Sea urchins – prickly critters of the sea

courtesy of Kirt L. Onthank
While we’re on the topic of marine life, I’m reminded of a wonderful past summer trip to the Big Island of Hawaii. A few friends and I had the opportunity a few years back to travel to the Big Island for a wonderful conference and after the conference, we traveled along the beautiful Kona coast enjoying gentle breezes, pristine white, green and black sand beaches, turtles, colorful fish and… sea urchin! Well, actually, one of us didn’t quite enjoy sea urchin. Somehow I managed not to step on the prickly black critters but my friend Josh wasn’t so lucky. He ended up with some of their prickly spines embedded in the bottom of his feet. Being medical students at the time, we figured we could treat this ourselves. With standard eyebrow tweezers, he carefully pulled out the spines. The wounds were pretty superficial and they got less painful over the next few days. Josh is now a neurosurgeon and probably doing much more complex surgeries.

Now, if you were to get a puncture wound from a sea urchin spine, you might want to go to a clinic and get it checked out. These wounds can get infected, and if they’re near a joint, you can develop arthritis.

Cruising in the Caribbean? Beware the seabather’s eruption.

Hopefully this hasn’t happened to you during your summer vacation, but if it does, you’ll know what it is! I recently saw someone who came in with itchy pink bumps of the torso and buttocks in a one-piece swimsuit distribution. Turns out it was “Seabather’s eruption” — aka “sea lice” which is actually caused by larvae! The culprits are either tiny little thimble jellyfish larvae in the waters off of Florida, Mexico and the Caribbean, or sea anemone larvae in the waters off of Long Island, NY. After you emerge from the water, these little critters get trapped under your swimsuit. Your body then develops a sensitivity reaction to these larvae. Thus the itchy rash in the swimsuit areas.

The seabather’s eruption typically occurs between May and August so we’re right at the tail end of the season for this rash. Now, if you get an itchy rash after a dip in the ocean, you might know what you have! (And no, this does not mean that you should necessarily go for a dip in the nude. But if you do, remember your sunscreen. If it’s during the day.)

Former sun worshipper? You may have actinic keratoses.

If you are a former sun worshipper, you may be no stranger to the actinic keratosis (abbreviated as AK). AKs are usually gritty skin colored, pink or red growths of the skin showing up on sun-exposed areas like the face, scalp, back of hands, etc. They’re more than just a cosmetic concern though. AKs are pre-cancers, meaning that a fraction of them evolve into squamous cell carcinomas (cancers) of the skin. Fortunately, there are many options for treating AKs. Most commonly, dermatologists use cryotherapy (the liquid nitrogen cold spray which is -196 degrees celsius!) to get rid of these spots. Creams such as 5-fluorouracil (brand names of Efudex, Carac or Fluoroplex), imiquimod (aka Aldara or Zyclara) or diclofenac can also be used. Other treatments include curettage, photodynamic therapy, chemical peels, or laser therapy. Your doctor will choose a treatment based on what your AK looks like, where it is, or how many you have. Now, if you have AKs, that’s probably a pretty good sign that you’ve gotten some sun in the past and you should be getting regular skin checks.

Xeomin joins Botox and Dysport in fighting wrinkles

The FDA recently approved Xeomin for use in temporary improvement against glabellar wrinkles (glabella = the area between your eyebrows and above your nose; wrinkles in this area are your frown lines). Similar to Botox and Dysport, Xeomin contains the botulinum toxin. Unlike Botox and Dysport, the toxin itself is naked and not associated with proteins. What this practically means in terms of aesthetic outcome is still unclear. So, the jury’s still out on how Xeomin will fare in comparison to Botox and Dysport. Xeomin will likely widely be available in the spring of 2012. It will be interesting to try it out and see what the key differences are between to botulinum toxins — or maybe they are more similar than dissimilar! Xeomin is manufactured by Merz Aesthetics while Botox is manufactured by Allergan and Dysport by Medicis.

Seborrheic keratoses – aka “Barnacles”

Seborrheic keratoses (SKs) account for many referrals to the dermatologist. What are seborrheic keratoses? If you’ve seen a dermatologist before, they may have been referred to as barnacles, wisdom spots, SKs, seb kers, or some other creative terms. Bottom line is, they are benign spots. Chances are mom or dad had them too and passed on some of the genes that dictate their growth to you. There are many flavors (or perhaps more appropriately, looks) to seborrheic keratoses. They typically look like stuck-on warty pigmented growths on the skin but they can also be smooth, barely raised, pink or non-pigmented. In general, they don’t cause problems so if your SK doesn’t bother you, don’t bother it! Unfortunately, sometimes they do get in the way — e.g. of your necklace, bra strap, waistband, eyeglasses, brush/comb, etc. Or maybe you’re just bothered by the way they look. (You can’t tell your SK where to grow and it might just crop up in a very visible area like the face.) In this case, talk to your dermatologist. There are various options for removal. Cryotherapy (the liquid nitrogen cold spray), curettage, and shaving are just some methods for removal. There are benefits and drawbacks to each so let a doctor take care of removal. You don’t want to exchange an SK for a scar. And you probably want a method that can keep your SK away for as long as possible. Some people also use a loofah sponge when showering or bathing to help even out the wartiness/roughness of the SK.

Just keep in mind, since seborrheic keratoses often are pigmented, it can be hard for the non-trained eye to distinguish a potential skin cancer from a seborrheic keratosis. So when in doubt, see a dermatologist for evaluation!

Summer AAD 2011

I spent this past weekend in New York City at the Summer American Academy of Dermatology (AAD) conference. What a nice well-run set of events the AAD put together. Although smaller in size compared to the annual meeting, there was a good selection of forums and events. It’s always nice to see everyone catching up at these conferences and working together to promote knowledge and innovation in the field. What continues to strike me is how diverse dermatology is. Dermatologists are interested in skin cancer, surgeries, cosmetic procedures, pediatrics, etc. Going to the AAD conference is like being a kid at the fair — you get to take sample talks in all these different parts of dermatology.

The other aspect of the conference that struck me is that people are really paying attention to the patient’s experience and talking about it. How do we blend quality care with customer service and patient satisfaction at the same time? The patient-doctor relationship is a complex one. The patient of course is no mere customer. But sometimes physicians can be overly focused on the medicine and forget that patient needs transcend purely medical needs. We need to communicate with patients and understand that personalization of the patient-doctor relationship makes it a successful relationship. And we need to be able to step back and assess when we aren’t doing the best job that we can do and improve upon that. It’s great to see people talking directly about it and coming up with solutions.

Pigmented lesions

Does the phrase “pigmented lesion” mean something to you? Or does is it sound strangely foreign? The online Merriam-Webster dictionary defines lesion as, “1. Injury, harm. 2. an abnormal change in structure of an organ orpart due to injury or disease; especially: one that is circumscribed and well defined.” So in the skin, a lesion is an area that presents with a change from the surrounding normal skin. Pigmented lesions account for a large proportion of referrals from primary care physicians. Many patients also self-refer after noticing a funny looking pigmented spot on their skin. The majority of these referred pigmented lesions do not turn out to be melanoma, but I still believe in better safe than sorry. Dermatologists are trained to distinguish a concerning pigmented lesion from a benign (safe) spot. We do this by looking at the spot and we might use a special lens to look at the spot (dermoscopy). If we’re concerned enough about the spot, we may biopsy it (cut out a small piece of it) or cut it out all together and send the skin to a pathologist. The pathologist is a doctor who looks at the cells of the tissue and tells us what the lesion is.

Pigmented lesions can be many things. Of course, we’re most concerned about catching a melanoma, which is a serious type of skin cancer that can spread to other parts of the body and cause all sorts of problems including death. Then there are atypical moles, which we call “dysplastic nevi.” We believe that some percentage of these can turn into melanomas. That’s why if the pathologist tells us that your mole is atypical with a certain degree of atypia (usually moderate atypia or worse), then we may suggest that you get your mole cut out. Keep in mind though that melanomas don’t have to evolve from moles. They can arise from a part of your skin that never had a mole before! This type of melanoma is said to arise de novo. A pigmented lesion can also be many other things. Again, better safe than sorry. When in doubt, find someone who is trained to distinguish the good, the bad, and the ugly pigmented lesions.

Welcome to DermBytes!

Hi Everyone!  I’m really excited to start this blog on all things skin-related (and more)!  I’m a second year dermatology resident physician (meaning, I finished medical school, one year of internship in medicine, and my first year of dermatology residency training).  I’ve always been intrigued by the largest human organ — it means so much from a physical and medical perspective and influences our day to day social interactions and emotional well-being.  I can still remember those awkward teenage years when I’d wake up with a huge zit on the top of my nose.  I tried all sorts of stuff to make the acne go away.  Many of them were quite creative.  In retrospect, I wish I had just gone to a dermatologist!

Now I’m done with medical school and learning about all things derm, and I can’t wait to share what I’m learning with you!

Thanks and let me know if you have any feedback or suggest topics you’d like me to cover.  
Best regards,
SJH

Susan Huang, MD
Combined Dermatology Residency Program @ Harvard Medical School
Brigham & Women’s Hospital, Massachusetts General Hospital, Beth Isreal Deaconess Medical Center, Children’s Hospital of Boston, West Roxbury VA Medical Center & Lahey Clinic