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Catching a skin disease from a patient

1999; Elsevier BV; Volume: 41; Issue: 6 Linguagem: Inglês

10.1016/s0190-9622(99)70280-x

1097-6787

Philip C. Anderson,

Nail Diseases and Treatments

To the Editor:It is a myth, centuries old, that you must not touch diseased skin, or if you do, you’ll catch it, whatever it is. Even medical students accept that myth, sometimes more subconsciously than consciously, and draw back from any patient with a severe dermatologic illness. Dermatologists know better. We know that contagion is slight, even when we freely touch the lesions, but in fact, we are more careful than that. This brief letter intends to fix a very rough estimate on that risk. I have interviewed 32 select senior clinicians, whose memories are dependable, judgment is credible, and experience is impressive. This small inquiry involves hearsay, self-diagnosis, and retrospection, but catching a skin disease from a patient is something an alert clinician won’t forget. The clinical experience surveyed is about 1000 years of equivalent expert dermatologic practice or about 12 million patient visits, beginning in 1941 and ending in late 1998. The interviewees are hard-working, full-time, US clinicians from 20 different states.I am not concerned here with other important risks such as exposure to x-ray, magnets, ultrasound, lasers, ultraviolet light, or chemicals. Nor is this review about the contagion of AIDS or hepatitis or other systemic diseases. We are concerned here only with simple medical dermatology in the office and only with catching a skin disease personally from a patient.My own experience working with more than 100 associated dermatologists, residents, and staff for 40 years is that I have never seen credible transmissions of lice, tinea, herpes simplex virus, varicella zoster virus, molluscum, candidoses, or deep mycoses. The two problems seem to be scabies and pyodermas.In the experience from my survey, we found 6 credible transmitted infections, 1 from scabies, 2 of warts, and 3 convincing pyodermas. The warts promptly healed, leaving only scabies and pyodermas to require therapy. These events are distributed evenly over the 57 years surveyed. No one had more than one event. The rate of adversity is 0.006 event per year of equivalent practice, which, in our dangerous world, does not seem bad. In an ordinary lifetime in practice you might expect 0.2 event, which we’ll pretend is about one event among five full-time dermatologists. Most will never see such an event.All of the dermatologists in the survey touch patients freely, with their bare hands, but use gloves regularly today for examining wet or bloody lesions and always are both cautious and expert. Over the decades, practitioners have become slightly more cautious. None of them use special gowns, goggles, or “moon suits.” None uses any other exceptional precautions. The risk of catching a skin disease from a patient is negligible with just the customary precautions. To the Editor:It is a myth, centuries old, that you must not touch diseased skin, or if you do, you’ll catch it, whatever it is. Even medical students accept that myth, sometimes more subconsciously than consciously, and draw back from any patient with a severe dermatologic illness. Dermatologists know better. We know that contagion is slight, even when we freely touch the lesions, but in fact, we are more careful than that. This brief letter intends to fix a very rough estimate on that risk. I have interviewed 32 select senior clinicians, whose memories are dependable, judgment is credible, and experience is impressive. This small inquiry involves hearsay, self-diagnosis, and retrospection, but catching a skin disease from a patient is something an alert clinician won’t forget. The clinical experience surveyed is about 1000 years of equivalent expert dermatologic practice or about 12 million patient visits, beginning in 1941 and ending in late 1998. The interviewees are hard-working, full-time, US clinicians from 20 different states.I am not concerned here with other important risks such as exposure to x-ray, magnets, ultrasound, lasers, ultraviolet light, or chemicals. Nor is this review about the contagion of AIDS or hepatitis or other systemic diseases. We are concerned here only with simple medical dermatology in the office and only with catching a skin disease personally from a patient.My own experience working with more than 100 associated dermatologists, residents, and staff for 40 years is that I have never seen credible transmissions of lice, tinea, herpes simplex virus, varicella zoster virus, molluscum, candidoses, or deep mycoses. The two problems seem to be scabies and pyodermas.In the experience from my survey, we found 6 credible transmitted infections, 1 from scabies, 2 of warts, and 3 convincing pyodermas. The warts promptly healed, leaving only scabies and pyodermas to require therapy. These events are distributed evenly over the 57 years surveyed. No one had more than one event. The rate of adversity is 0.006 event per year of equivalent practice, which, in our dangerous world, does not seem bad. In an ordinary lifetime in practice you might expect 0.2 event, which we’ll pretend is about one event among five full-time dermatologists. Most will never see such an event.All of the dermatologists in the survey touch patients freely, with their bare hands, but use gloves regularly today for examining wet or bloody lesions and always are both cautious and expert. Over the decades, practitioners have become slightly more cautious. None of them use special gowns, goggles, or “moon suits.” None uses any other exceptional precautions. The risk of catching a skin disease from a patient is negligible with just the customary precautions. It is a myth, centuries old, that you must not touch diseased skin, or if you do, you’ll catch it, whatever it is. Even medical students accept that myth, sometimes more subconsciously than consciously, and draw back from any patient with a severe dermatologic illness. Dermatologists know better. We know that contagion is slight, even when we freely touch the lesions, but in fact, we are more careful than that. This brief letter intends to fix a very rough estimate on that risk. I have interviewed 32 select senior clinicians, whose memories are dependable, judgment is credible, and experience is impressive. This small inquiry involves hearsay, self-diagnosis, and retrospection, but catching a skin disease from a patient is something an alert clinician won’t forget. The clinical experience surveyed is about 1000 years of equivalent expert dermatologic practice or about 12 million patient visits, beginning in 1941 and ending in late 1998. The interviewees are hard-working, full-time, US clinicians from 20 different states. I am not concerned here with other important risks such as exposure to x-ray, magnets, ultrasound, lasers, ultraviolet light, or chemicals. Nor is this review about the contagion of AIDS or hepatitis or other systemic diseases. We are concerned here only with simple medical dermatology in the office and only with catching a skin disease personally from a patient. My own experience working with more than 100 associated dermatologists, residents, and staff for 40 years is that I have never seen credible transmissions of lice, tinea, herpes simplex virus, varicella zoster virus, molluscum, candidoses, or deep mycoses. The two problems seem to be scabies and pyodermas. In the experience from my survey, we found 6 credible transmitted infections, 1 from scabies, 2 of warts, and 3 convincing pyodermas. The warts promptly healed, leaving only scabies and pyodermas to require therapy. These events are distributed evenly over the 57 years surveyed. No one had more than one event. The rate of adversity is 0.006 event per year of equivalent practice, which, in our dangerous world, does not seem bad. In an ordinary lifetime in practice you might expect 0.2 event, which we’ll pretend is about one event among five full-time dermatologists. Most will never see such an event. All of the dermatologists in the survey touch patients freely, with their bare hands, but use gloves regularly today for examining wet or bloody lesions and always are both cautious and expert. Over the decades, practitioners have become slightly more cautious. None of them use special gowns, goggles, or “moon suits.” None uses any other exceptional precautions. The risk of catching a skin disease from a patient is negligible with just the customary precautions.