BMJ Study: Why is Rudolph's Nose Red

The BMJ just published an observational study explaining the redness of Rudolph's nose—evidently, reindeer have 25% more capillaries carrying oxygen-rich blood in their nasal architecture than humans. Now, I'm not sure that this investigation answers all the questions—it might answer why reindeers have red noses, but it doesn't answer why Rudolph has a luminescent one! My personal belief?—elf fairy dust.

RED FLAG FRIDAY: Subungual Melanoma

Most melanomas are evident on plain site. But sometimes they can also be "hidden" or they can look like something else. For examples, a melanoma underneath a nail looks very much like a hematoma. And often the only way to tell a subungual melanoma from a hematoma to do a biopsy. Thankfully, melanomas in general are pretty rare. But it's good to remember that in non-caucacians, about 30% of melanomas are subungual.

RED FLAG FRIDAY: Shingles on Tip of Nose

Herpes Zoster (shingles) is not typically "dangerous". But when the rash presents on the tip of the nose (Hutchinson's Sign), we have to worry about possible eye involvement. Refer those patient's immediately to an ophthalmologist.

How to Order Compression Stockings

This is an awesome tip that I learned from Dr. Ernestine Lee (who is also faculty here at Florida Hospital Family Medicine Residency). This tips was given as part of our "Learning Center" morning teaching series which our faculty personally do for our residents. Enjoy!

Itchy After Seeing Scabies?

Is it me just me—or do other doctors get really itchy after diagnosing a really bad case of scabies?

Treating Scabies

FIVE simple tips for treating SCABIES... 
#1.  SCABIES CAN LOOK LIKE ALMOST ANYTHING. 

And the classic presentation of furrow lines between the fingers is rare (especially for norwegian scabies). In fact, scabies can accurately be described as "the great imitator". Here are some examples of the "non-classic" presentation of scabies:

#2.  SCABIES REALLY ITCHES. 

When you see a really itchy rash, scabies needs to be high in the differential. Other things in the differential include rhus dermatitis (i.e. from poison ivy), dyshidrotic eczema, and insect bites. I'm sure that are other itchy rashes in the differential but my mind is dull today.

#3.  THE ENTIRE HOUSEHOLD NEEDS TO BE TREATED. 

If one person has it, then it is likely that other people in the household have it. Dogs and cats in the home may need to be treated also.

#4.  THE RASH TAKES UP TO 1-2 WEEKS TO RESOLVE

Although the mite is dead, it's poop "lives on" under the skin! So unless you want an angry phone call the next day from the patient wondering why the rash did not spontaneously resolve after an overnight application of Elimite Cream, make sure you inform the patient that the rash takes a while to resolve. Also, it's not a bad idea to retreat the household in 1-2 weeks.

#5.  OTHER HOUSEHOLD MEMBERS DO NOT HAVE TO HAVE SCABIES FOR YOU TO MAKE THE DIAGNOSIS

Although the likelihood of scabies increases if other members have an itchy rash, that negative historical finding does not rule out your patient having scabies. It's all in the timing. Your patient may be the first in the household to demonstrate symptoms. Also some people also seem to develop a more rigorous allergic reaction to scabies than others. For example, five kids playing in a field of poison ivy will not all develop rhus with the same intensity—some who have never been exposed to poison ivy will likely not develop a rash at all.

Fungus Loves Baby Bottoms

Fungus love moist environments (i.e. a baby's bottom). Most diaper rashes will go away simply by leaving the diaper off (which is my recommendation for really bad diaper rashes). I still use anti-fungal creams (like Lotrimin), but keeping the bottom dry work wonders.

Warts and Duct Tape

My billing for cryosurgery for warts has gone down considerably since advising my patients to keep their warts covered with either duct tape or band-aids. This tip doesn't always work. But it works sufficiently well enough that I only get out the Cryo Gun about 2 times a week. That's too bad since using the Cryo Gun is kind of fun...

Tinea capitis NEEDS systemic anti-fungals!

I have seen two cases where other doctors prescribed topical anti-fungal creams for tinea capitis. The result: I have to manage the unfortunate treatment failures which, in these particular cases, resulted in large, purulent, disgusting kerions on the patients' scalp. So this post is just a simple reminder: the treatment of tinea capitis requires systemic anti-fungal agents! I like using griseofulvin with french fries.

Why won't this jock itch go away?

Have you ever been frustrated with the treatment of tinea cruris? I have! Once I went through several rounds of topical anti-fungals and the stick'in rash still wouldn't go away! In my case, the reason was because the patient did not have tinea cruris. Rather, it was erythrasma which, honestly, can be extremely difficult to differentiate from tinea cruris. Doing a KOH slide would have helped I suppose! Live and learn! I've also heard that a wood's lamp will make erythrasma glow, but I think that some forms of tinea will do the same.

The treatment for erythrasma is simple: erythromycin 333 mg, one tablet by mouth 3x/day for 10 days.