Skin Care Information

The Evidence Will Make You Free

(not exactly the Stanford University motto)

Aquagenic Wrinkling of Palms (first local patient 10/2011)

Pain and swelling of palms within minutes of exposure to water. Benign and not associated with cold urticaria (type of hives) or other skin changes. There are few cases reported.

I would like to be of help connecting patients with this condition who would like to consider doing Patient-Directed Research (P-DR) or form their own advocacy group. Patients need to join together to increase knowledge about the natural history of this condition including associations with other disorders, medications or environmental and genetic factors. If you have this conditon (see DOJ article linked to AWP), you should consider sharing your experience. You could be instrumental in building a database of folks wanting to know more and participate in the process of improving understanding, care and treatment of this uncomfortable condition. If you would be willing to share your experience with other patients or researchers, please consider contacting me (duluderm@yahoo.com).

Are vitamins always safe? What are currently recommended amounts to consider taking? The Medical Letter offers some clear advice.

Rosacea Advice

Rosacea may have a great effect on anyone's Quality of Life, sometimes more so than more life threatening conditions such as Diabetes, Smoking or not being at the weigh you desire. Most people bothered by rosacea would like to get better overnight.

To improve you should take to heart suggestions to try dietary change, topical prescrption and/or oral prescriptions (best to decrease flushing or pimples/swelling) or LASER (best with plain redness or spidery veins on face, but also demonstrated to be a treatment of all facial signs of rosacea yet, currently, seldom covered by insurance companies). Avoid other triggering factors: known or which you observe.

Following a 'Paleolithic' or South Beach diet (low glycemic diet) has been shown to decrease inflammed lesions (pimple of common acne) and also may help with some family blood lipid (cholesterol, triglyceride) problems. Avoiding dairy products (which are all high in progesterone, the hormone associated with flares of acne in women) has been helpful also. Some people find diet alone is sufficient.

Note the excellent information provided group of rosacea sufferers, National Rosacea Society. They fund important basic science studies into the cause of rosacea and put on an annual Rosacea Research Seminar (usually at the Society of Investigative Dermatology, it was a highlight of my educational year until they discontinued the meetings). They also have an excellent newsletter quarterly.

The RRDi is developing as a rosacean (person with rosacea) run non-profit. They want to direct medical research with their interests, understanding, lobbying power and funding. I believe this group represents a new group AND approach to medicine.  In 2008 I suggested that they consider P-DR, Patient-Directed Research: contacing NIH for help with logistics and ethical considerations and, then, working with skilled staff to carry out studies which would be voluntary rosacean changes - the dietary changes would be one which may never be well evaluated by traditional medical center studies because of cost. I look forward to RRDi's success.

To be successful in controlling rosacea appearance and discomforts,you need to be somewhat patient, regular in carrying out treatments and return in follow-up as needed, until your rosacea is under control you are satisfied with it. Many patients discontinue prescription treatment when they improve; and, then, normally, experience a recurrence (40% within two months, 60% within a year). Even so, when things are obviously clear, decreasing and then stopping no longer needed prescriptions for rosacea is the normal and recommended thing to do. Just resume the treatment, if it proves necessary again.

Unless you are advised differently, most topicals are for the entire area where rosacea comes, and, is not just to be placed on single lesions.

Cetaphil Cleanser Lotion not Cetaphil 'soap', is suggested as an alternative to soaps for removal of makeup or dirt when just water  is not adequate.

I suggest you avoid moderate or severe sun exposure (because you will be more likely to burn while on some treatments). Artificial tanning products rarely cause allergy and do not make rosacea worse, they make one option for rosacea coverup.

Home Management of Common Warts

• Soak your warts three times weekly for 10–15 minutes. Use water as hot as you can tolerate (avoid if diabetic or with decreased sensation).
• Sand down wart gently (remove dead skin layer with file, pumice stone) usually this is only possible on calloused palm or sole warts.
• Pat area dry.
• Apply topical treatments if prescribed OR 17% salicylic acid treatment (available over the counter) such as Compound W gel, Duofilm solution, Occlusal HP solution. An April 2007 study showed zink oxide paste, available OTC, works at least as well and cannot irritate the skin. After three months each gives a 50% cure rate.
• If this regimen is followed consistently every week, the wart infection will resolve more quickly (www.Cochrane.org).

Poison Ivy Facts

• No one is born with contact allergy (local reactions to PI or creams or the metal nickel).
• 75% of people can become allergic to PI, with enough exposure. Once allergic, the sensitivity is permanent.
• Immediate washing with a real soap can remove much of the oil which causes PI. After 20 minutes the PI material is permanently fixed to the dry surface covering of the skin. Because you cannot see the oil, washing all skin which may have been exposed is quite important.One washing of apparently unaffected skin, may remove some dead skin and poison. Further washing usually causes excessive dryness.
• With small exposure in a cold, dry environment you may only get a small amount of rash after about two weeks.
• With large exposure while hot, sweaty and rubbing material in you are more likely to get a more severe rash coming on within the first day or so.
• Average visit to doctor office occurs about 4 days after exposure.
• New areas will continue to develop for two weeks after your last exposure, because small amounts of PI take longer to react through your skin surface.
• Not treating PI thoroughly most often leads to a more prolonged course. This is no longer poison ivy but an eczematous reaction, all over rash which may go on for 6-8 weeks and does not have the typical linear streaks, where you were in contact with the PI oil.

What the doctor needs to know to tell you what to expect.

1. Have you ever had PI before? Y N
2. Have you ever been place that has PI? Y N
3. How many days between first possible exposure and your first rash? ______
4. How many days since last possible exposure ______
5. When was the last day you found a new lesion ______
6. Combining all areas, on what day was the overall condition most severe _____
7. The following graphs could help you understand the process of developing a contact allergy (like poison ivy, nickle, rubber, preservative):
8. The statum conrneum is the surface layer of skin. On the forearm it is replaced every two weeks, but, on the sole of your foot this can take about 6 weeks.

Post education Quiz

1. What percent of people cannot become allergic to poison ivy?
2. Given correct exposure, how many days does it take to learn to be allergic for the first time?
3. On future exposure, how soon could the rash develop?
4. Once allergic, do you get over the allergy with time?
5. If the poison (oil of plant) gets on your skin, how long does it take for it to be ‘fixed’ to your skin (harder to wash off)?
6. How many days does the poison stay on your skin, if not washed off?
7. Will it do any good to use a harsh soap and scrub all of you?
8. Why do you keep developing new lesions for about two weeks?
9. After one washing, can you spread poison ivy on yourself or to others?
10. What are the methods useful to hold the reaction down until the poison comes off your skin naturally?
11. If you do not adequately control the normal poison ivy rash, then it may cause a generalized allergic process in which rash comes out through the blood system – to all skin. It no longer has the lines or streaks which are the hallmark of contact dermatitis. How long could this type of reaction last?
12. Other than contact with the plants themselves, how can you contact the poison?

Once you know you have been exposed to PI

As soon as possible

• Remove and machine wash all clothes, gloves, hats, so that you cannot be exposed again. Shoes or boots also need to be cleaned of any oil
• Washing only once with a harsh soap (Ivory) will still remove some dead skin flakes with PI oil attached and prevent a great deal of PI rash from developing. Do wash all the skin NOT YET affected.
• Do not use soap to wash areas with swelling or blisters because it will not help them.
• Wash dog, tools, ATV, dirt bike anything which might have oil you will expose yourself to again.
• Although you cannot prevent rash from developing (if you did not remove it as described above), you can still help to make it less severe by avoiding heat (bathing, hot tubs, humidity and exercise which will cause more redness, swelling and blisters.
• Do not use soap again on any rash because now it will irritate your skin with rash as healing begins.
• Oral antihistamines can help with the itching, compresses are better able to improve itching, swelling, redness and blistering (sheet instructions).
• If you do not make a full effort immediately, you may find you cannot avoid the side effects of taking oral cortisone, steroids (prolonged use are associated with weight gain, mood changes and increases in acne, diabetes, hypertension). Sometimes oral cortisone is needed.

Note, though you followed all of these suggestions, new lesions will probably continue to occur for two weeks after your last exposure to PI. As long as your overall severity is steadily improving, expect total clearing without any permanent scar.

To prevent future exposures:

• Know Poison Ivy and similar plants (including the liquid on the outer surface of most mangos, read Wikopedia on WWW.
• Check with neighbors, bait stores to know where it is found
• Remember you dog walking in an area can bring home the oil, wood gathered from such areas may expose you when you make a mid-winter fire in the fireplace. Equipment such as ATV, motorcycles may be covered with the oil, so be sure to clean them or you will be re-exposed to the oil.

Websites:

Life-Affirming Sites:

Maria Bamford: Humor to heal

Sarah B Seidelmann: Author, Teacher, Life Coach

One Woman's Committment to a Soap Free Lifestyle (details at end of this file)

Men Susceptible to Skin Irritation Too

Medical Information Sites:

Summary of Many Skin  Disorders 

Wikipedia: Potentially the most up to date (if we each help by adding or correcting, so that it has the best current information.)

An English Perspective also on all conditions Medicine

Find and Interpret: original peer reviewed artiles including research

MedlinePlus.gov: US Library of Medicine (Spanish also available)

Evidence on Skin Disorder Treatments: Carefully combined results from individual studies. Each comes with a plain language summary written by a patient advocate.

Want to participate in developing as well as learning the best evidence?

Cochrane Collaboration: Patients, Practioners guided by those who can help determine what actually works ( in medication, treatment, testing, quality of life, cost) and presenting it in a readable and easy to understand evaluations to help patients, practioners and policy makers find the best measured by the evidence.

More in depth understanding of medical literature:

Translating Critical Appraisal of a Manuscript into Meaningful Peer Review a free on line course available for practioners and one for lay people         

Advanced training in Dermatology Residencies: Dermato-epidemiology

Improving peer reviewed medical journals: Next? Get the research protocol (completed before any patients enrolled) web location published for peer reviewers and then with the printed article.

Social Media and Medicine - the new communications

World Perspectives:

How Global Health Has Changed 1918-present 
Global Burden of Diseases project of WHO

Medical Volunteering: Health Volunteers Overseas

Bibliography

1.

Childhood stye and adult rosacea.