05/22/2012    

RESPONSES / COMMENTS (CLINICAL) - PART 3

RE: Hyperpigmentation of African-American Women After Using Corn Remover Pads (Shelley Gath, DPM)

From: Janet McCormick, MS

Hyperpigmentation is not usually due to friction, but if it is, it is usually temporary. Long lasting hyperpig is usually caused by sun or chemical damage, such as by incorrect or overuse of salicylic acid. Any color skin will produce darker coloring (called age spots by lay persons, no matter their cause), with of course the Fitzpatrick 4-6 skin classifications producing the darkest (olive-coloring Caucasians, Latinos, African Americans, Asians).

This discoloration is almost never cured, especially in the Fitz 4-6, though it can be controlled to some degree with continual care. You might reconsider prescribing hydroquinone 4% or higher, however, for discoloration on the foot. In most other countries, hydroquinone is already illegal for OTC (under 4%) and highly discouraged for use at medical level (4%+) due to potential systemic problems. The FDA is actively moving towards that here, with investigation happening right now. If you do prescribe it at medical level, it is recommended that its use be restricted to 90 days and then to change to alternative lighteners, such as those with kojic acid and other good but non-toxic lightening ingredients. These can be used from the start to produce lightening. They take longer, but they are non-toxic. All require continual use to control hyperpigmentation.

Janet McCormick, MS, Signal Mountain, TN janet.mccormick.info@gmail.com

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06/21/2012    

RESPONSES / COMMENTS (CLINICAL) - PART 3

RE: Bilateral Pain Submetatarsal 2 Metatarsal (Susan Bartos)

From: Gino Scartozzi, DPM

I was pleasantly surprised by the contribution of Ms. Bartos to the case in question from a "non-podiatrist." It was well-written, concise, and overall offered many treatment options regarding the condition. I would not be particularly concerned what any MD or DO would think of her post as a point of contribution. In my opinion, the failure to hear or be receptive of ideas/inputs from all fields of health professionals indicates a "closed mindedness" that would concern me. The only apology, which I would offer, is that for a colleague in question who apparently does not exhibit, in my opinion, an inter-disciplinary respect for others.

 

Gino Scartozzi, DPM, New Hyde Park, NY, Gsdpm@aol.com

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06/20/2012    

RESPONSES / COMMENTS (CLINICAL) - PART 3

RE: Chronic Calcaneal Apophysitis (Jeffrey Kass, DPM)

From: Eric Edelman, DPM

I recently had an unusual presentation of what I thought was calcaneal apophysitis in a 10 year old boy who was otherwise healthy and physically fit. Similar to Dr. Kass' case, the parents had brought the child to several doctors to try to figure out what the issue was, and I was his 3rd of 4th treating provider. No amount of rest, stretching, ice, or immobilization had been helpful, and the child had pain that seemed far out of proportion to what I have seen in other cases of Sever's Disease. He had several x-rays, MRI, and a bone scan.

I wound up ordering blood work, thinking about rheumatologic disease. Out of habit, I ordered him a serum uric acid test. It turns out, that my 10 year old patient is hyperuricemic. A few days on allopurinol, and he was back to normal, and returned to the pediatrician for long-term care. Consider bloodwork. Sever's disease seems to be somewhat self-limiting anyways, since when it's painful, the kids will stop their own activities from the pain.

Eric Edelman, DPM, North Syracuse, NY, ericedelman@gmail.com