Tuesday, October 18, 2011

Keep the Blood Pumping

Let’s revisit our discussion on dermatitis. So far, the forms of dermatitis that we have discussed had to do with a substance irritating the surface of the skin. But it is important to remember that there are internal factors that can cause dermatitis.

Stasis dermatitis is a form of skin irritation that results from problems with blood flow, especially on the lower leg. Under normal circumstances, blood flows away from the heart in arteries, unloads the oxygen it carries to body organs and tissues, then ending its journey by flowing back to the heart in veins. In order to prevent backflow of blood, veins have valves that make sure to keep blood flowing in the correct direction.

With stasis dermatitis, the valves in veins can malfunction and lose their ability to direct blood flow. Instead of being directed back to the heart, the blood pools and sits in the veins in the foot and lower leg. The veins begin to expand as the volume of blood within them increases. This leads to increased pressure inside the veins, pushing fluid out into the skin, giving the lower leg a swollen appearance. In addition, some of the pooling red blood cells can break down and cause the overlying skin to be discolored. The skin can become itchy, and it may cause people to have night cramping.

Probably the most serious complication of this condition is called a stasis ulcer. Unlike other ulcers, this sore is not due to friction or trauma. It is thought that the overlying skin is starved of adequate oxygen, causing the skin to die and form a very painful ulcer. To make matters worse, the ulcer usually does not heal quickly and can be an entry point for infectious bacteria into the body.

Luckily, podiatrists have become specialists in this arena of medicine. There are many potential treatments available that have shown to be beneficial. We’ll discuss treatment options in our next blog post.

Monday, October 10, 2011

There is a reason why they call it the Achilles

We’ve been talking about skin problems the last couple weeks, and we will return to that subject next week.  But this week something happened that has convinced me to discuss something else.

The Philadelphia Phillies are a baseball team that was expected to reach the World Series this year.  However, they were on the brink of being eliminated from the playoffs by the St. Louis Cardinals this last week.  Ryan Howard, the 1st baseman for the Phillies was Philadelphia’s last hope.  Unfortunately, he made the last out to end the game.  To make matters worse, as Howard tried to run to first base, he fell to the ground in pain.  Once evaluated, it was apparent that he had ruptured his Achilles tendon.

Achilles tendon ruptures are common and often happen with abrupt pivoting movements or when someone starts exercising after a long period of inactivity.  When it happens, the person describes the event as if they were hit in the back of their heel with a bat and they hear an audible pop.  Incredibly, they will still be able to walk, but with dramatic difficulty.  If you run your finger up the back of the heel, you’ll feel a depression or soft spot instead of the normal tense tendon inserting into the heel.  Some ruptures are partial while others may be complete.  If the rupture is bad enough, the tendon can recoil on itself like a fruit rollup.

If you try to treat a rupture conservatively, the recovery time is longer and the risk for re-rupture is very high.  For that reason, ruptures are most effectively treated with surgical repair.  Although you take on the risks of surgery, surgical repairs allow for better results long term.  You often can resume exercise sooner, the motion in the ankle is better, and overall the patients have fewer complaints.  Your podiatrist is a skilled surgeon that can perform this surgery and help you along your road to recovery.

Friday, October 7, 2011

Psoriasis Made Simple

Another dermatological term loosely thrown around is psoriasis.  Let’s discuss in more detail what this term really means.

The cells in our skin are known as keratinocytes.  These cells evolve from the basement part of our skin, but then proceed to migrate to our outer layers and die.  This process allows for continuous renewal of our skin.  Once a cell is “born,” it takes about 28 days or 4 weeks for it reach our skin’s surface and fall off.

Now, imagine instead of a month, this process took place in just 24 hours.  Such is the case with psoriasis.  Too many keratinocytes are produced in a very short amount of time.  The outer cells are pushed out faster than they can fall off.  This causes the skin to become very thick and elevated, especially on the elbows, knees, top of the feet, back, and scalp.  The elevated plaques are salmon colored and become shiny, like the skin of a fish.    Depending on circumstances, these plaques will go into remission but reoccur many times through a person’s life.

What causes psoriasis you ask? Psoriasis is usually something that runs in the family, and the first outbreak may be preceded by strep throat or a viral infection, or some other stressful event.  However, the exact causes are until unclear.  In more severe cases, psoriasis can spread into the joints and cause psoriatic arthritis.
How can you know if you have psoriasis?  If you’ve ever cut yourself where the skin was previously normal, but afterward had an elevated plaque show up on that spot similar to the plaques you have on your elbows and tops of your feet, check with your doctor to rule out this condition.

Fortunately, psoriasis does not shorten a person’s lifespan or lead to skin cancer.  Nonetheless, it can become a cosmetic nuisance depending on its location.  Thankfully, there are many treatments available including UV light, topical corticosteroids, and special wound dressings that can keep outbreaks in check.  More aggressive treatments are available if necessary.  Your podiatrist can help manage psoriasis that presents on the feet and toes.

Eczema Revealed!

Eczema… It’s a word we have all heard before, and a word we’ve probably used when describing someone’s skin. But what does it really mean?

Eczema is an “umbrella” term or “catch-all” phrase. It encompasses a wide variety of skin conditions that really have little or no relation to each other. In truth, eczema is a non-specific word whose definition is not clearly defined. Even among medical professionals, there is confusion on the true definition of the word.
For that reason, instead of eczema, we will use the word dermatitis, meaning inflamed skin. There are many causes of dermatitis, and we will discuss a couple here.

Contact Dermatitis is a skin reaction to something that comes into contact with our skin. This category can be further broken down into two categories: Irritation Contact Dermatitis, and Allergic Contact Dermatitis.
Irritation Contact Dermatitis is a skin reaction to a substance that most everyone would react to if they were exposed. Examples include exposure to harmful chemicals, harsh cleaning products, highly concentrated detergents, and strong solvents. This also includes diaper rash in babies when their skin is exposed to urine or stool for a prolonged period. Non-prescription lotions and creams may help to decrease itchiness and soothe the rash. On the foot, this condition may present after buying new shoes which use cement or other manufacturing agent that irritates your skin.

Allergic Contact Dermatitis is a skin reaction that only occurs if you are particularly sensitive to a specific substance. This is the proverbial “allergic reaction” people can have to different plants, fragrances, nickel or other metals, latex, or medications. Even if you aren’t originally allergic to one of these agents, with repeated exposure, you can develop them.

How can you tell if it’s allergic or irritation dermatitis? If it is irritation, the rash shows up the first time you are exposed to the agent, and the rash comes immediately after exposure. If it is an allergy, you will not develop a rash the first or even second time you are exposed. It is only after you have been exposed a couple of times that you develop a rash, and after exposure, the rash does not show up for a day or two. Your podiatrist can help recognize these types of reactions on the feet and give appropriate treatment.