More questions about warts – the gift that keeps on giving!

common wart

We’ve received a couple of follow up questions from a BuckMD reader on our last post about warts, and clearly this individual has excellent taste in writing:

Thanks for another great article. I like your writing style.  It almost sounds like the warts are more infectious after treatment than before. Is that true?

Also, one more follow-up question if you don’t mind: when the warts are removed, is the HPV virus still present in the body, or does it go away with the warts?

Thanks!

Who knew warts were such a popular topic!?  We may have to petition whoever’s in charge of these things to make August national wart awareness month.  Anyway, to answer the questions:

The warts are not more infectious after treatment than before.  Assuming a good application, whatever part of the warty skin gets hit by the treatment (freezing, acid) is dead and the virus within it is dead and therefore no longer infectious.  It’s just that the virus may also be on surrounding parts of the skin that look normal and if they aren’t hit by the treatment, then that remaining virus can cause new warts to form.

That kind of answers your second question as well.  The HPV virus is never “in” the body – it only lives on the surface of the skin.  It can be there and never cause a wart at all, and for most people it goes away on its own within 2 years.  So if a wart goes away on its own, you can safely assume that the HPV virus has gone away too.  If the wart goes away because of getting it treated, the virus may still be present on other parts of the surrounding skin and cause more warts to form in the future.

Again, we can offer you lots of effective treatment options at the Student Health Center so if you’re having trouble with pesky, persistent warts, come on in and see us.

John A. Vaughn, MD
Student Health Services
The Ohio State University

 

Are warts still contagious after treatment?

common wart

When removing the dead skin after treating a wart with salicylic acid, is that area of the hand still contagious with the HPV virus? If so, how can I reduce the chances of spreading the wart?

Another great question from a loyal BuckMD reader!  And on one of our favorite – and creepiest – topics.  We’ve covered how to get rid of warts and whether or not warts from the hand can spread to more private areas, but we’ve never talked about whether or not they can spread while you’re getting rid of them. 

There are a lot of different treatment options for warts, and while they may differ based upon location and other factors, the goal for most of them is to destroy the warty epidermis (top layer of skin) and the virus within it.  After a treatment, the skin will blister or get irritated and eventually slough off.  That skin is dead and so is the virus within it so it isn’t contagious anymore.  Unfortunately, even though the skin around the area of treatment may look normal, there is often virus still present in it. 

So to answer your question – yes, that area of the hand can still be contagious with HPV virus even after treatment.  Since warts are spread by skin-to-skin contact, the best way to prevent further spread is to keep it covered up in between treatments.

We try to extend the area of treatment to include the normal skin right around the wart to prevent this from happening, but HPV is microscopic so it’s impossible to tell whether we’ve gotten it all.  This is why it usually takes several weeks and multiple treatments to get rid of them.

When dealing with warts, you have to be patient and persistent.  But look on the bright side – while they are annoying, common warts are not dangerous and even if you don’t do anything to them, they’ll go away on their own within 2 years in up to two-thirds of people. 

If you’re having trouble with warts, or any other skin problems, come in to see us at Student Health – we’re always happy to help you out!

John A. Vaughn, MD
Student Health Services
The Ohio State University

Pale is Hot – Cancer’s Not! May is National Skin Cancer Month

Public Health Image Library

Public Health Image Library

Public Health Image Library

In news you can use, the World Health Organization announced that tanning beds definitely cause cancer. Until now, discussions about the cancer causing effects of ultraviolet radiation (either from the sun or from tanning beds) always involved wishy-washy modifiers like probably.   No more! Tanning beds have now officially joined the ranks of other goodies like asbestos, tobacco, coal tar, mustard gas, and (for all you chemistry majors out there) the ever popular N,N-Bis(2-chloroethyl)-2-naphthylamine.

The incidence of melanoma – the worst kind of skin cancer – from ultraviolet light exposure has increased dramatically over the last three decades, particularly in young women.  We aren’t talking about a few isolated cases here, either. According to the American Cancer Society, there were 62,000 new cases diagnosed in the United States in the last year alone, and 8,000 people died from it!  Researchers believe that excessive exposure to UV radiation before the age of 30 is a very significant risk factor for developing melanoma.

The tanning bed industry has long maintained that their beds were safe because they mostly emit the “safe” UVA form of ultraviolet light.  Turns out that in their rush to get you (and your wallets) on their tanning beds, they might have been a little… overly optimistic.  UVA, UVB, and UVC all cause cancer, no matter where it comes from.

The moral of this story, young Buckeyes, is that the healthy glow of a tan is not healthy at all.  This summer, make like an extra from the set of Dark Shadows and go for pale!  Pale is best – put your sunscreen to the test!

Vicki Rentel, MD (Student Health Services Alum)

Reasons to quit smoking that you might actually care about

photo: nytimes.com

Q: Yeah, yeah, yeah… smoking might give me lung cancer when I’m like 80.  So why should I worry about it now when I can just quit when I’m old?

A: Sure, lung cancer is one of the main reasons to quit, but we know you college (and graduate) students are invincible and don’t really care about little things like mortality, so here are a few other good reasons to quit smoking that might hit a little closer to home:

Tooth Loss

  • It is well known among dentists that smoking dramatically increases your chances of “edentulism” (i.e having no teeth). Smoking causes gum disease and plaque build-up which lead to tooth decay and loss. One study showed that the risk of tooth loss in smokers is more than 4 times that of non-smokers! Think you look cool holding that cigarette? Just think how much cooler you’ll look with dentures. The good news is that the risk of tooth loss decreases with smoking cessation.

Wrinkles

  • Smoking is one of the leading causes of premature skin aging. (One of the identical twins in the photo at the right smokes and has been in the sun more than the other – can you tell which one it is?) Tobacco leads to degradation of the collagen and elastic fibers that keep skin looking smooth and young, leading to premature wrinkles, especially around the mouth and eyes. The mechanisms for this are thought to be similar to the damaging effects of ultraviolet radiation on the skin – so stop tanning too while you’re at it!

Cervical cancer

  • Ladies, did you know that if you have been infected with certain types of Human Papillomavirus (HPV), smoking increases your risk of developing cervical cancer compared to nonsmokers? Researchers are still looking into why this is, but they have actually detected nicotine in the cervical mucous of smokers!  And cervical cancer isn’t one of those things you only have to worry about in the distant future; it is increasingly affecting women in their 20s and 30s. The risk gets higher the longer you smoke, so the sooner you quit the better.

Birth defects

  • It is amazing that in this day and age we still need to tell people to quit smoking before they become pregnant, but unfortunately we still see it all the time. Smoking increases a woman’s risk of premature delivery, still birth, low infant birth weight, and sudden infant death syndrome (SIDS). Since roughly 50% of pregnancies are unplanned, the time to quit is now!

Limb amputation

  • Smoking is one of the major risk factors for peripheral arterial disease (loss of blood flow to the extremities which can lead to tissue damage and amputation). Ok, maybe this is another one of those long term problems you don’t want to think about while you’re young and indestructible, but it’s out there and it affects many people as they get older.

Poverty

  • We know that financial concerns are far and away the biggest stressors for students: tuition, rent, books, fees, not having enough time to study for your classes because you have to work so many hours to pay for them. A pack of cigarettes costs around $5, so a pack-a-day habit costs you $1825 a year! Think about that. How many months of rent or credit hours would that buy? How many student loans could you pay off (or not take out in the first place)? Even if you’re just a casual smoker who only buys a pack on the weekend when you go out drinking, that’s $250 in a year. That would buy you an iTouch!

The thought of becoming a poor, wrinkly, stressed out, toothless, cancer-ridden amputee still not enough reasons to quit?  Check out the CDC’s website for more useful information on the risks of smoking and resources for quitting.  We’ll follow up with another post listing some local resources for quitting soon.

Angela Walker (Ohio State College of Medicine)

John A. Vaughn, M.D (Ohio State Student Health Services)

My toenails look funky

UpToDate.com

My right big toe nail cracked across in the middle and I noticed that the left big toe is starting to crack too.  It does not hurt but what should I do?

Certain (kinda rare) medical conditions can cause nails to warp or crack, but when you’re talking just the big toes, you’re usually dealing with a fungal infection. 

People tend to get really creeped out when I mention the word fungus, but it has nothing to do with poor hygiene or anything like that.  Fungi are germs that normally live on our skin; they just happen to like warm, moist places so sometimes they overgrow and cause trouble.  If it happens between the toes, we call it “athlete’s foot”; in the groin area, “jock itch”; under the toenails… “funky toe nails” I guess.  (The actual medical term is onychomycosis).

People who swim or whose feet sweat a lot might have a higher chance of getting a fungal nail infection, but we really don’t know why some people get them and others don’t.  

They happen in the toenails a lot more often than the fingernails and usually start on the big toe, occasionally affecting the nails on the smaller toes.  A fungal infection can cause a nail to:

  • Turn white, yellow or brown
  • Get thick, change shape, or raise up from the nail bed
  • Get crumbly and break off easily
  • Hurt

If your infection is mild or doesn’t bother you very much, you don’t have to do anything about it; it probably won’t go away, but it probably won’t cause any long-term problems either.

There are some over-the-counter creams or nail polishes you can try, but honestly, they’re a waste of money.  If you want to have it treated, you’ll need to take some prescription antifungal pills for about 12 weeks.  Your health care provider may order some blood tests before you start the medicine because they can affect the liver. 

But be warned – these infections can be a pain to deal with.  It can take months for a normal looking nail to grow back in, the treatment doesn’t work 25-40% of the time, and when it does, there’s a 20-50% chance that the infection will come back.  

To reduce your chance of getting a fungal toenail infection:

  • keep your feet clean and dry
  • Avoid sharing nail clippers
  • Wear flip-flops or other footwear in a gym shower or locker room

If you think you have a fungal toenail infection, come in and see us.  We can usually tell just by taking a look at it and asking you a few questions.  If there’s any doubt about what’s going on, we may take a small sample of the nail (cutting or scraping) and send it to a lab where another doctor can confirm which germs, if any, are causing the infection.

John A. Vaughn, MD
Student Health Services
The Ohio State University

Do I need to avoid the sun if I’m on medication?

PhotoTOXIC reaction

PhotoALLERGIC Reaction

Certain medications cause your skin to become more sensitive to the sun.  Contrary to popular belief, they don’t make you more likely to burn, but actually cause a separate type of painful and itchy rash that can look like a bad burn.  There are two types of photosensitive reactions: phototoxic and photoallergic. 

Phototoxic is the most common.  This happens when the drug itself gets dispersed throughout the body and ends up in the skin, where it absorbs UVA light and causes cellular damage.  A phototoxic event typically happens within hours of initial exposure to sunlight.

Photoallergic reaction occur when the UV light alters the chemical structure of the drug and the body’s immune system sees this new compound as an intruder and attacks it.  A photoallergic reaction doesn’t usually happen right away; it requires longer, and often multiple, exposures to sunlight before it happens. 

Many commonly used medicines can cause photosensitivity:

Antibiotics such as ciprofloxacin (Cipro®), levofloxacin (Levaquin®), sulfamethoxazole/trimethoprim (Bactrim®) and doxycycline, tetracycline, and minocycline.

Acne medicines such as (isotretinoin (Accutane®/Claravis®), tazarotene (Tazorac®), and tretinoin)

Medicines to prevent malaria while traveling like atovaquone/proguanil (Malarone®) and chloroquine).

If you are taking a medication that can increase photosensitivity, you should avoid excessive exposure to sunlight and tanning beds.  (Of course, you already know that you should avoid tanning beds anyway).  If you don’t want to be a shut in while the sun shines, make sure you wear a broad spectrum (UVA/UVB) sunscreen with a SPF rating of 30 or greater.  This will decrease that amount of sunlight exposure to your skin and therefore the risk of a bad reaction.      

Sun Screen Tips:

  • Make sure it is broad spectrum (UVA & UVB)
  • Apply roughly one ounce of sunscreen for the full body
  • Apply one-half teaspoon of sunscreen to smaller body parts i.e. face/neck, each arm and shoulder
  • Apply one teaspoon of sunscreen to larger body parts i.e. legs, back
  • Apply 15-30 minutes prior to sunscreen exposure to ensure optimal protection
  • If swimming or being physically active use a “water resistant” sunscreen
  • Reapply liberally, especially if excessive swimming , sweating or toweling off
  • Minimally use a SPF of 15, optimally use a SPF of 30
  • If applying insect repellant, put the sunscreen on first, wait 15 minutes and then apply the insect repellant

If you are planning on spending a lot of time in the sun while on a medication, be sure to ask your pharmacist about possible photosensitivity side effects.   The pharmacy staff at the Wilce Student Health Center is always willing to answer any questions you may have.  Feel free to stop by or call us at (614) 292-0125.

Dean Wagner, PharmD candidate 2012
Student Health Services
The Ohio State University

Jason Goodman, PharmD, RPh
Student Health Services
The Ohio State University

Photos: www.medicine.net

How Safe is That Tattoo?

www.pix.10tv.com

The Department of Internal Medicine at New York University (NYU) has a great blog called Clinical Correlations.  The blog is produced by and for physicians so it can be a little technical for the general reader, but it often covers topics that are of interest to everyone. 

A recent post about tatto safety was really good, and very relevant to all you ink-stained Buckeyes out there.  If you’re interested in the details, you can check out the full post here, but here are the highlights:

  • The most common health risk associated with tattooing is localized skin infection caused by Staphylococcus aureus (including MRSA) or Pseudomonas aeruginosa.  A thorough washing of the tattoo site with soap and water is usually effective in preventing localized skin infection.
  • Tattooing can also cause systemic infections such as staphylococcal toxic shock syndrome, pseudomonal abscesses, and infective endocarditis.  If you’ve ever been told that you need to take antibiotics before going to the dentist, you should talk to your health care provider before getting a tattoo.
  • Tattooing has caused tetanus, tuberculosis, hepatitis B and hepatitis C so if you are planning on getting a tattoo, it would be a good idea to make sure your tetanus and hepatitis B vaccines are up to date.
  • Tattoo inks don’t need FDA approval and can contain a wide variety of ingredients that can cause skin reactions.  The most common elements (aluminum, oxygen, titanium, and carbon) have been found to be safe, but mercury, chromium, cadmium, and cobalt are commonly used and have all been associated with delayed hypersensitivity reactions.

These risks are fairly small, but they can be minimized even further by choosing a professional studio to do your tattoo.  You should make sure that the artist changes needles and inkwells, disinfects all equipment, washes her hands and changes gloves between each client.  She should also shave and cleanse the body site with an antimicrobial wash before administering the tattoo and provide appropriate instructions on how to take care of your skin and what problems to look out for. 

If you ever have any concerns about your tattoo, you can make an appointment to see us.

John A. Vaughn, MD
Student Health Services
The Ohio State University

Is Spray Tanning Safe?

selftan.co.za

classicbeautytherapy.com.au

Q: Is spray tanning safe?

A: Sunless tanners generally use an ingredient called dihydroxyacetone (DHA), a chemical that reacts with amino acids in dead skin cells on the skin surface to cause a darkened color. The color does not fade but gradually sloughs off with the skin cells over about a week.

The Food and Drug Administration (FDA) regulates color additives such as DHA – if a color additive is used in an unauthorized way, it is considered unsafe under the law. The FDA safety regulations for DHA state that it should only be applied externally to the skin and not to the lips, around the eyes, or to internal body surfaces covered by mucous membranes: mouth, nose, vagina, rectum and lungs (by inhaling it). So home use of sunless tanning products is generally safe, as long as you are careful to avoid those areas. 

Spray tanning booths are a different story. The FDA cannot vouch for the safety of the use of DHA in spray tanning booths since it’s difficult to avoid exposure to the lips, eyes and mucous membranes. If you decide to go ahead with spray or mist tanning, make sure to ask whether your eyes and lips will be protected, and whether you will be protected from internal exposure by inhalation.

Compared to tanning in the sun or using UV tanning beds, spray tanning is probably a safer bet – we all know UV rays cause skin cancer, right?  Just be sure it only sticks to your skin!

John A. Vaughn, MD
Student Health Services
The Ohio State University

What can I do to keep from losing my hair?

washingtonpost.com

I get this question all the time at the student health center, which tells me that it’s time to drop some scalp science on you.  (DISCLAIMER – We are talking about hair loss in men.  Hair loss in women is a little trickier to diagnose and manage, and should be evaluated by a health care provider.)

You’ve basically got two options when it comes to preventing or treating male-pattern baldness:

Minoxidil (Rogaine) is a topical medication that is available without a prescription.  It comes in a 2% solution and a 5% solution or foam.  (I’ve seen a 15% strength advertised online but this is not FDA approved and is probably made in an off-shore pharmacy so best to stay away from it).  The 5% strength works a little better but has a higher incidence of skin irritation and itching.  The foam may be a little less irritating than the solution.

  • Not covered by insurance – costs around $30 per month
  • Must be used twice a day for at least 4 months before you can say whether or not it’s working
  • The maximum benefit plateaus at 12-18 months
  • It’s successful in about 30-40% of men who use it
  • Once you stop using it, all hair that has been maintained or re-grown will be lost

Finasteride (Propecia) is a prescription only oral medication that comes in a 1mg pill.  It works by blocking an enzyme that converts testosterone to dihydrotestosterone in the scalp.  A 5mg version is used to treat benign prostate enlargement – side effects at that dose include decreased sex drive and erectile dysfunction, but they aren’t seen too often with the 1mg dose.  Although it doesn’t affect testosterone in the body, finasteride has such a high risk of causing birth defects in male fetuses that pregnant women are advised to not even touch the medication.    

  • Also not covered by insurance – costs a little over $60 per month.
  • It’s successful in about two-thirds of men who use it
  • Positive effect continues to increase after 2 years of use
  • Improves not only hair count, but also length and thickness and color
  • Once you stop using it, all hair that has been maintained or re-grown will be lost

So they both work, but not always and only for as long as you are using them.  Finasteride works better than minoxidil and is easier to use, but it’s more expensive and has potentially worse side effects.  They’re both pretty expensive – we’re talking $360 to $720 a year – and you pick up the tab completely.

Like all medicines, you have to weigh the benefits and risks of taking it.  And you don’t need to take anything for your hair.  I mean, sure I’d love to have the flowing mane of Troy Polamalu, but paying 60 bucks a month for a pill that pregnant women can’t even touch!?  I’ll buy a hat, thanks.

But if you feel otherwise, you’re always welcome to come in to the Student Health Center and talk it over with us.

John A. Vaughn, MD
Student Health Services
The Ohio State University

Does HPV Really Cause Skin Cancer?

dfs.chesco.org

Q:  I heard a story on WCMH/Channel 4 recently that HPV causes skin cancer. Is this true? 

Short A:  Maybe.  We don’t really know.

Long A:  We know that there is a cause and effect relationship between certain strains of the Human Papilloma Virus (HPV) and cervical and anal cancers.  A recent study published in the British Medical Journal suggests there might also be an association between HPV and squamous cell carcinomas (SCC) of the skin.  Scientists measured HPV levels in patients who didn’t have SCC and compared them to those who did.  They found that patients had a 44% chance of having SCC if they had 2 or 3 strains of HPV; a 51% chance if they had 4 to 8 strains; and a 71% chance if they had more than 8 strains. 

But while those numbers look scary, they say nothing about whether HPV causes SCC or not.  They imply that there is a correlation between the two conditions, but correlation does not equal causation.  HPV and SCC occur together in a lot of people, but maybe having SCC makes some people more susceptible to getting HPV rather than the other way around?  You could just as easily say, “The more people you see on the oval carrying umbrellas, the more likely it is to be raining.”  But that doesn’t prove that the umbrellas caused the rain.

Here’s another good example of scary numbers, this time from the World Health Organization:

“The use of sunbeds before the age of 35 is associated with a 75% increase in the risk of melanoma”.

So if you’ve ever used a tanning bed, you have a 75% chance of getting melanoma!?  No.  That number is the relative risk.  The absolute risk of getting melanoma from tanning beds is actually very small: less than 0.003% of people who tan frequently get melanoma, compared to less than 0.002% of people who don’t.  While that rate is 75% higher, we’re still talking about a very small number – less than 3 out of 1000.  There’s a great article explaining all of this stuff over at the Association of Health Care Journalists website.

I’m NOT saying tanning beds are safe.  Melanoma is bad and even though it doesn’t happen that often, anything that increases your risk of it even a tiny bit should be avoided.  You should wear sunscreen and condoms as often as possible (well, you know, when appropriate… and maybe not at the same time… you know what I mean).  My point is that numbers can say very different things depending on how you look at them, and people will often exploit that fact to sell you stuff from milk to medicines, and not always with your best interests at heart. 

Being an informed and knowledgeable health care consumer is as important to your health as sunscreen and condoms.  So lather up, cover up and always read the fine print.  You’ll be glad you did. 

Victoria Rentel, MD
Student Health Services
The Ohio State University