Hand Dermatitis in Covid-19 times

In this stressful time of Covid-19, all of us are doing the right thing and keeping our distance and washing our hands. Due to the massive uptake in hand washing and hand sanitiser use in both the public domain and in health care worker (HCWs), we as dermatologists are seeing more and more cases of hand dermatitis. A very common question we get asked is “How do I keep my hands healthy with all this hand washing?” Dr Hope Dinh was asked this question by her previous dermatology nurse who is now ICU-nurse as her nurse wanted to post the response and help out fellow ICU-nurses around the country. The following documents were developed together with a group of Dr Dinh’s dermatology colleagues (who we are fortunate to also call friends) to answer these questions. The documents below have been endorsed by The Australasian College of Dermatologists and the Skin Health Institute and ODREC (Occupational Dermatology Centre).

We hope everyone can benefit from getting help for hand dermatitis ……. A – S – A – P! 

This first briefer document below can be suitable for the general public/our patients and even HCWs.

The 2 documents below are more detailed with more specific information and tips! Remember that dermatologists are here for you if you need help in treating your hand dermatitis. For appointments with any of our 5 dermatologists, call (03) 9039 56644 or email us! Stay safe everyone!

Biologics?! Hives? Psoriasis? Hidradenitis Suppurativa? There is an effective treatment!

Have you been suffering with the chronic itching of hives or are areas of your body covered in plaques of psoriasis? There is more that can be done than just topical steroids that you have probably been using for years and years with it only to really manage your condition. Topical steroids are good for acute attacks and for some do the job, but for others it just doesn’t seem to clear the psoriasis. That’s where biologics come in! Biologics can treat psoriasis but also hives or HS (Hidradenitis Suppurativa). YAY!

What are Biologic drugs?
Biologics, biologic therapies, or biological response modifiers, are drugs derived from living material (human, plant, animal, or micro-organism). They interfere with specific parts of the body’s immune system to treat and prevent immune-mediated inflammatory disorders and cancers. They are also called targeted therapies.
Biological agents work by interfering with specific components of the autoimmune response. Unlike general immunosuppressant’s that suppress the entire immune system, biological agents can fight more selectively and target only those chemicals involved in causing the specific disease.

How do I get onto a Biologic drug?
You will need to see a dermatologist to be prescribed this drug, the dermatologist will take a full history and determine if we should plan to put you on this drug.
Your skin condition will need to be fairly moderate or severe to be approved for this medication. It is also a bit of a process getting a patient on the drug, as patients must try lower strength medications and UVB therapy first and if your skin condition is still failing, then we can look to apply for the biologics! Biologics use to be very expensive but now some are on the PSB which is great; meaning it’s around $40 a script making it affordable for patients!

What to expect?
Biologics are administered through regular injections – the frequency depends on your skin condition. Patients normally find within 4-6 weeks an improvement in their skin, however this can sometimes take longer. Once treatment has kicked in people normally find around 90% clearance rate!


Once you are clear it doesn’t mean you can then stop treatment unfortunately. Normally you will need to be on this for a while, but the doctor may look to decrease the dose or frequency of the drug and slowly look to wean you off if you condition allows you to do this.

Biologics are not a new thing, it’s just many people don’t know that it is available and we need people to get to know about it! It is honestly life changing for people who have been suffering with chronic skin conditions for years and years. Book in with one of our dermatologists to start your path to clear skin! We can help you and you don’t have to live with these itchy debilitating conditions!

When a skin boil is more serious….could this be hidradenitis?

Hidradenitis Suppurativa (HS) – the latest information from the recent Melbourne Dermatology Conference May 2019.

Every year the Australasian College of Dermatologists holds an annual scientific meeting to update us all on the latest advancements in the diagnosis and management of dermatologic diseases. This year it was held in Melbourne (YES – my home town!). After 4 days of absorbing all this amazing information, my head is bursting with ideas for managing our existing patients. One session that really got my attention was the hidradenitis suppurativa lecture. Mainly under-diagnosed and sub-optimally managed, the prevalence of this condition is 0.67% (so, it’s more common than you think!). It was pleasing to hear that dermatologists lead the list of the medical specialists diagnosing this condition but there is STILL a LONG delay of MANY YEARS to patients being formally diagnosed with this condition.

WHY?

There can be many factors leading to diagnosis delay including embarrassment from the patient about the condition and so they never speak up about it, sub-optimal education of other medical specialties about the condition, patients thinking it is just a “simple boil” in the groin etc  ……in order to diagnose HS earlier, the public needs to be more aware that a condition like HS even EXISTS…..

We really should be asking our patients –Do you suffer from sore painful lumps or boils under your armpits or groin area?? Do you mind if I have a look? As it could be hidradenitis suppurativa.”

“SEEK and YOU WILL FIND”

_____________________________________________________________________________

Hidradenitis suppurativa is an inflammatory skin disease that affects gland-bearing skin in the underarms, in the groin, and under the breasts. It is characterised by recurrent boil-like nodules and abscesses that culminate in pus-like discharge, difficult-to-heal open wounds (sinuses) and scarring. Hidradenitis suppurativa also has significant psychological impact and many patients suffer from impairment of body image, depression and anxiety.

Hidradenitis often starts at puberty, it is most active between the ages of 20 and 40 years, and in women, can resolve at menopause. It is three times more common in females than in males. Risk factors include:

  • Other family members with hidradenitis suppurativa
  • Obesity and insulin resistance/metabolic syndrome
  • Cigarette smoking
  • Acne
  • Inflammatory bowel disease
  • Rare autoinflammatory syndromes

Signs and Symptoms

HS can affect single or multiple areas in the armpits, neck, sub mammary area, groin and inner thighs. Anogenital involvement most commonly affects the groin and vulva (in females), sides of the scrotum (in males), buttocks and perianal folds.

  • Open and closed comedones (white heads and blackheads)
  • Painful firm papules, larger nodules and pleated ridges
  • Pustules, fluctuant pseudocysts and abscesses
  • Draining sinuses (like “tunnels” under the skin) linking inflammatory lesions
  • Thick (hypertrophic) scarring

Hidradenitis can be associated with inflammatory bowel disease and so it is important for your dermatologist to also consider screening for your risk of this condition too. HS can also be associated with acne, psoriasis and hirsutism.

General measures you can do at home

  • Loose fitting clothing
  • Avoiding too much friction in affected areas (being careful with the types of exercise pursued). It may be worth considering the High Intensity Workout regimes which get your blood pumping quickly but minimise too much frictional irritation.
  • Reduction in weight (to lead to decreased friction in the skin fold areas); dietician advice may be helpful
  • Daily un-fragranced antiperspirants
  • If prone to secondary infection, wash with antiseptics or use dilute bleach baths
  • Apply simple dressings to draining sinuses
  • Analgesics, such as paracetamol (acetaminophen), for pain control
  • Seek help to manage co-existing mood issues such as anxiety and depression
  • Seek GP advice about weight loss, mood issues, quitting smoking etc. Also GPs can act and possibly come up with Team Care Arrangements which then allow patients to access some allied health services for FREE (like dietician consults and psychological support).
  • Join a support group so you can receive tips and support from people who going through the EXACT same issues as you!

We are here to help you manage your disease!

The dermatologist may prescribe local therapies such as –

  • anti-septic washes (such as Phisohex or Chlorhexidine),
  • antibiotic cream (such as Clindamycin 1% cream),
  • injections of steroid solution into the inflamed lumps.
  • Topical vitamin A creams (retinoids) to help unblock the blackheads and whiteheads

Oral medications include –

  • Oral contraceptive pill or hormonal treatments such as spironolactone (for females).
  • Oral antibiotics to clear any infection and reduce inflammation (must be taken for a few months to see the outcome).
  • Vitamin A tablets such as isotretinoin or acitretin
  • Metformin (a diabetic medication) which can help with the insulin resistance pathway which can drive HS
  • Oral immunosuppression tablets

Injectables

  • There are the new injectable “biologic” medications which have recently been approved under the PBS for eligible patients with hidradenitis.

Surgery

  • Simple surgery that can be done at the dermatologist without general anaesthetic. This is the technique of de-roofing the very inflamed lesions to allow for healing.
  • More complex surgery can be done in hospital via Plastics and usually done with consultation with the Dermatology Team.

Key points to remember

– Get the correct diagnosis from a professional such as a dermatologist EARLY, don’t mistake it just as a pimple

– Early treatment can mean less chance of scarring

– There are simple home measures you can do to prevent them from flaring

– With appropriate treatment you can stop this disease from returning

Want to know more? Here are some online resources

https://www.hs-online.com.au

https://www.dermnetnz.org/topics/hidradenitis-suppurativa/

http://anzvs.org/patient-information/hidradenitis-suppurativa/

http://hidradenitissuppurativasupportgroup.org/

Treatment options for viral warts

Warts are growths on the surface of the skin caused by human papillomavirus (HPV). While usually benign, these pesky bumps are in fact contagious.

Warts can be stubborn things to get rid of and can sometimes take months to resolve. You may have visited your GP for a wart where just freezing the wart can be an effective treatment. If however it doesn’t go away with a couple of freezing treatments, you may need to see a dermatologist to receive different treatment. The quicker you get on to the wart the easiest it will be to remove it.

Warts are contagious and you are more likely to pick them up in warm moist areas such as swimming pools or public showers. People who sweat more may be more prone and it is very common to see in children as they may pick them up at school from others.

Treatment in our clinic can involve different strength topicals that illicit the immune system to, in a sense, ‘’wake up’’ and shock the immune system to expel the viral skin lesion. The immune system will then start to fight the virus from the inside; the treatments can also attack the wart from the outside.

The topical solutions we use on the wart may provoke a blister to develop and this will typically begin to heal within a week. Once the blister resolves, so does that wart!

Sometimes, with in-clinic medication, only one or two treatments are necessary. We will also give you home treatment to do in the weeks after, to make sure the wart doesn’t have a chance to grow back! As we know, warts are stubborn little things and need to be attacked quite regularly to stop spreading and remove them for good!

Helpful hints to avoid getting warts!

As warts thrive in hot/sweaty conditions, if you sweat a lot, wear cool clothing/change socks frequently etc. Baby powder can be an option to put on the feet before socks, to soak up any excess sweat.

Wear thongs in public showers to avoid picking up viral warts

If you do have some warts, avoid picking/scratching them as they can directly spread via this method! Call us on 03 9039 5644 for an appointment to clear those warts for good!

Professional Help to Combat Hair Loss

Hope Dermatology welcomes our first guest blog contributor, Dr Elaine Sung (General Practitioner) from Doctors of South Melbourne, giving us her insights on hair loss from the GP perspective – 

 “Finding an increasing number of hair strands on the shower floor, in your brush or on your pillow can strike instant fear. The thought of premature baldness is something we would all rather not contemplate.

If this is something you have recently experienced, first and foremost don’t panic. There is every chance it’s a passing issue and absolutely nothing to worry about.

However, you should get the problem checked out if it persists or is severe.

As a GP, I’m usually the first medical professional patients visit to complain about their hair loss. We usually do a pretty good job at finding a cause. I always make a point to reassure patients that while not all hair loss is curable, it can be managed in the majority of cases.

GPs are well placed to discuss simple treatment options depending on the cause, of which there are many possibilities. Any good doctor will thoroughly go through a patient’s medical history, conduct an examination and order blood tests.

Importantly, I tell patients to steer clear of fads that promise quick results and deliver nothing but a lighter wallet. Herbal supplements and most lotions are as effective as placing a cut onion on your scalp (as someone had suggested to a recent patient).

I’ll usually write a referral to see a dermatologist if a patient’s diagnosis isn’t clear or more intensive treatment is needed.

Follicle Experts

Being leaders in the field of hair loss, dermatologists have access to an extensive range of treatment options. What’s more, they have the experience and tools to conduct more in-depth diagnosis, including scalp biopsies to determine the rarer causes of hair loss.

Depending on the circumstances, dermatologists can be better equipped to get patients on the right path to slow, stop or even reverse their hair loss.

Impact of Stress

Premature hair loss can cause enormous stress and anxiety. Sometimes it’s helped with education on the subject, other times this isn’t nearly enough.

Adding insult to injury, a poor mental state can itself contribute to further hair loss; quite a cruel double-edged sword.

Stress can be a factor in a hair loss condition called telogen effluvium. This is generally a condition that resolves on its own.

Stress and anxiety are also related to certain conditions that can trigger hair loss, such as trichotillomania: an anxiety disorder that results in people consciously or sub-consciously pulling their hair out.

GPs will talk with patients about options for managing anxiety issues stemming from hair loss. They can also arrange for specialists to assist in treatment, and coordinate care with a psychologist if required.”

Dr Elaine Sung is a local GP and owner of Doctors of South Melbourne. Her areas of special interest include women’s health, mental health and complex health needs.