Southern Skin The Clinical Newsletter of the UAB Department of Dermatology

Transcription

1 University of Alabama at Birmingham The Clinical Newsletter of the UAB Department of Dermatology Drs. Elmets, Elewski, and Mercado Best Doctors in America 2006 VOLUME 2, ISSUE 1 WINTER, Eye Foundation Hospital 1720 University Boulevard Birmingham, AL (SKIN) TKC Pediatrics Clinical Faculty: Craig A. Elmets, M.D. - Chair Eczema and Psoriasis, Phototherapy, Patch Testing, and Photosensitivity Diseases For the second consecutive year, UAB Department of Dermatology physicians Boni E. Elewski, M.D., Craig A. Elmets, M.D., and Patricia Mercado, M.D., have been named to the Best Doctors in America guide. The guide is developed by employers and insurance companies to facilitate the making of informed health care choices by consumers. Physicians were selected for the 2006 guide based on a peer survey sent to 2005 winners. Those physicians were asked, If you or a loved one needed a doctor in your specialty, to whom would you refer them? The designation of three physicians in one department is especially notable as less than five percent of all board certified specialists are chosen. Boni E. Elewski, M.D. - Vice Chair Fungal Infections, General Dermatology, Clinical Trials Corey Hartman, M.D. Ethnic Hair and Skin Disorders, General Dermatology Conway Huang, M.D. Skin Cancer, Mohs Surgery Lauren Hughey, M.D. General Dermatology, Cutaneous T- cell Lymphoma, Consultations Catherine Lucas, M.D. General and Pediatric Dermatology Seemal Desai M.D., AMA Resident Leader For the past six years, Seemal Desai, M.D., a current Dermatology resident, has been an active member of the American Medical Association (AMA). He has been elected to leadership positions at the local, state, and regional levels. Dr. Desai now continues his leadership within Inside this issue: Honors and Awards 1 Onychomycosis 2 Acne Ask Dr. Hartman 3 the AMA through his election to the AMA Resident and Fellow Section Governing Council. This is the national board of the AMA, representing the interests of all residents and fellows in the United States. The Council focuses on many national issues facing residents, fellows, and practicing physicians including: medical education, healthcare reform, physician reimbursement, and tort reform. Dr. Desai is the first and only Dermatology resident on this prestigious council. Patricia Mercado, M.D. Hair Disorders, General Dermatology Marian Northington, M.D. Cosmetic and General Dermatology Naveed Sami, M.D. Blistering Diseases General Dermatology Amy Theos, M.D. Pediatric Dermatology, Genetic Skin Diseases Consultation Dermatology - Q and A 4 Page 1

2 Onychomycosis describes infection of the nail bed by a dermatophyte, yeast, or mold. Men are affected about twice as frequently as women, and toenails are affected more frequently than fingernails. Symptoms include: brittleness, discoloration, thickening, shape distortion, nail crumbling, and UAB Department of Dermatology The The Department of Dermatology is currently conducting a clinical trial to compare the safety and efficacy of two different oral treatments for onychomycosis. Subjects must be between 16 and 75 years of age, be in generally good health, and have a great toe 25-75% affected by onychomycosis. Diagnosis will be verified through culture performed on a nail clipping. Ex- Onychomycosis clusion criteria include: sensitivity to the study medication, recent participation in a clinical trial, involvement of more than 75% of the great toenail, complete absence of nail growth, use of systemic immunosuppressants, history of drug or alcohol abuse, use of systemic antifungals within 12 weeks, and use of any topical toenail treatment within two weeks. nail detachment. Diagnosis may be confirmed through culture of an affected nail clipping. Onchyomycosis is quite difficult to treat, and is not usually improved with over the counter topical medications. Mild infections sometimes can be treated with a prescription nail laquer. However, for most infections, prescription anti-fungal medications taken orally are necessary to completely clear the problem. It is important to remember that nails grow slowly so that even with successful treatment the affected nail may not look normal for up to one year. Complete resolution of the infection is achieved in approximatel y half of treated Toenail demonstrating the typical physical findings seen in onychomycosis: breakage, yellowing of the nailplate, and crumbling Clinical Trial Onychomycosis Subjects may receive treatment with one of the two study medications, or may be given a placebo. Treatment group is determined randomly. All subjects will be required to make approximately nine visits over the course of one year. Subjects will receive screening blood tests, an ECG, free study medication, and compensation for time and travel. Culture of T. rubrum, the fungus most frequently responsible for onychomycosis Clinical Trials Program The Department of Dermatology offers numerous opportunities for patients to participate in clinical trials. These trials are usually designed to test the safety and effectiveness of medications, or to compare new medications to the currently standard treatment. Clinical trials may be sponsored by government agencies or private pharmaceutical companies. All clinical trials have undergone rigorous review by the UAB Human Subjects Institutional Review Board. The department is currently conducting studies of: -Acne -Psoriasis -Epidermolysis Bullosa -Cutaneous Candidiasis -Ocular Cicatricial Pemphigoid -Cutaneous T-Cell Lymphoma -Disseminated Superficial Actinic Porokeratosis (DSAP) -Onychomycosis Please call (205) for more information or to schedule a screening evaluation. All participants receive free treatment and are compensated. Page 2

3 UAB Department of Dermatology The Ask Corey Hartman, M.D. Dr. Corey Hartman is originally from New Orleans, Louisiana. He graduated Phi Beta Kappa from Emory University in 1997 and then received his medical degree from Meharry Medical College in Nashville, Tennessee in He completed his Internship (Medicine) at Tulane University and his Dermatology Residency at UAB. Dr. Hartman is interested in General Dermatology with a focus on pigmentary and follicular disorders that primarily affect ethnic populations with darker skin tones. He is committed to researching and treating the causes and esthetic consequences of these disorders. Call (205) (SKIN) for an appointment with Dr. Hartman at The Kirklin Clinic. Skin Q & A Acne and Rosacea What is acne? Acne is an inflammation of the hair follicles and oil producing glands of the face, trunk, and rarely, buttocks. This is evident to the physician and the patient as papules, pustules, cysts and nodules. If untreated and longstanding, acne may result in pitted, depressed or discolored scars. Acne may be worsened by factors such as: medication, emotional stress, exercise, sweat, or cosmetic products. Acne is not affected by chocolate or fatty food. Who gets acne? Acne is a very common condition, affecting approximately 85% of young people. It most commonly presents during puberty (10 to 17 years in females, 14 to 19 years in males). It is more severe in males than in females. Asians and African-Americans show a lower incidence of acne. Are there different types of acne? Acne has different forms based on the predominant lesions present. Acne is classified as comedonal (small superficial non-inflamed bumps or blackheads), papulopustular (red papules or pus-filled larger bumps), or nodulocystic (deeper, more painful, larger lesions that are more prone to scar formation). How is acne treated? There are many different available treatments for acne and the regimen should be tailored to the specific patient based upon the patient s presentation, lifestyle, age and severity. Available therapies include: topical and oral antibiotics (tetracycline, doxycycline, minocycline including Cleocin T and Duac ), benzoyl peroxide gels and washes, salicylic acid washes, azeleic acid, topical vitamin A derivatives (Differin, Tazorac, Retin-A ), systemic retinoids (Accutane ), hormonal based treatments (spironolactone, oral contraceptive pills), chemical peels and laser treatments. What is rosacea? Rosacea, or adult acne, is a chronic inflammatory disorder of the hair follicles and oil-producing glands of the face that is coupled with an increased reactivity of the blood vessels in the area, leading to flushing and redness. There are different stages of rosacea including flushing and blushing, persistent redness with broken blood vessels, persistent papules and pus-filled bumps, red eyes and thickened skin of the nose (called rhinophyma). Who gets rosacea? Rosacea is a disorder of adults aged 30 to 50 years old. It is usually seen in patients with fair-skinned tones, like those of Celtic descent, but may be seen in any lighter-skinned patient. Female patients outnumber males, but men are more prone to rhinophyma. What causes rosacea? The exact cause of rosacea is a matter of debate, but certain factors have been associated with the disorder. Hot liquids, spicy foods, alcohol, and exposure to sun and wind are all factors known to worsen rosacea. Historically, patients with rosacea were perceived as being alcoholic, but this is, of course, not true. How is rosacea treated? Treatments for rosacea are targeted to the specific type of rosacea that the patient presents with. The first important step is to avoid the specific triggers that worsen the disorder for each particular patient. The use of sunscreens is important for all patients to remove the insult inflicted by the sun. Other available therapies include: topical antibiotics (metronidazole, sodium sulfacetamide), oral antibiotics (minocycline, tetracycline), Accutane, and laser treatments, particularly for the persistent blood vessels and rhinophyma. Page 3

4 Consultation Dermatology Ask Lauren Hughey, M.D. Lauren Hughey, M.D. Lauren Hughey, M.D. received her undergraduate degree from Vanderbilt University in 1994, majoring in economics. After completing additional coursework at LSU, she attended medical school at the University of Alabama. Her medical internship and dermatology residency were also completed at UAB. Dr. Hughey is currently Assistant Professor of Dermatology, as well as Director of the Inpatient Dermatology Consultation Service and Assistant Director of the Kirklin Clinic Infusion Center. Dr. Hughey is Board Certified in Dermatology and is a member of many Dermatology societies. Aside from Consultation services, Dr. Hughey has several general dermatology clinics each week. She has a particular interest in cutaneous T-cell lymphoma. Call 996-SKIN (7546) to make an appointment. What is consultative dermatology? Consultative dermatology describes the act of a dermatologist answering a particular question posed by another physician either in dermatology or in another field of study. Consultations can occur within the outpatient clinic or within the hospital. These questions are broad in subject and include dilemmas in diagnosing a patient, advice on the appropriate work-up of a problem, as well as advice on alternative treatment options for diseases that are difficult to treat. Is there a dermatology inpatient service? At UAB we have a full-time inpatient dermatology consultation service which means that 24 hours a day, 7 days a week, we have someone available to answer questions and evaluate patients with skin disorders from all of the various areas of the hospital including internal medicine, psychiatry, orthopedics, neurosurgery, etc. Give us an example of a question that might be posed to your service. We often have patients admitted to the hospital with fever and rash, and the admitting physician asks Can you help us figure out what is going on? Or, for example, a patient may be admitted for hip replacement but now has a flare of his psoriasis; the orthopedist then asks Can you help us treat this patient s skin while he is in the hospital? In another example, a patient may be admitted with the new onset of firm, painful skin and kidney disease. The kidney specialist might then ask for aid in diagnosis. What can a dermatologist do to help a hospitalized patient? While the patient is in the hospital the dermatologist can review medical records, conduct a thorough physical exam, and perform diagnostic tests including cultures and biopsies of the skin. We use this information to diagnose the skin disorder at hand and to offer treatment options on newly diagnosed skin diseases or on previously diagnosed skin diseases exacerbated during hospitalization. We also facilitate follow-up appointments for dermatology after discharge. Can a dermatological condition be life-threatening? Yes. Drug eruptions can turn into a life-threatening event. In addition, chemotherapy and anti-rejection drugs can severely affect the functioning of the immune system. We see cancer patients on the Hematology/Oncology service and patients on the organ transplant service with serious bacterial, viral, and fungal infections that may first manifest on the skin. In addition, there are many other dermatologic conditions which can be life-threatening in their most severe forms. Why do you enjoy doing consultation dermatology? I absolutely love directing the inpatient consultation service for many reasons. The inpatient service allows me to participate in the care of the whole person and requires my knowledge and care about other organ systems in addition to the skin. I have always enjoyed taking care of sick patients in the hospital and making an impact on their recovery. In addition, the inpatient consultation service presents challenging and unusual cases that are less likely to be encountered in other settings. Ask the Dermatologist Send your dermatology questions to editor Jennifer Frank at jfranf@uab.edu and they will be referred to the appropriate specialist. Due to the high volume of mail, not all questions will receive a reply. Page 4

5 Department of Dermatology Residents and Friends The Department is deeply grateful to the following donors for their generous gifts to the Department of Dermatology Residents and Friends Fund. When the fund reaches $500,000, it will become an Endowed Professorship, which will assist the Department of Dermatology in recruiting new faculty, retaining outstanding mid-career faculty whom other universities are looking to hire, and attract superstar faculty who are recognized around the world as leaders and innovators in our specialty. Garrett S. Bressler, M.D. C. Ralph Daniel, M.D. Craig A. Elmets, M.D. Pamela Guest, M.D. & Robert McCall Lauren C. Hughey, M.D. Patricia Mercado, M.D. Robert M. Pritchett, M.D. Sidney P. Smith, M.D. Vera Y. Soong, M.D. Laura M. Tamburin, M.D. Anonymous (3) In making a gift to the Department of Dermatology you will do so much more than writing a check: -You will foster discovery through basic and clinical research. -You will provide quality care and support for our patients. -And you will supply physicians with the tools they need to further their work. Gifts to UAB are tax-deductible, and may be made with cash, appreciated securities, real property or through your estate plan. Pledges may be made over a period of up to five years. For more information on supporting the Department of Dermatology at UAB supporting great science, great care and great outcomes call or today: Erica Hollins Director of Development School of Medicine at UAB Faculty Office Towers th Street South Birmingham, AL (205) Fax: (205) ehollins@uab.edu Page 5