Saturday, August 15, 2009

Roy and his rash

For the past 2 years, Roy has suffered from a very bad skin disease. The rash is on his head, face, arms, abdomen and back which was crusted and looked really bad. His dad took another wife, so his mom left 3 months ago for Port Morseby and hasn't come back. His grandma and a neighbor, finally brought him for care. I felt so bad for him when I saw him, but he was smiling and didn't seem to think anything about having all these crusts all over his body. He obediently lifted up his shirt so I could see his skin and held still as we gave him Ketamine in order to get rid of all his crusts.
Rebekah Lamb, a med student from New Zealand, and I first did a punch biopsy in order make a diagnosis of what exactly was going on. The crusting that he had is called impetigo, but that is a secondary condition, something had preceded this. We found a few pustules and vesicles that hopefully were in the beginning stages of the progression, so we biopsied these. I need to know if it is something like pemphigus or phemigoid, which will require steroids, and at times can be fatal, or is it something else.
After the biopsies, we proceeded to give him probably the best bath he has ever had as we worked to descale him. The nurses and nursing students couldn't seem to keep us supplied with enough gauze as we kept going through it. After our descaling, we then proceeded to mummify him. Rebekah and I thought he looked pretty funny as we were wrapping him up in roller bandages. I am not so sure that his family thought of the process, but they were thankful when we were done and had helped him. Thanks to Ketamine, he tolerated the descaling well and now we will continue to treat for infection and watch to see if he develops any new lesions. Thankfully, he and his smile should be heading home in a few days.