Tag Archives: Surgery


The skin is the protective barrier between the inside of our bodies and the outside world of microorganisms, parasites and toxins. It is often the site of inflammation and infections.

In past times, before the advent of cleanliness and antibiotics, mankind was plagued by erysipelas, boils, carbuncles, and other severe infections of the skin, which are rarely seen now. The beta hemolytic streptococcus and Staphylococcus aureus were ubiquitous in the past, and mostly are contained today.

Severe Infections presently require some skin abnormality, immune deficiency, neglect, animal bite or other breach of skin integrity to be a problem. Antibiotic resistance, however, is allowing some organisms like MERSA to make a comeback.

ECZEMA. or Atopic Dermatitis, was common in my medical practice. This condition weakens the skin barrier, allowing Staphylococcal infection to gain a foothold. In my day, If there were a flare of eczema severity, antibiotics would often help. Leg edema and swelling. such as from heart failure, especially coupled with diabetes and blood vessel disease is also an invitation to infection, such as cellulitis.

Redness, swelling, warmth and pain- the classic rubor, tumor, calor and dolor- as well as swollen local lymph nodes and fever often betray infection of the skin. Please see the recently posted infographic on celulitis.

IMMUNE DEFICIENCY raises the likelihood and risk of severe skin infections. Infection from “flesh-eating bacteria”, often beta hemolytic streptococci in deep tissue planes , is a medical emergency. Immediate surgery is often needed.

Disproportionate PAIN after injury or surgery is often a clue. Certain age groups have characteristic skin infections, such as the scalded skin syndrome of infants, and the acne of adolescents. Viruses, molds, and arthropods can also infect the skin.

Viruses, such as herpes in particular can simulate bacterial infection. Ringworm from fungi is easy to distinguish, but arthropod bites, and especially bee sting can look very much like bacterial infection. Scabies and mite infestation are so itchy as to be distinct.

Topical antibiotics applied on skin breaks like cuts or breaks are useful in preventing infection. These ointments and creams are like “artificial skin”. Once again, prevention is key.

–Dr. C.


My Mother had Tic Douloureux, the traditional name for Trigeminal Neuralgia. I remember her suddenly covering her face with her hand and grimacing, but this was only occasionally.

Compression, degeneration or inflammation of the 5th cranial nerve may result in a condition called trigeminal neuralgia or tic douloureux. This condition is characterized by recurring episodes of intense stabbing , sever, excoriating pain radiating from the angle of the jaw along one or more branches of the trigeminal nerve on one side. Usually involves maxillary & mandibular branches, rarely in the ophthalmic division. Usually above 50 years and more in females. Can result from a redundant loop of superior cerebellar artery. Surgery is the treatment of choice.

TD is not very common for “101 chronic conditions”, but it is the most common cause of chronic facial pain. It occurs in the FACIAL region supplied by the 5th cranial, or TRIGEMINAL nerve. This is about the area covered by your widely spread hand, pinkie on the nose, and the butt of the palm along the jawbone.

Brief shocking pain occurs in “PAROXYSMS” in the facial area, on ONE SIDE, and TRIGGERED by tooth brushing, touching the face, or even by the blowing of the wind. This description is so typical and specific as to be “pathognomonic”, and can be diagnosed over the telephone.

Variants can give continuous pain, or occur on both sides, but the “classical” variety is most common. You should contact your Doctor, since some cases are caused by Multiple Sclerosis or a tumor. Effective medications are available, such as carbamazepine.

TD can be familial, but is often caused by compression of a nearby artery, and “decompression” is currently the most effective surgical treatment. It is one of the few “chronic 101” conditions not to be substantially prevented or helped by our old standbys, sleep, diet and exercise.

That being said, it is sometimes helped by exercise, and almost never occurs during sleep. The August 20, 2020 New England Journal of Medicine Has an excellent Review article, which will be appended to this posting.

–Dr. C.