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Hopkins Health
Ask the Dermatologist: Wound Care, Anal Cancer
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| Gerald Lazarus, M.D. |
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Are chronic wounds a problem?
Dr. Lazarus: Yes, and the costs to treat them can be sky high when you consider that up to 1 million people in this country experience venous insufficiency that results in skin ulcers, and 54,000 patients suffer chronic diabetic foot wounds each year. These chronic wounds destroy their quality of life, too. But many wounds are quite healable if patients receive appropriate and supportive care. This is certainly an area where expertise and patient education can make a big difference.
How so?
Dr. Lazarus: Patients who understand how to take care of these wounds do much better. Sometimes it’s just being aware of what can happen. For example, most diabetics with an insensate foot can’t feel their foot, even if it’s injured. So they don’t do anything to protect it.
What can you do?
Dr. Lazarus: We do a variety of things, including teaching diabetic patients how to redistribute their weight, how to exercise with an injured foot. Sometimes we use orthotics to help the patient protect the foot while exercising. If you can’t exercise or even walk, the diabetes is much more difficult to control.
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| Ciro Martins, M.D. |
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Is there a growing
incidence of anal cancer?
Dr. Martins: There’s definitely a higher incidence of dysplasia, a precancerous condition, among HIV-positive patients, which is why we’ve started an anal dysplasia clinic in our HIV service. We need to detect the disease earlier to prevent it.
How do you do that?
Dr. Martins: First we obtain an anal Pap smear. If we notice any abnormality, the patient is scheduled for high-resolution anoscopy, an examination of the anus in which we use a computer to obtain and store images. Any suspicious area seen under magnification is biopsied.
And if it’s positive?
Dr. Martins: If it’s a high-grade dysplasia, it has to be destroyed. People have used cauterization and cryotherapy, which have varied in their results. We’re one of five centers in the country using a new, less-invasive technique called infrared photocoagulation, a high-intensity pulse of infrared light, which can destroy the tissue without burning or freezing it.
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