Is that groin rash cancer ??

                                  Is that groin rash cancer ??


           A few years ago one of my male patients presented with a groin rash of

several months duration which was unresponsive to various topical antifungals and

topical corticosteroids prescribed by his health care practitioner.

            The rash was red and scaly encompassing both his groin and extending

to his scrotal areas. There was associated itching and burning at times.

           The most important clue here was the fact that the rash had been

chronically unresponsive to the above measures.

            And,I immediately suspected a condition called extramammary Paget's

disease (EMPD) which fortunately is  a rare cancerous condition of apocrine-

gland bearing sites.

            Two types of EMPD have been described: the primary type thought to arise

from a stem cell within genital skin and not associated with an underlying internal

malignancy involving the rectum and/or other internal body areas. However, it is

still a carcinoma of the skin and needs to be treated.

           Secondary EMPD  is the more dangerous type since it is associated with

an underlying adnexal  adenocarcinoma or an  underlying visceral (internal)

cancer and is the same as mammary Paget's disease of the nipple.

          I referred my patient to a general surgeon for a deep excisional skin

biopsy which confirmed my clinical suspicions. The presence of a cellular

protein called cytokeratin 20 helps to differentiate between the primary and

secondary types of EMPD.

         In addition, the presence of a gene called HER-2  in the biopsy specimen

may indicate a high risk for spread to lymph nodes and the need to follow this

patient very diligently.

          EMPD most frequently involves the vulva in women,the perianal area,perineum,

scrotum,penis, and armpits. Treatment includes wide surgical excision,radiation

therapy and several topical agents.

         

Brief Overview of Lasers in Dermatology

                     Lasers basically emit  bright beams of light energy that is converted

to heat energy in the skin. And,it is this heat energy that performs the many

dermatological functions of lasers.

                    These functions include treating spider veins,dilated blood vessels,

the redness of rosacea,scars,stretch marks, liver spots,freckles,tattoos, and benign dark

spots on the skin such as age spots.

                    In addition,lasers help to remove unwanted body hair and stimulate

collagen production to eliminate fine lines,skin creases,and wrinkles.

                   In my opinion,the birth of fractional resurfacing lasers  is one

of the most exciting developments in laser therapy since these lasers literally

treat only a "fraction" of the skin at a time and, therefore, dramatically reduce

the incidence of side effects such as scarring,pigment changes, and infection.

                 Future possible therapeutic uses for lasers include  enhancing

the percutaneous delivery of drugs and also healing chronic wounds  and ulcers.

Psoriasis: more than a skin disease ?

            A recent study implicates Psoriasis with a 70 % increased likelihood  of

developing non-alcoholic fatty liver disease (NAFLD) which is the most

common  form of chronic liver disease in Western countries.
         
           In addition,Psoriasis patients with NAFLD  were also 60 %

more likely to have the severe form of NAFLD.

           The most distinguishing feature of NAFLD is the accumulation of

triglycerides(a  type of lipid or fat) in the liver cells called hepatocytes.

           Risk factors for NAFLD besides Psoriasis include diabetes,hypertension,

obesity,a sedentary lifestyle,smoking and a poor diet.

          Besides advising my patients with Psoriasis about the increased

cardiovascular risks (see my earlier post on "the heartbreak of Psoriasis"),

I shall now inform them of the non-alcoholic fatty liver disease risk and

again recommend regular checkups with their healthcare practitioner.