Combating the opioid crisis

This alarming epidemic requires everyone’s help to counteract

The opioid crisis has been national news for the past several years, affecting thousands of people throughout the country, with seemingly no end in sight. It involves an increase in opioid addiction and overdose caused by misuse of opioids, such as prescription pain relievers, heroin, and synthetic opioids like fentanyl. 

Opioids trigger the release of endorphins, the “feel good” neurotransmitter, which numb your perception of pain and boost feelings of pleasure. When the drug wears off, you can have a desire to experience those good feelings again. Continuous use of this drug can lead to dependency and, eventually, addiction.

While the epidemic has peaked within the past five years, it has been gaining momentum since the late 1990s. This was a time when prominent pharmaceutical companies reassured members of the medical community that patients wouldn’t become addicted to prescription opioid pain relievers, resulting in widespread misuse of these medications by physicians before it became clear they were highly addictive. 

The statistics showing the prominence of opioid misuse and overdose warrant immediate attention from consumers and legislators. According to the Centers for Disease Control and Prevention (CDC), more than 130 people in the U.S. die every day after overdosing on opioids.

From 1999-2017, more than 700,000 people died from drug overdoses. That is more than 10 times the number of people who died in the Vietnam War.

Opioids are often prescribed for chronic pain; however, roughly 25 percent of patients prescribed opioids for chronic pain misuse them. Approximately five percent of people who abuse prescription opioids will transition to heroin.

The most common states of the country experiencing this opioid crisis are in the Midwest—including Ohio, Wisconsin, and Minnesota.

The CDC says the economic burden of this crisis is $78.5 billion a year, including costs of healthcare, loss in productivity, addiction treatment, and criminal justice involvement.

The significant magnitude of this national crisis is quite apparent. Here, we will identify and examine current approaches to correct the opioid crisis and what you can do in your community to combat the opioid crisis.

What government is doing

With all of these startling statistics, what is being done about it? Several government agencies are brainstorming new ideas and programs to counteract this growing crisis. For instance, the U.S. Department of Health and Human Services (HHS) has several approaches including:

  • Developing treatment programs that optimize the use of opioid treatment medications such as Buprenorphine, Naltrexone, Clonidine and Methadone.
  • Continuing to research the use of cannabis as a new tool in the treatment of opioid addiction. Cannabis and opioid systems in humans interact very closely. Perhaps this will open a door for the development and utilization of cannabis-related medicines to treat opiate addiction. Although promising, much more research needs to be done. Cannabis will not be the solution, but it may be a significant component in the war against the Opioid Crisis.
  • Improving access to treatment and recovery services.
  • Promoting the use and widespread availability of overdose-reversing drugs such as naltrexone (Narcan).
  • Strengthening understanding of the epidemic through more public health surveillance data.
  • Providing up-to-date research on pain and addiction.
  • Advancing better practices for pain management by healthcare professionals.

The National Institute of Health (NIH), a research branch of HHS, echoes these initiatives by conducting research for new non-addictive strategies to manage chronic pain, as well as meeting with pharmaceutical companies and healthcare professionals to prevent the snowball effect of opioid misuse.

The CDC plans to take it one step further by partnering with public safety, such as law enforcement, to address the growing illicit opioid problem. Officials are also considering attacking the source to reduce opioid availability. This includes targeting the opioid manufacturers who produce much more medication than is actually needed.

Purdue Pharma, the manufacturer of Oxycontin, is currently involved with lawsuits from over 30 different state attorneys general (including Minnesota’s) and over 1,500 personal liability suits. We are just at the beginning of these legal challenges.

Also, legal minds have discussed the possibility of prosecuting the large pharmaceutical distribution companies that make sure that the supply is plentiful across the country by delivering opioids to every drug store in the country at quantities that appear to be ridiculously high.

What local communities must do

An important question to ask is what you can do at a community level. You must realize that anyone who takes opioids is at risk of developing an addiction. The public must be made aware of this. An individual’s personal history and the length of time opioids are used both play a role, but it is impossible to predict who’s vulnerable to eventual dependence and abuse of these drugs.

Another thing you can do for your family and community is become aware of the signs of addiction, which include but not limited to:

  • Irresistible craving for a drug
  • Compulsive use of the drug
  • Continued use of the drug despite repeated harmful consequences

If you are prescribed an opioid by your physician to manage acute pain, such as after a surgery, opioids are safest when used for three or fewer days. Try to avoid using opioids unless you absolutely have to for recurrent chronic pain.

If you do need opioids, ask your doctor for the lowest possible dose for the shortest time required, and use it exactly as prescribed. The key is to have a discussion with your doctor on the proper pain management specific for you.

You can help prevent addiction in your family and community by disposing of unused opioids properly, specifically by contacting local law enforcement or using the Drug Enforcement Administration (DEA) medication discarding and take-back programs. If there are none in your area, contact your pharmacist on how to properly discard the medication.

It is critical to realize that anybody who uses opioids, either prescribed or illegal, are at risk of developing dependence and possible addiction. Therefore, we must educate ourselves and our community of this matter to combat this evolving crisis one neighborhood at a time.

Charles E. Crutchfield III, MD is a board-certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He received his M.D. and Master’s Degree in Molecular Biology and Genomics from the Mayo Clinic. He has been selected as one of the top 10 dermatologists in the United States by Black Enterprise magazine. Dr. Crutchfield was recognized by Minnesota Medicine as one of the 100 Most Influential Healthcare Leaders in Minnesota. He is the team dermatologist for the Minnesota Twins, Vikings, Timberwolves, Wild and Lynx. Dr. Crutchfield is an active member of both the American and National Medical Associations, and president of the Minnesota Association of Black Physicians.

 Alexis E. Carrington is a senior medical student at St. George’s University School of Medicine and a graduate of Pepperdine University. She is currently applying for a dermatology residency and research fellowship.

New technology could revolutionize food safety

Rarely does a month go by that there is not some national recall or warning about tainted foods. Food contamination is a worldwide problem. Recently, there was a nationwide ban on romaine lettuce in the U.S.

In 2008, for another example, 50,000 babies were hospitalized in China after eating infant formula contaminated with melamine, an organic chemical used in the manufacture of plastics. Melamine is toxic when present in high concentrations.

In April of last year, more than 90 people died and many others were blinded in Indonesia after drinking alcohol contaminated with methanol. Methanol is a toxic and cheap alcohol that is frequently used to dilute and extend liquor that is sold in black markets around the globe.

Here are some other facts bearing on the issue of food safety:

  • 48 million Americans get sick every year from the food they eat.
  • 128,000 Americans are hospitalized with illnesses that come from contaminated food.
  • Hundreds go blind from contaminants in bootleg alcohol.
  • 3,000 Americans die every year from contaminated foods.

If you have ever gotten sick from the food you have eaten or thought the food in the fridge smelled a bit off or wondered about the freshness or date printed on a food product you were about to consume, help may be on the way.

Researchers at the Massachusetts Institute of Technology (MIT) are using artificial intelligence to develop a wireless sticker system, called RFIQ (Radio Frequency IQ), that can check foods and drinks for a wide variety of illness-producing organisms and other tainted products. It would give consumers direct control over detecting contaminants in their food and drink.

They have developed a special, small, and very precise and accurate sensor that can attach to your smartphone and check for contaminants in food and beverages. The system should be able to:

  • Detect E. coli and other germs in produce and foods
  • Detect lead and mercury in water
  • Detect contaminants in alcohol and milk

MIT scientists are excited that they are developing a system that could revolutionize the field of food safety. Eventually, the device would be the size of a phone charger and plug directly into a smartphone. It would then interact with an app that directs the detection.

This technology has the potential to be a groundbreaking advance. There are thousands of people who have become critically ill from foodborne illness. As a result, many have a terrible relationship with food and live in constant fear, dreading every day doing something as essential to life as eating food.

The new system would enable people to test the food in grocery stores, farmer’s markets, restaurants and at home. For commercial foods and beverages, there could be a standardized, unique identifier code on the label that is scanned. If any contaminants are detected, not only would the device’s owner be alerted, but so would the product manufacturer, and even safety organizations like the Centers for Disease Control (CDC), for potential early and widespread warnings.

Ideally, the device will first serve individual consumers. Eventually, the MIT team’s goal is to scale-up the technology for commercial applications and then adopt it nationally, and even globally, so it becomes part of an invisible, seamless, food and beverage production infrastructure. Foods and drinks would then be scanned automatically before they ever hit the shelves or are sold in markets or served in restaurants.

Think about the profound effect this food safety technology can have; we could soon have the ability to check any food or liquid, before we eat it, making sure that they contain no contaminants.

The scientists are also developing additional technologies so the scanner can detect sugar, calories and other components. These additional capabilities would be extremely beneficial for people with diabetes, those watching their weight, or with food allergies.

Researchers say that the devices could be in consumer’s hands in as little as three to five years. The U.S. Food and Drug Administration has also expressed an interest in the project.

When it comes to food safety, the future looks bright.

For more information, read MIT’s RFIQ project report at bit.ly/2X2hXAC.

How safe is CBD oil?

From bath oils and soft drinks to skin creams and coffee bars, everywhere you look, you can see what looks like the next hot product: CBD oil.

CBD, or cannabidiol, oil is a member of the cannabinoid family of molecules found in marijuana and plants closely related to marijuana, such as hemp. Although CBD has been around since the 1940s, CBD’s popularity has dramatically increased along with the legalization of medical and recreational marijuana across the United States.

There are over 100 different cannabinoids found in marijuana and hemp plants. CBD and tetrahydrocannabinol (THC) are the most commonly studied cannabinoids. CBD oil is extracted from the buds and flowers of marijuana and related plants, such as hemp. But, unlike THC, which is psychoactive marijuana derivative oil, CBD does not produce a “high” or intoxicated feeling.

CBD does have medicinal benefits, however. Proponents of CBD claim that it can treat a variety of conditions including seizures, pain, anxiety, inflammation, insomnia, acne and other skin diseases, and even some forms of cancer.

Experts are not quite as enthusiastic because solid scientific research has not verified most of these claims, yet. That has not stopped marketers and producers. In addition to CBD-infused products popping up in bath and body stores and local coffee shops, many malls now have “CBD stores” dedicated to selling a variety of products containing CBD oil. You can even search “CBD oil” on Amazon.com and well over 1,000 products are displayed – all touted to treat a wide variety of health concerns.

Read on to learn more about the different types of cannabinoids and safety and effectiveness of CBD.

Three types of cannabinoids

Phytocannabinoids

These compounds, like CBD, are found in plants like marijuana and hemp.

Endocannabinoids

These are found in the human body, discovered as a result of studying phytocannabinoids. They are derivatives of a chemical called arachidonic acid. Many tissues and organs contain receptors for endocannabinoids, which are released by human tissues in times of pain and inflammation. It is well-documented that receptors for endocannabinoids are located throughout the human body, including skin cells and the nervous system and brain.

The endocannabinoids in the skin can regulate cell growth which can be used in cancer treatments. The endocannabinoids in the nervous system and brain may affect thinking and understanding, memory, body movements, and pain control.

Synthetic cannabinoids

These are man-made cannabinoids used for research purposes and in some currently available products. They may eventually be employed in pharmacologic preparations and drug treatments used for cannabinoid-responsive conditions.

The rest of this column will focus on the phytocannabinoid, CBD.

Is CBD safe?

Unfortunately, most CBD is being produced without regulation. As a result, purity and quality can vary greatly.

In a recent study, 70 percent of products evaluated contained a different amount of CBD than listed on the label. Most products examined had less CBD, but some had more. Also, about 15 percent of CBD-containing products had measurable amounts of THC. This derivative can cause anxiety, just the very thing CBD is reported to calm, and THC should not be in CBD products.

Additionally, CBD is poorly absorbed. Only about 20 percent of CBD gets absorbed, so the quality and purity of CBD products are critical for their effectiveness.

Some studies have shown that CBD can have adverse effects on the liver. This seems to be the case in about five percent of all people. Other studies need to be done to see how CBD affects a person if the person consuming CBD is taking other medications. This is extremely important.

In general, there are relatively few side effects. So, the downside in using CBD-containing products is relatively low, but liver and other possible drug interactions must be considered.

Is CBD legal?

This is really a grey and ever-changing area. It appears to be legal in the 30+ states where marijuana is legal, but the overall national legal status has not been challenged yet, and the FDA has taken a very quiet and conservative stance.

Recently, a farm bill was proposed and is expected to pass that will make hemp-derived CBD legal. Keep in mind that just because something is legal does not mean that it is FDA-approved to treat anything or everything that is printed on the label.

Is CBD effective?

There are CBD receptors in our bodies. In the presence of bound CBD, our bodies can produce physiologic responses. In fact, CBD is FDA-approved to treat certain epileptic seizures in children.

There is emerging research that CBD may be useful in treating anxiety, and there are countless anecdotal reports that it helps muscle aches, joint pain, depression, psychiatric conditions, and insomnia. The number of human trials for other diseases is small but promising.

In fact, CBD’s use as an anti-inflammatory may be the next area for future FDA investigation and approval. As mentioned, many cells in our bodies have CBD receptors, so it stands to reason that CBD can have other physiologic effects in humans, such as on pain, inflammation, anxiety, and sleep.

Unfortunately, due to the murky legal status of CBD, research to uncover these physiologic responses has been sparse. As for other health claims, much more research, especially on humans rather than animals, needs to be done. Unfortunately, due to lack of regulation, manufacturers of products that contain CBD can print just about any health claim that they want on the product label, and buyers, desiring a relatively inexpensive, natural treatment, may just believe it.

As the new farm bill clears, legality issues over research should move forward at a much faster pace. Additionally, the best method of CBD delivery (oral, topical or inhaled) should be studied for the best treatment results.

Should I use CBD?

CBD is a promising product for a variety of challenging medical conditions, but more research needs to be done. If one is considering the use of CBD when other tried-and-true treatments are not working, don’t just buy something off the shelf because the label says it will help you.

I would strongly suggest using CBD-containing products with the guidance and care of a physician knowledgeable about and familiar with CBD-containing products. The future appears bright for CBD-containing products, but its ultimate success will depend on the production of high-quality products with safe, proven and approved results.

Treating skin of color

First of a three-part series

Most skin diseases occur in people of all nationalities, regardless of their skin color. Particular problems encountered in the skin are more common in people with different hues of skin, and sometimes a disorder seems more prominent because it affects skin color. This column and the two that follow will consider these problems and their treatments.

Skin tones
Variations in human skin tone

Variations in skin color

Skin color is determined by cells called melanocytes. Melanocytes are specialized cells within the skin that produce a pigment known as melanin. Melanin is produced and stored within special structures known as melanosomes, contained in the melanocytes.

The melanocytes make up only a small percentage of overall skin cells. In fact, only two to three percent of all skin cells are melanocytes. The variation in skin color we see across all people is determined by the type and amount of melanin produced by the melanocytes.

All people inherently have the same number of melanocytes. A recent theory indicates that the differences in skin color are really a reflection of the skin’s ability to protect against ultraviolet radiation.

Persons living closer to the equator produce more melanin because the ultraviolet radiation is more intense and ultraviolet protection is required by the human body. Groups of people living further away from the equator produce less melanin, resulting in lighter skin color.

One reason treating pigmented skin can be somewhat tricky is that traditional textbooks have had only black and white photographs. Additionally, many lesions have been described as red, pink, salmon, or fawn-colored. This certainly is true in Caucasian skin; indeed, many of the textbooks that were written had this as the majority patient type.

However, in tan, brown, or dark-brown skin, inflammation can look grey, copper, or violaceous in color. Additionally, certain conditions will have a slightly different presentation in pigmented skin.

Post-inflammatory hyperpigmentation and hypopigmentation

Melanocytes can either stop producing color or produce excessive color in cases of inflammation. Generally, in children, the cells stop producing color, especially in irritation of the diaper area. (I explain to parents that the cells tend to go to sleep.)

It is very common for a child of color to have a very light area of post-inflammatory hypopigmentation. This is where the inflammation of diaper irritation causes the melanocytes to stop producing color, leaving light or white patches.

With the appropriate treatment, the color almost always returns to normal within a few weeks. In older patients, inflammation can lead to post-inflammatory hyperpigmentation. This is most commonly seen in areas where acne blemishes heal, leaving a dark spot behind. These, too, will fade with time; however, it can be quite persistent.

Vitiligo

Vitiligo is a skin condition that occurs in all people, but it is most noticeable in patients with tan, brown, or dark-brown skin. I believe that vitiligo is really the end stage of several different disorders.

In some disorders, the melanocytes are attacked by the immune system, and they die. In other conditions, the melanocytes are pre-programmed to die early. No matter what the cause, ultimately, patches of vitiligo are white spots devoid of melanin.

Because these areas lack natural protection, vitiliginous patients must wear sunscreens to prevent ultraviolet radiation exposure and subsequent cancer later in life. In the majority of cases, vitiligo is probably the result of an auto-immune or inflammatory attack on melanocytes.

In these cases, topical anti-inflammatories and phototherapy, most notably narrow-band ultraviolet B, tend to be most effective. We have a success rate of approximately 75 percent in our clinic. In the remaining cases, these are probably related to a genetic program in the melanocytes where they die prematurely. Usually, with the appropriate treatment, signs of vitiligo can be reversed in one to two months.

Pityriasis alba

Pityriasis alba is a condition where white patches occur on the arms, trunk and, most notably, on the face. This is a widespread condition seen primarily in adolescent patients of color. It is a result of very mild irritation and/or eczema leading to post-inflammatory hypopigmentation where the melanocytes temporarily stop producing color.

Gentle topical anti-inflammatory lotions, mild cleansing bars, and ultra- moisturizing lotions can be used to treat pityriasis alba. The loss of color in this condition is usually only temporary and is most notably seen on the cheeks of adolescents.

Dermatosis papulosa nigra

This most commonly occurs in African American patients. Some people call them “flesh moles,” “Bill Cosby spots,” “Morgan Freeman spots,” and, more recently, “Condoleezza Rice spots.”

It tends to occur slightly more frequently in women than in men. These are tan to brown to black, raised papules that can occur on the forehead, cheeks, and neck. Under the microscope, they resemble other benign growths known as seborrheic keratoses.

We use a unique surgical technique in our clinic that can achieve excellent results in treating dermatosis papulosa nigra. Indications for treatment can be pain, itching, irritation, and cosmetic reasons.

Treating skin of color: part three

Conclusion of a three-part series

Most skin diseases occur in people of all nationalities, regardless of their skin color. Particular problems encountered in the skin are more common in people with different hues of skin, and sometimes a disorder seems more prominent because it affects skin color. This column completes our consideration of these problems and their treatment in this series.

Pseudofolliculitis barbae

This condition is also known as “razor bumps.” Hair is made of a protein called keratin, and it can be extremely inflammatory to the skin. It is called “pseudo” folliculitis because the hair can actually come out of the follicular opening and penetrate nearby skin, causing it to look like inflammation, or folliculitis, of that pore.

However, because it is just nearby the actual follicle, it is “pseudo” folliculitis. This is most often seen in persons with curly hair or hair that grows at an oblique angle to the skin.

Sometimes, if curly hair is cut extremely close, it never even exits the skin surface, instead penetrating the sidewall of the follicle (known as transfollicular penetration), or it comes out of the follicle and pokes the skin (known as extrafollicular penetration). The results are the same: The keratin invades the skin, producing a brisk inflammatory reaction that causes itching and the formation of pustules.

When pseudofolliculitis is mild to moderate, many topical treatments can be implemented, including a very gentle oatmeal-based shaving cream, and a non-electric razor with a safety guard, so the hairs are not cut too short. Shaving after a shower is also recommended when the hair is hydrated, so the final tip is soft as opposed to sharp.

Also, using a soft-bristle toothbrush to make circular motions in the beard area before bedtime can prevent the hair from penetrating as it grows throughout the night. Topical anti-inflammatory aftershave lotions and oral anti-inflammatories can also be used if necessary. In the majority of cases, this can provide satisfactory relief.

However, in certain instances in which relief is not achieved through these means, the best treatment is to remove the offending agent. In this case, I recommend laser hair removal.

Pseudofolliculitis barbae has been a vexing problem throughout history and can even interfere with occupations that require a clean-shaven face, such as military officers, peace officers and firefighters. Thankfully, this condition can be addressed by implementing appropriate treatments and techniques.

Tinea capitis

Tinea capitis, also known as ringworm, is endemic in African American children. Any child with a scaling, itching scalp should be thoroughly investigated for tinea capitis.

One of the clues to this is enlarged lymph nodes in the nape of the neck. I recommend a topical anti-itch anti-inflammatory lotion in addition to an oral antifungal agent. No matter what agent is used, it is essential that treatment occurs for at least eight weeks at a somewhat high dose, as advised by a board-certified dermatologist.

It is also recommended that all objects that touch the hair, such as combs, barrettes, rubber bands and pillowcases, be replaced or treated to prevent re-infection. I also advise all members of the household to use an anti-fungal shampoo throughout the treatment period for two months.

This is a prevalent yet easily treatable condition in young children. I believe that as people get older, the milieu of their scalp sebum changes, preventing an active infection. However, many adults can be carriers and pass it to their children, who are prone to the infection.

Melanonychia striata

This is a condition where brown to black longitudinal bands occur in many, if not all, the fingernails and toenails. This is a common, benign condition that is often seen in multiple family members. However, if one band should occur spontaneously without a family history, this should be evaluated for an underlying mole or melanocytic malignancy.

Voigt or Futcher lines

These are lines seen most commonly on the upper arms and sometimes thighs and are normal variations. They were named after a physician and anatomist who first described these near the turn of the century. They are harmless.

Melasma

Melasma is a common and vexing problem that I see on a regular basis in our clinic. It presents as hyperpigmented patches occurring on the cheeks, upper lip, forehead, and sometimes dorsal forearms. It can be extremely challenging to treat, and I inform patients that 25 percent of the time there’s not much we can do about it.

I also tell patients that it is a lifelong battle and something that we’ll always have to treat and use preventive measures to keep from coming back. It’s usually a result of hormones, genetics, and sun exposure. Commonly the hormones can include the initiation of oral contraceptives and/or pregnancy and childbirth.

I often tell patients that it’s a very rapid, uneven suntan occurring in the areas described. It’s exacerbated by sun exposure and, we discovered recently, heat exposure. So, people who enjoy saunas, hot showers, steam baths, and warm climates should know these can exacerbate the condition.

I had one patient who we had difficulty treating, and I asked if heat might be a potential factor in his melisma. He looked at me with a frown and said, “I’m a chef. I’m over a hot stove and opening ovens all the time.”

So, patients with melisma must consider meticulous sun protection and heat avoidance. I tell patients that they need to apply sun protection before they leave the house. Any amount of sunlight that touches their skin while walking from a car across a parking lot into a building, even on a cloudy day, is enough to trigger its occurrence.

Treatments include topical lightening agents, deep skin peels, and newer laser treatments. In three-quarters of patients, we certainly can see satisfactory results, although it’s one of the most challenging conditions that I treat. I see it almost on a daily basis in my practice.

Treating skin of color part 2

Second of a three-part series

Most skin diseases occur in people of all nationalities, regardless of their skin color. Particular problems encountered in the skin are more common in people with different hues of skin, and sometimes a disorder seems more prominent because it affects skin color. This column continues from last week our consideration of these problems and their treatments.

Acne

When treating persons of color, post-inflammatory hyperpigmentation (brown spots after the acne blemishes have healed) and active acne need to be differentiated. It is important to note that when one is treating acne, the brown spots that occur afterward are only residual effects, not active acne.

SEE ALSO: Treating skin of color Part 1

I usually employ a combination therapy when I am treating acne to achieve optimal results. This usually involves topical treatments, oral treatments, laser treatments and, in persons of color, topical lightening agents. These can include retinol, anti-inflammatory agents, and the bleaching agents kogic acid and hydroquinone.

I also discuss with patients the difference between active inflammatory, bumps, and the flat, brown spots left behind.

Dry or “ashy” skin

This is a problem seen in all patients, but when one has tan, brown, or dark-brown skin, dry skin tends to turn silvery white. This phenomenon is often referred to as having “ashy” skin.

I believe the most important component of any skin care program is a gentle, non-detergent cleanser and an ultra-moisturizing lotion. I recommend the lotion be applied immediately after patting the skin dry after a bath or shower.

This seals in the moisture achieved from the shower, and the appropriate moisturizing lotion can provide continuous moisture and protection throughout the day. Often, two or three days of this program can completely reverse dry or “ashy” skin.

Keloids

keloids

Throughout evolution, our skin has become quite skillful at repairing any sites of injury or damage. Once the integrity of the skin barrier has been interrupted, invaders such as bacteria, fungus and virus can penetrate the skin and essential bodily fluids can leak out. As a result, the skin’s repair system is rapid and complete.

Cells known as fibroblasts migrate into the area and produce protein to fill in the hole. The primary component of the repair product is collagen, and that is what makes up a scar.

Unfortunately, in some cases, and commonly in African Americans, the fibroblasts receive the signal to come in and repair the defect, but they do not get the message to turn off. As a result, too much collagen is produced, and the scar can become thick and hard.

When the collagen presses on nearby sensory nerves, the keloidal scar can also produce tenderness, pain, and extreme itching. The difference between hypertrophic and keloidal scars is that hypertrophic scars usually stay right at the site of injury, whereas keloids can actually spread and invade normal surrounding skin.

In our clinic, we use an aggressive six-month program to treat keloids effectively. It is one thing to remove a keloid surgically, yet it is another thing to keep it from coming back. Remember, the development of a keloid is a response to injury. By surgically removing a keloid, the skin is being re-injured — and that area has already shown it can form a keloid.

We perform regular treatments every two to four weeks over six months, including anti-inflammatory injections, topical silicone-based preparations, pressure dressings, and laser treatments to prevent the return of keloids.

Acne keloidalis nuchae

neck treatment

This condition is also known as folliculitis keloidalis nuchae, where small, very itchy bumps can occur at the nape of the neck. This is most commonly seen in African American patients, but to a lesser degree it can affect all patients.

It is most commonly seen in men, but can also be seen in women. Many male patients believe this is a result of a barbershop treatment where the barber had unclean clippers. This is entirely untrue, and I have seen many cases that develop without any previous haircuts.

One theory is that this condition is a result of a deep fungal infection. However, in my experience, I have performed many biopsies and analyzed cultures for fungus and special histology stains, but I have not yet identified a fungus infection. I believe this condition is just an anatomic and genetic variant, with itchy bumps developing from very mild irritation in this particular anatomic location.

Smaller bumps can be treated very effectively with a combination of topical and oral anti-inflammatory medication. In many cases, a short course can provide long-term results. Often a surgical approach is required if the lesions are too large. Nevertheless, the condition can be managed quite well.

Presentation: Celebrating Minnesota’s African American Photographers and Artists

Saturday February 17, 2018

This presentation will take place at the Minneapolis Hennepin County Library, 300 Nicollet Mall.

Presenters include: Olivia Crutchfield, Bruce Palaggi, Gilbert Baldwin and Dr. Charles Crutchfield III.

The time of this event is 11 am – 1 pm.

The George Scott Trio will provide entertainment, and refreshment will be served. The Pollination Project Foundation will sponsor entertainment and refreshments.

Spotlight on Minnesota’s Black Community Project  

The news on sexually transmitted diseases in America is shocking

Here’s what you should know to be safe

Sexually transmitted diseases (STDs) are infections that are spread from one person to another during sexual acts. These include vaginal, anal and oral sex. STDs are common, and their occurrence is on the rise.

The bad news is that STDs can cause dangerous health problems. The good news is that getting tested for STDs is easy, and most STDs are easy to treat.

The best way to prevent getting an STD is not to have sex. If you are sexually active, the chances of getting an STD are markedly reduced by properly using latex condoms or dental dams during sex. If you are monogamous, get tested and, if clear, remain so.

The Centers for Disease Control and Prevention has announced that the number of cases of syphilis and gonorrhea has increased dramatically over the past few years. In fact, both diseases are up almost 20 percent.

In the United States, we have the highest incidence of STDs of any Western industrialized country in the world. This article will limit discussion of STDs to syphilis and gonorrhea.

Gonorrhea is an STD caused by infection with the bacterium Neisseria gonorrhoeae. It prefers to infect warm, moist areas of the body, including the urethra, vagina, rectum, throat, eyes, and female reproductive structures.

Syphilis is an STD caused by an infection with the bacteria Treponema pallidum. In addition to being spread during sexual contact, syphilis can also be spread from either an infected mother to a developing fetus during pregnancy or to the baby during exposure to the birth canal at the time of delivery. Syphilis can have severe and devastating health consequences if left untreated.

Experts say that the increase in the incidence of STDs is a result of several factors, making up almost a “perfect storm.” One significant factor is funding, pure and simple.

Both state and federal programs aimed at educating the public on STD prevention have been cut back across the board. As a result, the public is less aware of, and more likely to contract, STDs.

One of the biggest proponents of STD education, testing and treatment is Planned Parenthood. Of note, most Planned Parenthood patients are women, but they also treat men. Politically, there are groups that are calling for cuts in funding for Planned Parenthood. Decreased funding will directly affect STD screening and treatment for a vast group of citizens.

Additionally, there are many STD clinics that are run by state health departments that can be negatively influenced by state funding cuts. In fact, many state-funded STD clinics have already closed their doors.

These health department-associated specialty clinics are so important because many at-risk people are ashamed to discuss their health concerns and status with their family doctor, or they don’t have the financial resources to seek testing and treatment from traditional avenues or clinics. These clinics can provide confidential screening and no-cost therapies for patients and are critical in reducing the spread of STDs.

As mentioned earlier, some STDs are without symptoms. Because of this, fewer people are getting tested for STDs, and healthcare providers are not as thorough questioning patients about sexual histories, practices, and precautions. As a result, they are also not doing subsequent STD screening tests as frequently. By not picking up active STD cases, they can spread further.

Additionally, HIV-AIDS, with the effective new treatments, has commonly been re-recognized to be a chronic medical condition rather than the “death sentence” it once was. As a result, the “scare factor” of contracting STDs has inappropriately diminished.

In evaluating the STD increase, one notices that the numbers are rising in all patient groups. With this in mind, community disparities are also noted. For instance, groups with explosive increases include Southerners, Black and Latino women, young adults, and men.

Dramatic STD increases are also recognized in the group of men who have sex with other men; that is, in the gay community. Even with large STD rate increases in these specific groups, the STD incidence rate appears to be up everywhere.

There are very significant consequences in not treating STDs, more so in women, but still with unwanted results in all people. Untreated STDs can lead to infertility, cervical and penile cancer, neurologic disease, and even death. In pregnant women, it can be spread to babies in utero, with striking health effects, including heart problems.

Sex is still a taboo topic in most of America. Talking openly and honestly about sexual practices and issues surrounding sexual health is still difficult for most people, even with their doctors. These attitudes need to change, and patients need better education and improved access to STD screening, testing, and treatment.

The good news is that testing for STDs is simple, and most treatments are incredibly effective.

Reference: NPR.org

If you are concerned about having an STD or want educational materials, contact your doctor, a local Planned Parenthood Clinic, or in Minnesota visit www.RedDoorClinic.org.