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
|
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 .
|
|
|
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 .”
|
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
|
www . australiandoctor . com . au 28 July 2017 | Australian Doctor | 15