Responses to BK skin issues, part2
Jonathan Roskos
Description
Collection
Title:
Responses to BK skin issues, part2
Creator:
Jonathan Roskos
Date:
2/7/2008
Text:
> Date: Wed, 16 Jan 2008 12:32:20 -0800
> From: <Email Address Redacted>
> Subject: [OANDP-L] BK skin issues
> To: <Email Address Redacted>
>
> Hello,
>
> My name is Jonathan Roskos. I live in Los Angeles. This email address was give to me by my prosthetist, David Cooney at Beverly Hills Prosthetics and Orthotics. If I need to register, please send me the form/info at this email address. If not, my question:
>
> Does anyone out there have experience with laser removal of the hair follicles on the stump when they persistently become infected and uncomfortable? I have had skin that is prone to what I can best describe as cystic acne since puberty. It has been the greatest source of discomfort and discontent with my prosthesis for the past 3 or 4 years. My left foot and calf were amputated six years ago due to trauma, when I was 19. I have about 1.5 inches of tibia, and 1 inch of fibula, my knee does not bend past 90 degrees.
>
> Laser hair removal only advertises hair count reduction by 40 to 80 percent. This makes me wonder if the follicles that were getting infected in the first place would continue to become infected. I also wonder if the irritation could potentially worsen my situation in some unforseen way. Any thought and, especially, experience with this would be extremely helpful to me.
>
> I had a bursa removed from my stump about 6 months ago, and the way is flaring up now makes me think I am headed for a similar procedure. I have had two minor surgeries on the skin of my stump in the past 3 years to remove or drain what started as infected hair follicles. With the bursa, I was on crutches for a month after the surgery, and I would like to avoid that happening again if possible.
>
> I use an Alpha liner with suction system now, thinking that would help cut down on friction between my stump and liner (I formerly used an alpha locking liner), but the problem persists. I also use iodine on my stump every night and alcohol on my liner regularly.
>
> Thank you in advance for any responses,
> Jonathan Roskos
>
>
Jonathan... In my experience with amputees, the condition you describe, may because by the following:
Most individuals will take their prosthesis off a bed side, slip under the covers and go to sleep and as you might expect the surface of one's limb may not be the most hygienic at the point in the day. In this case their is bacteria the develops and builds up on the surface to your residual limb which manifests its self over night, sometimes leading to dry and itchy skin in the morning and can lead to infected hair follicles that may abscess on one's limb. Additionally, this can especially be problematic for someone who is fair skinned.
The above situation may possibly be resolved in one of two way.
Bathing your residual limb before jumping into bed, without putting on the soiled prosthetic socks and/or gel liner just taken off. An antibacterial soap, such as Antibacterial SoftSoap, is a good brand to use. There was a study some years ago the indicated this was the best choice and not to use Dial Antibacterial Soap. If one uses a gel liner, they should clean it nightly in the same manner as their residual limb.
If you are unable to follow the above procedure, as an alternative at bed side, I would suggest using an antibacterial hand gel on your limb before slipping under the covers, as this will also help to minimize the effects of perspiration and the development of bacteria on the surface of your limb. I have one patient who had a long-standing history you described and this technique, although not the approach I consider to be the best, totally resolved his problems with infected hair follicles or folliculitis ( <URL Redacted> ) and sebaceous cysts ( <URL Redacted> ).
Additionally, I have seen the condition you describe frequently in cases where someone has a very short residual limb, such as you describe your's as being, and, especially, where they lost their limb to trauma in a motorcycle accident in which they also struggle with infections post injury or post amputation. Losing a limb to trauma, were an infection develops from foreign matter or dirt that contaminates the wound site can lead to recurrent and ongoing infections that sometime lie dormant for months, even years, and then flare up again.
In any case, doing everything you can to keep your limb and prosthetic interface materials that come in contact with the skin surface of your limb is very important to the health of your skin.
I hope you find this to be helpful!!
John N. Billock, CPO/L, FAAOP. Clinical Director
Orthotics & Prosthetics Rehabilitation Engineering Centre
Warren, Ohio
onathan,
Unfortunately, I feel your pain. Literally. I am a right BK as of 2001 and I had the same issues. High pressure areas such as in the tibia or fibula head and also the soft tissue on the posterior (where you calf was previously) are prone to this because of pressure on the surface of the skin and the hair can’t poke out.
I had issue with follicles that resulted in some self surgery to get out the hair, a couple of lancings to remove fluid and what initially worked well was a cortisone (steroid) shot from a dermatologist that shrunk a cyst that was about the size and as hard as a peanut. The shot helped but would only fix it – not prevent them.
I looked into a few methods and luckily knew enough amputees to not try the no-nos. These include shaving or waxing which only remove the hair and then you have 1000 ingrowns coming back at once.
I ran into the lasering idea from a couple of amputee buddies which included Paul Martin who does a lot of distance running and triathlons. The deal is that only about 20% of your hair is grown in at a time which are the only follicles that can be treated each time. The cycle grows in about every 6-8 weeks. So, you have to have it done every 6-8 weeks about 4 or 5 times. I have particularly dark hair and it is thick, so after the original treatments, I still got it done once every 6 months to hit the stragglers. I started that about 3 years ago and I gotta tell you, it has really changed things for me. I occasionally get one now and then, but it is no where near as bad as it used to be. The hairs that do come back seem to be a lot lighter and thinner and less prone to becoming ingrown.
I was debilitated from time to time as you describe and occasionally they would take me off of my leg for a few days at a time. This was especially hard when I was running and competing in triathlons at the time. I highly recommend you seek it out and just get it done. It should only take about 15-20 minutes for an appointment and the irritating pain from the treatment is no where near that pain of an ingrown. It feels a bit like getting a tattoo or being snapped with a rubber band. Not super fun, but worth it.
The only other remedy I could think of is electrolysis, which should permanently remove the follicle. However, that is a LOT more time consuming, painful, and expensive. I find the lasering is a minor inconvenience and worth the limited expense.
Feel free to pass this back to the forum and let me know if you have any further questions.
Best regards,
Matt
cid: <Email Address Redacted>
Matt Henderson
Advisor, Technical and Marketing Services- Australia/ New Zealand
Ossur Asia-Pacific
Tel. +61 2 9630 9206
Mobile +61 400 232 251
Fax +61 2 9630 9268
E-mail <Email Address Redacted>
www.ossur.com
Notice to Recipient: This e-mail is confidential and meant only for the intended recipient[s] of the transmission and may be a communication privileged by law. If you received this e-mail in error, any review, use, dissemination, distribution or copying of this e-mail is strictly prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and please delete this e-mail from your
Jonathan,
As far as your question as to the laser removal of hair, it is just
that not
the follicles. I have one patient, female, who has regular laser
treatments
to remove hair and they last about 3 months for her.
The use of iodine regularly on your stump is actually problematic,
iodine
kills skin cells , I recommend good plain soap (not necessarily anti
bacterial) and water for washing and if your looking to clean the skin
deeper use a 50/50 water alcohol mix. There is a product called
Proactive
acne care which has been very helpful for my adolescent amputees with
acne.
As far as the liner and the use of the alpha, if your skin has had
problems
with the alpha liner you might want to try a pure silicone liner
instead of
a mineral gel liner. A preflexed like the ESP liner which helps reduce
skin
shear in the back of the knee and on the knee cap is sometimes the
better
choice for a short residual limb. The lock and suction suspension both
have
shear problems just slightly different in how they might manifest
themselves.
Until your skin has some control it might be hard to tell if the
suction is
better.
I hope these ideas help.
Carey Glass CPO FAAOP
You should contact a competent dermatologist. There is a skin condition similar to what you describe that responds to certain antibiotics. You also need to speak to your dermatologist about the hair removal, not whoever happens to be advertising. Choose a dermatologist based on their medical experience with skin problems not one who works for beauty.
Morris Gallo, LPO
No advice re. Laser but may consider applying liberal amounts of
non-dissipating lube (vaseline, A+D, etc.) To skin under liner. This combined
with expulsion sucvtion would minimize mechanical contribution to
proplem.
Best of luck.
I too used to suffer al lot with infected hair follicles years ago. I
live
in Florida where it is hot and humid most of the year. When I worked
outside, I would get the follicle infections routinely. I had one
surgery
for removing the infected area also. A doctor suggested I use Absorbine
Jr
on my skin when they flared up. IT WORKED! I WAS SHOCKED. Not only did
it
help the muscles relax, it knocked out almost all of the hair
infections as
soon as they tried to appear. I know it doesn't say it on the bottle
but it
sure helped me. I have had a couple patients over the years do the same
thing and their results were the same.Good luck,
Ronnie
Ronnie N. Graves BOCPO, CO, LPO, RTP
Prosthetics Research Specialists, Inc.
720 East Southland Ave
Bushnell, Fl 33513
352-793-4477 Work
352-603-4249 Cell
352-793-1448 Fax
<Email Address Redacted>
I asked that question of a dermatologist a few years ago. His response
is that the follicle remains and that it can still get infected. The
hair removal by laser is not permanent contrary to what they would have
you believe. Whether it matters is not clear.
I think changing liners to a silicone liner might be worth trying. It
may be less permeable to bacteria and fungus, I don't know if that is
true or not.
You may want to wear one of those silver liner socks under the liner
and
in direct contact with your skin(ask your prosthetist). They are meant
to kill bacteria.
If you have a pin suspension and you wear the silver sock on your skin,
you will lose suction.
You can remedy this by asking your prosthetist to make the shuttle lock
airtight and adding a suspension sleeve.
Mark Benveniste RN BS CP
Prosthetics Department
Michael E. DeBakey Veterans Affairs Medical Center
Houston, TX
USA
---------------------------------
Looking for last minute shopping deals? Find them fast with Yahoo! Search.
> From: <Email Address Redacted>
> Subject: [OANDP-L] BK skin issues
> To: <Email Address Redacted>
>
> Hello,
>
> My name is Jonathan Roskos. I live in Los Angeles. This email address was give to me by my prosthetist, David Cooney at Beverly Hills Prosthetics and Orthotics. If I need to register, please send me the form/info at this email address. If not, my question:
>
> Does anyone out there have experience with laser removal of the hair follicles on the stump when they persistently become infected and uncomfortable? I have had skin that is prone to what I can best describe as cystic acne since puberty. It has been the greatest source of discomfort and discontent with my prosthesis for the past 3 or 4 years. My left foot and calf were amputated six years ago due to trauma, when I was 19. I have about 1.5 inches of tibia, and 1 inch of fibula, my knee does not bend past 90 degrees.
>
> Laser hair removal only advertises hair count reduction by 40 to 80 percent. This makes me wonder if the follicles that were getting infected in the first place would continue to become infected. I also wonder if the irritation could potentially worsen my situation in some unforseen way. Any thought and, especially, experience with this would be extremely helpful to me.
>
> I had a bursa removed from my stump about 6 months ago, and the way is flaring up now makes me think I am headed for a similar procedure. I have had two minor surgeries on the skin of my stump in the past 3 years to remove or drain what started as infected hair follicles. With the bursa, I was on crutches for a month after the surgery, and I would like to avoid that happening again if possible.
>
> I use an Alpha liner with suction system now, thinking that would help cut down on friction between my stump and liner (I formerly used an alpha locking liner), but the problem persists. I also use iodine on my stump every night and alcohol on my liner regularly.
>
> Thank you in advance for any responses,
> Jonathan Roskos
>
>
Jonathan... In my experience with amputees, the condition you describe, may because by the following:
Most individuals will take their prosthesis off a bed side, slip under the covers and go to sleep and as you might expect the surface of one's limb may not be the most hygienic at the point in the day. In this case their is bacteria the develops and builds up on the surface to your residual limb which manifests its self over night, sometimes leading to dry and itchy skin in the morning and can lead to infected hair follicles that may abscess on one's limb. Additionally, this can especially be problematic for someone who is fair skinned.
The above situation may possibly be resolved in one of two way.
Bathing your residual limb before jumping into bed, without putting on the soiled prosthetic socks and/or gel liner just taken off. An antibacterial soap, such as Antibacterial SoftSoap, is a good brand to use. There was a study some years ago the indicated this was the best choice and not to use Dial Antibacterial Soap. If one uses a gel liner, they should clean it nightly in the same manner as their residual limb.
If you are unable to follow the above procedure, as an alternative at bed side, I would suggest using an antibacterial hand gel on your limb before slipping under the covers, as this will also help to minimize the effects of perspiration and the development of bacteria on the surface of your limb. I have one patient who had a long-standing history you described and this technique, although not the approach I consider to be the best, totally resolved his problems with infected hair follicles or folliculitis ( <URL Redacted> ) and sebaceous cysts ( <URL Redacted> ).
Additionally, I have seen the condition you describe frequently in cases where someone has a very short residual limb, such as you describe your's as being, and, especially, where they lost their limb to trauma in a motorcycle accident in which they also struggle with infections post injury or post amputation. Losing a limb to trauma, were an infection develops from foreign matter or dirt that contaminates the wound site can lead to recurrent and ongoing infections that sometime lie dormant for months, even years, and then flare up again.
In any case, doing everything you can to keep your limb and prosthetic interface materials that come in contact with the skin surface of your limb is very important to the health of your skin.
I hope you find this to be helpful!!
John N. Billock, CPO/L, FAAOP. Clinical Director
Orthotics & Prosthetics Rehabilitation Engineering Centre
Warren, Ohio
onathan,
Unfortunately, I feel your pain. Literally. I am a right BK as of 2001 and I had the same issues. High pressure areas such as in the tibia or fibula head and also the soft tissue on the posterior (where you calf was previously) are prone to this because of pressure on the surface of the skin and the hair can’t poke out.
I had issue with follicles that resulted in some self surgery to get out the hair, a couple of lancings to remove fluid and what initially worked well was a cortisone (steroid) shot from a dermatologist that shrunk a cyst that was about the size and as hard as a peanut. The shot helped but would only fix it – not prevent them.
I looked into a few methods and luckily knew enough amputees to not try the no-nos. These include shaving or waxing which only remove the hair and then you have 1000 ingrowns coming back at once.
I ran into the lasering idea from a couple of amputee buddies which included Paul Martin who does a lot of distance running and triathlons. The deal is that only about 20% of your hair is grown in at a time which are the only follicles that can be treated each time. The cycle grows in about every 6-8 weeks. So, you have to have it done every 6-8 weeks about 4 or 5 times. I have particularly dark hair and it is thick, so after the original treatments, I still got it done once every 6 months to hit the stragglers. I started that about 3 years ago and I gotta tell you, it has really changed things for me. I occasionally get one now and then, but it is no where near as bad as it used to be. The hairs that do come back seem to be a lot lighter and thinner and less prone to becoming ingrown.
I was debilitated from time to time as you describe and occasionally they would take me off of my leg for a few days at a time. This was especially hard when I was running and competing in triathlons at the time. I highly recommend you seek it out and just get it done. It should only take about 15-20 minutes for an appointment and the irritating pain from the treatment is no where near that pain of an ingrown. It feels a bit like getting a tattoo or being snapped with a rubber band. Not super fun, but worth it.
The only other remedy I could think of is electrolysis, which should permanently remove the follicle. However, that is a LOT more time consuming, painful, and expensive. I find the lasering is a minor inconvenience and worth the limited expense.
Feel free to pass this back to the forum and let me know if you have any further questions.
Best regards,
Matt
cid: <Email Address Redacted>
Matt Henderson
Advisor, Technical and Marketing Services- Australia/ New Zealand
Ossur Asia-Pacific
Tel. +61 2 9630 9206
Mobile +61 400 232 251
Fax +61 2 9630 9268
E-mail <Email Address Redacted>
www.ossur.com
Notice to Recipient: This e-mail is confidential and meant only for the intended recipient[s] of the transmission and may be a communication privileged by law. If you received this e-mail in error, any review, use, dissemination, distribution or copying of this e-mail is strictly prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and please delete this e-mail from your
Jonathan,
As far as your question as to the laser removal of hair, it is just
that not
the follicles. I have one patient, female, who has regular laser
treatments
to remove hair and they last about 3 months for her.
The use of iodine regularly on your stump is actually problematic,
iodine
kills skin cells , I recommend good plain soap (not necessarily anti
bacterial) and water for washing and if your looking to clean the skin
deeper use a 50/50 water alcohol mix. There is a product called
Proactive
acne care which has been very helpful for my adolescent amputees with
acne.
As far as the liner and the use of the alpha, if your skin has had
problems
with the alpha liner you might want to try a pure silicone liner
instead of
a mineral gel liner. A preflexed like the ESP liner which helps reduce
skin
shear in the back of the knee and on the knee cap is sometimes the
better
choice for a short residual limb. The lock and suction suspension both
have
shear problems just slightly different in how they might manifest
themselves.
Until your skin has some control it might be hard to tell if the
suction is
better.
I hope these ideas help.
Carey Glass CPO FAAOP
You should contact a competent dermatologist. There is a skin condition similar to what you describe that responds to certain antibiotics. You also need to speak to your dermatologist about the hair removal, not whoever happens to be advertising. Choose a dermatologist based on their medical experience with skin problems not one who works for beauty.
Morris Gallo, LPO
No advice re. Laser but may consider applying liberal amounts of
non-dissipating lube (vaseline, A+D, etc.) To skin under liner. This combined
with expulsion sucvtion would minimize mechanical contribution to
proplem.
Best of luck.
I too used to suffer al lot with infected hair follicles years ago. I
live
in Florida where it is hot and humid most of the year. When I worked
outside, I would get the follicle infections routinely. I had one
surgery
for removing the infected area also. A doctor suggested I use Absorbine
Jr
on my skin when they flared up. IT WORKED! I WAS SHOCKED. Not only did
it
help the muscles relax, it knocked out almost all of the hair
infections as
soon as they tried to appear. I know it doesn't say it on the bottle
but it
sure helped me. I have had a couple patients over the years do the same
thing and their results were the same.Good luck,
Ronnie
Ronnie N. Graves BOCPO, CO, LPO, RTP
Prosthetics Research Specialists, Inc.
720 East Southland Ave
Bushnell, Fl 33513
352-793-4477 Work
352-603-4249 Cell
352-793-1448 Fax
<Email Address Redacted>
I asked that question of a dermatologist a few years ago. His response
is that the follicle remains and that it can still get infected. The
hair removal by laser is not permanent contrary to what they would have
you believe. Whether it matters is not clear.
I think changing liners to a silicone liner might be worth trying. It
may be less permeable to bacteria and fungus, I don't know if that is
true or not.
You may want to wear one of those silver liner socks under the liner
and
in direct contact with your skin(ask your prosthetist). They are meant
to kill bacteria.
If you have a pin suspension and you wear the silver sock on your skin,
you will lose suction.
You can remedy this by asking your prosthetist to make the shuttle lock
airtight and adding a suspension sleeve.
Mark Benveniste RN BS CP
Prosthetics Department
Michael E. DeBakey Veterans Affairs Medical Center
Houston, TX
USA
---------------------------------
Looking for last minute shopping deals? Find them fast with Yahoo! Search.
Citation
Jonathan Roskos, “Responses to BK skin issues, part2,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 5, 2024, https://library.drfop.org/items/show/229056.
