You Don’t Know What You’re Missing: 10 Practical Uses for the Wood’s Lamp

Vo, Theresa, and Richard P. Usatine. "Persistent on feet." The Journal of family practice 67.2 (2018): 107-109. Logan Kolb, DO, PGY-4 Orange Park Medical Center Orange Park, FL

This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this 1 expressed in this publication represent those of the author(s) do not necessarily represent the official views of publication represent those of the author(s)HCA or do any not of necessarily its affiliated represent entities. the official views of HCA or any of its affiliated entities. DISCLOSURE OF RELATIONSHIPS WITH INDUSTRY

Logan Kolb, DO, PGY-4 You Don’t Know What You’re Missing: 10 Practical Uses for the Wood’s Lamp

DISCLOSURES The content of my material(s)/presentation(s) in the CME activity will include discussion of unapproved or investigational uses of products or devices. I otherwise have no relevant disclosures.

This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities. Learning Objectives

• Understand wavelengths of light emitted by Wood’s lamp • Learn tips for proper use of the Wood's lamp and to make it more accessible • Learn ten practical dermatologic uses for which a Wood’s lamp can be used GmbH, IDEALDERM. “Wood Lamp Light Lamp for Diagnose and Analysis.” IDEALDERM Democosmetic Professional, https://www.idealderm.com/contents/en- us/d15.html.

This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities. The Wood’s Lamp

Radford, Max, and Francis Riemensperger. “The Electromagnetic Spectrum.” Mini Physics, 22 May 2016, https://www.miniphysics.com/electromagnetic-

spectrum_25.html.

“Robert W. Wood.” Wikipedia, Wikimedia Foundation, 28 June 2019, https://en.wikipedia.org/wiki/Robert_W._Wood

• Invented in 1903 by Baltimore physicist, Robert W Wood. • Emits long-wave UV radiation, aka “black light”, that is passed through “Wood’s filter”  emits lights rays between 320 to 450nm with peak at 365nm • Photons hitting skin are either reflected, scattered, transmitted, or absorbed by target chromophore • Tissue fluoresces when shorter Wood’s light wavelengths (340-400nm) are absorbed and longer wavelengths of visible light (e.g. yellow or red) are emitted.

Vo, Theresa, and Richard P. Usatine. "Persistent rash on feet." The Journal of family practice 67.2 (2018): 107-109. Bolognia, Jean., Jorizzo, Joseph L.Schaffer, Julie V. (Eds.) (2012) /[Philadelphia] : Elsevier Saunders,

This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities. Tips for Wood’s Lamp Use

GmbH, IDEALDERM. “Wood Lamp Ultraviolet Light Lamp for Skin Diagnose and Analysis.” IDEALDERM Democosmetic Professional, https://www.idealderm.com/contents/en- • Make it accessible!    us/d15.html. • Room should be perfectly dark, preferably windowless; allow your eyes to become adapted to dark • Topical creams, lint, soap residues can be gently wiped from area with dry gauze • Light should be held 4-5” from lesion • Normal skin is slightly blue • Oily skin is slightly yellow • Clothing lint is bright white

Jolita Brilliant. “What Is Woods Lamp?” Jolita Brilliant, 23 July 2019, https://jolitabrilliant.com/what-is-woods-lamp/.

1-16 Of over 50,000 Results for ‘Portable Black Light’ Sort by: Featured Price: Low to High Price: High to Low Avg. Customer Review Newest Arrivals Sort by:Featured Go.” Amazon,

Amazon, https://www.amazon.com/s?k=portable+black+light&ref=nb_sb_noss_2. This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities. 10 Practical Uses for the Wood’s Lamp

Harkness, Ryan. “Let's Look Back At David Letterman's Top 'Top 10 Lists'.” UPROXX, UPROXX, 21 Mar. 2019, ChrisAriens. “Are These David Letterman's 10 Best Top 10 Lists?” Adweek, Adweek, 19 May 2015, https://www.adweek.com/tv-video/are-these-david-lettermans-10-best-top-10-lists-164523/. https://uproxx.com/tv/the-top-ten-david-letterman-top-ten-lists/.

This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this 6 expressed in this publication represent those of the author(s) do not necessarily represent the official views of publication represent those of the author(s)HCA or do any not of necessarily its affiliated represent entities. the official views of HCA or any of its affiliated entities. #10 – Milia

• Milia are tiny filled with keratin • At times, they can be difficult to distinguish from syringomas and verruca plana • Keratin undergoes max excitation at 405 nm and emits fluorescence at 460-500 nm • Due to bright yellow fluorescence, milia can be distinguished from other on the face

Lee, J.H., Kwon, H.S., Jung, H.M., Kim, G.M. and Bae, J.M., 2018. Wood's lamp–induced fluorescence of milia. Journal of the American Academy of Dermatology, 78(5), pp.e99-e100.

This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities. #9 – Trichomycosis axillaris

• Trichomycosis axillaris is superficial bacterial of hair shaft caused by tenuis • 46 year old male with axillary malodour x2 years • Exam revealed waxy, adherent yellow deposits on hair shafts • Wood’s lamp revealed green fluorescence • Patient cured via shaving axillary hair and using 2% sodium fusidate ointment BID

Gupta, V. and Sharma, V., 2018. Four views of trichomycosis axillaris: Clinical, Wood's lamp, dermoscopy and microscopy. Indian Journal of Dermatology, Venereology, and Leprology, 84(6), pp.748-748.

This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities. #8 Hyperpigmented /Lesions

• Wood’s light is absorbed by , while lesser pigmented adjacent skin scatters the light, resulting in contrast between tissue with more melanin • – can be epidermal, dermal, or mixed – Determine amount of epidermal pigment (which is usually more responsive to treatment) • Epidermal pigment has ENHANCED contrast under Wood’s lamp while dermal pigment does not. – Wood’s lamp is less helpful for Fitz V and VI patients 2/2 less contrast with surrounding skin • – Identify clinical borders of maligna Azza, S. (2017, May 3). Wood’s light in dermatology. Retrieved from – Locating the site of a completely regressed primary cutaneous https://www.slideshare.net/AzzaSamy/woods-lamp-75654892 melanoma

This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities. #7 Hypopigmented Lesions

• Can be difficult to assess in lighter skin types How to Confirm the Diagnostic.” How to Confirm the Vitiligo Diagnostic | Vitiligo Pictures, • Vitiligo https://www.vitiligozone.com/tips-and-tricks/how-confirm-vitiligo-diagnostic. – Depigmented patches are bright blue-white, which contrasts with surrounding normal skin – Helps distinguish from , anemicus, & post-inflammatory , all of which DO NOT ACCENTUATE with Wood’s lamp • Ash leaf macules of – Can be difficult to see on light skin types; Wood’s lamp can help detect lesions • vs – Nevus depigmentosus (actually hypopigmented) mildly accentuates whereas nevus anemicus does not

This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities. #6 (vs )

• acnes produces copropoporphyrin leading to orange-red fluorescence of comedones

HELPPP! Could This Be Acne Rosacea?? Pictures Included!!!” Acne.org, 5 Jan. 2019, • Example: 33 year old female comes to https://www.acne.org/forums/topic/372125-helppp-could-this-be-acne-rosacea-pictures- included/. clinic with longstanding history of inflammatory papules on the mid-face. – You don’t appreciate comedones on exam – You grab your Wood’s lamp….

Azza, S. (2017, May 3). Wood’s light in dermatology. Retrieved from https://www.slideshare.net/AzzaSamy/woods-lamp-75654892

This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities. #5 - Pseudomonas

• Pseudomonas organisms produce pyoverdine, which makes green fluorescence under Wood’s light – Fluorescence is produced with bacterial counts >105/cm2 • What dermatologic conditions may this be helpful for? – Hot tub – Assessment of secondary infection in burn patients or those with widespread erosions (e.g. SJS, TEN, ) – Wound (especially on foot) Amichai, B., Finkelsten, E. and Halevy, S., 1994. Early detection of pseudomonas infection using a Wood's lamp. Clinical and experimental dermatology, 19(5), pp.449-449.

Azza, S. (2017, May 3). Wood’s light in dermatology. Retrieved from https://www.slideshare.net/AzzaSamy/woods-lamp-75654892

This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities. #4 – Diagnosis of

• result from deficiencies in biosynthetic pathways leading to accumulation of metabolites • (PCT) – Most common porphyria; due to acquired or inherited defects in UROD – Examine patient’s urine with wood’s lamp after acidifying with 10% HCl • Congenital erythropoetic porphyria – Staining of teeth; fluorescent urine • used as photosensitizer in photodynamic therapy (PDT) Lee, W.H., Tai, W.C. and Wu, P.Y., 2012. Congenital . Dermatologica Sinica, 30(2), pp.62-65. – Shine Wood’s lamp to ensure even distribution of levulinic acid and “no missed spots”

This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities. #3 –

• Superficial fungal infection caused by Malassezia furfur, which emits a yellow-white or - orange fluorescence upon illumination with Wood’s lamp • Not only helpful to make diagnosis, but for detecting extent of infection and response to treatment • May also help to distinguish Pityrosporum folliculitis from other causes of folliculitis

Azza, S. (2017, May 3). Wood’s light in dermatology. Retrieved from https://www.slideshare.net/AzzaSamy/woods-lamp-75654892

This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities. #2 –

• infection of scalp • 3rd order question: you suspect tinea capitis. You shine your wood’s lamp and you see fluorescence. How does this alter treatment – Fluorescence  ectothrix  Microsporum canis is MC  Tinea Capitis.” Tinea Capitis | DermNet NZ, responds best to griseofulvin https://www.dermnetnz.org/topics/tinea-capitis/. • Note: Trichophyton Tonsurans is an ENDOthrix treated with Terbinafine • Trichophyton schoenleinii is only trichophyton that likes to “put on a show” and fluoresce too • The wood’s lamp can also assess response to treatment (emergence on non-fluorescent hair)

Gupta, L.K. and Singhi, M.K., 2004. Wood's lamp. Indian Journal of Dermatology, Venereology, and Leprology, 70(2), p.131.

This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities. Fluorescent Ectothrix: Cats And Dogs Fight and Growl Sometimes (T Schoenleinii)

Endothrix: Ringo Gave Yoko Two Squeaky Violins

Bolognia, Jean., Jorizzo, Joseph L.Schaffer, Julie V. (Eds.) (2012) Dermatology /[Philadelphia] : Elsevier Saunders

This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities. #1 –

• Common, chronic superficial bacterial infection with Corynebacterium minutissimum – Corynebacterium is a common flora on everyone’s skin, however overgrowth leads to erythrasma • Fluoresces coral red due to production of coproporphyrin III • Why is the distinction of erythrasma from tinea important?...

– Erythrasma responds well to or Vo, Theresa, and Richard P. Usatine. "Persistent rash on feet." The Journal of family practice 67.2 (2018): 107-109. , while tinea/candida responds better to topical imidazoles

This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities. 10 Practical Uses for the Wood’s Lamp

10. Milia 9. Trichomycosis axillaris 8. Hyperpigmented rashes and lesions 7. Hypopigmented rashes and lesions 6. Acne (vs rosacea) 5. Pseudomonas infections 4. Porphyrias 3. Tinea versicolor 2. Tinea capitis

Harkness, Ryan. “Let's Look Back At David Letterman's Top 'Top 10 Lists'.” UPROXX, UPROXX, 21 Mar. 2019, 1. Erythrasma https://uproxx.com/tv/the-top-ten-david-letterman-top-ten-lists/.

This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities. Top 10 Non-dermatologic Wood’s Lamp Uses

Harkness, Ryan. “Let's Look Back At David Letterman's Top 'Top 10 Lists'.” UPROXX, UPROXX, 21 Mar. 2019, 10. Illuminating your https://uproxx.com/tv/the-top-ten-david-letterman-top-ten-lists/. posters in your bedroom in 1993 “I Envisioned Turning Our Dining Room into the Most Insane 90's Nana Parlor and Thankfully @Mall.goff Is Always on Board and Supporti...: • Light It up • in 2019: Chill Room, Stoner Room, Hippy Room.” Pinterest, 29 Apr. 2019, 9. Detecting counterfeit money https://www.pinterest.com/pin/300263500147274512/. used at AOCD Casino night, fall meeting 2018 8. Attracting mosquitos into a

“Blacklight.” Wikipedia, Wikimedia Foundation, 2 Aug. 2019, bugzapper like samples https://en.wikipedia.org/wiki/Blacklight. attracting you all into the exhibit hall.

The Best Bug Zappers on Amazon, According to Hyperenthusiastic Reviewers.” The Strategist, The Strategist, 10 June 2019, http://nymag.com/strategist/article/best-bug-zappers.html. Vanicream - Fragrance Free Products for Sensitive Skin Care.” Pharmaceutical Specialties, Inc., https://www.psico.com/.

This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities. Top 10 Non-dermatologic Wood’s Lamp Uses

Harkness, Ryan. “Let's Look Back At David Letterman's Top 'Top 10 Lists'.” UPROXX, UPROXX, 21 Mar. 2019, https://uproxx.com/tv/the-top-ten- david-letterman-top-ten-lists/. They Wondered If Hotels Always Change the Sheets When Guests Check Out, So They Decided to Test Them.” TipHero, 24 June 2019, https://tiphero.com/dirty-hotel-beds. 7. Hotel bedsheet checks 6. Tanning bed bulbs for the perfect murder weapon in Final Destination 3 / Nightmare Fuel.” TV Tropes, Final Destination 3 https://tvtropes.org/pmwiki/pmwiki.php/NightmareFuel/FinalDestination3. 5. Tanning bed bulbs for that perfect Fitzpatrick type 1 to type 5 conversion

Mom Shocked The World With Her Tanning Addiction. Now She's Suing Her Child's School Over .” Scribol.com, 12 Oct. 2017, http://scribol.com/anthropology-and-history/bizarre-and-offbeat-news/mom- shocked-world-tanning-addiction-now-suing-childs-school-over-sunburn/.

This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities. Top 10 Non-dermatologic Wood’s Lamp Uses 90s Problems - Laid in the Tanning Bed and Forgot My Playboy Bunny Sticker. Harkness, Ryan. “Let's Look Back At David Letterman's Top 'Top 10 Lists'.” UPROXX, UPROXX, 21 @Morgankruzicki: That's a Mar. 2019, https://uproxx.com/tv/the-top-ten-david-letterman-top-ten-lists/. Good One!: Workout Humor, Nurse Humor, Jw Humor.” Pinterest, https://www.pinterest.com/pi n/367184175839300414/. 4. Tanning bed bulbs for the perfect Playboy bunny sticker mark 3. Fluorescing urine to make the diagnosis of ethylene glycol poisoning, Thompson, Alexandra, and Mailonline. “Man's Urine Turns FLUORESCENT after Antifreeze Poisoning.” Daily Mail Online, Associated Newspapers, 30 June 2017, https://www.dailymail.co.uk/health/article-4654388/Man-s-urine- in 1942. turns-FLUORESCENT-antifreeze-poisoning.html.

How to Use a UV Blacklight Flashlight to Find Pet Urine Stains FAST.” shopiLumen8, https://www.shopilumen8.com/blogs/news/how-to-use-a-uv-blacklight-flashlight-to-find-pet-urine-stains- 2. Finding where the puppy missed the fast.

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This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities. Thank You!

This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities. References

• Gupta, L.K. and Singhi, M.K., 2004. Wood's lamp. Indian Journal of Dermatology, Venereology, and Leprology, 70(2), p.131. • Gupta, V. and Sharma, V., 2018. Four views of trichomycosis axillaris: Clinical, Wood's lamp, dermoscopy and microscopy. Indian Journal of Dermatology, Venereology, and Leprology, 84(6), pp.748-748. • Lee, J.H., Kwon, H.S., Jung, H.M., Kim, G.M. and Bae, J.M., 2018. Wood's lamp–induced fluorescence of milia. Journal of the American Academy of Dermatology, 78(5), pp.e99-e100. • Kaliyadan, F. and Kuruvilla, J., 2015. Using a hand-held black-light source instead of a Wood's lamp. Journal of the American Academy of Dermatology, 72(6). • Paraskevas, L.R., Halpern, A.C. and Marghoob, A.A., 2005. Utility of the Wood's light: five cases from a pigmented lesion clinic. British Journal of Dermatology, 152(5), pp.1039-1044. • Oakley, A. (2014, August). Wood lamp skin examination. Retrieved from https://www.dermnetnz.org/topics/wood-lamp-skin- examination/ • Azza, S. (2017, May 3). Wood’s light in dermatology. Retrieved from https://www.slideshare.net/AzzaSamy/woods-lamp-75654892 • Bolognia, Jean., Jorizzo, Joseph L.Schaffer, Julie V. (Eds.) (2012) Dermatology /[Philadelphia] : Elsevier Saunders • Vo, Theresa, and Richard P. Usatine. "Persistent rash on feet." The Journal of family practice 67.2 (2018): 107-109. • Amichai, B., Finkelsten, E. and Halevy, S., 1994. Early detection of pseudomonas infection using a Wood's lamp. Clinical and experimental dermatology, 19(5), pp.449-449. • Lee, W.H., Tai, W.C. and Wu, P.Y., 2012. Congenital erythropoietic porphyria. Dermatologica Sinica, 30(2), pp.62-65.

This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities.