Doctors on Call – Skin Problems


AND QUITE EVENING, AND WELCOME TO “DOCTORS ON CALL.” WE WILL TALK ABOUT SKIN CANCER, ECZEMA, AND PSORIASIS. I’M FROM THE UNIVERSITY OF MINNESOTA MEDICAL’S GOAL. WHAT WOULD YOU LIKE TO KNOW ABOUT SKIN PROBLEMS? 218-788-2844 OR 1-877-307-8762. DR. HEATHER — A DERMATOLOGIST WITH ST. LUKE’S DERMATOLOGY ASSOCIATES. A FAMILY OF MEDICINE PHYSICIAN FOR GATEWAY FAMILY HEALTH CLINIC . AND A DERMATOLOGIST WITH THE DULUTH CLINIC. GRANT CARLYLE FROM GRAND RAPIDS, AND NOW ONTO TONIGHT PROGRAM ON SKIN PROBLEMS. THIS IS A COMMON TIME OF YEAR FOR DRY SKIN. EVERYBODY HAS ITCHY DRY SKIN, INCLUDING ME.>>THAT IS A GREAT QUESTION.>>MINIMIZE THE EXPOSURE TO SOAPS. YOU DON’T NEED TO QUIT SHOWERS BUT IT WOULD PROBABLY JUST MAKE WARM WATER AND NOT SUPER HOT WATER. AND IF YOU’RE STILL A LITTLE DAMP, IT’S GOOD TO PUT ON THICK MOISTURIZER. USUALLY WITHIN THREE MINUTES IS A GOOD IDEA TO TRY TO SEAL IN THE MOISTURE FROM THE SHOWER. I SELECT THE FRAGRANCE FREE. THAT CREAM LOTION IS AN EXCELLENT ALL-PURPOSE MOISTURIZER. THERE IS A LOT OF PRODUCTS OUT THERE NOW BUT USUALLY SIMPLER IS BETTER.>>ANOTHER QUESTION THAT COMMONLY COMES UP IS PEOPLE COME IN WITH SKIN CHANGES OR MOLES>>WE WORRY ABOUT MOLES IF THEY BECOME ASYMMETRIC. OR IF THEY GET A CHANGE IN COLOR OR IF THE BORDER STARTS TO MOVE. IF IT SEEMS TO START TO CREEP SOMEWHERE ELSE. OR IF IT IS DARK BLACK. IF THEY BECOME RAISED OR LIKE THE HEAD OF A PENCIL.>>SOME OF THESE CAN BE SKIN CANCERS. WHAT IS THE LIKELIHOOD OF GETTING ANOTHER ONE? DOES IT INCREASE YOUR RISK?>>THAT’S A GREAT QUESTION AND SOMETHING I ANSWER ALMOST EVERY DAY IN THE PRACTICE. STUDY JUST CAME OUT LAST YEAR TALKING ABOUT THIS VERY PROBLEM. THE MOST COMMON SKIN CANCERS, THE STUDY PUBLISHED WAS THAT YOU HAVE A 40% CHANCE OF GETTING ANOTHER IN THE NEXT TWO YEARS. RELATIVELY HIGH WHICH IS WHY WE RECOMMEND PATIENTS BE SEEN ON A REGULAR BASIS. IF YOU DON’T HAVE IT FOR TWO YEARS, IT’S DOWN TO ABOUT 5%. THE RISK GOES UP TO 80% AND IT’S QUITE HIGH FEAR OF MORE THAN ONE WHICH IS WHY WE LIKE TO SEE OUR PATIENTS BEFORE SO THAT WE CAN CATCH THINGS EARLY.>>SPEAKING ON THIS, WE HAVE A CALLER THAT WOULD BE THE DIFFERENCE BETWEEN A BASAL CELL.>>THEY’RE BOTH VERY COMMON TYPES OF SKIN CANCER. PATIENTS THINK IT IS A PEBBLE THAT DOESN’T GO AWAY AND TENDS TO PERSIST. IT IS THE SECOND MOST COMMON TYPE AND HAS AN INCREASE RISK AND CAN METASTASIZE BUT NOT VERY OFTEN. THEY CAN BE A SCALY DRY PATCH AND NALA NOMA WOULD BE THE MORE DANGEROUS TYPE OF SKIN CANCER. THAT’S WHAT THEY WERE TALKING ABOUT WITH CHANGING THE BORDERS. IT’S SOMETHING THAT CAN BE KIND OF TENDER OR ITCHY.>>A CALLER WOULD LIKE TO KNOW ABOUT HAND ECZEMA. SHE JUST USES HAND CREAM NOW. ARE THERE ANY PRESCRIPTIONS FOR ECZEMA?>>I WOULD RECOMMEND AVOIDING HOT WATER AND SOAP. DOING DISHES SEEMS TO EXACERBATE THE ECZEMA. THERE ARE CREAMS THAT ARE VERY STRONG STEROIDS. AND WE HAVE SEEN — PEOPLE THAT SEEM TO GET BETTER AFTER ANTIBIOTICS BUT IT’S NOT SOMETHING WE LIKE TO DO VERY OFTEN. AND BE CAREFUL TO KEEP THE STEROIDS ON THE HANDS. A CAN THIN THIS SKIN.>>A CALLER WOULD LIKE TO KNOW ABOUT ANGIOMA. SHE HAS APPARENTLY HAD LASER TREATMENT AND IT IS EFFECTIVE BUT HOW MANY TREATMENTS CAN A PERSON HAVE?>>I THINK IT’S A GOOD TREATMENT AND DEPENDS A LITTLE BIT WHAT YOU MEAN. ALMOST EVERYBODY HAS IT AND THEY RESPOND REALLY WELL TO TREATMENT. THE LARGER ARE CONGENITAL AND MAY REQUIRE A LITTLE BIT MORE WORK. AND HOW MANY TREATMENTS ARE APPROPRIATE.>>A CALLER WOULD LIKE TO KNOW ABOUT A HIGH BLOOD PRESSURE MEDICATION BEING USED FOR ACNE.>>IT IS EFFECTIVE FOR ADULT FEMALE ACNE, SPECIFICALLY. I LIKE IT WHEN YOU CAN KILL TWO BIRDS WITH ONE STONE. IT CAN HELP A LOT WITH ACNE. SOMETIMES IT’S A GOOD ALTERNATIVE. IT CAN WORK VERY WELL FOR ADULT FEMALE ACNE.>>WHAT IS THE MECHANISM OF THAT?>>IT IS TESTOSTERONE. IT IS OFTEN TIMES FACE MODE, CHEEKS, THEY CAN BE A LONGER TIME AND YOU WANT TO MAKE SURE THE PATIENT IS PUT ON BIRTH CONTROL. YOU NEED TO BE COGNIZANT AND MAKE SURE THE PATIENT IS USING BIRTH CONTROL RELIABLY.>>PEOPLE ARE VERY HAPPY ABOUT THAT SIDE EFFECT.>>WITH HAVE A CALLER FROM DULUTH WHO HAS ITCHY SHOULDERS AND NECK BUT DOESN’T HAVE A RASH.>>AT THIS TIME OF YEAR, SOMEBODY WITH ITCHINESS. I THINK MOISTURIZING AND TRYING TO AVOID A LITTLE BIT. IT’S JUST ON ONE SIDE AND IT WAS SHINGLES. THERE ARE LOTS OF REASONS IT COULD BE.>>A CALLER WOULD LIKE TO KNOW THE BEST WAY TO GET RID OF COLD SORES.>>THERE ARE OVER-THE-COUNTER CREAMS THAT ARE AVAILABLE AT THE PHARMACY. THERE IS PRESCRIPTION ANTIVIRAL MEDICATIONS THAT HELP. FREQUENTLY, WE CAN GIVE ALL MEDICATION AND IT IS STARTED AT THE TIME THE LESIONS APPEAR.>>HE WOULD LIKE TO KNOW — HE HAS A FAMILY HISTORY.>>IF THERE IS A FAMILY HISTORY, DEFINITELY. I ASK MY NEW MELANOMA PATIENTS HAVE ALL RELATIVES SCREENED. ANY SIBLINGS, PARENTS, CHILDREN. WE DO SEE FAMILY PATTERNS BUT A LOT OF IT HAS TO DO WITH THE CONCEPTIONS THAT THEY INHERIT IT. BLUE-EYED, FAIR SKINNED, THEY GET AN INCREASED RISK.>>A CALLER WOULD LIKE TO KNOW IF LIGHT THERAPY SUPPLY VITAMIN D3.>>LIGHT CHANGES CHOLESTEROL INTO A PRECURSOR OF VITAMIN D. THE PROBLEM WITH THAT IS IT CAN BE IRRITATING AND IN ORDER TO GET IT, YOU MIGHT HAVE TO INCREASE YOUR RISK OF SKIN CANCER. WE DO RECOMMEND PEOPLE GET VITAMIN D THROUGH THE DIET AND TRY TO GET A GOOD HEALTHY AMOUNT WITHOUT RAISING THE RISK OF SKIN CANCER BY EXPOSING YOURSELF BY NOT USING GOOD COVERING UP WITH CLOTHING OR SUNSCREEN.>>A CALLING HERE FROM SUPERIOR THAT WOULD LIKE TO KNOW ABOUT THE MOLES PROCEDURE.>>I NEEDED MOLES SURGERY. THE MICROSURGERY, I LIKE TO CALL IT REAL-TIME SURGERY WHERE WE CUT THE CANCER OUT AND IMMEDIATELY PROCESS IT AND LOOK AT IT TO SEE IF THERE IS ANY LEFT IN THE SKIN. WE CAN GO BACK AND ENSURE THAT THE CANCER IS GONE. A SIDE EFFECT THAT PATIENTS LIKE IS THE SURGICAL DEFECT, IT STAYS AS SMALL AS POSSIBLE. THE DOWNSIDE IS THAT IT TAKES A LITTLE BIT LONGER AND IT’S ONLY APPROVED FOR CERTAIN AREAS AND CERTAIN SIZE OF TUMORS.>>DO PEOPLE HAVE TO HAVE PLASTIC SURGERY SOMETIMES? AN AREA THAT HAS BEEN EXCISED?>>WE DO RECONSTRUCTIONS. WE DO TRAINING IN THAT. SOME INDIVIDUALS WE SEND TO OUR COLLEAGUES.>>WENT TO CALLERS WONDERING ABOUT SKIN TAGS. WAS THAT ALL ABOUT? THEY CAN COME BACK.>>SKIN TAGS ARE LITTLE CASES OF SKIN OFTEN SEEN IN FRICTIONAL AREAS LIKE UNDER THE NECK AND ARMS. THEY ARE VERY COMMON. THEY ARE NOT CANCER BUT THEY CAN BE A NUISANCE. SKIN TAGS CAN BE TREATED WITH LIQUID NITROGEN OR FROZEN. OFTENTIMES, PRIMARY DOCTORS WILL DO THAT OR THEY CAN BE SNIPPED OFF. SOMETIMES IT’S A GOOD REMINDER TO TRY TO KEEP THE DMI LOWER.>>A COUPLE OF CALLERS WITH PSORIASIS. HOW DO YOU START OUT?>>THERE IS FRICTION, THE ELBOWS AND KNEES. LIKE A SUNBURN OR A CUT. DO WANT TO TRY TO PREVENT DAMAGE. JUST OVER-THE-COUNTER, WE USE THINGS THAT ARE OFTEN EASIER. WE CAN TRY TO CHANGE THAT SKIN. YOU HAVE NOT QUITE AS MUCH SKIN GROWTH. AND IT CAN BE STEROIDS. THEY CAN BE A RELATIVE OF VITAMIN D OR RELATIVE OF VITAMIN A. AND IN SEVERE CASES OF PSORIASIS , YOU CAN HAVE STRONGER MEDICATIONS THAT MIGHT AFFECT THE IMMUNE SYSTEM TO CALM IT DOWN EVEN FURTHER.>>I NOTICED TREATMENTS FOR PSORIASIS.>>IT IS A PHIL THAT WE HAVEN’T HAD FOR A LONG TIME IT IS BEEN THERE FOR SOME TIME. MOST OF THEM ARE IMMUNOSUPPRESSANTS. IT’S BEFORE WE DO ANY PILLS BUT THE ONE PEOPLE OFTEN TALK ABOUT IS THE ADVERTISEMENTS ON TV. IT’S OFTEN HARD TO GET THEM FIRST. A NUMBER OF GOOD TREATMENTS. THE ONLY OTHER THING I WOULD ADD IS THAT LIFESTYLE IS A VERY BIG FACTOR. SIMPLE CHANGES TO YOUR LIFESTYLE CAN LEAD TO SIGNIFICANT IMPROVEMENT AND CAN BE EXISTING FOR CARDIOVASCULAR DISEASE.>>A CALLER WOULD LIKE TO KNOW WHAT KIND OF TREATMENT IS RECOMMENDED FOR GRANULOMA AREA.>>IS IN THE INFLAMMATORY CATEGORY. OFTENTIMES, THE BACK OF THE FEET. IT CAN BE MUCH MORE WIDESPREAD. SOMETIMES PEOPLE CAN HAVE ITCHING. TOPICAL OR HIGHER POTENCY STEROIDS CAN BE USED IF IT IS MORE WIDESPREAD. SIMILAR TO HOW WE TREAT PSORIASIS. TYPICALLY, PEOPLE RESPOND QUITE WELL THE TOPICAL STEROIDS.>>A GREAT QUESTION. WHAT CAUSES ACNE?>>BACTERIA ON THE SKIN. THE THING TO BACTERIA LIKE THE OILS ON THE SKIN. THE HORMONES IN THE BODY CAN AFFECT HOW THE SKIN WORKS. AND TO PROVIDE AN ENVIRONMENT WHERE THE OIL AND BACTERIA CAN GROW TO CAUSE INFLAMMATION.>>PATIENTS COME AND SAY, IT CAUSES MY ACNE AND WE DID NOT HAVE EVIDENCE TO REALLY SUPPORT THAT THE DEAD BEEN STUDIES SHOWING THAT DIETS THAT HAVE A HIGH GLYCEMIC LOAD AND CARBOHYDRATES AND PROCESSED FOOD CAN INCREASE THE RISK OF ACNE. TRYING TO EAT A HEALTHY DIET, TRYING TO MINIMIZE THE AMOUNT OF PROCESSED FOODS AND FAST FOODS.>>SOME MEDICATIONS CAN DO IT, TOO. WITH DOGS THAT DEVELOP ACNE, IT’S CHECKING THE MEDICATION.>>A CALLER FROM SUPERIOR HAD A BIOPSY AND WAS TOLD IT WAS SCLERODERMA. HAD YOU CONTROL THAT.>>THAT’S A TOUGH ONE. IT IS A SYSTEMIC DISEASE AND A LOCALIZED FORM THAT BASICALLY THE SKIN BECOMES ALMOST SCAR LIKE. IT USUALLY MEANS IT IS MORE WIDESPREAD AND OFTEN WE HAVE TO WORK AS A TEAM WITH FAMILY MEDICINE DOCTORS AND SOMETIMES THE JOINTS ARE AFFECTED.>>THE CALLER WOULD LIKE TO ASK YOU A QUESTION ABOUT HOW DOES CREAM WORK ON CANCER CELLS OF THE FACE.>>WE HAVE A COUPLE OF DIFFERENT OPTIONS. A SUPERFICIAL FORM OF SCANNER. WE HAVE A MEDICATION THAT BASICALLY ACTS AS AN IMMUNO RESPONSE SO YOUR BODY GETS TO HELP FIGHT OFF THE CANCER ITSELF. IT IS SOMETHING YOU APPLY AT HOME. AND OFTENTIMES THERE WILL BE A TIME THAT IT CAN BE A TOUGH TREATMENT. I KNOW WHAT YOU USING BECAUSE THEY HAD DONE IT THEMSELVES.>>BUT NOW, A CALLER ASKS ABOUT ACNE ROSACEA. IS THAT SOMETHING THAT GOES AWAY?>>AS PEOPLE GET OLDER, YOU GO FROM ACNE VULGARIS TO ACNE ROSACEA. THERE ARE A COUPLE OF DIFFERENCES. THEY CAN BE BLOOD VESSELS THAT ARE DILATED IN THE SKIN. YOU CAN HAVE MORE REDNESS. SOMEONE AS A TEENAGER, IT CAN AFFECT THE EYES. AND THERE’S A TREATMENT OF TAKING CARE OF PEOPLE WITH ACNE ROSACEA.>>A CALLER FROM VIRGINIA. A LOT OF COLORS FROM VIRGINIA. ITS SKIN THINGS GOING ON OUT THERE.>>IT IS>>IT IS PURPLE AND ITCHY. IT CAN AFFECT ALMOST ANY PART OF THE BODY AND CERTAIN FORMS OF THE DISEASE CAN LEAD TO HAIR LOSS. IT CAN BE TREATED IN THE FIRST INSTANCE AND SOMETIMES NEED TO RESORT TO STRONGER MEDICATIONS.>>I HAD A PATIENT BRING TO ME A TREATMENT OF JUST USING A ONCE A WEEK INJECTION OF A BLOOD THINNER. A VERY LOW DOSE. IT IS A FORM OF IMMUNOTHERAPY THAT WORKED VERY WELL FOR THIS PATIENT THAT DID NOT GIVE QUITE THE SAME CONCERNING AMOUNTS OF IMMUNE THERAPY YOU MIGHT GET IN OTHER WAYS.>>THIS IS A GOOD QUESTION FROM SUPERIOR. DOES ANY OF THAT STUFF WORK?>>A CAN BE SOME PROTECTION. YOU CAN DO RETINAL ACID. IT CAN CAUSE DRYNESS AND IRRITATION. THERE ARE QUITE A FEW DIFFERENT CUSHIONS. TRYING TO HAVE GOOD TREATMENT. THE ARE DIFFERENT THINGS YOU CAN DO.>>IT IS NICE TO WORK WITH PROFESSIONALS.>>YOU CAN RESURFACE THE FACE. THEY ARE GOING TO HAVE SOME DOWN TIME TO EXPECT IN THAT CONTEXT.>>WHEREAT THE END OF OUR HALF AN HOUR. A LOT OF GREAT QUESTIONS. THANK YOU FOR COMING. PLEASE JOIN ME NEXT WEEK. THANK YOU FOR WATCHING, AND GOOD NIGHT. >>DEMENTIA IS A DIAGNOSIS THAT IS DREADED AND CERTAINLY LIFE CHANGING. LEARN HOW TO DEAL WITH DIFFERENT ASPECTS OF IT NEXT ON SPEAK YOUR MIND.

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