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OFFICE NOTES

Sports forms and other physical forms: At this time of year we are doing many physicals and filling out many forms for sports and camps. Please make sure that the parent/patient history form is filled out before giving us the form. In signing the form, we are stating that we not only examined your child and found him/her to be healthy, but also that we have reviewed your medical history.

Credit cards: As your children get older sometimes they come for their visits alone. Since we now take credit cards, you have the option of leaving your credit card information on file with us, so that you can easily pay for these visits and not have to worry about paying the bill later. If you are interested in doing this, please talk to Chris or Dara.

Physicals: Now that we see patients to the age of 21, we remind our older patients that we do not do parent conferences after high school. While we are happy to greet parents who accompany their young adults to the visit, the private conferences we hold with parents of 12-18 year old students stop. "This continues the health ownership of the young adult and transitions care."

Travel: Many people travel outside of the country during the summer. If your child is up to date on routine immunizations, there may not be any other vaccines needed for travel. However, sometimes a Hepatitis A vaccine and occasionally other vaccines or malaria prophylaxis are recommended. You can check our website for the link to the CDC website at www.yankusandungerleider.com or click here for the direct link wwwn.cdc.gov/travel/default.aspx. There you can look up what is recommended for the place to which you are traveling. We can do the Hepatitis A vaccine and malaria prophylaxis here, but we may recommend that you go to a group of Infectious Disease specialists who do travel health and can do these other specialized vaccines.

WARTS

Warts are very common in children and adults. They are caused by the human papilloma virus, which has many different strains. The most common type of wart, called the “common wart” can occur on the skin anywhere on the body, however they tend to occur more frequently on the fingers, hands, elbows and feet. They are small hard bumps, which are grayish brown, with rough surfaces and black dots in the center.

Warts are contagious and can be spread by touching someone’s wart, especially with an open area on your own skin, or touching something that someone with a wart has used, such as a towel or other moist surface. Children who bite or pick at their fingernails or tips of the fingers are more susceptible to contracting warts, because they expose areas under the skin which allows the virus to enter and cause the wart.

Most warts are not painful, but some can be. Plantar warts, which occur on the bottom surface (plantar surface) of the foot tend to be larger and are often painful, since they are constantly being walked on.

Some warts occur in the genital area, but not usually in children. Please see our article on the Gardasil vaccine and genital warts. www.yankusandungerleider.com/Gardasil.htm

Warts can be treated, but they often go away on their own, although it can take 6 months to 2 years. Since there is no medicine to treat the virus causing the warts, even with treatment, there is no guarantee that the warts will not recur. If there are many warts or they are painful, we may recommend treatment. The first treatment we often recommend is an over-the-counter topical liquid medication, which has an acid in it which gets rid of the layers of the wart over a period of time. When doing that, you need to be careful not to apply the acid to the surrounding skin. Another treatment that has shown to be effective in some studies is covering the wart with duct tape. This is thought to irritate the skin where the wart is and the body then has an immune response which destroys the wart. Not all studies have confirmed that this works, but it is harmless and it may make sense to try it if the acid is not helping.

If that doesn’t work or if there are many warts or the warts are on the face, we usually recommend seeing a dermatologist, who can freeze the warts, burn them off or use laser treatment. If the warts are plantar warts, you can also see a podiatrist for treatment. We do not recommend home treatment for warts on the face, genitals or rectum.

MOLLUSCUM CONTAGIOSUM

Another wart-like rash is molluscum contagiosum. It is caused by a different virus, called molluscum contagiosum virus, which is in the pox virus family. The rash is made of separate firm bumps which are flesh colored and can occur anywhere on the body. Unlike warts, though, they commonly occur on the arms, underarms, legs and trunk. They can also occur in the genital area. They are typically about 1/8” and have a small indentation in the center.

They are more contagious than warts; we often see them in family members, especially children. They are spread by direct person to person contact or contact with contaminated surfaces. They can also spread by scratching or rubbing the lesions.

The natural course for most people is for the molluscum to resolve without treatment in 6-12 months, but they can last longer. We often do not treat them, but if there are many or they are spreading through the family, we may refer you to a dermatologist for treatment. There they may remove them by freezing, scraping (curettage) or laser. Some children also develop an itchy rash or eczema around the areas of molluscum.

To prevent the spread of molluscum, your child should avoid touching, rubbing or scratching the lesions and should not share towels or washcloths. If in the genital area, they can also be spread through sexual contact. It is unlikely that they are spread in a chlorinated pool, but it is best to keep them covered. They can be spread by sharing towels or direct skin contact at the pool.

FIREWORKS SAFETY

As we are approaching the summer and in particular, July 4^th, many children and adults are excited to watch fireworks displays. That is the key: watching them, not setting them off. There are reasons why in New Jersey and New York all consumer fireworks are illegal.

Fireworks can cause severe burns, leading to scarring and disfigurement for life. They can also lead to loss of fingers and or hands and to blindness from eye injuries. They can even be fatal. Even those types of fireworks considered by many to be safe, such as sparklers, can cause minor burns, corneal abrasions and even serious burns, caused by clothing catching on fire from the extremely hot tips (can be 1800 degrees Fahrenheit). Bottle rockets are another type of fireworks commonly used at home; they often cause eye injuries, including those leading to permanent blindness or even enucleation (loss of the eye).

Another significant consequence of home use of fireworks is property damage (by the fires which can be caused by igniting fireworks).

Some of the causes of injuries included delayed or early fireworks explosions, errant flight paths of rockets, debris from aerial fireworks and mishandling of sparklers.

We and the AAP therefore recommend attending community fireworks displays, which are run by professionals.