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Skin maladies abound in Katrina's wake


According to the Centers for Disease Control (CDC), some cultures from adults and children with skin abscesses in a Texas evacuation center indicate methicillin-resistant Staphylococcus aureus (MRSA) infection.

"A number of chronic skin diseases will flare in the absence of medication or therapy of one type or another," says Ronald G. Wheeland, professor and chief of dermatology, University of Arizona, and editorial advisor to Dermatology Times.

"Psoriasis, for instance, requires lifelong management through pharmaceuticals, including Remicade in extreme cases, and other interventions such as PUVA.

Similar patterns, exacerbated by changes in bathing routines, can impact eczema and acne, he notes.

Walking wounded

"We're starting to see some shingles cases coming out from all the stress," reports Trent Massengale, M.D., a private practitioner who is treating outpatient hurricane victims in conjunction with five colleagues at The Dermatology Clinic of Baton Rouge.

"People have lost their homes. They don't know what's going to be left and what their insurance is going to cover."

Additionally, Dr. Massengale says, "We're seeing all the patients who went to a dermatologist in New Orleans the week before Katrina, had biopsies and lab work and were told to return to clinic the next week.

"Now those clinics are underwater; we don't know what the results of the labs were; all the phone communications in New Orleans are gone. We're not even sure if the specimen has floated away or not.

"We've had to rebiopsy some lesions and rashes to restart the workups," says Dr. Massengale, who, in his capacity as assistant clinical professor of dermatology at the Louisiana State University (LSU) Medical Center, schedules resident rotations at the Earl K. Long Medical Center in Baton Rouge.

On a positive note, he says his usual crew of two second-year residents has been supplemented by at least 10 more who were displaced from LSU's New Orleans facilities.

A slew of maladies

"We can't forget about the problems that are intrinsic to being in a traumatic situation where one might have lacerations, abrasions or wounds of various sorts that dermatologists are capable of treating," Dr. Wheeland says.

Shortly after the hurricane, he says, "the media was playing up the issue of alligators in the swamp water. But far more likely to ultimately cause problems would be spider bites and other insect or snake bites that contain venom that can injure the skin and ultimately lead to ulcers and significant problems. If primary care physicians and first responders are not clued-in to look for those, they're asking for trouble."

Dr. Massengale adds, "We're seeing a lot of gram negative toe web infections, which are a result of walking around in wet conditions where the feet don't dry out and the skin begins to break down. We're also treating incredible amounts of poison ivy. The wind took down many old oak trees loaded with poison ivy" that people must chainsaw through to re-enter their houses.

He says he also sees frequent cases of cellulitis, along with pyodermas that start when people who have cut themselves kicking their way out of rooftops contact contaminated water.

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