Posts for: May, 2012
Summer is just around the corner, insect bites and stings occur more commonly this time of the year. Bites from a group of insects classified as Hymenoptera by scientists account for the vast majority insect stings associated with significant medical problems and occasionally deaths in the USA. This group of insects include the bees, wasps, yellow jackets, ants, and hornets.
About 10 million people are stung each year by these insects. Ant bites alone make up more than 90% of that number. While distressing, serious manifestations affecting more than one body system e.g, skin/ lining of the nose, mouth or throat and the intestinal system or even the circulation can occur. These serious manifestations are called anaphylaxis in the medical literature and can be life threatening in about 60,000-80,000 children annually. Actual deaths from wasp and bee stings overall ranges between 30-120 annually in the USA.
These insects are social creatures and often sting to defend their colony. The bees, wasps and hornets of the Hymenoptera family fly slowly at about 4mph and often leave ample room for escape. Little children are slower moving and often can’t take advantage of this opportunity to get away quickly and avoid multiple stings.
How best to remove a stinger?
The honeybee is unique among other members of its species because it usually leaves a stinger in the skin after attacking. Wasps, hornets, yellow jackets do not do this. The longer the stinger stays in the skin, the more venom is released into the victim. Efforts to avoid disruption of the venom sac and release more poison into the body are at the heart of the current recommendation to use the blunt side of a spoon or other such utensil to scrape away the residual stinger when embedded in the skin. Tweezers are discouraged because these may actually encourage more venom release by squeezing in a pincer-like fashion. Bathing the affected skin areas with soap and water after removal and presenting for medical evaluation if additional concerns persist or symptoms worsen is recommended immediately. Prolonged prescence of the stinger deep within the skin may increase the likelihood of a serious medical reaction. Researchers at the Department of Entomology at the University of California, Riverside CA reported that prompt removal was far more important than the method of removal since their study showed that the bulk of the venom release occured shortly after the sting in their study published in the Aug 1996 issue of The Lancet.
The largest organ in the human body is the skin and the first line of defense against all things foreign like bacteria. The bite or stinger pierces through the skin and causes a good enough breach in the skin for bacteria from the environment to take advantage of this "open door" and make their way to cause infection under the skin. This could make the distress from the sting even worse, complicate the recovery process and will need to be evaluated by your physician.
Most stings occur in the proximity of a colony and noisy man-made activity. Perfumes, bright or dark colored clothing are well known inciting agents. Necessary precautions should always be taken when around a bee colony and local authorities need to be notified if there’s a swarm of bee sighting in the southwest USA. As of May 2000, reports of the very aggressive honey bee species called “ africanized killer bees” migrating from Brazil to the arid areas of Arizona, California, Nevada and New Mexico occurred.
Birth marks are common in the newborn period and depending on their characteristics can be observed for spontaneous resolution or mandate emergent medical attention. These marks often cause a lot of concern for parents who understandably worry about their newborn, the cosmetic effect and the clinical course.
What are these pinkish marks on the baby’s skin, Doc? Will they go away? What can be done to make it go away?
Many different skin lesions are possible in the newborn period, some are present at birth and others develop after birth. The scope of this post is not to describe every skin lesion possible in the newborn period. We apologize for the gross simplification and will concern ourselves with two types of skin malformations commonly seen in the newborn period. These are hemangiomas and vascular malformations.
The best example of a vascular malformation is the “Stork Bite”, also called a “Salmon Patch”. The medical terminology used is Nevus Simplex. These occur as a result of variation and flaccidity in the tiny blood vessels beneath the affected area of skin called capillaries, they are superficial and pale- pinkish in appearance as a result and very closely similar to salmon fish color hence, the common name. They are commonly seen in 30% to 40% of newborns especially around the neck, hairline posteriorly, forehead, area between the eyebrows and along the lower back. These marks require no treatment and usually fades within the first year of life. Crying episodes, changes in environmental temperature and, breath holding are some of the changes that can briefly make these marks more obvious. Salmon patches on the back of the neck and head usually persist and are often covered by hair.
Hemangiomas are seen in up to 10% of newborn. Hemangiomas could be present at birth or appear shortly after birth. Experts currently believe the to-be affected skin areas are determined early in the first trimester (1st 13 weeks) of pregnancy. Hemangiomas grow in volume as a result of the excessive increase in blood vessel formation. This growth is most rapid in the first few weeks of life and results in the formation of bright red lesions with some elevation above the surrounding skin and range in size from being smaller than a dime to lesions several inches across in size. Some hemangiomas are located deep in the skin and changes in body position can affect their color intensity as they fill and empty with blood with gravity. The potential body surface area involved, appearance and association with other medical conditions vary considerably. They usually reach 80% of the maximum size at about 3-6 months of life and a marked cessation of growth follows this period. This is then followed by a slow process of involution where the blood vessels are gradually converted to fibrous type tissue. The lesions undergo a slow regression with about 25% of lesions resolving between ages 2-3 and 75% resolving between ages 5 and 6. Even after lesion resolution, residual skin changes with redundant post inflammatory changes are not uncommon. All hemangiomas do not follow the course above and complications like bleeding, infection or the disturbance of adjacent body organ and function are possible. These cases are managed with specialists. Different treatment options including laser therapy, steroids, propranolol, embolization are being used. A current study is underway in Europe and the USA to learn more about the safety profile and the exciting therapeutic advantages promised by propranolol and related medications which were traditionally used for other purposes in the past.
Primary care physicians have long waiting times, however we will strive to put parents of these patients ahead of the line, the anxiety and the stress imposed by lesions on the skin of the newborn cannot be stressed enough and needs to be addressed promptly.
This information is for educational purposes only and not a substitute for professional medical care or advice. Always follow your healthcare provider’s instructions.