Dermatology
Xplained
Dermatology
Dr Kate Kelso
What’ s up with this skin tag?
involves removing the extra bone, which is blocking the range of motion.
In addition to removal of the loose bodies, the tight capsule of the elbow, which is acting as a static restraint to movement, is also released to further improve the range of motion.
Patients with loose bodies in the elbow commonly also have arthritis of the elbow. The arthritis will create some ongoing pain and stiffness even after surgery, but range of motion is significantly
Xplained
App of the Week
THE Xplained app is actually a series of apps, such as Schizophrenia Xplained and Parkinson’ s Xplained. This month, developers released the latest app in Australia, Aortic Stenosis Xplained, taking the total number to 15. Each app tells a simple illustrated story of a patient diagnosed with the condition, their symptoms and the treatments they receive. The idea is to explain a condition without‘ doctor speak’ and to help patients understand their diagnosis and the road ahead.
The full list of conditions receiving the Xplained treatment is: Parkinson’ s disease, food allergy, advanced prostate cancer, colostomy, rheumatoid arthritis,
improved, returning reasonable function of the elbow.
Generally patients are given a regional block postoperatively to provide pain relief and to allow the muscles, which have not moved through their full range of motion for some time, to be stretched out. Recovery from the arthroscopic procedure is significantly faster than recovery from the older open technique, with a stay in hospital of 1-2 days and return to normal activities after six weeks. ●
psoriasis, AF, type 2 diabetes, depression, epilepsy, presbyopia, schizophrenia, diabetic macular oedema, pulmonary hypertension and aortic stenosis.
Specifications
COST: Free COMPATIBLE WITH: Apple IOS 10 or Android 4.1.
A 53-YEAR-old male presents requesting removal of an axillary skin tag, which has become uncomfortable, itchy and started to discolour in the past few days. The patient thinks the tag might have been irritated by chaffing from his shirt, during an afternoon of heavy pruning in his garden. On examination, you note a
THE QUIZ
Q. What is the most likely diagnosis? a. Nodular melanoma b. Gangrenous skin tag c. Inflamed seborrhoeic keratosis d. Engorged tick A. The answer is d. These clinical features and the recent history of high risk activities for tick exposure are highly suggestive of an engorged tick. On closer inspection under magnification, the tick legs were also just visible.
Q. Which of the following is not a recognised complication of tick bite in Australia? a. Tick anaphylaxis b. Lyme disease c. Tick paralysis d. Mammalian meat allergy A. The answer is b. Tick anaphylaxis is a wellrecognised complication. In recent years Australian researchers identified that mammalian meat allergy can also develop as a consequence of tick bites, as well as mammal milks and gelatine. Tick paralysis is a rare complication in humans, but more common in children than adults. Although tick typhus due to rickettsial infection can occur after a local tick bite, a recent expert consensus found there is no evidence that Australian ticks carry Borrelia burgdorferi, the causative organism associated with Lyme disease.
Q. How should you treat this lesion? a. Apply methylated spirits b. Immediate removal with fine forceps c. Wait for the tick to fully engorge and fall off d. Apply cryotherapy to the tick and leave it to fall out number of typical axillary skin tags, as well as another darker skin lesion measuring 5mm( pictured). When touched, the lesion appears to move, burrowing into the skin to become more perpendicular and causing the patient acute localised discomfort.
Dr Kelso is a GP in Sydney and Australian Doctor’ s medical co-editor.
A. The answer is d. In the light of emerging evidence about the risk of allergy associated with tick bites, the Australian Society of Clinical Allergy and Immunology last year published revised advice about tick removal strategies.
Measures that disturb the tick( such as topical irritants) or squeeze the body of the tick may cause the tick to release more allergen-containing saliva. Ticks should therefore ideally be killed in situ and left to fall out. In-rooms, adult ticks can be treated using liquid nitrogen. Patients can self-treat using an over the counter ethercontaining spray. Small larval ticks should be treated with permethrin cream. The tick / s can be left alone to drop off, or removed gently with tweezers 24 hours after application of the insecticidal treatment.
PHOTO: Austrian National Library |
Friendly fire
Medical history
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WOULD you let doctors intentionally infect you with malaria? No? What about to treat an equally deadly disease?
Well, this was exactly what happened during the first half of the 20th century when syphilitic patients were deliberately dosed with malaria in hopes of a cure.
Pre-penicillin, the stigmatising STI was incurable and resulted in the gradual and debilitating decline of body and mind.
In its tertiary stage, known as neurosyphilis, the destructive spirochete Treponema pallidum attacked the brain and spinal cord, leading to progressive blindness, dementia and paralysis.
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Many patients in the final throes of the disease were involuntarily institutionalised, which was where Austrian neuropsychiatrist Dr Julius Wagner-Jauregg( pictured) chanced upon a malarial solider.
The physician had previously observed the therapeutic value of febrile illness in patients with nervous disorders, and this encounter provided him with a ready source of the fever-provoking parasite:“ I obtained, during a paroxysm, a small sample of the soldier’ s blood, and I inoculated three general paralytic patients by rubbing a few drops into several superficial scarifications of the skin.”
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He went on to test nine patients, of which six recovered, and in 1927, Dr Wagner- Jauregg won the Nobel Prize for Medicine for his pioneering pyrotherapy. This extreme fever treatment tended to be reserved for later in the disease, but it was nevertheless deemed an acceptable risk. After all, syphilis was usually fatal, and malaria could easily be treated later on with quinine.
While the action of malaria on syphilis is unclear, even today, its partial success was enough for doctors worldwide to treat thousands of syphilitic patients before the advent of antibiotics by fighting fire with fire.
Sophie Attwood
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www. australiandoctor. com. au 28 July 2017 | Australian Doctor | 15