Health for a Lifetime

Skin Disease For Children

Three Angels Broadcasting Network

Program transcript

Participants: Don Mackintosh (Host), John Chung

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Series Code: HFAL

Program Code: HFAL000213


00:01 The following program presents principles
00:03 designed to promote good health and
00:05 is not intended to take the place of
00:06 personalized professional care.
00:09 The opinions and ideas expressed are those
00:11 of the speaker. Viewers are encouraged
00:13 to draw their own conclusions about
00:15 the information presented.
00:50 Hello and welcome to Health for a Lifetime.
00:51 I'm your host Don Mackintosh,
00:53 and today we're gonna be talking with
00:54 Dr. John Chung. He is a Dermatologist from
00:56 Dalton, Georgia. He's practiced dermatology
00:59 for about 10 years there and we're glad you
01:01 with us today doctor. Now a dermatologist
01:04 is a what? What's that mean?
01:10 A doctor of the derm, of the dermis, skin.
01:13 Okay the dermis, which means skin.
01:15 And what are the functions of the skin?
01:17 Well there are many functions.
01:19 As you know it's the largest organ
01:21 of the body, okay. And it maintains homeostasis,
01:25 helps, which means the balance, balance, alright.
01:28 Exactly. It helps temperature regulation
01:32 with through sweating mechanisms and stuff like
01:35 that. And also it helps function as a barrier,
01:40 that is helps you from losing water and also
01:46 retards the entrance of potentially toxic chemicals
01:50 and microorganisms and also it has a way
01:55 to protect you from harmful ultraviolet rays.
01:59 And as your sense of touch to anything that's
02:01 related with that tactile sense. Yes.
02:04 Intimacy all those different things. Exactly.
02:06 So, I mean to ask a dermatologist what does
02:09 the skin do, I mean you could probably go on
02:10 for years. Right. But those are the general
02:13 type things, that's correct. What are some of
02:16 the more common problems that you see in your
02:19 practice? Well I see a lot of problems,
02:22 but you know before I go on with that I would
02:25 like to just tell you, when I was in residency
02:28 I saw a patient without skin, what happened was,
02:34 no skin? No skin, the reason why,
02:36 he had skin when he was born but he took
02:39 a medication and his entire skin slipped off.
02:44 And he looked like a raw meat. And he died from
02:49 dehydration and sepsis, which is an infection.
02:53 Right exactly. So skin is very,
02:56 very important organ. So you can actually do
02:58 something that would, man I never heard that
03:00 before though all your skin fell off,
03:02 that guy's skinless, right. So, a medication
03:07 from taking one pill. Oh man. You wouldn't mind
03:13 sharing with us what that pill was, would you?
03:15 No. Okay, so it was something.
03:17 Well I don't want to take it that's why I asked. So
03:19 let's talk about some of the common skin disorders
03:22 that you see you know day and day out.
03:25 Well you can divide into children and adults.
03:29 Alright talk about the children's then.
03:31 In children you have a, like Atopic dermatitis.
03:34 Okay what is that, what's Atopic dermatitis?
03:37 Well Atopic dermatitis is inflammatory condition
03:44 of the skin that occurs in, it usually
03:49 occurs in children starts before age two months.
03:54 Okay. And most of them get it before age 5 up to,
04:00 about 60 percent or so and by well actually
04:09 60 percent by age one. Okay. And by age 5 you
04:14 have about 90 percent. Alright. And so how many
04:18 kids get it in America? You know how many of the
04:22 population will get it. I mean it's significant.
04:26 There are probably about maybe 2 or 3 percent,
04:33 2 or 3 percent, so that's a lot of kids.
04:34 Is it inherited, is it genetic, is it some kind
04:36 of familiar thing that goes with. Yes. Aha.
04:40 About I would say about 60 percent of the children
04:43 will have Atopic dermatitis if one of the parent
04:46 has it, but if both of the parents have it then
04:50 about 80 percent. Okay. So maybe you people
04:54 are dating they should find out they have this.
04:57 Maybe sad, it can be treated right? Right,
05:00 absolutely. Okay so we'll talk about in a minute.
05:02 What are some of the things that can make
05:04 it worse, exacerbated as you would say? Right,
05:07 well certain foods. Okay. For example like eggs,
05:11 dairy products, peanuts there's some like soy beans
05:20 some people are allergic to, and also wheat
05:25 and fish, okay. So when they come to you,
05:28 just have to do a checklist of all the stuff
05:29 they eat? Yeah that, you know sometimes you know
05:32 the parents would tell me every time he drinks milk
05:35 he breaks out, you know, you know that.
05:38 Actually that doesn't cause it but it's a
05:41 exacerbating factor. Okay, because this is
05:43 more of a genetic condition.
05:45 Now there are other things it can be caused
05:48 by is like dust mites inhalation. Okay.
05:52 And also with microorganisms like
05:56 Exotoxin from Staphylococcus Aureus.
05:59 So from an infection. Infection, a toxin from
06:04 infection. Yeah. And also dehydration like frequent
06:09 washing and winter time, you know when there,
06:13 your skin is dry, exactly. And stress can play
06:18 a significant role as well. So think kids go through
06:22 stress, one parent divorces another,
06:24 something like that you've seen them come
06:25 in with things like this. Right. So what other
06:28 problems is it associated with,
06:30 if you get this Atopic dermatitis,
06:33 can it cause other problems?
06:35 Well it can be associated with other problems.
06:37 Okay. Asthma, hay fever and there's something
06:41 called Pityriasis Alba, what that is,
06:44 is a condition that you see in darker skin
06:47 in individuals. Asians and Afro-Americans were,
06:54 they have kind of whitish areas on the skin,
06:57 especially on the face, torso and the arms,
07:01 and that's, it comes out of Atopic dermatitis.
07:05 Some people call it as a Burn Top Atopic Dermatitis.
07:08 But you can have that and also you have
07:11 something called Keratosis Pilaris which
07:14 is a bumpy like a goose bump type of rash
07:18 that occurs on the upper lateral arms,
07:21 thighs, cheeks, sometimes it could be much
07:23 more extensive on the trunk. And also it can be
07:26 associated with something called Ichthyosis
07:30 Vulgaris which is just a fancy term for very,
07:35 very dry skin. And it can be associated with
07:42 something called Molluscum Contagiosum
07:44 which we maybe talking by later on.
07:47 And that is a virus, a special wart virus that
07:54 occurs in the area lot of times and the area
07:58 of the damaged skin. Okay. And also common
08:04 warts and there is a, and a lot of people
08:08 have like fever blister, we call that Herpes
08:12 and they can also be exacerbated by the,
08:18 when you have the condition of Atopic
08:21 dermatitis. So what do you do when someone
08:23 comes in, you diagnose them, they have Atopic
08:25 dermatitis and how long is it gonna last?
08:28 Do they have a long life? Is it gonna be forever?
08:31 Is it gonna be throughout their life?
08:32 And what do you for it? Well usually they
08:34 improve with time. Okay. But some people
08:38 maintain that for the rest of their life.
08:39 Is that right, and you can't really tell when
08:42 they come in? Yeah. Right. You know more severe
08:45 it is initially, probably it will last longer.
08:48 So what do you do to treat it? Main thing
08:53 is hydration of the skin. Hydration, hydration,
08:55 hydration. So fluids, liquids and you can,
08:58 will you display yourself? No. actually let's start
09:02 with bathing. Bathing is much more moisturizing
09:09 than shower. Okay so don't just spray yourself,
09:12 in other words get in the tub. Right,
09:15 get in the tub short and make sure it's not
09:18 too hot, you come out and you can use a soap
09:22 if you want. The type of soap that I like
09:24 to use is a hydrating type of soap without
09:27 any fragrance. So look for the type that has
09:29 kind of some moisturizers in it and no scent.
09:33 Right, Moisturizing soap. Okay. And then we,
09:36 after that use to get moisturizer and lot
09:41 of times, you probably, you could probably give,
09:43 prescribe some of these things or you get them
09:45 over the counter. You can get most of these
09:46 over the counter. Okay. So when you do that a lot
09:49 of times you can avoid going to the physician.
09:52 But once you come to the Physician
09:55 you'll be prescribed some medications,
09:58 for example a topical steroid and also there
10:03 is something out there that is Steroid-sparing
10:07 agents, which act like steroids without much
10:12 side effects. What about plant steroids,
10:13 you know lots of people have these now and
10:15 get them in a health food stores,
10:16 is that's something is good for this?
10:18 Well I wouldn't recommend that.
10:21 Because it's not really something you don't
10:22 know how much you are getting from it?
10:24 Right, exactly. And so it's better if you are
10:25 gonna take something like that have a physician
10:27 involved. Yes, because the type of steroids
10:29 we give it has exact concentration,
10:31 you will know what side effects it may give.
10:33 Well let's switch gears for a minute,
10:35 what about Acne, I mean lot's of people probably
10:37 there are kids come and talking about Acne,
10:38 that's maybe your number one seller.
10:41 Yes. Acne is very, very common.
10:43 And it's the inflammation of the something
10:47 called Pilosebaceous unit, that is Pilosebaceous
10:51 unit, yes. What that is, is a hair and
10:54 oil gland unit. Every time you've hair usually
10:59 have oil gland associated or attached to it.
11:02 Okay. Now the common places that you have
11:07 this is on the face and trunk.
11:10 Now you may not see much hair but,
11:14 we call that Vellus hair or peach fuzz
11:15 type of hair. That is, that is where usually
11:20 the Acne is involved. So that somehow gets
11:25 inflamed, somehow, what happens?
11:28 Well it occurs after puberty. It tend to occur
11:32 earlier and more severely in men, in males.
11:37 And it's multi-factorial and there,
11:39 it is pretty complicated. And it has several
11:44 factors we have to consider. Number one
11:47 is hormones which mainly the male hormones
11:50 called androgens. Okay. And the other is
11:54 bacteria, there is something called
11:58 Propionibacterium, Acnes. Okay.
12:03 And also abnormal characterization of the
12:10 hair follicle and there also has to be
12:12 a genetic predisposition. Let's say those again
12:15 real quick we have, we have what is it again
12:19 that we have there? The hormones, bacteria,
12:22 abnormal characterization and genetics.
12:26 So what's abnormal characterization? Okay.
12:28 Let me try to explain this, what happens is after
12:31 puberty your, the androgens, the hormones,
12:35 your hormones kick in, start stimulating your,
12:40 stimulating the production of the sebum or
12:43 the oil gland. Okay. So lots of, lot more oil
12:47 is produced. Which in turn causes excess
12:54 amount of sebum and bacteria that live
12:56 in there loves to eat that and it breaks down
13:00 the lipids into fatty acids because the bacteria
13:04 contains something called Lipase.
13:06 And these sebum and fatty acids combination
13:11 it causes, there's something called characterization
13:19 that occurs within the hair follicle unit.
13:22 Okay. That is hair follicle itself produce
13:27 kind of like, something like skin and it sheds
13:30 normally. I see. But influence of this,
13:35 these acids and bacteria, it causes these cells
13:43 instead of being extruded it gets sticky and
13:46 gets stuck. And then everything builds up under.
13:49 Right, exactly. And then oil keeps on producing
13:53 and then eventually it's kind of pops
13:55 to the dermis. And your body comes and tries to
13:58 get rid of it and forming pus and inflammatory
14:02 nodules. We're talking with Dr. John Chung,
14:05 we are talking right now about Acne,
14:07 I'm sure you are going to want to find out
14:09 how to take care of it so join us when we come back.
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15:13 Welcome back we're talking with Dr. John Chung,
15:15 we're talking about dermatology,
15:16 the study of the skin. We're talking about
15:19 on this program some common problems with
15:21 the skin that children have. Right now
15:23 we're talking about Acne, when we left on
15:25 the break we were talking about what it was,
15:28 how it happened, how it came about.
15:30 And now we're gonna ask Dr. Chung how
15:32 to treat it. Let's say I come in with 15 year
15:35 old Donald, my son, and I bring him and he
15:38 is just embarrassed, he's got Acne all over and
15:42 I'm saying you know we got a problem here and
15:45 then you're talking to him. Talk to me like you
15:47 talk to him. What would you say to him and
15:50 explain it to us? Well first of all you know
15:52 we talked about the fact that it's due to hormonal
15:56 control. That you would talk to him about the
15:58 hormones? Right hormones and the fact
16:00 that you know, you really can't control that.
16:02 It's natural, usually it's, it's, everybody goes
16:09 through it, it's normal levels. Right.
16:11 But the thing is there's some study show that milk,
16:14 because it contains hormones, okay
16:15 and stress and people you know not in
16:19 in son's case but in females around their periods
16:22 okay, their androgen levels tend to go up and during
16:26 those times there is a exacerbation of the Acne.
16:29 So you probably say hey you know if you're
16:31 hitting the dairy or the milk you might wanna
16:33 knock that off and. Well instead go home and
16:37 scrub his face, get out a Brillo pad or something
16:39 and try and get it off. Absolutely not,
16:40 because it doesn't, it doesn't work, not matter
16:42 how much you scrub that is gonna happen.
16:45 It may actually make it worse, it leads to more
16:47 scaring, but you know I always tell them
16:51 something you know that is you have to
16:53 give them hope, you know what I mean, right.
16:55 Because you don't, first of all you don't see
16:57 a Acne in 5 year olds or 95 year olds because
17:03 the hormone levels are low at that time.
17:05 Okay, so when they become 95 you know
17:07 you can tell them that their Acne will go away
17:08 absolutely. I'm sure that will be comforting,
17:11 that's almost like 80 years away. So,
17:16 are there certain kind of soaps or different
17:18 things they should use or is it just what,
17:22 do they take the dairy and the milk away and
17:24 then just wait? Well, there are some medications
17:27 but before we talk about the medications,
17:30 we need to talk about some other things that
17:34 maybe associated with different types of Acne.
17:37 Okay. Can we do that? Yeah, sure, go ahead.
17:39 What could be some different types of Acne?
17:41 Well, you know there is Acne that occurs in
17:45 females. Okay. That is associated with male
17:49 pattern hair growth called Hirsutism, okay.
17:53 That they may or may not have irregular menses
17:57 and sometimes they have weight gain,
18:02 we call that Polycystic Ovary Syndrome.
18:05 Okay. So if you have that, people like that they
18:08 need to see an endocrinologist or their
18:10 OB GYN to have it worked out. And also there's
18:14 something called Acne Conglobata,
18:15 which is a very severe form of Acne occurs
18:19 more commonly on the trunk, okay.
18:22 And there is another form of Acne called
18:24 Acne Fulminans, now this is a very severe form
18:28 of Acne, this is the most severe form of Acne.
18:30 Fulminans like Fulminats it goes all over the
18:33 place rapidly? Absolutely, very, very,
18:34 it's usually occurs in young males between
18:39 about 13 and 17. Acute onset, very severe
18:43 cystic acne, with pus formation and there
18:47 is ulceration involved. And there is malaise,
18:50 fever, joint pains, and elevated white count
18:55 and many times they need to get hospitalized
18:57 you know. Can you imagine, because
18:58 of all that infection that get into the blood stream
19:01 and really make it a problem. People actually
19:03 can die from this. and can you imagine
19:06 you know you come out of the hospital they
19:07 go did you have heart attack or stroke,
19:10 what do you have? No, I was in for Acne.
19:14 So Acne can be severe you know it's not just.
19:18 Right. So you have to explain if the severe type
19:22 of fulminating type and then everyone will
19:24 get quiet, right? Right. And we can talk about
19:29 treatment now. Yes so what do we do
19:30 to treat it? We said we do not try and scrub it off,
19:34 that doesn't work? Right absolutely.
19:35 We've already said get rid of the dairy products,
19:37 try that, those different things but what else
19:40 can we do? Okay. You can get rid of your
19:44 parents you know genetic predisposition,
19:46 but that doesn't gonna work.
19:47 That's not gonna work 'cause you're already
19:49 there, okay. Now, you have three major types,
19:56 they actually four, four. One is a antibiotics,
20:00 topical or oral, okay, the other is something
20:03 called Benzoyl peroxide, topical, the other
20:06 is retinoids, retinoids. Now these things in
20:12 combination will get best not just by itself.
20:17 So taking antibiotic, they used to give when
20:19 I was a kid, tetracycline, do they still do that?
20:21 Yes, tetracycline is a common thing and also,
20:24 any dangers with that? You always can have
20:29 side effects. But this is probably fairly safe,
20:33 but you have to take on an empty stomach
20:35 and most dangerous part about this is not
20:38 becoming pregnant. I emphasis that even
20:40 to males not becoming pregnant,
20:43 because they can always share with the female.
20:46 Okay. They need to know the fact. Alright.
20:48 And also there's something called
20:50 Minocycline, that you can take that a couple
20:54 of times a day or once a day because of this
20:56 severity and with that you can have sometimes
21:01 dizziness associated with it. So all of these things,
21:05 the antibiotic serves upsides and downsides,
21:08 right, potential downside. So what I am trying
21:11 to do is give them, if they need to,
21:16 oral antibiotics but I try to pick them off the oral
21:20 antibiotics as fast as possible.
21:22 But I try to use them, seven or ten days.
21:26 Oh no, no, no. Two months three months.
21:27 Few months, depends on how they respond.
21:29 Okay. But my main state is a topical medication.
21:33 So you get some kind of creams or something
21:35 you give them. Right, right. Topical medication,
21:37 Benzoyl peroxide product and retinoic product
21:41 like Retin A and so. If the Acne is really you know
21:45 open sores and stuff, you probably don't use
21:47 the topical, yes or no? Yeah, you can, you can.
21:51 But you really need unless it's very mild I usually
21:55 like to use some type of oral antibiotics and
22:01 females you can use estrogen products, okay,
22:04 birth control pills with high estrogen content.
22:08 Now there are patients who are,
22:10 we concentrate to conventional therapy and
22:16 very severe Acne and I go straight to something
22:20 called Accutane or Isotretinoin and that is
22:27 probably the best and a revolutionary way of
22:31 treating Acne. It's been around for sometime but,
22:36 and it's not an antibiotic it's not a cream but
22:38 it is something else. You say a form of Vitamin A.
22:41 form of Vitamin and would most dermatologists
22:43 know about that or you special in that regard.
22:47 Well most, almost, most physicians know about
22:50 that but you know that is very, very effective
22:54 but it has some side effects, okay.
22:56 Vitamin A therapy has some side effects.
22:59 Well Accutane, not Vitamin A. Because Vitamin A
23:02 and Accutane, Accutane is slightly different from
23:04 Vitamin A, okay. Now number one is dryness,
23:07 every single person who has gone through
23:11 Accutane they will tell you one of the worst
23:14 side effects is dryness. Because what it does
23:16 is it dries up the oil gland, that's what it causes.
23:18 Right. And also it can increase your triglyceride
23:22 level. So you got to be careful. Yeah,
23:25 since we monitor their blood levels and you have,
23:31 only goes up to over 800 or so,
23:34 you have to worry about Pancreatitis.
23:37 So it's although, that's why you would use it last,
23:39 you use other things because these are
23:41 some very risky side effects then, right.
23:42 And one of the and absolutely not to do while
23:49 on Accutane is pregnancy. It can cause very
23:54 severe birth defects. I see, you got to be very,
23:57 very careful about that. So these are the treatments
23:59 for Acne, anything else? That's pretty much okay.
24:03 Let's go on and talk about common warts.
24:06 And we got about three minutes left in the
24:08 program so let's talk as much as we can here
24:10 about warts. Well. What about that,
24:14 how do you get that? People think they're
24:17 from frogs actually. I'm just kidding.
24:19 That's what sometimes people say.
24:20 That's an old wives tale yeah. but it's you know
24:24 it's a virus that you get it from other people,
24:28 other kids. And so you give antiviral medication,
24:31 you got creams, what you do for them?
24:34 Well there are several ways one is freezing them,
24:39 the other is actually burning them off and
24:43 the other is cutting it off, but I would not
24:47 recommend that but one of the best treatment
24:50 at this point is something called Candida antigen
24:52 injection right into the wart and about 70 percent
24:56 of the people respond. So you would try and
24:58 take your own warts off at home. Yes we can.
25:01 And you know wart is a very funny thing
25:03 because a lot of times they respond even without
25:06 any treatment. And so you know if you don't
25:10 have to treat it, don't treat it.
25:12 the reason why you treat wart is because
25:15 it's unsightly and if it's on the bottom of the
25:17 foot it's very painful. Now the other thing
25:21 is if you're a criminal you know you're gonna
25:23 have a hard time with your thumb prints you know,
25:25 when you give your, if it's on the thumb
25:30 I mean so you got to get that out. Get that out.
25:34 Well I think there are another ways to track
25:36 criminals now besides warts probably DNA and
25:39 what not but that's interesting.
25:41 Okay so that gives us kind of an overview of
25:43 warts you know you see a lot of patients
25:46 I don't know hundreds of patients come through
25:48 your clinic every day, you're in the room only
25:50 for a brief moment many times just to say
25:54 a word and look over this or that, how do you
25:57 as a Christian physician you're part of the
25:58 Adventist Medical Evangelism Network,
26:01 how do you as a Christian physician gives
26:03 that caring touch of Christ to the patients you
26:06 see just briefly maybe they're just coming
26:08 in to get checked. Well being kind and also
26:13 touching them. I like to touch all my patients,
26:16 even though they have a skin problem you
26:18 touch them, right. Very important.
26:20 Just don't touch the warts, you know, right,
26:24 but touch them and sometimes I pray with them,
26:27 depends on their need, I don't pray with all the
26:29 patients but when the Spirit leads, that's when.
26:35 And as a result of working especially with kids,
26:42 what's the hardest? Is it most difficult to talk
26:44 to the children or to their parents?
26:48 Well probably parents, but you know treatment
26:53 when you actually treat, you know the children
26:56 are very, very scared and they cry and,
27:00 but at the same time the parents want to know
27:03 what's going on and try to explain and dealing
27:06 with all that, you know. So this is a, you know,
27:10 it sometimes some other things we talk about
27:12 sometimes are seemingly a little funny but they're
27:16 really not if it's happening to you, right,
27:18 it's kind of like you know this is happening to me
27:21 and so I'm sure you know I used to work in an
27:23 emergency room and we'd see a lots of different
27:25 people come through with different things and try
27:28 and be as helpful and direct as possible,
27:31 but you know let them know they're appreciated.
27:34 I can tell you're that type of doctor.
27:36 Thank you so much for talking with us today
27:37 about some of the common skin problems with
27:39 children, we didn't cover them all,
27:41 but we'll maybe talk about some more in
27:43 a future program. And thank you for joined us
27:45 today on Health For a Lifetime. Some really
27:47 practical things today and it's good to know that
27:51 we have dermatologists and frontline,
27:54 that can go pass the frontline defenses,
27:56 we hope that today's program will give
27:57 you skin health that lasts for a lifetime.


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Revised 2014-12-17