>> getting under your skin, next "on call with the prairie doc." >> good evening, and welcome to "on call with the prairie doc." we are coming to you live from the studios of south dakota public television in vermillion tonight. we were involved in meetings here this week and sdpb was gracious enough to allow us into their facilities. which is great. one might say that the skin is sometimes thought of as the "red-headed stepchild" of body parts. we would like it to look good, but we don't always give it the respect it deserves as the organ that keeps us all together. we may only pay attention to it when something is wrong, a rash or a cut. the skin is vitally important for more than structural and
cosmetic purposes, it interacts directly with our internal parts, it protects, it absorbs vitamins, it communicates important environmental data to the brain. it is important. but, first, let's take a look at this week's prairie doc quiz question. it is a fill-in-the-blank question. in the upper prairie mid-portion of our country, especially in winter, the most common cause for a rash is? fill in the blank. viewers who call in the correct answer will be entered into a drawing to win a signed copy of our book, "the picture of health." each of my essays, originally written for this show, comes with a wonderful accompanying photograph by dr. judith peterson. we will announce the answer and the winner at the end of the show.
remember, you only have 10 minutes to get your answer in! but you have the whole time to ask your questions, concerning diseases of the skin, treatments and methods of the prevention. and as you call in or you send them to us, do it by facebook or e-mail or call in your questions to 1-888-376-6225. or send us an e-mail to the address on your screen. to help us answer your questions tonight we have three wonderful doctors. first, dr. john wollner from cedar rapids, iowa. next is dr. louis hogrefe of regional health in rapid city, south dakota. and filling out tonight's panel is our old friend, young at heart, but been our friend for a long time, dr. james
mcgrann of dakota dermatology in sioux falls, south dakota. let's dive right into the topic tonight. what is the one piece of advice that you find yourselves giving to most of your patients? john, what advice would you like them to take home? we'll start with that. >> what i do so much of the time, rick, got to be so careful about being in the sun. cannot be too careful. >> so that's a really good bit of advice. you're from here now? >> cedar rapids, iowa, originally from lake okoboji area of northwest iowa. also a proud 1974 graduate of the university of south dakota here. >> so, gee, you were at the university of south dakota and, gee, that's where we met,
isn't it? >> yeah. i'm happy to be here. i looked up all you guys going to college here. >> so you were in what fraternity, may i remember? >> lambda chi alpha. >> we happen to be a reunion tonight, it's a great deal. thanks for joining us. louie, tell us a little bit about you, too, before you say that, though, let's hear your advice for people. >> i think the number one advice is staying out of tanning booths. i was driving down from rapid city today, and trying to find a station where you could hear something. and i heard this big ad for tanning booths, and what they were promoting, you'd get for every minute that you bought you got an extra minute. so what was basically half price for a tanning booth. same way with the sun, stay
out of tanning booths. >> it just makes trouble. >> yeah. >> so you're from where originally? >> originally from gregory, south dakota. and went to the first -- undergrad here at the university of south dakota, first two years of medical school here, graduated brown. and did my family medicine residency in sioux falls, practiced in gregory for ten years. and then i had a little diversion. i spent 26 years in san diego. >> flight. >> yeah. >> then you came home. >> i came home. i've been back in -- i live in the black hills, been there for about a year. i'm the vice president of physician services with regional health. >> when you were undergrad at usd, when you were in med school, at usd, you were my
classmate that whole six years together. >> yeah. >> you went to brown, i went to emory. what a great joy. were you in a fraternity? >> i was also in lambda chi. >> what's happened with lambda this weekend? >> they're having the 100th anniversary of the chapter here at usd. wow, that's very interesting. >> thank you for joining us. >> you bet. >> jim mcgrann, you're from where? >> sioux falls. >> you've been on the snow a long time, you think i'd remember that. >> crazy stuff. >> where did you go? >> well, i'm a watertown native and amazingly i went to the university of south dakota and i was in that fraternity, lambda chi also as well. i trained at the university of wisconsin as a dermatologist and a fellow in mole surgery
and i've been back in sioux falls for the last, well, let's see, they're still making dirt when i got here. >> were they? >> 35 years. yeah. >> so you did -- you were, like, the first mole surgeon in south dakota, were you not? >> yes. >> and that's really changed. i mean, right now it's really kind of standard therapy for many kinds of cancers. >> the wonderful thing is, you don't have to travel too far to get great care in this day and age. rapid city has now several outstanding physicians. pierre is getting one. we have a number here in sioux falls. so, i tell people, you have the luxury of having great options wherever you go. >> that's great. well, we've got some different format for tonight. we're going to run through
some slides that jim was happy to send me. 60 slides, we cut it down to 30 and we're going to start. but, first, we're going to start with decubitus ulcers because that is one of the major problems that we see in nursing homes, in particular, people who are debilitated. and now we have the picture of the four characteristics of cancer, of malignant melanoma or skin lesions. let's go through that one by one. we've done decubitus ulcers, we know you can have redness, blister, go through the skin slightly, then it goes way in. so those are the levels of severity of pressure ulcers that we need to avoid. let's go to the next slide. >> are those also called pressure sores? >> they're called pressure sores. we can see them in anybody who's debilitated.
doesn't know to push up off the chair and get the pressure off their bottom. let's take that first slide now. what do you see there? louie? >> well, i see three separate -- several lesions here. but the largest lesion on the skin is a red lesion, it's formed a papal, it's also rated, then you have two satellite lesions on the right side of that lesion. >> i was thinking it has a border basil cell cancer. you guys pop right in. what do you think? >> you think of any type of cancer, don't usually see four of them kind of grouped together like that. so you think of something inflammatory, too. where the skin's very inflamed. maybe a reaction to an underlying illness. >> jim? >> well, you know, this is one
of things where you're taking your boards, they give you a picture like this and say, what am i thinking? a good doctor doesn't look just at one spot, they look at the whole skin surface, think assess the process that's going on, then they come back to the anatomy say, well, what are the possibilities? in a lesion like this we need a differential. so, could be a tumor. could be a blistering disease. answer is you need a biopsy. >> and history is important. >> this is interesting. i was thinking the malignant -- that you see on the temple, it could be a bruise or something like that. >> it could be. that would be pretty extensive. and your point about melanoma or some tumor like that, i'm not sure i've ever seen it that widespread. i might think of another type of tumor. >> less likely. right.
this is a straightforward one. >> this is in dermatology we call a door exam. you're standing at the door and say, you have... herpes simplex. >> yeah. herpes simplex. could it be herpes zoster? >> sure. >> herpes zoster, also called shingles. >> right. let's go back to the shingles picture. you see the tiny little blisters, i guess they're not all together in a cluster. if you see it wrapping itself around up to halfway around, you know that's a zoster. >> that usually follows a nerve. >> cold sore if it's near the lip. next. >> what's the classic mean? >> it means, kind of the color of the skin, that means the orange, and then it's swollen. it gives you that kind of dimpled look, too. >> the orange peel. it's the peel of the orange. and, so, that's why it has that -- it's called that
because it almost looks like an orange peel-type consistency. >> and the diagnosis is, jim? >> it's probably paget's disease but there can be other things like mastocytosis. differential is an issue, history is an issue, as lou mentioned. a picture where you look at this, come up with a differential. probably paget's disease. >> a kind of cancer. >> usually associated with in situ breast cancer. >> next slide. we're ready. that's the rash of the hand. it could be a burn, i suppose. >> burn. >> yeah. again, i mean, history's very important. it could be a contact dermatitis. this person could have their hands in different chemicals and that sort of thing. >> it could be something to do with the sun, too. it just looks like it stops
right at the middle part of the finger. >> an interesting one. next slide. patch of dermatitis. it's scaly. i saw that this week on a friend who i think is a classic scotch irish light-skinned, too much hot showers, too much soap, dry, dry, dry skin. >> 2% of us have psorisis and that's also a possibility. >> john? >> eczema, maybe flat, round shaped, coin-shaped. >> yeah. >> how would you treat that, john? >> well, usually people are overbathing. you got to cut down on their showers. usually i would do a scraping first to make sure it's not a fungus. it's a simple test. if that was negative, then i'd probably give them some
topical steroid, tell them to start using moisturizing lotions on their skin a lot more. >> cerave. after the shower. blistery kind of a rash on the hands, circular area on the thumb there. what do you think? >> i think the disease called dyshidrotic dermatitis, that's one thing, lots of little water-filled blisters on the hand. again, history is important. usually it itches like crazy on the sides of the fingers. >> what's the cause of that? >> no one really knows. some people it's seasonal. >> popped up. >> you have to use powerful steroids, though. ointments. >> avoid any irritating solution, strong soaps, you'll find raw vegetables, raw meats, anything that defats the skin can exacerbate these things.
>> being a hairstylist with this condition wouldn't be good. >> get another job. next slide. okay. jim? >> well, this is what they call putch jagr and this is something that as a dermatologist, this is what it is, go see rick holm. >> same vascular blisters lining the g.i. tract and oftentimes present with blood, you don't do anything except you know it's not cancer. that's the thing and it comes in familial so it's hereditary hemorrhagic. >> go ahead. >> this is a little bit different than that. these are -- >> does run d -- >> pigmented areas and they could have an underlying cancer of gastrointestinal tract. >> these people, sometimes they could lose blood from their g.i. tract and become anemic.
>> you need to have a scope. >> usually how you find out about it. >> yeah. >> so this is -- it almost looks like a warty growth on the lips. and big tongue, differential for a big tongue. >> well, it can be vitamin -- >> b-12. >> b-12, certain essential amino acids. you look at the patient, how healthy is it? this could also be a person with aids and the lesions could be any number of atypical infectious agents. >> we see a lot of people with cheilosis or this irritation of the lips from -- >> a lot of that's aging. as people get older, we start to get a little traction going here and gravity falls down, creates a crease, it becomes moist and is a great place for yeast to grow.
>> it looks like impetigo to me, you guys went on and on as we went through these earlier. what would you call it? >> abnormal sebaceous is what those bumps are, rick, that goes along with something called tuberous sclerosis, inherited problem, disease. >> but impetigo is something a lot of kids will have. what do you treat it with? >> usually it's oral antibiotics or topical antibiotics because it's either staph or strep. >> okay. yeah. we have a question. let's just finish this off. i think that the person might have a sepsis, an infection, they're flipping off the heart valve and hitting the tongue but there's other things. jim? >> could be something as simple as eating a really hot food, it can injure the tongue. also could be related, these could be vascular, so those
could be lesions that attack and some other conditions related. here, biopsy. >> next slide. and this is a severe infection, glossitis, it could be infections in the tongue. next slide. this is an interesting one, louie. >> well, again, you have multiple lesions on this patient and, you know, you know, you think about the conditions like tuberous sclerosis, things like that. >> neurofibromatosis. >> yup. >> disease that's not rare in south dakota. >> i've seen a number of -- -- >> this is an extreme case but it's not unusual for people to show up with this. and there are 12 different kinds of neurofibromatosis. types 1 and 2 are fairly common in this state, present fairly asymptommic. >> here's the elephant man who
they say they had neurofibromatosis, maybe he didn't is what you're telling me. >> well, they're starting to come up with some other theories on that, i think at this point they're theories, you know, nobody knows for sure. >> next slide. and this could be a million things. next slide. and this is stasis of the legs. any comments? >> my first thought is, sometimes with people who have low thyroid can get these thickened changes on the legs. it could be other things. but that could be a common thing, this is on the shins of the patient. >> and this patient's had it for a while. because you've got staining, deposits there. so this isn't something that's come on just in the last few days.
this is something the patient's had for weeks or months. >> this is a great case of what, jim? >> scleroderma. they taught about the sclerosis process. this is a late stage of one of these diseases that's a metabolic disease. unfortunately, this is advanced to severe severe state. >> there's not much we can do for it either. >> not once it gets this far. >> this is distal. i mean, it's the last parts of the fingers, kind of a dermatitis. what do you think? john? >> it could be somebody that's stained from working with some chemicals, could be a smoker, too. >> could be frostbite. >> frostbite. >> you know, in dermatology, if you don't know what something is, you give it a
beautiful name, so we could call this distal dactylitis, very impressive and hope they don't ask what it is. >> this is what? louie? >> i'm not sure. i'd probably call my local dermatologist to be honest with you. >> the key thing is profuse, so we're looking at something that is palpable purpura, in dermatology, palpable purpura, think infection. >> it could be a reaction to other underlying illnesses. it's a reactional state. >> this is a blister type of an illness. i guess i'm getting word that we should -- >> i don't know if it's a blister there, though. >> targety. >> target lesions, different shapes and sizes. >> yeah. internal malignancy. my producer just said, let's go to the questions.
62-year-old woman from aberdeen, how do we treat thin skin due to low estrogen after menopause when skin gets very thin in the vaginal area? >> well, there are topical estrogens that you can use. oral estrogens have fallen out of favor. but they are starting to come back a little bit. there's a lot of research in that. we tend to start out with the basics. and that is, avoid strong cleanser says, no soaps, no detergents, we often tell people, best way to clean, water. and then light lubricants, unscented. that's probably -- john, you may have some other ideas. >> estrogen creams. >> then the estrogen creams, and you've got to build the tissue back up and the estrogen cream will help do that. >> my female patients with vaginitis, irritations down
there. i have had this redness on my face for months, i have tried nystatin, athlete's food cream, steroid cream, what's on my face, how can i get it to go away? redness on my face for months. >> could be a number of things. tried some antifungal, antiyeast medicines, steroids, maybe it's something inflammatory like a rosacea. >> the other thing that happens, too, i've seen patients, they'll come in, they've been self-treating these and sometimes they're using neosporin and different products like that. >> they're allergic to the neosporin. >> they develop a sensitivity, and the redness continues because of the product they've been using. >> lupus, for example, you need to get in. be seen probably by a skin expert. i would say. 84-year-old woman from sioux
falls asks about her 12-year-old granddaughter, does a rash with bumps all over the body come from a virus or is it a food allergy? next to someone with a cold when the rash broke out? could that have something to do with it? >> 12-year-old granddaughter, rash with bumps all over the body, come from food allergy? >> the timing is your whole answer here. if it's a food-related allergy, it will occur within a certain period of time. a lot of these are i.g. mediated. you take it, within minutes you got a rash. now, if it's related to a virus, it's there and it stays. and, so, history history history. okay. >> 74-year-old -- john, you want to add to that? >> no. again, it depends on how long they've had it. that sort of thing. it could be something infectious or contagious, too.
it needs to be checked out. >> there's too much possible causes. too many -- 74-year-old woman from yankton, i have adult acne. could you touch on that subject? what are the best treatments for my age? i'm not sure if rosacea or not but i would just like some more information. so, adolescent acne is called acne vulgaris. adult acne is called acne rosacea. what's the difference? >> there is an adult acne, too, that's based on an excess of a chemical in the skin. and those individuals, unfortunately, will have acne their whole life. and the new studies suggest now that antigen blocking agents, something like one of the -- well -- [ overlapping conversation ] >> in one of the birth control pills for younger people would
be acceptable. so mayo clinic has actually developed a woman's division and they're looking at this in great detail. rosacea is more in that area but it's more of an environmental effect that relates to sunlight and predisposition. so, there are two entities that can occur in that age group. >> okay. >> unfortunately, rosacea gets called acne rosacea so people think it's one in the same but it's not. >> but you treat it -- >> pretty close to the same. >> some similarities. some of the oral antibiotics are similar. the topical medicines are very different because they're more anti-inflammatory. >> topical for an adolescent would be? >> usually benzoyl peroxide or something called retinol a, common type medicines.
>> for an adult? >> if the adult has acne they'd use that, too. but for somebody who has rosacea, metronidazole would be common things. >> 64-year-old from mitchell, have spots on my back that are brown and turn into a scab-like thing and i want to ask about them. spots on the back that are brown and turn into scabs. >> you've just left the pepsi generation. these are keratosis in all likelihood. seems to me related to a hormone, epidermal growth factor. as we get older, 85% of us are going to get these. they are benign, they don't require treatment but many times we do treat them because they're not elegant and they can be a nuisance. >> and they itch. >> yeah. >> well, the challenge is, you'll see some patients, though, they'll have hundreds of these. >> right.
>> on their back. and, so, treating them gets to the point where, you know, it's almost a why bother, you know. >> right. >> not cost effective. >> now, john mentioned something we were talking earlier about when these occur in certain fashions. you mentioned that. unless they're too late. >> well, there's pretty unusual, where you rapidly get these rough, i call them warty-like lesions all over your body in a few months, oftentimes that's due to an underlying cancer, usually of the gastrointestinal tract. but i've only seen one case of those. >> louie, as practicing family physician, have you seen internal malignancies present in a dermatologic fashion in your history? >> not so much.
although i've seen patients who will, it's not so much in the skin, but they'll get a blood clot, they'll get blood clots and weird things and blood vessels under their skin due to, for example, lung cancer. and i've seen that be the first sign of a lung cancer in a patient, where they get these -- this phlebitis, they come in with red area, what they've got is a blood clot in the vein under the skin, and it's their first sign of lung cancer. there's a lot of plebitis and clotting that can be triggered by hyper doingable state that comes after certain cancers. >> when a section of your skin is subjected to repeated pressure or abrasion, it begins to react. that reaction can be painful and potentially damaging to the area in question. >> decubitus ulcer is commonly
called a pressure ulcer or a bed sore. the national advisory panel classifies it as a localized injury to the skin or the underlying tissue. over a bony prominence as a result of a pressure or pressure in combination with sheer. bony prominences are anywhere on your body that you have a bone fairly close to the surface. such as your hips, your elbows, your knees, your ankles, your heels, your spine, your buttocks, if you're laying on your back. tops of your ears, even though that's not a bone can be very prone to pressure as well. there are four stages that are actually staged, stage one is just a redness of the skin that does not blanch, when you push your finger on it, it doesn't turn white and then pink again, it stays red. a stage two is a shower
ulceration, some tissue lost, usually not very deep, very superficial but there is tissue gone. a stage three is more involved into the subcutaneous and dermis of the skin, can be down to the muscle depending on what bony prep incidence it is, say over the nose. a stage four usually involves muscle and bone is visible. there's also one called an unstagable where there is escar covering the surface of the wound, or a big scab that's covering the surface of the wound and we can't see what's underneath the wound and we call those an unstagable. another one that they use is called a deep tissue injury, that's a purpling, looks like a bruise, it starts as a bruise, over the bony prominence, not just in the middle of your thigh or on
your knee or your hip or your buttock, where it would be a bony prominence that's causing tissue underneath. those are typically caused by sheer. two other main causes of decubitus ulcers, other than pressure. pressure itself is probably the primary number one reason. friction is just the force of dragging skin or dragging a person up in bed or shifting themselves out of a couch or a chair to get up. not using the lift mechanism of their lift chair and scooting themselves out. and that's just that surface abrasion, looks like a rug burn, what people would call a rug burn or looks like just a tiny little bruise or burn to the skin. sheer is actually underneath the surface of the skin. it's where the epidermis and
dermis kind of separate and the two separate, so maybe the pelvic bone will go one direction but the skin goes another direction. and that's internal, it's not visible on the surface of the skin, but it's one of the primary causes for deep tissue injuries and pressure ulcers. quicker the treatment, the better. if it's not something that you think you can take care of yourself, definitely seek assistance from your primary care provider. sometimes it results in a referral to me. we can look at all of our options as far as what do we need to use for wound healing, what do we need to do to reduce pressure, do we need do that pressure mapping. moisturization of their skin, again, i can't stress that enough, as far as internally
taking enough liquids during the course of the day for hydration, and applying some type of moisturizer on a regular basis. frequent skin assessments, if you have a loved one that's somewhat immobile, someone that's not able to check themselves. you know, you can't see your own bottom so it's hard to tell. but just frequent assessments to make sure that things are doing okay. [music] >> so, that really speaks to quality. i mean, that's what you had said earlier, louie, we're talking quality, and i know that in nursing homes as a medical director of a nursing home, they're the bane of our existence.
we don't want to have ulcers that represent not getting enough good nursing care. of course, no matter how you do it, two to 20 -- 2 to 20% of them are going to get ulcers. why would they get ulcers? >> well, because they're not moving, they're staying in one spot for prolonged periods of time, either they're lying on their back for prolonged periods of time. and that pressure on the skin causes a breakdown of the skin and you get the different stages of those pressure ulcer, just like they talked about. so, that's one of the keys is, if you have a patient that is not mobile, is turning that patient, and so most nursing homes, most of the physicians will write an order to turn the patient or the nursing care plan will be to turn that patient every so many, like
every 15 minutes or every half hour, that sort of thing. and then it's just good skin care. keeping skin clean, keeping it well moisturized, keeping it dry, making sure people are not in those -- those ulcers that people get on their buttocks, making sure that they're not incontinent stool and incontinent urine and that you keep them clean and dry. >> right. there you go. any additions to that? it's a measurement of quality, but i don't care how wonderful your nursing home is, how many times you turn them, if they're malnourished, they're going to break down like nobody's business. >> there's so many factors. the malnourishment. some of these patients are incontinent, kind of like a little baby, you can't be there fast enough to clean them often enough.
>> and it's just not patients, in nursing homes, you have people who have had either traumatic injuries, paraplegics, their legs are paralyzed or they're quadriplegics, sometimes they're living at home. and, so, that good skin care is just as important in the home for those patients as it is for the nursing home patients or patients in hospitals. >> i have a nephew who's a total quad from a bike accident in college. he moves in his chair by blowing on a straw. but when you're hanging with him, he'll crank that thing up and move it around and shift himself around and has no problems because of the wonderful care he's been taught to do. jim, you have any additions? >> you guys nailed it.
number one, nutrition. number two, skin care. that's it. >> there we go. well, we've got questions. and my question monitor just pooped out. any other further comments about it? we nailed it. here we go, i gave the wrong deal. so, the next question is, would you describe what happens that seems to separate the upper layer of skin from the layer beneath when you take a lot of prednisone? what happens with a person who takes a fair amount of prednisone, jim? >> they're prone to bruising. the skin doesn't really separate. when you take large doses of prednisone, the blood vessels become more fragile, they're more likely to bleed underneath, and, so, what we're typically seeing are not
blisters, we're seeing per from, which is bleeding under the skin. >> which is bruises. >> yeah. >> that's the prednisone. >> yup. >> boy, they come in with bruises all over their forearms and i say, okay, are you taking your baby aspirin? well, there it is. and you're on a little steroid, there it is. and are you doing fine otherwise? yup, i'm doing fine. don't worry about it. >> the only one as a dermatologist i look at, after taking the history, if there's no answer, then i do a biopsy. because occasionally we're going to see systemic disease. >> well, and you want to look at -- i'm sorry. >> and then you get a history. what medications have they been taking? are they taking quinine?
i mean, i've seen some very interesting things from people taking various medications aside from prednisone or people self-medicating with, for muscle cramps, with quinine. >> i've seen people who have the first sign of it is their bone marrow disease and they have platelets that are way low or they're on warfarin or one of the platelet agents. >> most people, if it happens just on their forearms and hands, as we get older, we're on aspirin, things like that, bump it, all of a sudden you got the bruise, don't remember the bump. >> don't remember. you get fragile when you get older. what's senile? older than how old? [ laughter ] >> getting older now. >> yes. >> 66-year-old woman from mitchell had the shingles shot
60 years old, six years ago, a few weeks ago she had a slight case of shingles, treated for it. common to contract shingles after you've had the vaccination? >> it only decreases the incidence of shingles only about 50%. usually when you get it, it's not as severe. and hopefully cuts down on the problem that a lot of shingles patients have, which is post herpetic neuralgia, chronic, severe pain that is really really difficult to treat. >> so how many here in the room have had their shingles shot? oh! you're too young yet. >> no, i'm not. i need get it. >> i couldn't emphasizes enough, the importance of getting the shingles shot. and it is mandated by insurance now. the federal government mandates that insurance companies cover it.
>> yup. >> all right. would you describe what happens that seems to separate -- oh, we asked that. man from yankton prescribed anti-inflammatory gel for right hand swelling. what's the correct amount of gel to apply to the skin with a wrap to avoid drying and thinning the skin? >> when i tell patients all the time, our age group, i say, do you remember brylcreem, a little dab will do you. apply a small amount, otherwise you're wasting it. >> a little dab will do it. >> maybe one of the greatest marketing slogans ever. >> probably was. don't you remember the signs on the roads? you know, brylcreems. 73-year-old man from sioux falls, caller has impetigo. let's talk about impetigo. it's a condition where you have white spot lesions on the body, three doctors have given
him three different reasons why it's happened, none were 100% sure, all three doctors were with the veterans administration and haven't done anything to help with the symptoms. do the doctors have any ideas as to what causes it? and if there is a cure. so impetigo, does it sound like this man has impetigo? >> possibly. possibly not. let's talk about impetigo. the skin breaks down, you're exposed to a pathogen, that's impetigo. >> a bug, bacteria. >> is it quite possible he doesn't have that? >> sure. it's possible he does have it. in this day and age, it keeps coming back, i would culture it to see if it's like mrsa, one of the resistant staphs. you might want to think about culturing his nose, could be a carrier staph, i think sometimes we infect ourselves.
>> if it's always coming back in the same spot, you know, maybe think about a biopsy. >> yeah, because it could be something else. >> yes. >> you have to remember that there's a typical -- about 20% of people who get herpes simplex will have a secondary staph overgrowth. so it could be both. >> yeah. >> if it's coming back in the same spot. >> and there is something called infatigo, called impetigo, of course, infants can get it. 83-year-old woman from rock valley, iowa. how far from your home? >> probably about an hour. >> which way? >> it would be west. closer to the south dakota border. >> she puts vaseline on after she showers and seems to have nice skin because of it. how effective is this for the general population, is vaseline good lotion to use?
should you put it on after the shower? >> i think vaseline's the best thing you can use. pure, pure grease, hardly any preservatives or anything in there that you'd react to. most people find it a little too heavy or greasy. if you don't mind it, it's great. >> yeah, i think it's great. i think putting it on right after the shower when your skin is still kind of damp and supple is an excellent way to do it. >> yeah. >> it's inexpensive, it works, you can't be allergic to it. you just can overuse it. like john said, a little dab will do you. >> i like the idea of using it on an open wound to keep the wound from drying out instead of bactroban or triple antibiotic because studies show that vaseline works just as well as the other three
except the other three develop allergies. >> right. >> and the vaseline, you don't get an allergy. so, you got four yeses on that one. >> keep it up. >> good job. 75-year-old woman from rapid city, questioned granddaughter visited recently, sophomore in college with orange discoloration in the tongue, tried baking soda but it didn't work. what now? >> stop the orange pop. >> orange pop. all right. any other thoughts? >> orange tongue. >> she may have been on some antibiotics, maybe it's an overgrowth of yeast and bacteria, too. something like the so-called black hairy tongue. >> black hairy tongue, weird thing, viral things that could happen, too. louie? >> yeah, i mean, if she had other things turning orange, rest of her skin is turning
orange, i'd wonder if she's overdoing on the carrots. and that sort of thing. >> so that's a great answer. my answer, i had -- i was at a teaching hospital and as the attending of the outpatient clinic, intern ran in and said, dr. holm, i've got a guy, i think his liver's failing, he's got -- he's got orange color of liver failure. you know? i went up to him, i looked at him. he was orange as could be. and i looked at his eyes and they were white and beautiful. and i said, so, are you drinking a lot of carrot juice? and he said, yeah, i've been -- i got into a new machine, makes carrot juice, and i've been eating carrots like crazy. carotenemia. >> one of the things with the tongue, though, you look at it, say if it's only the tongue, take a scraping, see
what's there because the vast majority of time it's going to be food or drink. i mean, orange tongue is not pathognomonic of any disease. >> 80-year-old woman from huron, what is -- >> that's just a medical term for preskin cancer. >> it's from? >> sun damage, red, scaly, sun exposure, head, neck, arms, each little spot has about a 10% lifetime risk of being a type of skin cancer. >> yeah. scaly areas, red-headed blonde people, in particular. >> pink and crusty, feels like sandpaper, come and see us. >> right. i got a question, is spray sunscreen as good as cream sunscreen? you can do the spray stuff and you can make sure that you get it on and guys will be willing to put that on, not put the cream stuff. >> you know, in this day and age, we're happy to have them
use it, any way we can get. you know, if it's a guy, you're more likely to get it -- and i confess, i'm a spray guy. my wife is a cream person. and a lot of it relates to who you are and what you like. i just say, if you're going to use it, that's great. often i'll suggest, if you spray that you take a cloth or something, rub it in to make sure you don't miss anything. >> the other important thing, too, the need for reapplication. somebody is spending the day at the beach or, you know, the day doing something, they're going to have to reapply the sunscreen, i don't know, every couple of hours or something like that. >> for it to be effective. >> i love the time you told me, this is off camera sometime years ago, we were talking about how sitting under a shady tree on a sunny
day at the lake, broad-brimmed hat, and, you know, long-sleeve shirt, and well protected, doesn't like to use sunscreen, and it was a -- actually it was a cloudy day. and you said, clouds mean that there was a sun protective factor to it the most. the broad-brimmed hat, the tree, that person is like spending a day in sun protective factor 3 or 4, at the very best. did i miss -- >> well, even in on a cloudy day, 80% of the u.v. light gets through. so the concept that there's no sun, i don't have to worry about it doesn't cut. and you remember, sun bounces. so if you're in a snow-covered area, it reflects off the sun, when you're skiing, reflects off the water in the summer.
and, so, you know, yes, hat's good, the clothing's good, sunscreen's also part of the equation. >> not just one thing. it's usually different things. for total protection. >> use the sunscreen. >> use the sunscreen. >> what's the best product for me to use for black spots, dark age spots on my face? i haven't found one cover-up that works and i don't want to just try to hide it, i want to get rid of it. just keeps growing and spreading. i sometimes cryo those, what do you guys do? >> freeze them. you can do that. my only problem with that, sometimes leaves the big white spots. what's more noticeable, you know? people are laserring them off now. >> you can covering that, though, with a little makeup, but the black spots aren't
coverable. >> it's hard. sometimes you get a makeup that's close to that, you kind of blend it all in. >> but they're benign. >> well, not always. i mean, it's a sign of sun damage. i mean, common layperson's term, sun freckles, they can turn into a type of low-grade melanoma. so you got to be -- usual things, does it look dark, irregular. >> i'm from aberdeen, 47-year-old woman had regional rashes for ten years, prescribed every kind of topical ointment, had no relief, maybe my lower arm or thigh region, for example, the area is extremely itchy and the area can turn into blood blister after scratching, raised, irregular shape, cover a large area, i've had biopsies, those have come back without definite answers, type
of dermatitis, put on methotrexate, doesn't help. cortisone shots helps. >> this patient, not necessarily a skin disease, perhaps it's urticaria, it's the old, is it the chicken or the egg? why does she have the rash? because she's scratching. why does she scratch? because she itches. why does she itch? because she has hives. you're going to treat with antihistimine or some type of an agent to block that. that's a case where she really needs to sit down with a good medical dermatologist. >> all right. we're going to go back to what we kind of touched base earlier. detecting skin cancer, it's a vital, important thing. we have some pictures that
represent the five phases of diagnosis. a, b, c, d, and e. a - asymmetry. what are we talking about here? >> well, yeah, it's not a uniform circle. it's asymmetry, it bulges out of the -- the lesion bulges out on one side. it's not symmetrical. >> okay. b - border. >> usually around the outside of the mole or the skin lesion should be nice and kind of a crystalline, not chopped up or anything. >> or hazy or fuzzy. >> no. >> border needs to be sharp and if it isn't, it's abnormal. >> it could be. >> it should be sharp. >> color, what we're talking about is symmetry. you know, is there variegated color? so a normal mole may be light in the center, dark at the edge, if you see multiple colors, blacks, browns,
changes, variegated color, very worrisome. >> d diameter, what's the size we start to worry about? >> usually, should be no bigger than the size of a pencil eraser. >> which is seven millimeters. >> six to seven millimeters, yeah. >> so you guys agree with that? >> no. >> what do you say, jim? >> i look at the patient. i've taken melanomas off that are two millimeters, and i have seen benign lesion that is are several centimeters. you have to look at the patient. and we use something called diascopy, doctors use, look with magnification, the patterns can give you great, meaningful information. >> really quickly, e means evolving. >> to jim's point, i think the d is probably the least helpful of all the signs for me. e is evolving, is it changing? is it getting bigger?
does it stand out from the others? >> all right. >> and, now, for the winner of tonight's prairie doc quiz question. fill in the blank. in the upper prairie mid-portion of our country, especially in winter, the most common cause for a rash is? gentlemen? >> dry skin. >> so we got it in unison there. it's called winter's itch. it was louise from aberdeen, who answered the question correctly. thank you, louise, for participating. and a book will be in the mail to you soon. let's talk about dry skin. most common problem that we see. quick treatment? >> stay away from strong soap. >> yup. >> light moisturizers. >> most people are overbathing in the winter. they're taking their 10, 15-minute shower with their deodorant soap like dial or zest.
>> and hot hot hot hot shower. >> hot hot hot shower, can't figure out why they're so itchy. >> so, -- and some people say, the best thing is to put the ceramide on after a shower. i learned that from you, jim. tell me a little bit more about that. >> it's going to work better if you put it on when the skin is damp. a lot of people will complain. i tried to use this lotion but when i did it burned. i tell them, here's the answer. when you take your shower, bathe, as soon as you're done, get out, dry off, while the skin's still damp, apply your lotion. >> all right. good. cerave cream, we'll be right back after this. >> as your baby grows, there are new surprises and adventures every day.
with each new milestone, remember, immunizations are safe. and one of the best ways to protect against serious diseases, especially between birth and age 5. >> now that my grandson, henry, has reached his first birthday, and our granddaughter, stella, has arrived, we're making sure that they stay on their immunization schedules. >> schedule your children's immunizations today. for baby's sake. >> despite his caring and interesting conversation, i heard very little of it because his large, rosie, bulbous and bumpy nose had stolen my attention. years later, when i met him again, he looked like a different man. the rosacea and rhinophyma skin condition, which had made his face so red and nose so
massive, was calmed down with medication, and the excessive growth of skin over the nose had been trimmed away by laser scalpel. this time my eyes were no longer drawn to that globular and swollen proboscis and instead i was able to see his kind and wizened eyes. acne rosacea, or more commonly called just rosacea, affecting 14 million people in the u.s., or 5% of the population, is sometimes said to be an adult version of acne vulgaris. we see rosacea more often in 30 to 50-year-old women, and it can flair as menopause approaches. when it does affect men, it can be severe. and in a percentage of cases, rosacea can cause an ever-growing piling up of skin over the nose, called rhinophyma. rosacea more often targets
fair-skinned, freckle-faced, blond or redheaded, blue-eyed people who flush easily. it seems triggered by sun exposure, hot drinks, hot baths and showers, hot, spicy foods, stress, exercise, and steroid medications. of course, one way to prevent rosacea is to try to avoid such triggers. acne vulgaris, or more commonly called just acne, is similar to rosacea, seems also related to hormonal swings, but it affects about 85% of all u.s. adolescents and, more often than rosacea, causes whiteheads and blackheads. adolescents living in western modernized civilizations struggle with acne, however, it affects few living in non-industrialized societies. this has led some experts to believe acne, and also rosacea, might be made worse
by soap, excessive cleanliness, antibiotic use, and alteration of the normal flora living on our skin that protects us from invasive bacteria, like grass on a lawn protects against weeds. the two conditions of rosacea and acne have common methods of treatment. over-the-counter lotions like benzoyl peroxide, prescription antibiotics and vitamin a, both in lotion and pill form, are still the mainstay of therapy. in contrast, recently there is a trend to move toward supporting one's normal flora, avoiding antibiotics, cleansing agents, or oil-removing methods, and even trying probiotics. this is all in an effort to re-establish a lawn of protection to fight the invasion of weeds.
any of these treatments are effective in most people, but not all. so if you don't find relief with typical treatments, or your nose starts growing, it's time to see the dermatologists. >> i sincerely want to thank our three great volunteer guests. john, louis and jim, we could not have done as well as we did tonight without all three of you. thank you. that does it for tonight, thank you once again to south dakota public broadcasting here in vermillion for being such wonderful hosts. we may do this again someday. and thank you all at home for allowing us to come into your living room for another hour. we genuinely appreciate it. so, from all of us here at "on call with the prairie doc,"
until next time, stay healthy out there, people. >> eating a good meal can bring us great pleasure, unless you have potentially painful conditions. bleeding ulcers and the upper digestive system, next "on call with the prairie doc." >> funding for "on call with the prairie doc" is provided in part by: >> avera is a proud sponsor of "on call" on south dakota public broadcasting. >> larson manufacturing is proud to support "on call television" as it continues to open doors for important medical information. >> and by the south dakota foundation for medical care, an organization working with the state's health care community to improve quality of care as part of the great plains quality innovation network.
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