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Health Enewsletter January 2016

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Management of Eczema and Skin Rashes

Psoriasis and Psoriatic Arthritis Management Options

Rheumatology and Dermatology Associates
8143 Walnut Grove Road
Cordova TN 38018
1-901-753-0168; Rheuderm@Comcast.net

 

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Dr. George
Woodbury and Dr. Cathy Chapman
Rheumatology and Dermatology Associates
8143 Walnut Grove Road
Cordova, TN 38018
 (901) 753-0168
Rheuderm@comcast.net
 

 
 
This baby is suffering from eczema, also called atopic dermatitis. Photo used by permission of the American Academy of Dermatology.
 
Management of Eczema and Rashes:
  The winter is a challenging time for many patients with sensitive skin rashes, so let’s review management options for these conditions.
  The first step for itchy or dry skin is to get to the correct diagnosis, which leads to proper treatment. I’ve seen many patients over the years who actually were suffering from a fungus, from a virus, or even from an allergic condition, rather than from eczema, which is a general term for atopic dermatitis. So sometimes we will take a test called a skin biopsy to diagnose the condition, or else take tests called fungal cultures or even allergy patch testing to try to get at the cause.

  A skin biopsy is a test that involves
having a small piece of
skin removed under local anesthetic, and then sent in to a dermato-pathology laboratory, to be examined. This test can sometimes reveal whether you are reacting to a drug that you have become allergic to. Sometimes a brushing taken from the skin—for a test called a fungal culture-will reveal that you are actually suffering from a contagious fungus—such as a dog or cat ringworm fungus.  We do have several effective prescription creams and tablets for fungal infections, so having this information about the organism can be really useful. I do maintain my own fungal culture laboratory right in-house, at Rheumatology and Dermatology, for identifying these organisms. More stubbornly itchy rashes often benefit from a test called allergy patch testing, in which low concentrations of suspected culprit chemicals are placed upon the skin, then examined 2, 4, and 7 days later, to get readings. We save this type of testing for stubborn or recalcitrant rashes, because of the need for several visits. But once we get a reading on the allergy patch testing, we can often point out the chemical to avoid, like a preservative, fragrance, or dye (coloring), or even nickel, which is the most common chemical causing contact dermatitis. I use testing to over 140 common culprit chemicals, and I stay up to date on these chemicals through my membership in the American Contact Dermatitis Society. 

  Fortunately, in 2016 we have many more effective medicines that can help alleviate the itching and pain that comes from atopic dermatitis. It's mainly a matter of getting at the cause of the rash, figuring that out, and then applying some of the therapies that work for that rash.  -George Woodbury Jr. M.D. (01/29/2016)

 

 
Rheumatology and Dermatology Nurse Kristen reviews educational materials relating to medications with a patient and counsels him about skin care. We believe that an educated and engaged patient is more likely to achieve better results, so we can many times  offer educational materials to help. You can help us in caring for you if you bring products like soaps, shampoos, and toiletries that you've been using at home with you to your follow-up visits. Dr. Woodbury (01/30/2016)
 

Rheumatology and Dermatology Medical Assistants Vicki and Shirley encourage families to learn about eczema through several on-line tools. The phrase is "improving patient engagement" in healthcare services. Knowledge is helpful in getting people better.
 


The Arthritis Foundation sponsors an event each June in Memphis to raise support for arthritis research. Here Dr. Chapman greets Medical Assistants Shirley (left) and Vicki (right) at Shelby Farms, for the Walk to Cure Arthritis. The 2016 event has been scheduled for Saturday morning June 4th 2016, so go to the Arthritis Foundation website for details.

Dr. Cathy Chapman
did her rheumatology fellowship at the University of Rochester Strong Memorial Hospital, in Rochester, New York. She manages over 300 types of arthritis, with laboratory testing helping to make a correct diagnosis and to monitor medication. Arthritis treatment has advanced markedly in the last 5 years, now including both new oral medications and injectable medicines and even intravenous medicines.
 
Emily Woodbury designed our practice's grassroots logo to illustrate
that people benefit most when patients and healthcare personnel work together in a team-wise approach. Everything comes together in a big circle.
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Psoriasis and Psoriatic Arthritis Examined:
Psoriasis is a type of genetic skin condition in which the body’s immune system attacks certain tissues, particularly the skin but also frequently also the joints, in which case we call the condition psoriatic arthritis. It can also affect the scalp and the nails.
Psoriasis is a actually a medical condition with a lot of overlap between rheumatology and dermatology, since it often first presents in the skin, particularly the scalp and the extremities. About 1/3 of psoriasis patients also have joint pain, particularly in the hands, the extremities, and the spine. Milder cases of psoriasis often respond to topical steroid creams or ointments, or sometimes to a vitamin D ointment called Calcipotriene. Sometimes nonsteroidal oral drugs are helpful for the joint involvement.
  More stubborn cases of skin psoriasis often respond to what is called intralesional treatment, meaning that the doctor injects steroid medicines into the skin to cool off the inflammation. This treatment sometimes needs to be done once a month for several months to put the lesions into what is called remission, meaning that they clear up. 
  Even more severe cases of psoriasis often require what are call systemic agents—which are oral, injectable, or iv medicines that act on the whole body, targeting parts of the immune system. These medicines include methotrexate pills, cyclosporine, and biologic medications, such as etanercept and adalimumab. Such treatments require careful monitoring because they can re-activate a lung condition called tuberculosis. Many of these drugs are metabolized through the liver, so one must limit alcohol and limit use of other drugs that affect the liver. These drugs must also be avoided by pregnant women, since they have not been studied during pregnancy. These medications can only be used for patients who are willing to keep required follow-up visits, since safe treatment requires lab monitoring i.e. follow-up lab testing. There is even an intravenous medication approved for severe psoriasis - called infliximab - which offers durable relief to many patients.

  Fortunately, therapy that’s tailored to the specific patient’s medical presentation offers the hope that we can limit joint and skin damage by psoriasis. It’s been said that psoriasis never killed a patient, but it can ruin a patient's life. Fortunately, the scourge of psoriasis is becoming more and more easier to manage, with medical research and the help of these new medications. George Woodbury Jr M.D. (01/30/2016)
 
Would you like to become more engaged in the
politics of your healthcare?

Dr. Woodbury is the matchmaker within the PURPLhealth Network. That means he sets up coffees, breakfasts, and lunches between both state and federal legislators and healthcare personnel, to discuss issues that have been identified by the Tennessee Medical Association, the Memphis Medical Society, and the American Academy of Dermatology Association. If you would like more information on these meetings, or to get involved, please drop me a return Email or phone call to PURPLhealth@yahoo.com, or call 901-753-0168.
 

For questions, comments, or if you would like to
be added to our email list, please email “purplhealth@yahoo.com”or call 1-901-753-0168.
George Woodbury Jr. M.D. (01/30/2016)