El Salvador Mission Trip 2012 - Part 5 -- Assorted medical problems

Fingernail clubbing

Just some pictorial representations of common findings from some of the 800 patients we saw. Keep in mind that most of the patients we saw did not have medical problems that could be photographed. The most common complaints and diagnoses were headaches, fatigue, eyes burning (all secondary to dehydration and dust from an acidic volcanic iron-rich soil). The picture shows fingernail clubbing (note the curvature of the nails) in a young paraplegic. He is wheelchair-bound and hunched over so does not take deep breaths. I suspect his clubbing is related to some lower lung atelectasis from his poor posture.


Ear pits

  Look at the little 'dot' in front of the ear near the place where the auricle attaches to the head. This young lady came in complaining of chronic drainage from this ear pit, which was located in front of both ears. The drainage was clear to white. I suspect it is a brachial cleft tract -- a tract left behind during embyrological development. Unfortunately, we did not have a solution for her. If she lived the States, we might have had an ENT specialist inject something into the tract and image it to delineate the anatomy and come up with a solution to the problem of constant drainage.


Flat wart

  This little boy had a flat wart. We offered reassurance to the family, explaining that these resolve without treatment.


Gum abscess

  This young girl was brought in by her mother for the two red bodies near the attachment of the inner lip to the gum line. I confess: I did not know what this was. Fortunately, our dentist did. He taught me that there were abscesses running from the roots of the maxillary incisors (the two front teeth) because of infection. Because of her age, he pointed out that when the teeth fell out this should resolve. We did give her some antibiotics. We saw a lot of dental caries and brought kits to varnish teeth with fluoride for the children. We varnished as many teeth as we could.


Lichen planus

  This older lady had adequate circulation in her upper extremities. When I got back to the States, I asked my dermatology colleagues what they thought this was. They suggested lichen planus. I could not think of anything I could do for this lady while I was in El Salvador. In any case, they did not hurt, had not progressed and did not bother her.


psoriatic patch on elbow

 This gentleman came in with a scaly rash on his elbows, lower legs, scalp. It was a textbook case of psoriasis.


psoriatic patch on dorsum of foot

 





Venous stasis dermatitis

 We gave him steroid creams to use for flare-ups. Treatment of psoriasis is expensive and sometimes technology-dependent. Could not offer any of the fancy immunumodulating drugs we have here in the U.S.

This picture of a leg from another patient showed some dermatitis due to decreased venous circulation in a diabetic.









Infected dermatitis

  This young man broke out in circular lesions on his arms bilaterally. We were suspecting a sexually transmitted disease related rash, or a viral infection. The skin lesions were itchy and had begun oozing pus. We treated him with antibiotics to cover him for the first and last condition we thought likely. (In the States, I might have done a punch biopsy and got the pathologist to weigh in, or sent him to a dermatologist)












This elderly woman came in with a non-healing, persisting ulcerative lesion slightly above her left eyebrow. From the appearance of it, we suspected squamous cell carcinoma, one of the skin cancers. We excised it. Here she is after the excision.

Skin closed after a squamous cell carcinoma excision


 I guess bathing is not a high priority when other problems are more pressing. This young man's ears were so packed with cerumen (ear wax) that it hurt him. We tried to remove it with a currette but it was painful and would not budge. Rather than damage his eardrum, we flushed his ears out.


getting ears flushed for cerumen impaction

 We did this for a lot of children and adults, getting out quite a bit of cerumen. Patients were surprised and in some cases, horrified, that all that came out of their ears. We followed it up with some basic hygiene education.