dry, sensitive and itchy forehead, cheeks and scalp rash is noted; later spreads to trunk, creases of elbows, knees, wrists. Often a family history of asthma, allergies or eczema.

There is no cure; however, most children “grow out of it”. Steroid creams are the main treatments for eczema flare ups; in severe cases steroid ointments are used. Application of prescription strength steroid cream/ointment to the face and diaper area should be avoided, unless specifically instructed to do so.

After eczema settles, it is best to taper steroid use by applying every other day for 2 to 3 weeks before completely stopping. Oral antihistamines helps control itching. Daily bath for 15-20 minutes helps moisturize the skin. Use a mild, nondrying soap, (e.g. Dove) and avoid vigorous scrubbing, use a soft towel to pat the skin dry. A doctor recommended lubricating cream or ointment should be liberally applied to the skin within 3 minutes of bathing (and after the steroid cream/ ointment) and throughout the day as needed; this should be used every day, even when the eczema isn't flaring-up.

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Chickenpox - Caused by a virus: varicella-zoster It is extremely contagious, and can be spread by direct contact, droplet transmission, and airborne transmission.

When someone becomes infected, the pox usually appear 10 to 21 days later. People become contagious 1 to 2 days before outbreak. They remain contagious while uncrusted blisters are present.

Associated symptoms include fever, headache, tummy ache, or loss of appetite, for a day or two before breaking out in the rash. These symptoms last 2 to 4 days after breaking out. The blisters often appear first on the face, trunk, or scalp and spread from there. In most cases, it is enough to keep children comfortable while their own bodies fight the illness.

Oatmeal baths in lukewarm water provide a crusty, comforting coating on the skin. An oral antihistamine can help to ease the itching, as can topical lotions. Safe antiviral medicines have been developed and are most effective when started within the first 24 hours of the rash.

The outcome is generally excellent in uncomplicated cases. Encephalitis, pneumonia, and other invasive bacterial infections are serious, but are rare, complications of chickenpox.

A chickenpox vaccine is about 100% effective in preventing moderate or severe illness.

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Corns/Calluses – Feet - Extensive walking and standing, especially in poorly fitted shoes, subjects the skin to friction and pressure. The skin attempts to protect itself by building thick, hardened layers.

• Corns are smaller than calluses and have a hard centre surrounded by inflamed skin. Corns develop along the tops and sides of toes. Corns often painful and tender to touch.
• Calluses develop on the soles of the feet. Rarely painful and vary in size and shape. Often larger than corns.

A corn or callus may be present if there is:

• Thick, rough area of skin
• Hardened, raised bump
• Tenderness/ pain under skin
• Flaky, dry or waxy skin

Corns and calluses need treatment only:

• When painful
• In diabetics
• If there is poor circulation

Treatment

• Avoid repetitive action that causes them to develop Wear properly fitting shoes
• Use protective pads and socks
• Your Podiatrist or GP can pare down thickened skin and may also suggest applying an antibiotic ointment
• For underlying foot deformities, your Podiatrist may prescribe custom-made padded shoe inserts (orthotics)

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Cracked Heels - This condition is often referred to as heel fissures. This problem is not only cosmetic, because it can result in infection and bleeding.

Factors that can cause of cracked heels include:

• Obesity Prolonged standing on hard surfaces
• The recurrent wearing of open back shoes
• Medical conditions – e.g. diabetics; hypothyroid, etc.
• Skin conditions – e.g. Psoriasis and Eczema

Self Treatment – A word of caution: You should never try to reduce the hard skin your self with a razor blade or a pair of scissors. A complication of such includes infection. In persons with diabetes or circulatory problems you are be better off visiting a podiatrist.

Podiatric treatment includes:

• Determining cause of problem.
• Removing hard thick skin by debriding it. This may have to be done repeatedly.
• Strapping may be used to 'hold' the cracks together Advice re the most appropriate moisturizer or emollient
• Advice re footwear
• Insoles used to alter the way you walk to prevent the thick skin from developing
• A heel cup may be used to keep the fat pad from expanding sideways.

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Cold sores - Cold sores (fever blisters) are clusters of small fluid filled lesions that develop on the lip, corner of the mouth or on the nose; they are usually inflamed and painful. Cold sores are caused by the Herpes Simplex Virus (Most often Type-I). They are highly contagious and are readily passed on from person to person through sneezing, coughing, kissing, touching the area or by sharing utensils and other items (e.g. lip sticks, lip balms, etc.).

There is no cure and repeated outbreaks may be secondary to stress, illness, the menses and on many occasions there is no identifiable reason. Between outbreaks the virus hides within the nerves. Cold sores may be treated with an anti-viral cream which is applied directly to the lesion and/ or by using anti-viral tablets (e.g. Acyclovir, Famciclovir, etc.). Complete healing may take up to 10 days. While medication does not cure the outbreak, however, it reduces the length of the symptoms, the severity of symptoms and the likelihood of passing on the infection.

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Cutaneous Larva Migrans-Creeping Eruption - Cutaneous larva migrans (Beach Worm) is a skin manifestation of hookworm infestation most commonly dog or cat hookworm. Hookworm ova in the dog or cat faeces develop into infective larvae when left in warm moist ground or sand; transmission occurs when skin directly contacts contaminated soil or sand and larvae penetrate unprotected skin, usually of the feet, legs , buttocks or back. Cutaneous larva migrans occurs most commonly in tropical environments.

Cutaneous larva migrans causes intense itching and signs are redness and raised lesions at the site of entry, with a winding, threadlike subcutaneous trail of reddish-brown inflammation. Diagnosis is by history and clinical appearance and treatment is by either topical Thiabendazole liquid or cream. Albendazole tablets or suspension can also be used.

Cutaneous larva migrans should always be treated as it may be complicated by a self-limiting pulmonary reaction called Loffler’s syndrome.

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Ingrown Toenail - This is relatively common. The corner or side of the toenail grows into the soft flesh of the toe. Often results in pain, redness, swelling and an inflammatory discharge. It usually affects the big toe. While it can often be taken care of at home, seek further attention from a podiatrist or GP in the following instances:

• Severe cases – not responding to home care or where pain, swelling or infection is severe
• Diabetics
• If there is poor circulation

Causes:

• Wearing shoes that crowd/ squeeze toes
• Cutting toenails too short or not straight across
• Injury to toenail
• Unusually curved toenails
• Thickening of toenails

Possible complications:

• Bone infection
• Amputation of toe or foot in diabetics or persons with other circulatory problems

Treatment includes:

• Trimming or removing the ingrown portion of the nail
• Doctor may recommend using topical or oral antibiotics For a recurrent ingrown toenail, your foot doctor or GP may remove a portion of toenail along with the nail bed to prevent that part of nail from growing back.
• Avoiding wherever possible the above causes

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Insect Bites - A minor insect bite or sting may cause a little swelling and itching. The site may be painful for a while. Mosquitoes, biting flies, and some spiders usually cause mild reactions. Yellow jackets, honeybees, paper wasps, and fire ants cause more severe sting reactions.

A severe allergic reaction to a bite happens within minutes of the bite. The symptoms may include:

• severe swelling of the lips, tongue, or throat
• trouble breathing
• nausea, cramping, diarrhea, or vomiting
• hives
• dizziness
• loss of consciousness

Call 511 and make your way to an emergency room immediately if any of these symptoms develop. Some insects especially mosquitoes carry diseases and should be avoided. Eliminate potential breeding sites. Keep the body covered; wear long clothing and use insect repellent where biting insects are rampant. Don't use more repellent than recommended in the package directions. Repellent products containing either DEET or picaridin have been proven to provide longer-lasting protection than others. Observe the wound for any signs of infection – e.g. worsening pain, swelling, warmth or redness. These may need further treatment.

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Keloids - A keloid is the term applied to a scar secondary to a cut or wound that extends and spreads beyond the size of the original wound. Keloids vary in size, shape, and location. Often the tendency to develop keloids may run in a family.

The most common locations are the ear lobes, chest, neck, back, navel and arms. Keloids may follow injury, infection (e.g. chickenpox), piercing (ear and navel), acne, vaccination sites, tattoos, etc. Occasionally, they occur spontaneously, especially on the mid-chest.

The lesion may itch during formation and growth. There may be varying degrees of psychological distress depending on the keloid’s size and location. They may be irritated from rubbing on clothing or other forms of friction. Most keloids will flatten and become less noticeable over a period of several years.

Keloids often require no treatment. Treatment may consist of cortisone injections, pressure dressings, silicone gels, surgery, laser treatment, cryosurgery, liquid nitrogen, radiation therapy or combination therapy. Unfortunately, keloids are difficult to treat and tend to return, sometimes larger than before. Newer treatment regimens are being developed.

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Protect your skin from the sun - The sun's rays contain two ultraviolet (UV) rays that can damage our skin – A and B. UVA primarily causes premature aging, wrinkles, and tanning, while UVB causes sunburns. Both UV rays can cause a range of skin cancers.

Here are some ways to protect our skin from the ravages of the sun’s UV rays:

• Generously apply and reapply every two hours water-resistant sunscreen with a Sun Protection Factor (SPF) of at least 15 that provides broad-spectrum protection from both UVA and UVB rays to all exposed skin.
• Wear protective clothing, such as a long-sleeved shirt, long pants, a wide-brimmed hat and sunglasses, where possible.
• Seek shade when appropriate, remembering that the sun's rays are the strongest between 10 a.m. and 4 p.m.
• Use extra caution near water and sand as they reflect the damaging UV rays of the sun which can increase your chance of sunburn.
• Check your entire skin around your birthday. If you notice anything changing, growing, or bleeding on your skin, see your GP or a dermatologist. Skin cancer is very treatable when caught early.

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Puncture Wounds - These are generally caused by sharp narrow objects.

On the day of injury seek medical attention if:

• Bleeding does not stop after you have put pressure on it for 10 minutes
• The wound is deep, large, or jagged or it gapes open
• The wound is on the face and you are concerned about scarring
• Around the wound feels numb.
• The wound is from an animal or human bite.
• There is any possibility that a foreign body remains in the wound
• The object went through your shoe or was dirty
• It’s more than 5 years since your last tetanus shot
• You are DIABETIC or otherwise immunocompromised

First Aid includes washing the wound thoroughly with warm water and soap. Put pressure on the wound with a bandage or clean cloth until the bleeding stops. After initial treatment keep the wound covered with a clean bandage and change it each day or whenever it becomes wet or dirty, until the skin has healed. This usually takes about a week for minor injuries.

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Tretinoin Gel Can Be a Safe Alternative for Treating Preteens With Acne - At the 68th Annual Meeting of the American Academy of Dermatology (AAD) researchers presented their findings during a poster presentation showing that the use of a tretinoin gel appears to be effective in reducing acne that occurs among preteen boys and girls.

"Although acne vulgaris is a disease typically seen in teenagers, it is also common in preadolescence and early adolescence," said Catalina Matiz, MD, Rady Children's Hospital, San Diego, California.

Dr. Matiz said that treatment in the preadolescent population is not currently addressed by standard guidelines. While topical retinoids are recommended as first-line treatment of acne, she said that little data on retinoid use in preadolescent patients exist.

Tretinoin gel has been proven effective in the treatment of both inflammatory and noninflammatory acne lesions and has demonstrated favourable safety and tolerability profiles in preteens. Mild skin irritation was the most commonly reported treatment-related adverse event.

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Urticaria/ Hives - Hives present as raised wheals on the skin and often burn and itch. They may appear in isolation or in clusters. Up to 20% of persons will have an episode in their lifetime. In most instances the hives disappear within a few weeks and in the rare case the person may have for months to years.

Their size varies from a pencil point to a very large area. Histamine, released from “mast cells” as a consequence of an allergic reaction, results in leaky blood vessels in the skin which allow the escape of blood plasma resulting in the hive. When hives causes difficulty in breathing or swallowing medical help should be sought immediately.

Foods most often linked to hives are: nuts, shellfish, eggs, chocolate, tomatoes, berries and milk. Almost any medication, prescription or over-the-counter, can cause hives. Viral upper-respiratory tract infections (colds) are a common cause. Hives may be caused by physical agents – e.g. sunlight, heat, cold, water, pressure, vibration or exercise. The best treatment is to identify and eliminate the cause. Antihistamines are often prescribed. No one antihistamine works for everyone. In severe cases, an injection of adrenalin and or cortisone may be administered.

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