Tuesday, March 27, 2007

Palm Pense-Bête

You may remember La Maladie du Petit Papier which was reported here on January 27th. Today, Twentysomething Generation's equivalent emerged.

I propose calling it: La Maladie du Palm Pense-Bête. This was brought in by a 24 yo woman. Will the ingenuity of our patients never cease? "O brave new world [electronic]!"

Dermatomyositis -- New York Times

An interesting article appeared in the New York Times today on myositis. It is well-written and researched. You will benefit from and also enjoy perusing it. In addition, your patients will read it and may bring it to your attention.

March 27, 2007
An Elusive Diagnosis, and One That Comes With a Risk of Cancer


To read the article click on Permalink

Friday, March 23, 2007

Is Treatment Worse Than Disease?

The patient is a 48 yo woman with many actinic keratoses on face and chest. After discussing therapeutic options, she elected to use fluouracil cream. She was started on nightly 5% 5FU cream and at two weeks was noted to have a moderate inflammatory response. The 5FU was continued. By 23 days, I got an email indicating that she wasn't sleeping and was very concerned. I had her come in and the pictures speak for themselves.

I stopped the 5FU, placed her on cold compresses b.i.d. and desonide cream. Ambien 5 mg was given for sleep since she had not slept well for 4-5 nights and requested a soporific.

1) What would you have done differently?
2) Is this a good argument for PDT?

One Year Follow-up

The patient still does not feel she is perfect. However, her skin looks great and she has virtually no AKs.

Your comments will be appreciated.

Dave Elpern

Thursday, March 15, 2007

Infant with Scalp Mass

The patient is a twenty-week-old infant with a scalp mass present for 2-3 months. It appears to be growing slowly. He was seven weeks premature; but otherwise all milestones have been normal. He had a type one intracranial bleed post partum but it was not complicated. He did have scalp vein IVs whilst in hospital, but it's unclear where they were.

The examination shows a 4x2.5 cm in diameter freely movable mass on the left parietal area. It feels firm. Skin and hair normal over it (in the photo it the hair looks a bit sparser over the lesion). Ultrasound was done and was interpreted as normal.

The mass looks benign. Do you have any suggestions about what this might represent and what to do at this point? Skull x-ray and CT may be indicated, however, I thought I'd get some opinions first.

Thursday, March 01, 2007

Case from Cambodia

These photos were sent to Dr. Doug Johnson from Cambodia without any information.
It's sad to think that adequate medical care could have likely prevented most of this.
Your comments are welcome.