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Healthcare Reform – A Guide For the Perplexed

As the great campaign to reform the American healthcare system heats up and enters an important new phase – the phase in which key legislative leaders take the five bills that have been passed, here and there, by sundry Congressional committees, and, behind closed doors, attempt to cobble together a compromise bill which they believe they can threaten and/or bribe a majority of Congresspersons into supporting – many Americans find themselves confused about what it all means. What, after all, are we attempting to accomplish here? How much will it cost, and who will pay for it?  Why does the whole process seem so darned difficult and confusing?

Fear not. As a public service, DrRich will now explain healthcare reform in a very simple way, so that – whether you study the issue closely on a day-to-day basis, or just accidentally come across some relevant headlines now and again as you look for the sports page – you will always know what’s going on. For, once you understand a few key concepts, this thing is really pretty easy to follow. Read more »

*This blog post was originally published at The Covert Rationing Blog*

Tips For Treating Dermatitis, Eczema, And Chronic Wounds

Being a plastic surgeon, I have a great interest in the skin and no I don’t see or treat much dermatitis as the primary physician.  Patients do occasionally ask me about patches/rashes they have.  It’s always nice to be up on the topic and to know when it’s important to make sure they see a dermatologist.

The article listed below is a nice, simple  review of conditions that fall into the eczema /dermatitis categories.  The article discusses atopic dermatitis (AD), nummular (coin-shaped) eczema, contact dermatitis, and stasis dermatitis.  It is not a deep article on the subject, but did include some nice reminders and tips.

Allergic dermatitis is not uncommon in patients with chronic wounds.  One study documented more than 51% of leg ulcer patients acquire contact allergic dermatitis to local dressings and other topical treatment.  This is important to any of us who treat wounds, acute or chronic.  Sometimes the wound fails to heal due to this.

There is a nice table which lists the common allergens in patients with chronic wounds.  If your chronic wound patient has a contact allergy to these products, it can certainly complicate their wound healing.

  • lanolin (common in moisturizing creams and ointments)
  • perfumes/fragrances
  • cetylsterol alcohol (used as an emulsifier, stabilizer, and preservative in creams, ointments, and paste bandages)
  • preservatives:  quaternium 15, parabens, chlorocresol  (all are used to prevent bacterial contamination in creams, but are not in ointments)
  • rosin (colophony)  — a component of some adhesive tapes, bandages, or dressings
  • rubber / latex

The key to treatment and prevention of future exacerbations is identification of any provocative factors so that they may be avoided as there is no absolute cure for dermatitis.   Here is a summary of tips the article gives:

Laundry and Clothing Suggestions

  • Avoid wearing wool or nylon next to their skin as they may exacerbate itch.  Choose materials made of cotton or corduroy which are softer.
  • Rather than use fabric softeners and bleach, which may be irritating to the skin, add a white vinegar rinse in the washing machine rinse cycle cup/dispenser to remove excess alkaline detergent.

Moisturizers

  • Keep water exposure to a minimum.
  • Use humectants or lubricants regularly to replenish skin moisture.  Apply these agents immediately after bathing while the skin is damp.
  • For severe hand eczema, cotton gloves may be worn at night to augment the moisturizing effect of humectants and other topical treatments.

Topical Steroids

  • Topical steroids continue to be the mainstay therapy for treating dermatitis.
  • Topical steroid creams can be kept in the refrigerator or combined with 0.5% to 1% of menthol (camphor and phenol are alternatives) to give a cooling effect.   This often helps.
  • Treat the dermatitis with a topical steroid when the skin is red and inflamed.  Tapering the topical steroid use by alternating  with moisturizers as the dermatitis resolves.
  • Remember that  percutaneous absorption of topical steroids is greatest on the face and in body folds.  They suggest only weak or moderate preparations be used in these areas.
  • Moderate to potent topical steroids should be used on the trunk and the extremities.
  • The palms and soles are low-absorption areas, so may require very potent topical steroids

REFERENCE

The ABCs of Skin Care for Wound Care Clinicians: Dermatitis and Eczema; Advances in Skin & Wound Care: May 2009, Vol 22, Issue 5, pp 230-236;  Woo, Kevin Y. RN, MSc, PhD, ACNP, GNC(C), FAPWCA; Sibbald, R. Gary BSc, MD, MEd, FRCPC (Med, Derm), ABIM DABD, FAPWCA (doi:10.1097/01.ASW.0000350837.17691.7f)

*This blog post was originally published at Suture for a Living*

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Latest Book Reviews

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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