Leprosy Mailing List – August 20th, 2007
Ref.:
Care of the feet in leprosy and in other conditions.
From:
Ryan T., Oxford, U.K.
Dear Salvatore,
I have learned from the
recent correspondence. I
was glad to have a response to my comment on the need to think
sometimes in terms of what is helpful in General Health Services and
not just in terms of a leprosy service. Patients like advice to be
focused on their disease while Health care workers like common
denominators. Thus my patients with psoriasis will not read leaflets
on washing prepared for atopic eczema. My
nurses learn washing techniques which need not be specific for any one
of 3000 or so skin diseases benefiting from washing.
There are many resources and
I struggle a little in deciding which is best when their information
on something as simple as washing and oiling can differ greatly. There is of course the Wisdom
gained from Experience and I delight in what Grace Warren has to say
and I did start with Paul Brand when I was first introduced to Leprosy
here in Oxford while he was a visitor seeking the Chair of
Orthopaedics. The Recent
“Tissue Viability Journals” and two recent Texts on Pressure
Ulcers quote him in full. I
know some of the Hesperian books but had not looked at their web site. Thank you Felton! Glad too to get support for the
need to get those who treat Diabetes aware of the prior knowledge and
value of those who treat Leprosy.
The knowledge of those who
are experienced and much of Traditional Knowledge has to be questioned
for its evidence base. Of
course lack of evidence does not mean it must lack effectiveness. There is also much which is
obvious or common sense.
I have in front of me two
leaflets which I like very much but I question content. One is H.O.P.E. from DANLEP It
includes advice on soaking for 20-30 minutes and adds one teaspoon
full of common salt. I
question whether 30 minutes could be too long. Would patients ‘comply’
better with a shorter period (which anyway could be sufficient for
hydration and do less damage to the lipid responsible for barrier
function)? What is the
effect of common salt?
The second is from The
International Skin Care Nursing Group entitled How to look after Big
Foot. It adds a drawing
entitled “use a mosquito net”. Mosquitoes
of course transmit Filariasis, but nets do little to improve actual
elephantiasis. Nevertheless
in LF regions “use a mosquito net” is a priority message in the
General Health Services. Although
having nothing to contribute to Leprosy it is equally an important
message in the general health services where many patients with
leprosy live. Would the
present leaders in Leprosy ever entertain having such a message in
their leaflets? This is a
question to those who are taking leprosy into general health services.
I believe there is
information overload there which down grades the most important health
messages.
I have three Science papers
before me. From which I quote:
1) “our results provide a
better understanding of the disruptive effect of prolonged water
exposure on lipids.” It
is against prolonged soaks of the skin.
2) From a paper from Proctor
and Gamble reviewing the trend for skin creams manufactured by the
cosmetic industry for skin health “in short the multiplicity of
effects and formulations benefits seen with Niacinamide (Vit B3) make
it an ideal choice for a variety of cosmetic products targeting young
and old skin alike”.
Having recently done a skin
camp and identified several cases of Pellagra but also seen
beneficence from locally applied vegetable oils for a large number of
skin conditions I am visiting P&G to investigate whether there would be more science in
using Vegetable oils than a teaspoonful of salt.
3) epidermal barrier function
recovers at 360-400C and is delayed at 340C
or 420C,
What is it we are trying to
do with water when we wash and use emollients? Is it to prevent
cracking, reduce entry points, or restore epidermal barrier, or
promote healing? Do we really know
what we are doing when we call for tepid water?
Terence
