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- Abrasions, anal fissure, autolytic debridement, bed sore, Clostridium sp., collagen, collagen matrix, cuts, debridement, decubitus ulcer, diabetic ulcers, electrotherapy, epithelial, epithelialization phase, extravasation, gangrene, gas gangrene, human growth factors, hydrocolloid, hyperbaric oxygen, incision wounds, incontinence, infected surgical wounds, infectious arthritis, inflammatory phase, injuries, laceration, macrophages, mechanical debridement, microvascular, minor injuries, myonecrosis, necrotizing fasciitis, pressure ulcers/wound care, proliferative phase, puncture wound, remodeling phase, scrapes, scratches, sepsis, septic arthritis, skin damage caused by incontinence, skin graft healing (split thickness), skin ulcer, surgical skin flap ischemia, skin wounds, squamous, stitches, superficial, suture, vulnerary, wound care, wound healing.
- A wound is a break in the outer layer of the skin, called the epidermis. Wounds are usually caused by cuts or scrapes. Different kinds of wounds may be treated differently from one another, depending upon how they happened and how serious they are. Other wounds include puncture wounds, lacerations (cuts), pressure sores, anal fissures, extravasations (a drug accidentally going outside of a vein causing tissue damage), skin damage caused by incontinence (lack of bladder control), skin graft healing (split thickness), diabetic ulcers, and surgical skin flap ischemia (lack of blood flow to surgically attached skin).
- Healing is a response to the injury that sets into motion a sequence of events. With the exception of bone, all tissues heal with some external scarring. The object of proper care is to minimize the possibility of infection and scarring.
- There are basically four phases to the healing process: the inflammatory phase, proliferative phase, remodeling phase, and epithelialization phase.
- The inflammatory phase begins with the injury itself. In the inflammatory phase, there is bleeding, immediate narrowing of the blood vessels, clot formation, and release of various chemical substances into the wound that will begin the healing process. Specialized cells (macrophages) clear the wound of debris over the course of several days.
- Next is the proliferative phase in which a matrix or latticework of cells forms. On this matrix, new skin cells and blood vessels will form. It is the new small blood vessels (known as capillaries) that give a healing wound its pink or purple-red appearance. These new blood vessels will supply the rebuilding cells with oxygen and nutrients to sustain the growth of the new cells and support the production of proteins (primarily collagen). The collagen acts as the framework upon which the new tissues build. Collagen is the dominant substance in the final scar.
- The remodeling phase begins after 2-3 weeks. The framework (collagen) becomes more organized making the tissue stronger. The blood vessel density becomes less, and the wound begins to lose its pinkish color. Over the course of six months, the area increases in strength, eventually reaching 70% of the strength of uninjured skin.
- Epithelialization is the process of laying down new skin, or epithelial, cells. The skin forms a protective barrier between the outer environment and the body. Its primary purpose is to protect against excessive water loss and bacteria. Reconstruction of this layer begins within a few hours of the injury and is complete within 24-48 hours in a clean, sutured (stitched) wound. Open wounds may take 7-10 days because the inflammatory process is prolonged, which contributes to scarring. Scarring occurs when the injury extends beyond the deep layer of the skin (into the dermis, which is the second layer of skin).
- Unclear or conflicting scientific evidence:
- Aloe: Transparent gel from the pulp of the meaty leaves of Aloe vera has been used topically for thousands of years to treat wounds, skin infections, burns, and numerous other dermatologic conditions. Study results of aloe on wound healing are mixed with some studies reporting positive results and others showing no benefit or potential worsening of the condition. Early studies suggest that aloe may help heal skin ulcers. High-quality studies comparing aloe alone with placebo are needed.
- Avoid if allergic to aloe or other plants of the Liliaceae family (garlic, onions, tulips). Avoid injecting aloe. Do not apply to open skin, surgical wounds or pressure ulcers. Avoid taking by mouth with diarrhea, bowel blockage, intestinal diseases, bloody stools or hepatitis. Avoid with a history of irregular heartbeat (arrhythmia), electrolyte imbalances, diabetes, heart disease or kidney disease. Avoid taking by mouth if pregnant or breastfeeding.
- Alpha-lipoic acid: Alpha-lipoic acid (ALA) may reduce tissue damage that is often caused by long-term exposure to high levels of oxygen. While early studies are promising, more research is needed to fully understand how ALA might work for wound healing in patients undergoing hyperbaric oxygen therapy.
- Avoid if allergic to alpha-lipoic acid (ALA). Use cautiously with diabetes and thyroid diseases. Avoid with thiamine deficiency or alcoholism. Avoid if pregnant or breastfeeding.
- Arginine: Arginine, or L-arginine, is considered a semi-essential amino acid, because although it is normally synthesized in sufficient amounts by the body, supplementation is sometimes required (for example, due to inborn errors of urea synthesis, protein malnutrition, excess ammonia production, excessive lysine intake, burns, infection, peritoneal dialysis, rapid growth, or sepsis). Arginine has been suggested to improve the rate of wound healing in elderly individuals. A randomized, controlled clinical trial reported improved wound healing after surgery in head and neck cancer patients, following the use of an enteral diet supplemented with arginine and fiber. Arginine has also been used topically (on the skin) to attempt to improve wound healing. Early studies suggest that arginine may also help treat chronic anal fissures. Additional studies are needed.
- Avoid if allergic to arginine, or with a history of stroke, liver, or kidney disease. Avoid if pregnant or breastfeeding. Use caution if taking blood-thinning drugs (like warfarin or Coumadin®) and blood pressure drugs or herbs or supplements with similar effects. Blood potassium levels should be monitored. L-arginine may worsen symptoms of sickle cell disease. Caution is advised in patients taking prescription drugs to control sugar levels.
- Aromatherapy: Aromatherapy is a technique in which essential oils from plants are used with the intention of preventing or treating illness, reducing stress, or enhancing well-being. Preliminary data from one small study suggests aromatherapy may contribute to reduced pain intensity during dressing changes in wound care. Data are insufficient for forming any opinion for or against this application.
- Essential oils should only be used on the skin in areas without irritation. Essential oils should be administered in a carrier oil to avoid toxicity. Avoid with a history of allergic dermatitis. Use cautiously if driving or operating heavy machinery. Avoid consuming essential oils. Avoid direct contact of undiluted oils with mucous membranes. Use cautiously if pregnant.
- Ayurveda: There is some evidence that a traditional Ayurvedic treatment using specially prepared alkaline threads (ksharasutra or Ayurvedic setons) to achieve gradual cauterization may provide an effective alternative to surgery in patients being treated for anal fissures. Further research is needed to confirm these results.
- Ayurvedic herbs should be used cautiously. Some herbs imported from India have been reported to contain high levels of toxic metals. Ayurvedic herbs can interact with other herbs, foods and drugs. A qualified healthcare professional should be consulted before taking. Use guggul cautiously with peptic ulcer disease. User should avoid sour food, alcohol and heavy exercise. Mahayograj guggul should not be taken for long periods of time. Pippali (Piper longum) should be taken with milk and avoided with asthma. Avoid sweet flag, and avoid amlaki (Emblica officinalis) at bedtime. Avoid Terminalia hebula (harda) if pregnant. Avoid Ayurveda with traumatic injuries, acute pain, advanced disease stages and medical conditions that require surgery.
- Bovine cartilage: Reduction in inflammation and edema (swelling) and enhancement of the healing of wounds were effects that appeared in the medical literature of bovine cartilage during the 1950s and 1960s. In a preliminary comparison of potential wound healing effects with a commercially available ointment of 10% powdered bovine cartilage (Catrix® 10 Ointment) or Aquaphor® original formula in post-operative facial skin care with a laser resurfacing agent, Catrix® 10 Ointment was better. However, this study was a pilot study so its results need confirmation by follow-up clinical studies that clearly have the appropriate randomization and are double-blinded, given that such were in absence in this study. Also lacking in this study was a definition of primary outcome that therapeutically differentiated Catrix® 10 Ointment.
- Avoid if allergic or hypersensitive to bovine cartilage or any of its constituents. Use cautiously with cancer, renal (kidney) failure, or hepatic (liver) failure. Avoid if pregnant or breastfeeding.
- Calendula: Calendula (Calendula officinalis), also known as pot marigold, has been widely used on the skin to treat minor wounds, skin infections, burns, bee stings, sunburn, warts, and cancer. Calendula is commonly used topically (on the skin) to treat minor skin wounds. Reliable human research is necessary before a firm conclusion can be drawn regarding the use of calendula for wound healing.
- Avoid if allergic to plants in the Aster/Compositae family, such as ragweed, chrysanthemums, marigolds, and daisies. Use cautiously in patients taking sedatives, blood pressure medications, cholesterol medications, blood sugar-altering agents, and immunomodulators. Use cautiously with diabetes and in children. Avoid if pregnant or breastfeeding.
- Chamomile: Chamomile (Matricaria recutita, Chamaemelum nobile) has been used medicinally for thousands of years, and is widely used in Europe. There is promising preliminary evidence supporting the topical use of chamomile for wound healing. However, the available literature is not adequate to support the use of chamomile for this indication.
- Avoid if allergic to chamomile. Anaphylaxis, throat swelling, skin allergic reactions and shortness of breath have been reported. Chamomile eyewash can cause allergic conjunctivitis (pinkeye). Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk, and do not use immediately after these procedures. Use cautiously if driving or operating machinery. Avoid if pregnant or breastfeeding.
- Chitosan: There is limited evidence on the effects of chitosan in wound healing. Better studies are needed.
- Avoid if allergic or sensitive to chitosan or shellfish. Use cautiously with diabetes or bleeding disorders. Use cautiously if taking drugs, herbs, or supplements that lower blood sugar or increase the risk of bleeding. Chitosan may decrease absorption of fat and fat-soluble vitamins from foods. Chitosan is not recommended during pregnancy or breastfeeding.
- Dimethylsulfoxide (DMSO): Dimethylsulfoxide (DMSO) is a sulfur-containing organic compound. DMSO occurs naturally in vegetables, fruits, grains, and animal products. DMSO applied to the skin may prevent tissue death after extravasation of anticancer agents. It can be applied alone or with steroids. Limited available study also suggests that DSMO improves lack of blood flow in surgical skin flap ischemia. Currently, there is not enough scientific evidence available for the use of topical DMSO for diabetic ulcers.
- Avoid if allergic or hypersensitive to DMSO. Use caution with urinary tract cancer or liver and kidney dysfunction. Avoid if pregnant or breastfeeding.
- Eucalyptus oil: Eucalyptus (Eucalyptus globulus) oil contains 70-85% 1,8-cineole (eucalyptol), which is also present in other plant oils. Limited evidence suggests that eucalyptus essential oil may be beneficial for patients with skin ulcers when combined with antibiotics. More studies are needed to confirm these early findings.
- Case reports describe allergic rash after exposure to eucalyptus oil, either alone or as an ingredient in creams. Avoid if allergic to eucalyptus oil or with a history of seizure, diabetes, asthma, heart disease, abnormal heart rhythms, intestinal disorders, liver disease, kidney disease, or lung disease. Use caution if driving or operating machinery. Avoid with a history of acute intermittent porphyria. Avoid if pregnant or breastfeeding. A strain of bacteria found on eucalyptus may cause infection. Toxicity has been reported with oral and inhaled use.
- Gotu kola: Gotu kola, Centella asiatica (formerly known as Hydrocotyle asiatica), has a long history of use, dating back to ancient Chinese and Ayurvedic medicine. Preliminary study has demonstrated the ability of Centella asiatica extracts to promote wound healing, possibly through the stimulation of collagen synthesis. However, additional human study is needed in this area.
- Avoid if allergic to gotu kola, asiaticoside, asiatic acid, or madecassic acid. Avoid with a history of high cholesterol, cancer, or diabetes. Avoid if pregnant or breastfeeding.
- Honey: Honey is a sweet, viscid fluid produced by honeybees (Apis melliflera) from the nectar of flowers. The primary studied use of honey is for wound management, particularly in promoting rapid wound healing, deodorizing, and debriding necrotic tissue. The types of wounds studied are varied; most are non-healing wounds such as chronic ulcers, postoperative wounds, and burns. Currently, there is insufficient human evidence to support the use of honey for skin graft healing. Although honey has apparent antibacterial effects, more human study is needed in this area.
- Avoid if allergic or hypersensitive to honey, pollen, celery, or bees. Honey is generally considered safe in recommended doses. Avoid honey from the genus Rhododendron because it may cause a toxic reaction. Avoid in infants younger than 12 months of age. Use cautiously with antibiotics. Potentially harmful contaminants (like C. botulinum or grayanotoxins) can be found in some types of honey and should be used cautiously in pregnant or breastfeeding women.
- Hydrotherapy: Hydrotherapy is broadly defined as the external application of water in any form or temperature (hot, cold, steam, liquid, ice) for healing purposes. It may include immersion in a bath or body of water (such as the ocean or a pool), use of water jets, douches, application of wet towels to the skin, or water birth. These approaches have been used for the relief of various diseases and injuries, or for general well being. Hydrotherapy has been used in patients with pressure ulcers, and preliminary research suggests that daily whirlpool baths may reduce the time for wound healing. Better research is necessary in this area before a firm conclusion can be drawn.
- There is a risk of infection from contaminated water if sanitary conditions are not maintained. Avoid sudden or prolonged exposure to extreme temperatures in baths, wraps, saunas, or other forms of hydrotherapy, particularly with heart disease, lung disease, or if pregnant. Avoid with implanted medical devices like pacemakers, defibrillators, or hepatic (liver) infusion pumps. Vigorous use of water jets should be avoided with fractures, known blood clots, bleeding disorders, severe osteoporosis, open wounds, or during pregnancy. Use cautiously with Raynaud's disease, chilblains, acrocyanosis, erythrocyanosis, and impaired temperature sensitivity, such as neuropathy. Use cautiously if pregnant or breastfeeding. Hydrotherapy should not delay the time to diagnosis or treatment with more proven techniques or therapies, and should not be used as the sole approach to illnesses. Patients with known illnesses should consult their physician(s) before starting hydrotherapy.
- Iodine: It is not clear if healing of wounds or skin ulcers is improved with the application of topical iodine solutions. Iodine solutions may assist with sterilization as a part of a larger approach to the wound healing process.
- Reactions can be severe, and deaths have occurred with exposure to iodine. Avoid iodine-based products if allergic or hypersensitive to iodine. Do no use for more than 14 days. Avoid Lugol solution and saturated solution of potassium iodide (SSKI, PIMA) with hyperkalemia (high amounts of potassium in the blood), pulmonary edema (fluid in the lungs), bronchitis, or tuberculosis. Use cautiously when applying to the skin because it may irritate/burn tissues. Use sodium iodide cautiously with kidney failure. Avoid sodium iodide with gastrointestinal obstruction. Iodine is safe in recommended doses for pregnant or breastfeeding women. Avoid povidone-iodine for perianal preparation during delivery or postpartum antisepsis.
- Magnet therapy: The use of magnets to treat illness has been described historically in many civilizations. In modern times, magnetic fields play an important role in Western medicine, including use for magnetic resonance imaging (MRI), pulsed electromagnetic fields, and experimental magnetic stimulatory techniques. Early scientific evidence suggests that the time to heal wounds, including ulcers, may decrease with the use of static magnets. Better quality studies are needed before a firm recommendation can be made for wound healing.
- Avoid with implantable medical devices, such as heart pacemakers, defibrillators, insulin pumps, or hepatic artery infusion pumps. Avoid with myasthenia gravis or bleeding disorders. Avoid if pregnant or breastfeeding. Magnet therapy is not advised as the sole treatment for potentially serious medical conditions, and it should not delay the time to diagnosis or treatment with more proven methods. Patients are advised to discuss magnet therapy with a qualified healthcare provider before starting treatment.
- Pantothenic acid (vitamin B5): Pantothenic acid (vitamin B5) is essential to all life and is a component of Coenzyme A (CoA), a molecule that is necessary for numerous vital chemical reactions to occur in cells. Pantothenic acid is essential to the metabolism of carbohydrates, proteins, and fats, as well as for the synthesis of hormones and cholesterol. In animal research, oral and topical pantothenic acid has been associated with accelerated skin wound healing. However early human study results conflict. Additional evidence is necessary before a clear conclusion can be reached regarding this use of pantothenic acid or dexpanthenol.
- Avoid if allergic or hypersensitive to pantothenic acid or dexpanthenol. Avoid with gastrointestinal blockage. Pantothenic acid is generally considered safe in pregnant and breastfeeding women when taken at recommended doses.
- Papain: Papain is an enzyme that breaks protein bonds and has been used in Africa for treating burns. In standard western medical care, papain-containing debridement agents are commonly used to remove necrotic tissue and slough in burns, postoperative wounds, pilonidal cyst wounds, carbuncles, trauma wounds, infected wounds, and chronic lesions, such as pressure ulcers, and varicose and diabetic ulcers. According to reviews and clinical trials, papain may be very useful for wound debridement and for stimulating wound healing. More high-quality research is needed in this area.
- Use cautiously in patients sensitive to papain. Use cautiously in patients being treated for prostatitis. Use Wobenzym®, which contains papain, cautiously, especially in those with bleeding disorders or taking anticoagulants or antiplatelets. Use cautiously as an adjuvant to radiation therapy. Avoid in patients with gastroesophageal reflux disease. Avoid in patients using immunosuppressive therapy.
- Physical therapy: Physical therapy techniques, such as laser treatment, have been used to clean and heal wounds. Early evidence also suggests that high voltage stimulation or pulsed electrical stimulation may speed the healing of some types of skin ulcers. More research with similar outcome measures is needed to better understand the role of physical therapy for wound care.
- Not all physical therapy programs are suited for everyone, and patients should discuss their medical history with a qualified healthcare professional before beginning any treatments. Physical therapy may aggravate pre-existing conditions. Persistent pain and fractures of unknown origin have been reported. Physical therapy may increase the duration of pain or cause limitation of motion. Pain and anxiety may occur during the rehabilitation of patients with burns. Both morning stiffness and bone erosion have been reported in the literature although causality is unclear. Erectile dysfunction has also been reported. Physical therapy has been used in pregnancy and although reports of major adverse effects are lacking in the available literature, caution is advised nonetheless. All therapies during pregnancy and breastfeeding should be discussed with a licensed obstetrician/gynecologist before initiation.
- Psyllium: Psyllium, also referred to as ispaghula, is derived from the husks of the seeds of Plantago ovata. Psyllium contains a high level of soluble dietary fiber, and is the chief ingredient in many commonly used bulk laxatives. Results from human study suggest that psyllium may reduce the number of surgeries necessary to heal anal fissures. Further evidence is necessary.
- Avoid if allergic or hypersensitive to psyllium, ispaghula, or English plantains (Plantago lanceolata). Avoid in patients with esophageal disorders, gastrointestinal atony, fecal impaction, gastrointestinal tract narrowing, swallowing difficulties, and previous bowel surgery. Avoid ingestion of psyllium-containing products in individuals with repeated or prolonged psyllium exposure who have not manifested allergic or hypersensitive symptoms. Prescription drugs should be taken one hour before or two hours after psyllium. Adequate fluid intake is required when taking psyllium-containing products. Use cautiously with blood thinners, antidiabetic agents, carbamazepine, lithium, potassium-sparing diuretics, salicylates, tetracyclines, nitrofurantoin, calcium, iron, vitamin B12, other laxatives, tricyclic antidepressants (amitriptyline, doxepin, and imipramine), antigout agents, anti-inflammatory agents, hydrophilic agents, and chitosan. Use cautiously with diabetes and kidney dysfunction. Use cautiously if pregnant or breastfeeding.
- Rose hip: Rose hips are the fruits that develop from the blossoms of the wild rose (Rosa spp.). They are typically orange to red in color, but some species may be purple or black. When applied topically, the volatile oils of aromatic plants may have physiological effects that will facilitate wound healing. Rose hips contain several vitamins and minerals, including vitamin C, vitamin B1, vitamin E, calcium, zinc, and carotenoids, which could potentially promote wound healing when applied to the skin. Much larger and high quality clinical trials are needed to establish the therapeutic efficacy of rose hip and rose oil preparations in the topical treatment of surgical wounds and ulcers.
- Use cautiously in patients who are avoiding immune system stimulants. Use cautiously in patients who are taking anticoagulant or anti-platelet aggregating agents, antibiotics, antineoplastics, antiretrovirals, anti-inflammatory agents, "Long-Life CiLi", antilipemics, aluminum-containing antacids, salicylates, or laxatives. Avoid in patients who are allergic to rose hips, rose pollen, its constituents, or members of the Rosaceae family.
- TENS: Transcutaneous electrical nerve stimulation (TENS) is a non-invasive technique in which a low-voltage electrical current is delivered through wires from a small power unit to electrodes located on the skin. Electrodes are temporarily attached with paste in various patterns, depending on the specific condition and treatment goals. TENS is often used to treat pain, as an alternative or addition to pain medications. Therapy sessions may last from minutes to hours. TENS is often used in conjunction with acupuncture therapy. TENS has been tested for its effects on blood flow to skin flaps used in plastic surgery procedures such as breast reconstruction. TENS has also been evaluated in patients with skin ulcers, diabetic foot ulcers, and chronic ulcers of various causes. More research is needed in this area.
- Avoid with implantable devices, like defibrillators, pacemakers, intravenous infusion pumps, or hepatic artery infusion pumps. Use cautiously with decreased sensation, like neuropathy, and with seizure disorders. Avoid if pregnant or breastfeeding.
- Therapeutic touch: Although some studies report an improvement in wound healing with therapeutic touch, others show no benefits.
- Therapeutic touch is believed to be safe for most people. Therapeutic touch should not be used for potentially serious conditions in place of more proven therapies. Avoid with fever or inflammation, and on body areas with cancer.
- Vitamin A: In preliminary study, retinol palmitate significantly reduced rectal symptoms of radiation proctopathy, perhaps because of wound healing effects. Further research is needed to confirm these results.
- Avoid if allergic or hypersensitive to vitamin A. Vitamin A toxicity can occur if taken at high dosages. Use cautiously with liver disease or alcoholism. Smokers who consume alcohol and beta-carotene may be at an increased risk for lung cancer or heart disease. Vitamin A appears to be safe in pregnant women if taken at recommended doses; however, vitamin A excess, as well as deficiency, has been associated with birth defects. Excessive doses of vitamin A have been associated with central nervous system malformations. Use cautiously if breastfeeding because the benefits or dangers to nursing infants are not clearly established.
- Zinc: Although zinc is frequently cited as having beneficial effects on healing of incision wounds, few studies have investigated this use. Further research is needed. There are conflicting findings regarding the potential benefit of zinc for healing leg ulcers. Available studies reported no or few adverse effects.
- Preliminary evidence suggests that topical zinc oxide oil may help manage perianal and buttock skin damage in incontinent patients. Further research is needed to better understand the role of zinc for treatment of skin damage caused by incontinence.
- Zinc is generally considered to be safe when taken at the recommended dosages. Avoid zinc chloride since studies have not been done on its safety or effectiveness. Avoid with kidney disease. Use cautiously if pregnant or breastfeeding.
- Fair negative scientific evidence:
- Aloe: A well-designed human trial found no benefit of topical acemannan hydrogel (a component of aloe gel) in the treatment of pressure ulcers.
- Avoid if allergic to aloe or other plants of the Liliaceae family (garlic, onions, tulips). Avoid injecting aloe. Do not apply to open skin, surgical wounds or pressure ulcers. Avoid taking by mouth with diarrhea, bowel blockage, intestinal diseases, bloody stools or hepatitis. Avoid with a history of irregular heartbeat (arrhythmia), electrolyte imbalances, diabetes, heart disease or kidney disease. Avoid taking by mouth if pregnant or breastfeeding.
- This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
- American Academy of Family Physicians. .
- American Academy of Pediatrics. .
- Arnold M, Barbul A. Nutrition and wound healing. Plast Reconstr Surg. 2006;117(7 Suppl):42S-58S.
- Centers for Disease Control and Prevention. .
- Dini V, Bertone M, Romanelli M. Prevention and management of pressure ulcers. Dermatol Ther. 2006;19(6):356-64.
- Langemo D, Anderson J, Hanson D, et al. Nutritional considerations in wound care. Adv Skin Wound Care. 2006;19(6):297-8, 300, 303.
- de Laat EH, Schoonhoven L, Pickkers P, et al. Epidemiology, risk and prevention of pressure ulcers in critically ill patients: a literature review. J Wound Care. 2006;15(6):269-75.
- Natural Standard: The Authority on Integrative Medicine. .
- National Institute of Allergy and Infectious Diseases. .
- Pieper B, Sieggreen M, Nordstrom CK, et al. Discharge knowledge and concerns of patients going home with a wound. J Wound Ostomy Continence Nurs. 2007;34(3):245-53; quiz 254-5.
- Wu SC, Driver VR, Wrobel JS, et al. Foot ulcers in the diabetic patient, prevention and treatment. Vasc Health Risk Manag. 2007;3(1):65-76.
- Overview: Chickenpox (Varicella) is a highly contagious viral infection that causes red, itchy bumps on the skin.
- Before the chickenpox vaccine (Varivax®) was created, most children contracted chickenpox before age 15, with the majority of cases occurring between the ages of five and nine. The vaccine was developed in 1995 and since then, there has been a significant decrease in the number of chickenpox cases. In the few instances when the vaccine does not prevent the chickenpox (about 15% of the time), the infection is much milder than if the child had not received the vaccine.
- Chickenpox is not usually a serious infection in healthy children. However, it may cause problems for newborns, teens, pregnant women, adults, and people who have weak immune systems that make it hard for the body to fight against infections.
- Causes: A virus, called the human herpes virus 3 or varicella-zoster (VZV), causes chickenpox. This virus spreads easily from person to person through the air and physical contact.
- Symptoms: The first symptoms of chickenpox usually include a fever, a vague feeling of sickness or discomfort (called malaise), or decreased appetite. Within a few days, an itchy rash appears as small red bumps or blisters. The rash appears in batches over the next 2-4 days. It usually starts on the trunk and then spreads to the head, face, arms, and legs. Blisters may also be found in the mouth or the genital areas. Although some children may have only a few blisters, some may have as many as 100-300. The pimples will progress to red blisters that are teardrop shaped. The blisters mature, break open, form a sore, and then crust over. Most of the blisters will heal within 10-14 days, and usually do not cause scarring unless the blisters become infected when germs enter the open skin.
- Diagnosis: In children, chickenpox is usually diagnosed after a physical examination. A viral culture may also be performed to confirm a diagnosis. This is usually done if other conditions, such as herpes simplex, impetigo, insect bites, or scabies cannot be ruled out. However, it takes between 1-14 days to get test results. This same test may also be performed in vaccinated patients to determine if the natural Varicella virus or the vaccine is causing a Varicella-like infection. This test is useful, but it is sometimes difficult to detect the virus in the samples.
- Treatment: Treatment for chickenpox includes pain medicines such as acetaminophen (Tylenol®) or ibuprofen (Motrin®, Advil®). Do not give children younger than 18 years of age aspirin because Reye's syndrome, a life-threatening condition that causes brain inflammation and vomiting, may develop. Caregivers should talk to their children's pediatricians about recommended medications.
- Frequent, lukewarm baths are particularly helpful in relieving itching, especially when used with preparations of finely ground (colloidal) oatmeal. Commercial preparations of oatmeal, such as Aveeno®, are available in drugstores, or one can be made at home by grinding or blending dry oatmeal into a fine powder. Use about two cups per bath. The oatmeal will not dissolve, and the water will have a scum. One-half to one cup of baking soda in a bath may also be helpful. Do not rub the skin dry with a towel because this may irritate the skin. Instead, carefully blot the skin dry.
- Calamine® lotion and similar over-the-counter preparations can be applied to soothe the skin and help dry out blisters and soothe the skin.
- For severe itching, a type of over the counter medication called antihistamine diphenhydramine (Benadryl®) is useful, and it may also help children sleep. However, Benadryl® should not be given to children younger than six years of age as hyperexcitability may occur.
- Some experts recommend an antiviral medication, called acyclovir (Zovirax®), in children who catch chickenpox from other family members because such patients are at risk for more serious cases, which may lead to bacterial infections of the skin, pneumonia, or swelling of the brain (called encephalitis). To be effective, acyclovir must be taken by mouth within 24 hours of the first signs of the rash. Early intravenous (IV) administration of acyclovir is also used to treat chickenpox pneumonia.
- Prevention: A live vaccine, called Varivax®, was developed in 1995 to prevent chickenpox, and it is still used today. Data show that the vaccine can prevent chickenpox or reduce the severity of the illness even if it is used within three days, and possibly up to five days, after exposure to the infection. The vaccine against chickenpox is now recommended in the United States for all children between the ages of 18 months and adolescence who have not yet had chickenpox. Children are given one dose of the vaccine. Two doses one to two months apart are given to people over 13 years of age.
- Side effects of Varivax® include discomfort at the injection site. About 20% of vaccine recipients have pain, swelling, or redness at the injection site. Only about five percent of reactions are serious; these may include seizures, pneumonia, a life-threatening allergic reaction (called anaphylaxis), swelling of the brain, a rare skin reaction called Stevens-Johnsons syndrome, nerve damage (called neuropathy), herpes zoster, and blood abnormalities. Although these reactions are serious, they are uncommon and temporary. Children who have recently been vaccinated should avoid close contact with anyone who might be susceptible to severe complications from chickenpox until the risk for a rash has passed. Months or even years after the vaccination, some people develop a mild infection, called modified varicella-like syndrome (MVLS). MVLS causes similar symptoms as chickenpox, although it appears to be less contagious and has fewer complications than naturally acquired chickenpox.
- Recent evidence suggests that Varivax® effectively prevents the chickenpox 71-100% of the time. Vaccinated children who develop chickenpox generally experience a milder form of normal chickenpox infections. The Advisory Committee on Immunization Practices (ACIP) to the Centers for Disease Control and Prevention (CDC) recommends that children who are 4-6 years old get a booster shot to help maintain immunity against the virus.
- Overview: Croup refers to a group of conditions involving inflammation and swelling around the vocal cords and windpipe that leads to a cough that sounds like a bark, particularly when a child is crying. This cough may also cause difficulty breathing.
- Because children have smaller airways, they are more likely to develop croup than adults. It is most common in children who are younger than five years old.
- In North America, about 5-6 cases occur in every 100 children. About five percent of children experience more than one episode.
- Croup is not usually a cause for concern. Although croup usually goes away without medications, about 5-10% of children need to be admitted to the hospital to receive treatment, such as intravenous antibiotics.
- Causes: Croup is most often caused by the parainfluenza virus, which causes infections in the lungs and airways. The respiratory syncytial virus, the measles virus, or various other viruses, such as the flu, may also cause croup. In rare cases, a bacterial infection may cause croup. These infections may occur when a child inhales mucus droplets that have been sneezed or coughed into the air by an infected person. Children may also become infected if they touch a surface with germs on it and then touch their mouths, eyes, or noses.
- Symptoms: Symptoms include a loud, barking cough that is often worse at night. The child's breathing may be labored or noisy. Other symptoms include fever and a hoarse voice.
- Diagnosis: Doctors usually diagnose croup based on the observable symptoms and a physical exam. A doctor listens to the child's breathing with a stethoscope to see if there is wheezing or signs of a respiratory infection. The doctor also observes the child's throat for swelling. The doctor may swab the throat to determine what type of infection is causing the illness.
- Treatment: Croup does not usually require medical treatment. Instead, it can be treated with simple self-care techniques. Professionals recommend that children drink plenty of fluid, including water or low-sugar and low-acid fruit juices, and get plenty of rest. A humidifier may help reduce symptoms and improve breathing. If the child has a fever, acetaminophen (Tylenol®) may help. Avoid aspirin in children because it may cause serious side effects, including Reye's syndrome, a life-threatening condition that causes brain inflammation and vomiting.
- In rare cases, if the child's symptoms worsen, a doctor may prescribe medications, such as epinephrine or corticosteroids, to help open the airways. Antibiotics are only effective if the infection is caused by bacteria. In rare cases, a breathing tube may need to be placed in the child's airway.
- Prevention: To help prevent croup, children should regularly wash their hands with soap and warm water. This is especially important after using the bathroom, before eating food, and after touching objects that may contain disease-causing germs. Avoiding close contact with people who have contagious illnesses may also help reduce the risk of contacting infections. Parents or caregivers are also encouraged to talk with their children's pediatricians about recommended immunizations.
- Overview: Diarrhea is characterized by loose or watery stools. Diarrhea is a symptom of an underlying health problem, such as an infection, that prevents the intestines from properly absorbing nutrients from food.
- Diarrhea causes dehydration because the body loses more water and salts. Compared to adults, infants and young children have a greater risk of developing severe dehydration as a result of diarrhea. Symptoms of dehydration include dry skin, thirst, less frequent urination, light-headedness, headache, and dark-colored urine.
- It is estimated that children younger than five years old experience about one episode of diarrhea per year in the United States. About 222,000 people are admitted to the hospital each year for complications related to diarrhea, of which about 10% of patients are five years old or younger. About 400 people die each year due to complications, such as severe dehydration, in the United States.
- Causes: There are many potential causes of diarrhea. Infants and young children are most likely to develop diarrhea as a result of a rotavirus infection. Other common causes include bacterial or parasitic infections, lactose intolerance, certain medications, artificial sweeteners, and abdominal surgery.
- Symptoms: Children usually experience acute diarrhea, which only lasts a few days. Symptoms of diarrhea often include frequent and loose stools, abdominal pain or cramping, bloating, and fever. Other symptoms, such as nausea, vomiting, fever, and sometimes bloody stools, may occur if a patient has an infection. When a patient experiences frequent (several times a day), severe, and bloody diarrhea, the condition is often called dysentery.
- Diagnosis: Infants, young children, and older adults should visit their doctors if diarrhea lasts longer than 24-48 hours, if they have high fevers (100 degrees Fahrenheit or above), or if they have severe signs of dehydration, such as dry skin or dark urine. A physical examination and detailed medical history will be performed. Patients should tell their doctors if they are taking any drugs (prescription or over-the-counter), herbs, or supplements because these substances may be causing diarrhea. A doctor may take a sample of the patient's blood or stool to check for an infection.
- Treatment: Diarrhea usually requires little to no medical treatment, but anti-diarrheal medications, such as bismuth subsalicylate (Pepto-bismol®, Bismatrol®, or Kaopectate®) or loperamide hydrochloride (Imodium®), may help reduce symptoms. Parents and caregivers should carefully read the package labeling before giving medications to children. Children should also drink plenty of fluids to prevent dehydration. Patients may also benefit from drinks that contain electrolytes, such as Pediatric Electrolyte®, Pedialyte®, or Enfalyte®, to help restore lost salts.
- If a bacterial infection is causing diarrhea, antibiotics are prescribed to treat the infection.
- Prevention: Parents or caregivers should properly wash all produce thoroughly before eating to reduce the risk of developing gastrointestinal infections.
- If people are traveling to areas of the world that have poor sanitation, they should only drink bottled water. Parents or caregivers are also encouraged to carry anti-diarrheal medications with them, such as bismuth subsalicylate (Pepto-bismol®, Bismatrol®, or Kaopectate®) or loperamide hydrochloride (Imodium®).
- Children should only consume dairy products that have been pasteurized. Pasteurization involves heating liquids in order to kill viruses, bacteria, molds, yeast, protozoa, and other harmful organisms. This reduces the risk of developing a gastrointestinal infection that may cause diarrhea.
- Children should avoid or limit their intake of the artificial sweeteners sorbitol and mannitol because they are absorbed slowly and incompletely by the intestine and may cause diarrhea. These artificial sweeteners are commonly found in sugar-free products and chewing gum.
- Overview: A fever is an increase in normal body temperature. Healthy individuals typically have a body temperature of about 98.6 degrees Fahrenheit. The body temperature fluctuates by about one degree throughout the day. However, if a person's body temperature increases more than it normally does throughout the day, he/she has a fever.
- Fevers are usually not dangerous for adults, unless they are 103 degrees Fahrenheit or higher. However, in infants and very young children, even a slight increase in body temperature may indicate a serious infection. If a baby younger than 12 months old has a temperature higher than 100 degrees, a healthcare provider should be consulted immediately. Adults and children who have temperatures higher than 102 degrees that are not responding to medications, such as ibuprofen (Motrin®, Advil®), aspirin, or acetaminophen (Tylenol®), should visit their doctors.
- In serious cases, a fever may lead to a febrile seizure. This occurs when an infant or young child develops a seizure or convulsions when he/she has a fever higher than 102 degrees Fahrenheit. Most febrile seizures are caused by viral upper respiratory infections, ear infections, or roseola. A febrile seizure may cause shaking or jerking of the arms or legs, fixed stare, eyes rolling back, heavy breathing, drooling, and bluish skin. Children who experience any of these symptoms should be taken to the emergency department of a nearby hospital immediately.
- Causes: A fever is considered a sign of an underlying medical problem. Most fevers are caused by infections, such as the flu, pneumonia, or strep throat. Other common causes include extreme sunburn, exposure to hot environments, and certain medications. In rare cases, there may be no known underlying cause.
- Symptoms: The duration and severity of a fever may vary, depending on the cause. Children who have fevers may experience chills, increased sweating, shivering, and warm skin.
- Additional symptoms may also be present, depending on the cause. For instance, if a viral infection, such as the flu, is causing a fever, additional symptoms may include a runny nose, sore throat, headache, aching joints and muscles, nausea, and vomiting.
- If a child develops a fever when the body becomes overheated (called hyperthermia) as a result of vigorous exercise or exposure to extremely hot or humid weather, symptoms may include confusion, lethargy, or even coma. In some cases, people suffer from hyperthermia may also have an extremely high body temperature without the ability to sweat.
- Diagnosis: If a baby younger than 12 months old has a temperature higher than 100 degrees, a healthcare provider should be consulted immediately. Adults and children who have temperatures higher than 102 degrees that are not responding to medications, such as ibuprofen (Motrin®, Advil®), aspirin, or acetaminophen (Tylenol®), should visit their doctors.
- A doctor can easily identify a fever after taking a person's body temperature with a thermometer. However, because it is a symptom of an underlying medical condition, the cause must be identified in order to treat the patient. During a physical examination, a healthcare provider will take a careful medical and social history to determine the underlying cause. If a patient is taking a medication that is known to cause fevers as a side effect, the medication is usually the suspected cause of the fever. Medical tests may also be necessary.
- Blood tests may be performed to determine if an infection is causing a fever. Individuals with infections will have a high level of white blood cells, which fight against disease and infection. Samples of the patient's mucus, urine, blood, stools, and/or cerebrospinal fluid may also be taken to determine if an infection is present.
- Treatment: Children with fevers should be given acetaminophen (Tylenol®) or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin® or Advil®), and should drink cool fluids to help reduce a fever and maintain hydration. Although these do not treat the underlying cause of fever, they will minimize symptoms until the underlying cause is effectively treated. Medication is only recommended for the treatment of fevers that are higher than 102 degrees Fahrenheit. Parents or caregivers should carefully read the packaging labels to ensure that they give their children the appropriate dosages. Avoid aspirin in children because it may cause serious side effects, including Reye's syndrome, a life-threatening condition that causes brain inflammation and vomiting.
- Additional treatments, such as antibiotics, may be necessary depending on the underlying cause of the fever.
- Prevention: People can take precautions to avoid contracting infections that may cause fevers. Individuals should regularly wash their hands with soap and warm water. This is especially important after using the bathroom, before eating food, and after touching objects that may contain disease-causing germs. Avoiding close contact with people who have contagious illnesses may also help reduce the risk of contracting infections. Patients are also encouraged to talk with their doctors about recommended immunizations, such as the flu shot.
- Individuals should minimize exposure to ultraviolet light and use sunblock when they are exposed to sunlight for prolonged periods of time. This helps reduce the risk of sunburn, which may cause fevers.
- Overview: An ear infection occurs when a cold, allergy, or upper respiratory infection leads to the accumulation of pus, inflammation, and mucus behind the eardrum, blocking the Eustachian tube. This tube connects the middle ear to the back of the nose.
- More fluid may collect and push against the eardrum, causing pain and sometimes a temporary or, in severe cases, a permanent loss of hearing.
- Acute ear infections usually clear up after one to two weeks of treatment. Sometimes, ear infections last longer and become chronic (long-term). After an infection, fluid may stay in the middle ear. This may lead to more infections and hearing loss.
- Although ear infections are most common in young children, they may also affect adults.
- Causes: Ear infections can start with a bacterial or viral infection. In such cases,
the middle and/or outer structures of the ear become inflamed from the infection. Fluid may also build up behind the eardrum.
Bacteria cause about 65-75% of all ear infections. The most common types of these bacteria are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Viruses that may lead to ear infections include the respiratory syncytial virus (RSV), the most frequent type found, followed by influenza (flu) viruses.
- Ear infections also may be associated with problems, such as swelling in the Eustachian tubes, the narrow passageways that connect the middle ear to the throat. Normally, these tubes equalize pressure inside and outside the ear. A child's Eustachian tubes are narrower and shorter than an adult's. This makes it easier for fluid to get trapped in the middle ear when the Eustachian tubes dysfunction or become blocked during a cold. It also provides a perfect breeding ground for infections. Also, just as the mucus in the nose becomes thicker and harder to expel, fluid inside the ear may also become thick and difficult to drain.
- Another factor that contributes to ear infections is swelling of the small clumps of glandular tissue at the back of the nose (called adenoids). These are tissues located in the upper throat near where the Eustachian tubes connect. Adenoids contain lymphocytes, white blood cells that normally fight against infections. Sometimes the adenoids become infected or enlarged, blocking the Eustachian tubes. Infection in the adenoids may also spread to the Eustachian tubes, causing ear infections.
- Children also do not have fully developed immune systems, so it is easier for them to develop many illnesses, including ear infections.
- Symptoms: Ear infections are often difficult to detect in children because many children affected by this disorder do not yet have sufficient speech and language skills to tell someone what is bothering them. Common signs to look for include unusual irritability, difficulty sleeping, tugging or pulling at one or both ears, earache, fever, fluid draining from the ear, loss of balance, and unresponsiveness to quiet sounds or other signs of hearing difficulty. These signs may include sitting too close to the television or being inattentive. Fluid buildup in the middle ear also blocks sound, which can lead to temporary hearing loss.
- If the pressure from the fluid buildup is high enough, it may cause the eardrum to rupture, resulting in drainage of fluid from the ear, which may include blood and thick, yellow pus. This releases the pressure behind the eardrum, usually relieving pain.
- If there is fluid in the middle ear, it may feel similar to a sensation of ear fullness or "popping." The fluid behind the eardrum may block sound, so mild temporary hearing loss can happen, although it may not be obvious.
- Possible complications include short- or long-term hearing loss, ruptured ear drum, and inflammation of the rounded protrusion of bone just behind the ear, called the mastoid bone. When the mastoid bone swells, it is commonly called mastoiditis.
- Diagnosis: Ear infections are usually diagnosed after a medical history, physical exam, and ear exam. If a middle ear infection is suspected, a healthcare provider will use an instrument, called a pneumatic otoscope, to look at the eardrum for signs of redness, bulging, or fluid behind the eardrum.
- Reflectometry is used if the ear exam with a pneumatic otoscope does not indicate that fluid is behind the eardrum. The tip of a small handheld instrument is placed in the ear canal. This instrument sends off a sound. How the eardrum reacts to the sound tells the doctor if fluid is present.
- Tympanocentesis is performed when fluid stays behind the eardrum (chronic otitis media with effusion) or if an infection continues despite treatment with antibiotics. Tympanocentesis can remove the fluid. The doctor uses a needle to pierce the eardrum and suck out the fluid. A sample is usually tested for bacterial or viral growth. These tests reveal what kind of bacteria or virus is causing the infection and what medication is best for treatment. Patients may receive pain relievers or sedatives before the procedure.
- Treatment: Ear infections can be treated several ways. The best treatment option for a patient depends on several factors, including the person's age, medical history, level of pain, and the type of ear infection. Most ear infections go away without treatment in just a few days, and antibiotics will not help an infection caused by a virus. About 80% of children with acute otitis media recover without antibiotics, according to the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP).
- If a patient (adult or child) is uncomfortable, the doctor may recommend an over-the-counter (OTC) pain reliever, such as acetaminophen (Tylenol® or Tempra®) or ibuprofen (Advil® or Motrin®). It is important to read the labels closely on these medications and give the proper dosage, especially in children and infants.
- Ear drops are commonly used in both adults and children to relieve pain and inflammation. If fluid is not draining from the ear or ear tubes, prescription eardrops containing a local anesthetic (numbing agents) and anti-inflammatory drugs may be an option. Examples include benzocaine (Americaine Otic® or Otocain®) and antipyrine/benzocaine (Auralgan®, Auroto®, or Otocalm®). Ear drops containing neomycin and polymixin B (both antibiotics) are available for infections. These medications are also available as solutions and suspensions to treat a rupture.
- If the individual is younger than six months or has two or more ear infections within 30 days or fluid remains behind the eardrum (chronic otitis media with effusion), the doctor may recommend an antibiotic. The AAP and the AAFP recommend the use of high doses and short courses of amoxicillin (Amoxil®, Trimox®) or amoxicillin combined with clavulanate potassium (Augmentin®) in individuals (including children) with otitis media. Erythromycin antibiotics (Eryped® or Erytab®) may also be used.
- If fluid in the individual's ear is affecting his or her hearing or recurrent ear infections do not respond to antibiotics, surgery may be needed. The most common surgery for ear infections is a myringotomy. During this procedure, which requires general anesthesia, a surgeon inserts a small drainage tube through the eardrum. This helps drain the fluid and equalize the pressure between the middle ear and outer ear. Hearing should improve immediately. If the ear infections continue after age four, the surgeon may recommend removing the adenoids.
- Prevention: Ear infections are more common in children who are exposed to cigarette smoke in the home. Even fumes from tobacco smoke on the hair and clothes may affect the child.
- Breastfeeding a baby helps improve immunity and resistance to infections. This is because a mother's breast milk contains important proteins that improve a baby's developing immune system. The baby should be breastfed in an upright position to prevent the possibility of acquiring infections.
- Individuals should talk to their doctors about recommended vaccinations. Although there is currently no vaccine for infections, many immunizations can prevent illnesses that may progress to ear infections.
- Practicing good hygiene may also help reduce the risk of acquiring infections.
- Overview: A food allergy occurs when an individual's immune system mistakes a food protein (called an allergen) for a foreign substance. During an allergic reaction, the immune cells overreact to substances that are normally harmless and the body releases chemicals that trigger symptoms that can than affect the eyes, nose, and throat, as well as the skin and the lungs. Even a trace amount of the allergen can cause a reaction in sensitive individuals.
- Food allergy is usually common among people who have family histories of allergies. About eight percent of children (compared to only two percent of adults) in the United States are estimated to have food allergies. Food allergies are most common during the first few years of life, and as the immune system continues to develop, allergic sensitivity declines over the first decade of life for most children.
- According to the American Academy of Allergy Asthma & Immunology (AAAAAI), six foods cause 90% of food allergies in children. These six foods are milk, peanuts, soy, eggs, wheat, and tree nuts (such as pecans and walnuts). Children usually outgrow allergies to milk, eggs, and soy. However, allergies to peanuts, tree nuts, fish, and shellfish continue throughout adulthood.
- Risk factors: Children with skin disorders, such as eczema, which causes itching, scaling, and thickening of the skin, or psoriasis, which causes, dry, red patches of skin, are more likely to develop food allergies. In fact, food allergies are seen in about 35% of children with eczema.
- Children who have allergic reactions to inhaled substances, such as dust, mold spores, or pollen, also have an increased risk of developing food allergies.
- Even exposing children to trace amounts of peanut protein or peanut oil products may cause peanut allergies in children, according to one study. Because peanut allergies are among the most common and severe food allergies, the American Academy of Pediatrics recommends that children with histories of food allergies do not consume peanuts or peanut-containing products until they are three years old. Strawberries should also be avoided until the baby is about 10-12 months old.
- Children whose mothers have food allergies may be more likely to inherit the allergy if born by cesarean section, according to one study. One study of children with allergic mothers who had C-section deliveries found that the babies were seven times more likely to develop food allergies than predisposed children who were born vaginally. Although the reason for this is not clear, it has been suggested that cesarean deliveries might delay the colonization of the newborn intestine.
- Causes: Most allergies are inherited, which means they are passed on to children by their parents. Although people inherit a tendency to be allergic, they may not inherit an allergy to the same allergen. When one parent has allergies, each of his/her children has a 50% chance of developing allergies. That risk increases to 75% if both parents have allergies.
- The first, or several times after the body is exposed to nickel, the immune system becomes sensitized. During this process, the body's white blood cells develop immunoglobulin E (IgE) antibodies, which are proteins that are specialized to quickly detect and bind to the food allergens when they enter the body. These antibodies also trigger the release of chemicals (such as histamine) that cause allergic symptoms, such as red, itchy, and swollen skin.
- In some food groups, especially tree nuts and seafood, an allergy to one food may cause the patient to be allergic to all the members of the same group. This is known as cross-reactivity. However, it is also possible to be allergic to both peanuts and walnuts, which are from different food families. This is because the allergens for these products are very similar.
- Cross-reactivity is not as common in the meat food group. For instance, many patients who are allergic to eggs can eat chicken, and many patients who are allergic to cow's milk can eat beef.
- Symptoms: Food allergy symptoms vary among patients. Symptoms can develop anywhere from several minutes to several hours after ingestion. Reactions usually lasts several hours. Hives are the most common allergic skin reaction associated with food allergies. Hives are red, itchy, swollen welts on the skin that may appear suddenly and disappear quickly. They often develop in clusters, with new clusters appearing as other areas clear up. The most severe type of reaction is called anaphylaxis because it causes low blood pressure and swollen airways. The most dangerous symptoms of anaphylaxis are low blood pressure, breathing difficulties, shock, and loss of consciousness, all of which can be fatal. Asthma symptoms, including coughing, wheezing, shortness of breath, or difficulty breathing, may be triggered by food allergies, especially in infants and young children. Eczema, which is itchy, scaly, red skin, may also be triggered by food allergies. Others may experience itchy skin or facial flushing. Gastrointestinal symptoms may include vomiting, diarrhea, gas, and abdominal cramping. Some patients may develop a red rash around the mouth, as well as swelling of the mouth, stomach, and throat.
- Diagnosis: Food allergies may be diagnosed using a skin test or blood test. During a skin test, the skin is exposed to allergens that may be causing symptoms. A diluted form of the allergen may be scratched onto the skin's surface, injected under the skin, or applied to a patch that is stuck onto the skin. The skin is then observed for an allergic reaction. During an allergen-specific immunoglobulin E (IgE) test, or radioallergosorbent test (RAST®), a sample of the patient's blood is sent to a laboratory and mixed with allergens to determine if he/she has allergies.
- Treatment: Very severe reactions, such as anaphylaxis, can be treated with epinephrine. This medicine is injected and acts as a bronchodilator, which means it widens the breathing tubes. It also helps narrow the blood vessels, which increases blood pressure. Patients who experience anaphylaxis may be admitted to the hospital to have their blood pressure monitored and possibly to receive breathing support. Other emergency interventions may also include placing a tube through the nose or mouth into the airway (called endotracheal intubation) or emergency surgery to place a tube directly into the trachea (tracheostomy or cricothyrotomy).
- Less severe allergic reactions that affect breathing and blood pressure may be treated with an inhaled epinephrine bronchodilator. Some inhaled bronchodilators are available over-the-counter in the United States.
- Antihistamines, such as diphenhydramine (Benadryl®), reverse the actions of histamine, a chemical that triggers allergic symptoms. Diphenhydramine is injected when quick action is needed during a severe allergic reaction. It may be given by mouth to treat a less severe reaction.
- Corticosteroids are usually given through an IV (intravenously) at first in order to quickly reverse the effects of the chemicals (like histamine) that trigger allergic symptoms. These drugs reduce swelling and many other symptoms of allergic reactions. Individuals may also need to take a corticosteroid in pill form for several days after the initial treatment. These drugs are often given for less severe reactions. Also, a corticosteroid cream or ointment may be used for skin reactions.
- Prevention: Avoiding known food allergens is the best way to prevent an allergic reaction from occurring. Children's baby-sitters, teachers, and other caretakers should be informed of their allergies. To avoid eating a food allergen, parents should always ask about ingredients in the food when dining at a restaurant or someone else's home. Even a trace amount of the allergen can cause a reaction in sensitive individuals. Therefore, all cooking utensils should be thoroughly washed before serving food to children with food allergies.
- Parents should also read food labels carefully. Many countries, including the United States, have food labeling laws that require manufacturing companies to list all food allergens in common language, rather than scientific or technical terms.
- Some ingredients, such as hydrolyzed proteins, edible oils, lecithin, lactose, starch, flavors, and gelatin, may be derived from food proteins known to cause allergic reactions in sensitive individuals. To help patients avoid known food allergens, the U.S. Congress passed the Food Allergen Labeling and Consumer Protection Act of 2004 (FALCPA). The law, which went into effect January 1, 2006, requires food manufacturers to clearly state on their packages whether the food is made with any ingredients that contain protein derived from the eight major allergenic foods. These foods include milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat, and soybeans.
- If a child has a history of anaphylaxis, parents or guardians should carry an autoinjectable epinephrine device (known as an EpiPen®) with them at all times.
- Children with food allergies can also wear an identification bracelet that describes the allergy.
- Healthcare professionals should be aware of food allergies because some medications and vaccines contain food allergens that may trigger severe allergic reactions.
- Overview: Lice (also called pediculosis) are tiny, parasitic insects that feed on blood from their hosts, which may be human. When a human becomes infected with lice, it is not considered a major health concern. However, it typically causes the skin to become red and itchy.
- There are several types of lice, including head lice, body lice, and pubic lice. Head lice develop on the scalp, and they may be visible near the ears, shoulder, and at the nape of the neck. The lice produce small eggs, called nits, which attach to the shaft of hairs. After about one week, the nits hatch and more lice are then present. Body lice spend most of their lives on a person's clothing, crawling on the person's skin to feed a couple times a day. The females attach their sticky eggs to the seams and folds of clothing. Pubic lice, commonly called crabs, are found on the skin and hair of the pubic area and eyelashes. Lice are easily spread through close personal contact with an infected person or his/her belongings. However, lice cannot jump or fly from person to person.
- Lice are most common among schoolchildren, individuals living in crowded areas, and people living in poverty or unsanitary conditions.
- Causes: Humans can get lice after coming into direct contact with lice or their eggs. Lice cannot fly, but individuals may be exposed to them when they touch an infected person or his/her personal belongings, such as bed linens, clothing, stuffed animals, or towels. For instance, head lice are commonly transmitted after sharing pillows, combs/brushes, or hair clips. They can live for up to two days off of the body. Lice can also be spread through sexual contact or after using a toilet seat that was recently used by someone who is infected. Lice can survive about 1-3 days without a human host.
- Symptoms: Lice typically cause intense itching and small red bumps to develop on affected areas of the skin. The lice may be visible on the skin, body hair, clothing, or other personal items. They are about three millimeters long. Lice eggs, called nits, may also be visible on hair shafts. Nits look similar to dandruff, but they are not easily brushed away.
- Symptoms of head lice typically develop on the scalp, ears, nape of the neck, and shoulders. Symptoms of body lice may develop anywhere on the body that has hair. Symptoms of pubic lice typically develop in the pubic area and on the eye lashes.
- Lice usually do not cause serious health problems, even if it goes untreated. However, if children frequently scratch the skin, bacteria may enter the skin and cause an infection.
- Diagnosis: A diagnosis can be made after a physical examination. Although lice are very small, they are visible to the human eye. If lice are present, a positive diagnosis is made.
- Treatment: Lice can be successfully treated in several days with over-the-counter products and/or prescription-strength anti-parasitic medications. In order to prevent re-infection, it is recommended that parents or caregivers wash and vacuum items that may be contaminated. Also, people who live with or have close personal contact with someone who has lice should receive treatment as well.
- Children older than two years old who have lice can use over-the-counter lotions and shampoos, such as Nix® or Rid®, to kill lice and their eggs. These products are made with anti-parasitic medications (such as permethrin) that kill the lice. These products should be used as directed on the package labeling. Sometimes, treatment may need to be repeated 7-10 days later in order to get rid of all the lice. If over-the-counter (OTC) products do not successfully treat lice, a doctor may recommend stronger shampoos or lotions, such as malathion (Ovide®) or lindane (Kwell®), which are only available by prescription. Rare side effects may include seizures, dizziness, clumsiness, fast heartbeat, muscle cramps, nervousness, restlessness, irritability, vomiting, or skin irritation.
- Parents may also rinse their children's hair with vinegar after using an anti-parasitic shampoo. First, a parent pours vinegar onto a clean cloth. Then, the parent holds a lock of hair and wipes the hair from the root to the end. This process is repeated until all of the hair has been treated. Rinsing the hair with vinegar helps remove nits that stick to the shaft of the hair.
- Combing wet hair with a fine-toothed comb, or a nit comb (available at local pharmacies), may help remove lice and their eggs from the hair. This is generally used in combination with shampoos or lotions that are designed to kill lice.
- In order to prevent re-infections with lice, it is important to wash all items that may be contaminated. This includes items such as bed linens, pillows, clothing, hats, and stuffed animals. Wash the items for at least 10 minutes in hot, soapy water that is at least 130 degrees Fahrenheit. Then dry the items at high heat for at least 20 minutes. This kills any scabies, lice, or eggs that may be present. Combs and brushes should also be washed in hot soapy water or soaked in rubbing alcohol for one hour. Items that cannot be washed should be sealed in airtight bags for at least two weeks. The lice and scabies will die because they have nothing to eat. Individuals may also cover furniture with plastic drop cloths for two weeks to kill the parasites. However, plastic furniture coverings are not recommended if a toddler lives in the home because there is a risk of suffocation. Thoroughly vacuuming carpeting, furniture, mattresses, and tapestry effectively kills scabies and lice. After vacuuming, the vacuum bag should be thrown away immediately.
- Prevention: It is often difficult to prevent lice in young children. This is because children are in close contact with many other children during school and daycare. Children can reduce the risk of getting lice by not sharing hats, combs, hair pins/clips, or other hair products with others. Also, caregivers should wear gloves when treating children who have lice.
- Overview: Pinkeye (conjunctivitis) describes the inflammation or bacterial or viral infection of the membrane that lines the eyelid (called the conjunctiva) and part of the eyeball. Bacterial conjunctivitis is most common among children, and it is highly contagious.
- Even though conjunctivitis that is caused by an infection is highly contagious, it does not cause serious health problems if it is diagnosed and treated early. However, if left untreated, it can lead to serious eye damage, including permanent vision loss.
- Causes: Conjunctivitis can be caused by an infection, allergic reaction to allergens (such as dust mites or pollen), or exposure to chemicals or irritants. Bacterial conjunctivitis is most common among children, and it is highly contagious. If the bacteria are present on the skin, it may spread to the eyes, where it causes conjunctivitis. The bacteria can also be spread from sharing eye makeup or contact lenses or after touching or rubbing the eyes with dirty hands.
- Symptoms: In general, common symptoms include red, irritated, and watery, itchy eyes, blurred vision, and discharge from the eyes that forms a crust at the edges of the lids and on the eyelashes during sleep. Other less common symptoms may include pain and sensitivity to light.
- Allergic conjunctivitis affects both eyes. The eyes become extremely itchy and the eyelids swell. This form causes swelling as a result of excess water in the tissues of the conjunctiva and sometimes the whole eyelid. The eyes may also secrete a mucus discharge. Symptoms will continue as long as the person is exposed to the allergens, unless anti-allergy medicine is taken.
- Bacterial conjunctivitis usually affects one eye at first and often spreads to the other. Common symptoms include a feeling of grittiness in the eyes, irritation, reddening of the eyes, and a thick yellow-green discharge that may cause the lids to stick together, especially after sleeping. Symptoms generally last a few days. Depending on the type of bacteria that is causing symptoms, eye damage and/or vision loss may occur if treatment is not started.
- Viral conjunctivitis usually starts with one eye and often spreads to the other. Viral conjunctivitis is usually caused by the same viruses that cause upper respiratory (lung) infection, a common cold, or sore throat. Common symptoms include watery eye discharge and itchy eyes. Symptoms generally last a few days.
- Conjunctivitis caused by chemicals or irritants is usually painful and it may cause reddening of the eyes and sometimes mucus secretion. Depending on the type of chemical or irritant, eye damage may also occur.
- Diagnosis: Although tests are available to diagnose the specific cause of conjunctivitis, a diagnosis is typically made after a physical examination and medical history. A slit lamp exam, which uses a microscope to observe the eye, can confirm a diagnosis based on swelling observed in the conjunctiva. A sample of the patient's eye discharge may be cultured to determine whether a bacteria or virus is the cause. Allergy tests may be performed to determine whether the patient is allergic to specific substances.
- Treatment: Treatment of conjunctivitis depends on the cause of the infection. Patients who have bacterial or viral conjunctivitis in one eye may be prescribed antibiotic eye drops, pills, or creams for both eyes. This helps prevent the infection from spreading. It may take up to 2-3 weeks for symptoms of infectious pinkeye to completely go away.
- Patients who have allergic conjunctivitis are typically treated with antihistamines, ocular (eye) decongestants, and mast cell stabilizers. All of these medications help decrease the immune response, thereby reducing allergy symptoms. These medications are available as eye drops, eye creams, and oral pills.
- If conjunctivitis is caused by a chemical or irritant, the affected eye, including under the eyelid, should be flushed with saline. Some patients may also need topical steroids. Some chemicals can severely damage the eye, leading to vision loss, scarring, or surgical removal of the eye.
- Refrigerating medicated eye drops may help temporarily soothe eye discomfort.
- Prevention: Avoid exposure to known allergens. Do not touch or rub the eyes. Wash hands often with soap and water, especially after coming in contact with an individual who has bacterial or viral conjunctivitis. Wash bed linens and pillowcases regularly with hot water and soap to reduce allergens. Do not share eye makeup, contact lenses, or washcloths with other individuals. Wash hands thoroughly with soap and water before handling contact lenses. Properly clean contact lenses before wearing them. Wash hands thoroughly with soap and water before applying eye drops or ointment. Individuals who are diagnosed with contagious conjunctivitis (caused by a virus or bacteria) should minimize contact with others until they begin treatment and symptoms start to improve. This will help reduce the chance of spreading the infection to others.
- Overview: Whooping cough, also called pertussis, is a highly contagious bacterial infection of the respiratory system that causes uncontrollable coughing.
- Anyone can get whooping cough, but it is more common among infants (younger than six months of age) and children (ages 11-18) who have weak immune systems. This is because the immune system helps the body fight against diseases and infections.
- Before the whooping cough vaccine was developed, it was one of the most common childhood diseases and a major cause of childhood deaths in the United States, killing 5,000-10,000 children each year. There are fewer cases today because there are both pertussis-only vaccines and combination vaccines for tetanus, diphtheria, and pertussis.
- Infants and toddlers have the greatest risk of experiencing complications from whooping cough, and they are most likely to need hospital treatment. Complications may include ear infections, seizures, pneumonia, emphysema, bleeding in the brain, swelling in the brain, dehydration, slowed or stopped breathing, and/or hernias.
- If a person is diagnosed with whooping cough, treatment with antibiotics may help if given soon after symptoms develop.
- Causes: Whooping cough is caused by the bacterium Bordetella pertussis (or B. pertussis). The infection is passed from person to person by droplets of respiratory secretions that are coughed or sneezed into the air by someone who is already infected.
- Symptoms: Symptoms of whooping cough typically last 6-10 weeks, but they may last longer. Symptoms usually occur in three stages. During stage one, patients usually experience cold-like symptoms, such as sneezing, runny nose, mild coughing, watery eyes, and sometimes, a mild fever. This stage usually lasts several days to two weeks. An infected person is most contagious during this stage.
- During stage two, cold-like symptoms fade, but the cough worsens, changing from a dry, hacking cough to bursts of uncontrollable, often violent coughing. During a coughing episode, it may be difficult to breath. When the patient is able to breathe, a high-pitched, "whooping noise" may occur when he/she inhales through the swollen and narrowed airways. Vomiting and severe exhaustion often follow a coughing spell. But between coughing episodes (about 15 coughs an episode), the infected person often appears normal. This is the most serious stage of whooping cough, usually lasting from 2-4 weeks or longer.
- During stage three, the patient may improve and gain strength, but the cough may become worse. Coughing episodes may occur from time to time for weeks to months and may flare up if a cold or other upper respiratory illness develops. This final stage may last a few weeks longer in people who have never received the whooping cough vaccine. Children often have a much more severe form of the illness than adults who are younger than 60 years of age.
- In infants, complications may include pneumonia, ear infections, slowed or stopped breathing, seizures, and/or brain damage. In children and teenagers, uncontrollable coughing may lead to complications, such as a bruised or broken rib or a hernia.
- Diagnosis: Sometimes, doctors diagnose whooping cough simply by listening for a cough that is high-pitched and makes a "whooping noise." Medical tests, including nose or throat cultures or blood tests, may be needed to confirm the diagnosis. These tests look for the bacterium Bordetella pertussis, which causes the condition.A chest X-ray may be needed to look for signs of bruised or broken ribs.
- Treatment: Treatment for whooping cough varies, depending on the age of the patient and the severity of signs and symptoms. With treatment and rest, a case of whooping cough usually resolves in six weeks.
- Almost all infants with whooping cough who are younger than two months, as well as many older babies, need hospital care for a few days. With treatment, most babies overcome the infection without lasting effects, but the risk exists until the infection clears. In the hospital, infants and babies usually receive intravenous antibiotics, such as erythromycin, to treat the infection. They may also receive corticosteroid drugs, such as hydrocortisone, to help reduce swelling in the lungs. Sometimes, an infant's airway may be suctioned to remove mucus that might be making it difficult to breathe. The infant's breathing will be carefully monitored in case extra oxygen is needed. If the infant cannot keep down liquids or food, intravenous (IV) fluids or nutrition may be needed. In some cases, prescription sedatives may be prescribed to help the infant rest. The infant will also be isolated from others to prevent the infection from spreading.
- When whooping cough is diagnosed early in older children or teenagers, doctors usually prescribe vaccination, bed rest, and an antibiotic, such as azithromycin (Zithromax®) or erythromycin (E-mycin®, Eryped®). Although antibiotics will not cure whooping cough, they can shorten the duration of the illness and help prevent the infection from being passed to others. Some patients may need to take antibiotics for two weeks or longer. If the illness has progressed to the point of severe coughing spells, antibiotics are not as effective but may still be used. Unfortunately, there are few medications that help provide relief from the symptoms of whooping cough. Over-the-counter (OTC) cough medicines, such as dextromathorpan (Robitussin®), generally have little effect on whooping cough.
- Prevention: Vaccines for whooping cough are available. Doctors may give children a three-in-one vaccine (called DTaP) that protects against whooping cough and two other serious diseases called diphtheria and tetanus. This vaccine is generally recommended during infancy. It is given in a series of five shots that are usually given when children are two months, four months, six months, 12-18 months, and 4-6 years old. It takes at least three shots of the vaccine to fully protect a child against whooping cough, but a total of five shots are recommended by age six.
- Because the vaccine starts to wear off by age 11, doctors recommend a booster shot of the vaccine when children are 11-18 years old. This booster shot is commonly called Tdap.
- Adults are also encouraged to receive an initial Tdap or booster shot every 10 years instead of the Td booster shot. This vaccine protects adults from whooping cough and reduces the risk of spreading the infection to infants.
Copyright © 2011 Natural Standard (www.naturalstandard.com)
The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.