Buffalo Medical Group, P.C. Robert E. Kalb, M.D. Phone: (716) 630-1102 Fax: (716) 633-6507 Department of Dermatology 325 Essjay Road Williamsville, New York 14221 2 FOOT- 1 HAND SYNDROME 2 foot - 1 hand syndrome is a superficial infection of the skin caused by the common athlete's foot fungus. It is quite common for people to have a minor amount of an athlete's foot condition. This would appear as slight scaling and/or itching between the toes. In addition, patients may have thickened toenails as part of the athlete's foot condition. Again the problem on the feet is very common and often patients are not even aware of it. In some patients, however, the athlete's foot fungus can spread to another area of the body. For some strange and unknown reason, it seems to affect only one hand. That is why the condition is called 2 foot - 1 hand syndrome. It is not clear why the problem develops in only one hand or why the right or left is involved in some patients. Fortunately there is very effective treatment to control this minor skin problem. If the problem with the superficial fungus infection is confined to the skin, then a short course of treatment with an oral antibiotic is all that is required. This antibiotic is very safe and normally clears the skin up fairly rapidly. It is often used with a topical cream to speed the healing process. If, however, the fingernails of the affected hand are also involved then a more prolonged course of the antibiotic will be necessary. Normally it takes six to nine months to grow a fingernail from beginning to end. It is therefore necessary to take the antibiotic pill for many months until the fingernails regrow normally. The antibiotic pill used for this problem is extremely safe even when taken for long periods of time. It is very important to take the pills regularly so that the condition will continue to slowly improve. It is also necessary to apply a cream to the hand in the area around the nails to aid in the healing of the condition. Although 2 foot - 1 hand syndrome may sound unusual, it is truly a minor skin problem for which very effective treatment is available. If you have any other questions about this condition, please ask me before you leave the office. Buffalo Medical Group, P.C. Robert E. Kalb, M.D. Phone: (716) 630-1102 Fax: (716) 633-6507 Department of Dermatology 325 Essjay Road Williamsville, New York 14221 5-FLUOROURACIL 5% CREAM INSTRUCTIONS 5-fluorouracil 5% cream is a topical medication for the treatment of actinic keratoses. Actinic keratoses are the dry, red scaly spots on the skin caused by sun damage. They often appear as rough or uneven texture on the face. These spots are not skin cancer, but in rare cases, may turn into cancer years later. Treatment of these spots requires removal of the defective skin cells. As you probably have experienced, there are various ways to remove actinic keratoses, including freezing with liquid nitrogen and removal of the skin surface with s-craping procedures. In addition, there are creams and gels to treat actinic keratoses. 5-fluorouracil 5% cream is a topical cream used to treat actinic keratoses. It works by interfering with the growth of abnormal fast-growing skin cells, such as actinic keratoses. These cells peel off and are replaced by healthy ones. INSTRUCTIONS: 5-fluorouracil 5% cream only needs to be used two weeks per month. A thin layer should be applied once a day at bedtime for two weeks. Avoid contact with your eyes, nostrils, and mouth. Wash your hands after applying 5-fluorouracil 5% cream on your skin. A moisturizer or sunscreen with a minimum SPF 30 should be applied each morning. After two weeks of applying 5-fluorouracil 5% cream, stop using it for two weeks (or for the rest of the month). The cycle then repeats the following month for two weeks. Continue the cycle until the spots reduce. In some cases it may take only 1-2 cycles for the lesions to resolve. For some patients it is necessary to use the 5-fluorouracil 5% cream for 6-12 months (cycles) to obtain the best results. SIDE EFFECTS: When using 5-fluorouracil 5% cream, you may have mild irritation, such as redness, dryness, swelling, or a mild burning sensation. This usually resolves within 2 weeks. The more actinic keratoses you have, the more redness and inflammation you can expect during treatment. There are no reported food or drug interactions with 5-fluorouracil 5% cream. Serious side effects do not occur. Eye irritation has been reported in some cases. If this occurs, please let me know. Do not use 5-fluorouracil 5% cream on infected or open wounds. If you treat individual lesions with the medication then the irritation would only occur in the area where the medication is applied. 5-fluorouracil 5% cream offers an easy way to treat sun damage and actinic keratosis, smoothing out your skin and preventing surgical treatment in the future. If you have any trouble using this cream, please call the office. If you have any other questions about this information, please do not hesitate to ask me before you leave the office. Buffalo Medical Group, P.C. Robert E. Kalb, M.D. Phone: (716) 630-1102 Fax: (716) 633-6507 Department of Dermatology 325 Essjay Road Williamsville, New York 14221 ACCESSORY NIPPLE Accessory nipples are relatively common, and consist of nipples and/or related tissue in addition to the two nipples normally appearing on the chest. Medical terms for accessory nipples include “polythelia” or “supernumerary nipple”. Accessory nipples are generally located somewhere along a line from a point slightly beyond the armpit on the arms, down the chest and the abdomen, to the inner sides of the thighs. Accessory nipples are typically smaller than the normally placed nipples, are often not well formed, and are usually mistaken for moles or other benign growths. Although it is possible to have multiple accessory nipples, most people have only one, and most are found on the chest or abdomen, somewhere below the normal breast. Most commonly, a person will have only an extra nipple, without any other breast structures. If they appear complete with breast tissue and ducts they are referred to as polymastia, and may go through changes during puberty or pregnancy like any regular nipple or breast. Accessory nipples are benign and require no treatment. Surgical removal is an option for cosmetic reasons. In general these harmless lesions are best left alone. Buffalo Medical Group, P.C. Robert E. Kalb, M.D. Phone: (716) 630-1102 Fax: (716) 633-6507 Department of Dermatology 325 Essjay Road Williamsville, New York 14221 ACNE KELOIDALIS NUCHAE Acne keloidalis nuchae is a common skin problem, which occurs on the neck and scalp. Unfortunately it has this large confusing name but it is a well-recognized condition. If you would tell any dermatologist that you had acne keloidalis he would know exactly what you are talking about. The name of the condition is a descriptive term. Acne refers to the fact that the bumps tend to be like small pimples. Keloidalis refers to the fact that the pimple like bumps tend to form these scar type or keloid areas. Nuchae is an anatomical term referring to the neck where the problem occurs. Acne keloidalis tends to occur in young men in their twenties and thirties. Patients who have acne keloidalis often have trouble with ingrowing hairs in the beard area. If the problem is longstanding, the pimple like scars around the scalp hair roots can lead to a thinning of the hair. In some cases this may not be entirely reversible. Acne keloidalis nuchae usually occurs on the back of the neck and the lower scalp. Often it is preceded by small pus pimples or pimple like inflamed areas. These develop around the hair roots. If the condition persists, the pimples can form scar like or keloid like areas. Unfortunately the exact cause of this condition is not known. Normally there is treatment which helps significantly in controlling it but technically there is no cure for it. One of the most effective treatments for acne keloidalis is the injection of a material directly into the bumps. This decreases the swelling and the chance for scarring. In addition, lotion or cream medication can be rubbed into the area, which also helps. The treatment that I will prescribe will be individualized to your case. Although this problem tends to be persistent, it often can be controlled quite well. Please do not hesitate to ask me any other questions about this problem before you leave the office. Buffalo Medical Group, P.C. Robert E. Kalb, M.D. Phone: (716) 630-1102 Fax: (716) 633-6507 Department of Dermatology 325 Essjay Road Williamsville, New York 14221 ACNE Acne is the term for the pimples and complexion problems that develop in many teenagers and young adults. Pimples occur mainly on the face but can involve the neck, chest, back and upper arms. Acne is only a skin problem and does not affect your general health. There is no one single cause of acne. There are many factors involved. The first is heredity that is the tendency of other family members to have acne. The second is hormonal stimulation. That is why acne usually occurs at puberty when the hormones stimulate the oil glands. In addition many women notice a fluctuation of their acne with their menstrual cycle and this is also hormonally related.