Lyme Disease

RECENTLY IN THE NEWS:

NBC News (3/5/2015) reports on its website that "family practioners, gynecologists and even dentists are getting into the cosmetic procedure business, and dermatologists say they're seeing the side effects."  Several dermatologists "from around the country told NBC News that they've had to the fix the mistakes of physicians who are dabbling in their specialty."  In a statement, the American Academy of Dermatology said, "A dermatologist is a licensed medical doctor and the only residency-trained physician fully educated in the science of cutaneous medicine, which includes medical and surgical conditions of the skin, hair, nails, and mucous membranes."

DRY SKIN CARE:

Keep your bathing to a minimum!  Wash with lukewarm water and keep your bathing to less than 10 minutes.  Wash with a soapless cleanser such as Dove and avoid harsh soaps such as Ivory or Irish Spring.  After bathing, moisturize within a few minutes of patting dry with a towel.  Moisturize with a sensitive-skin moisturizer without fragrance.  If you have a skin condition such as eczema, you will need to moisturize a few times per day.

WOUND CARE:

The day after your procedure, allow the cleanser and water to wash over the site.  That is adequate cleaning of the wound.  Thereafter, apply a generous layer of petroleum jelly (Vaseline) or another greasy substance such as Aquaphor healing ointment.  If the area is in contact with clothing, we advise you to cover it with a dressing.  Repeat the same procedure the next day and every day until the wound has healed.

HOW TO APPLY YOUR TOPICAL RETINOID (ACNE PATIENTS):

Topical retinoids include adapalene (Differin), tretinoin (Retin-A, Atralin, Ziana, Veltin, Tretin-X).  Apply a pea-sized amount to your entire face a few minutes after washing your face at bedtime (since most retinoids are inactivated by sunlight).  If your face is dry with the retinoid, apply a moisturizer prior to the application of the retinoid.  

CARE FOR SKIN IN THE SUN:

Use a daily moisturizer with a sunscreen of SPF 15 or higher on the areas that will be exposed.  If you're going to be directly out in the sun, wear an SPF of 30 or higher and make sure the sunscreen says that it is "broad spectrum."  Remember to reapply after two hours and after swimming or any exercising.  Physical sunscreens which contain titanium dioxide and/or zinc oxide are gentle and will not react with the skin.   Seek shade between the hours of 10 am-4 pm.

Check your skin for any new, changing, non-healing or itching lesions four times a year or every major holiday.  If you notice anything that is new or changing or not healing, please call and get it checked.

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Lyme disease is a bacterial illness and inflammatory disease that spreads through tick bites. Deer ticks house the spirochete bacterium (Borellia burgdorferi) in their stomachs. When one of these ticks bites the human skin, it may pass the bacteria into the body. These ticks tend to be attracted to creases in the body, so Lyme disease most often appears in armpits, the nape of the neck or the back of knees. It can cause abnormalities in the skin, heart, joints and nervous system.

Lyme disease was first identified in 1975 in Old Lyme, Connecticut. More than 150,000 cases have been reported to the Centers for Disease Control since 1982. Cases have been reported from every state, although it is more commonly seen in the Northeast, Upper Midwest and Pacific Coast. Lyme disease has also been reported in European and Asian countries.

There are three phases to the disease:

Early Localized Phase. During this initial phase, the skin around the bite develops an expanding ring of redness. The ring may have a bull's eye appearance with a bright red outer ring surrounding clear skin in the center. Most people don't remember being bitten by a tick. More than one in four patients never gets a rash. The skin redness may be accompanied by fatigue, chills, muscle and joint stiffness, swollen lymph nodes and/or headaches.

Early Disseminated Phase. Weeks to months after the rash disappears, the bacteria spread throughout the body, impacting the joints, heart and nervous system. Symptoms include migrating pain in the joints, neck ache, tingling or numbing of the extremities, enlarged lymph glands, sore throat, abnormal pulse, fever, changes in vision or fatigue.

Late Dissemination Phase. Late in the dissemination of the disease, patients may experience an inflammation of the heart, which can lead to heart failure. Nervous system issues develop, such as paralysis of facial muscles (Bell's Palsy) and diseases of the peripheral nerves (peripheral neuropathy). It is also common for arthritis and inflammation of the joints to appear, which cause swelling, stiffness and pain.

Lyme disease is diagnosed through a combination of a visual examination and a blood test for Lyme bacteria antibodies. Most cases of Lyme disease are curable using antibiotics, but the longer the delay, the more difficult it is to treat. Your dermatologist may prescribe medications to help alleviate joint stiffening.

The best form of prevention is to avoid tick bites. Use insect repellent containing DEET. Wear long sleeves and pants when outdoors. Tuck the sleeves into gloves and pants into socks to keep your skin covered. After a hike, check the skin and look for any tick bites, especially on children. If you do find a tick, don't panic. Use tweezers to disengage the tick from the skin. Grab the tick by the head or mouthparts as close as possible to where the bite has entered the skin. Pull firmly and steadily away from the skin until the tick disengages. Clean the bite wound with disinfectant and monitor the bite mark for other symptoms. You can place the tick in a jar or plastic bag and take it to your dermatologist for examination.