Live Blog: Oddballs That You See All The Time. Faculty: Matthew Zirwas, MD
In this live blog we touch on some of the highlights from Dr. Matthew Zirwas’s lecture “Oddball Cases That You See All The Time.” Here are some of the oddball treatment tips and tricks that surprised us.
Dr. Zirwas said he was excited to give this lecture, as he knows that there are lots of “oddball” or one-off presentations that healthcare providers encounter all the time but that don’t fit into a bigger teaching “theme.” Some of these oddballs include digital mucous cysts, Grover’s disease, toe web infections, and tinea versicolor.
Digital Mucous Cyst
This is a cyst that will appear around the perimeter of the fingernail. The patient will complain of pain and the cyst may be causing the fingernail to have a dent. Dr. Zirwas notes that if you simply poke the cyst area with a needle and drain it, yet the cyst will almost always reoccur. You can cryo freeze the cyst after draining, but still the cyst is likely to reoccur. Zirwas said that to get a good chance at success that the healthcare provider should instead inject the area with TAC. However, if all those approaches fail, Dr. Zirwas will send the patient to a hand surgeon.
Grover’s disease is also known as transient acantholytic dermatosis. To treat Grover’s disease, Zirwas will first prescribe calcipotriene cream and topical steroids combined with a chlorhexidine wash. If that fails he will try acitretin, isotretinoin, or phototherapy. Zirwas acknowledged phototherapy is essentially referring the patient to a tanning bed. He stressed that sunlight can be healthy for a patient, though if a patient has a family history of melanoma there should be more caution to such a treatment, and it’s crucial to be specific with the patient about how and when they use a tanning bed treatment.
Toe Web Infections
Also known as polymichrobial toe web infections, Zirwas emphasizes the importance of keeping the infected area dry. Cream treatments are too wet to effectively treat the area. Instead he will prescribe betadine daily on a q-tip or a chlorhexidine wash. A second alternative is applying rubbing alcohol to the area alternating with vinegar. Dr. Zirwas said that this application will sting and burn but that simply means it’s working.
Zirwas’s simple diagnostic test is to scratch the area in question. If the skin flakes, it’s likely tinea versicolor. For tinea versicolor Zirwas recommends topical antifungals and a 7-day regiment of dandruff shampoo as a body wash. He emphasizes that even though the skin will stop flaking the skin is not cured. It can take up to three months to relieve the color.