DERMATOLOGY
Ingrowing toenails differ in aetiology in both young and old.
Antibiotics will only bring about short term relief if the nail margin is not removed.
Phenolisation of the nail matrix is recommended after removal of the toenail.
VIRAL WARTS / VERRUCA
There are a number of human papilloma viruses (HPVs) which cause different clinical features and infect different body sites. Generally warts affect children of school age usually contracted in communal areas, barefoot environment of school changing rooms as well as being the first time that the body has encountered the pathogen. In adults who have recently taken up sport and uses communal changing rooms may also develop verrucae.
Clinical features include rough cauliflower-like surface with sometimes black dots of thromboses capillaries and can be painful on weight bearing areas.
MANAGEMENT
it is recommended to allow body's immune system time to recognise the virus and it will resolve spontaneously. However, if a verruca is painful we recommend the use silver nitrate (develops brown eschar / scab); salicylic acid (macerates tissue turning it white) and dry needling which all rely on the destruction of the wart tissue with an increased opportunity for the HPV to present in the immune system. Generally salicylic acid and silver nitrate treatment need to be repeated 1 x weekly for 6 or more visits to be effective. N.B. over enthusiastic application of topical caustics can cause ulceration and are therefore not suitable of high risk clients.
PITTED KERATOLYSIS (SWEATY FEET)
Too much sweat (hyperhidrosis) or too little sweat (anhidrosis) secreted by the eccrine gland in the skin will cause changes in the skin's mechanical strength. This gives rise to moist fissures usually between the toes and dry fissures usually around the edge of heels. Both can develops complications such as fungal and bacterial infections especially if the skin is broken.
Management of hyperhidrosis include sweat absorbing insoles, changing and airing footwear frequently and the application of astringents, antiperspirants & deodorants.
DERMATOLOGY
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VENOUS ULCERATION
Venous insufficiency is characterised by discolouration and varicose eczema on the lower leg
Ulcers follow minor trauma
Venous ulcer healing is protracted
PLANTAR PUSTULOSIS / DERMATOSIS
Plantar Pustulosis is a form of psoriasis seen on the feet.
Juvenile plantar dermatosis is a contact dermatosis caused by synthetic footwear.
Erythematous lesions are managed with steroids and emollients.
Fungal infections of the skin and nails are common, affecting 10% of the population.
They are caused by dermatophyte infections.
Skin and nail infections are often found together
Infections of the skin require advise and astringents or if persisent azoles or allylamines.
DERMATOLOGY
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CHILBLAINS & CHILLING
Chilblains are an exaggerated response to cold and are seen secondary to Raynauds affecting both young and old. Raynaud's is a vasoconstrictive disorder mainly affecting middle-aged woman. It is associated with scleroderma. Management involves avoidance of cold or rapid temperature change. Insulating footwear as well as adding insulating materials can be helpful. Topical ointments which cool and sooth control the inflammatory response. When the chilblain is broken it is essential to keep it free from infection and protect the issue by using paddings and suitable dressings. In some cases, vasodilators may be required.
PLANTAR PUSTULOSIS / DERMATOSIS
Plantar Pustulosis is a form of psoriasis seen on the feet.
Juvenile plantar dermatosis is a contact dermatosis caused by synthetic footwear.
Erythematous lesions are managed with steroids and emollients.
VARICOSE ECZEMA
Occurs with venous hypertension and often accompanied with brown staining of the skin. It can be painful, itchy, dry and scaly. Venous hypertension results in poor metabolic and fluid removal (swelling) resulting in poor weak skin texture causing tissue breakdown and venous ulceration. White, patchy scars may also be viable with this condition.