4 Tuesday May 24 2022 | the timeshealth
Both are rare and due to underlying
problems with the immune system
that result in the skin and mucous
membranes (mouth, eyes and genitals)
being attacked. Dermnetnz.org
features classic examples: clues include
large flaccid, fluid-filled blisters and
sores in the mouth, normally
accompanied by general malaise.
Triggers include some types of
medication (gout pills, antidepressants
and anti-inflammatories for SJS),
infections and vaccines. And for
pemphigus, stress, burns and
pregnancy. Treatment varies
depending on the severity,
and the age and general
health of the patient, but
often involves steroids,
immunotherapy and
supportive treatment in
specialised burns or
intensive care units.
Most people will
make a full
recovery but
fatality rates
are still about
one in ten.
The take-
home
message?
Large fluid-filled
blisters can occur
after trauma (eg
running a marathon)
and following reactions
to some insect bites, but
if unexplained and
multiple always require
urgent medical appraisal.
You can find more
information on all of
the above, including
photos of typical
presentations at the
DermNet NZ website.from plants such as wolfsbane,
euphorbia, oleander and cow parsnip,
or in people strimming verges in
shorts and getting splattered by the
debris of plants such as hogweed.
Prevention is better than cure, so
know your plants, wear gloves/long
sleeves/trousers (and consider eye
protection if getting up close and
personal with euphorbia). Topical
steroids such as hydrocortisone will
help to soothe affected areas, but you
may need to avoid sun exposure for a
few weeks afterwards because UV rays
can reactivate some toxins (psoralens).
Pemphigus and SJS are two distinct
conditions, but they share many
features and both can be fatal.
Differentiating them is a job for a
hospital specialist, and the role of GPs
like me is to get suspected cases into
expert hands as quickly as possible.M
onkeypox may pose a
tiny risk to most of us
(so far, anyway), but it
has prompted quite a few
doctors to brush up on
blistering rashes. Myriad causes make
it difficult to generalise, but blisters on
the skin tend to indicate more serious
problems than most other types of
rash, with the list including
pemphigus, one of just a handful of
true dermatological emergencies.
However, before looking at some
examples I would like to share a trade
secret. Dermatologists aside, most
doctors are not very good at
diagnosing unusual rashes. So the first
thing I do when faced with one is visit
the New Zealand Dermatological
Society website (dermnetnz.org) to
look at photos and whittle down the
differential diagnosis (similar offerings
are available from other organisations
but most GPs I know favour this one).
Years ago I’d make an excuse to leave
the room to check, but these days I
swallow my pride and do it in front of
the patient on my desktop screen.
You will find a long list of skin
conditions at dermnetnz.org, but I
would like to concentrate on five.
Shingles and herpes simplex because
they are common, plant dermatitis
because awareness among gardeners is
not what it should be (plus I saw a
case last Friday), and pemphigus and
Stevens-Johnson syndrome (SJS)
because they can be life-threatening.
Shingles is, typically, an easy
condition to diagnose. It is caused by
re-emergence of the chickenpox virus
(herpes zoster), which can hide away
in the central nervous system for
decades after childhood illness and
re-emerge as immunity wanes with
age or due to other illness.
Telltale signs include discomfort and
altered sensation in the affected area
(the virus spreads along nerves) that
precedes the classic one-sided
localised rash: red skin with clusters of
small blisters. Antivirals given within
72 hours of onset of rash may speed
recovery and reduce the risk of
lingering discomfort after the skin has
healed, so seek help promptly.
Herpes simplex virus (HSV) causes
similar discomfort and blistering to
shingles, and typically affects the skin
around the mouth (cold sores) and
genitals. There are two main types:
HSV-1 is typically spread by oral to
oral or oral to genital contact and
causes cold sores and genital herpes.
HSV-2 brings genital herpes and
spreads through sexual contact. Both
are very common. The World Health
Organisation estimates that 67 per
cent of the global population has been
infected with HSV-1, and 13 per cent
with HSV-2. Many of those infected
have no continuing problems, and for
those that do, both types of infection
can be, at least partially, controlled
using antivirals such as aciclovir.
Phytodermatitis is the umbrella
term for plant-induced rashes that
often include painful blistering. The
most common type I see result from
contact with irritant or sensitising sapMost doctors are
not very good at
diagnosing
unusual rashes
6 At the time of
writing there have
been 56 confirmed
cases of monkeypox
in England.
6 The infection can
be passed on
through close
contact or contact
with clothing or
linens used by a
person who has
monkeypox.
However, the virus
does not usually
spread easily
between people
and the risk to the
UK population
remains low.
6 Anyone with
unusual rashes or
lesions on any part
of their body,
especially their
genitalia, should
contact NHS 111
or call a sexual
health service if they
have concerns.
6 A notable
proportion of early
cases have been in
gay and bisexual
men, and so the
UK Health Security
Agency is urging
this community
in particular to
be alert.
6 Initial symptoms
of monkeypox
include fever,
headache, muscle
aches, backache,
swollen lymph
nodes, chills and
exhaustion.
6 A rash can
develop, often
beginning on
the face, then
spreading to
other parts of the
body including
the genitals.
6 The rash
changes and goes
through stages —
it can look like
chickenpox —
before finally
forming a
scab that later
falls off.
6 For photos of
the rash visit
dermatology
advisor.
comMonkeypox:
the facts
fDr Mark Porter
Is your blistering rash monkeypox?
Unlikely — but it’s still concerning
S
ipping any green soup is
guaranteed to make you
feel virtuous, but perhaps
not quite as worthy as
I feel drinking the one in
front of me, which comes
with an impressive stamp
of approval for its health-
boosting properties. Developed by
scientists at the Quadram Institute,
a centre for food and health research
that combines the Norfolk and
Norwich University Hospitals’
endoscopy centre and the University
of East Anglia’s (UEA) Norwich
Medical School, the SmarterNaturally
soup is a glorified instant soup,
prepared from a sachet of dried
powder mixed with 250ml boiling
water. It looks — and tastes —
nothing special, although it’s thicker
and more flavourful than your average
packet soup, and yet consumed once
weekly has been shown to lower and
maintain blood sugar levels to cut the
risk of type 2 diabetes.
What sets this super-soup apart is
its ingredients: in particular a broccoli
that has been bred to produce very
high levels of a naturally occurring
substance called glucoraphanin,
which is converted in the body to
the compound sulforaphane.
“What sulforaphane does is turn
on a set of genes that are regulated by
the protein NRF2, involved in blood
sugar control,” says Steve Morrison,
a medical biochemist who is
head of clinical research for the
SmarterNaturally product. “Stored
sugar is drawn out of the body and we
are prevented from laying down more
sugar, so that blood glucose levels are
lowered when the glucoraphanin-rich
broccoli is consumed regularly.” Just
one soup a week is enough: according
to one of their papers published in the
American Journal of Clinical Nutrition,
participants with elevated blood
sugar who ate their super-soupweekly saw their blood glucose levels
drop to a normal range during the
12-month trial.
Most cruciferous vegetables —
including cauliflower, cabbage, kale
and Brussels sprouts — contain
glucoraphanin, but the broccoli variety
being used in the soup contains about
five times more glucoraphanin than
usual varieties, Morrison says. It was
discovered growing wild in Sicily
several decades ago by Richard
Mithen, honorary professor in the
school of pharmacy at UEA and the
lead “soup” scientist, who developed
a hybrid of the plant that reliably
produces high amounts of beneficial
compounds. “It has been grown using
traditional breeding techniques,
similar to the way roses are bred to
create new varieties, and is non-GM,”
Morrison says.
A diet with a high glucoraphanin
intake could bring wide-ranging
health benefits. Morrison says it
helps to recalibrate our metabolism,
activating processes in our body that
ensure our metabolic machinery
functions well. “It’s a bit like taking
your car for a service and getting it
retuned so that it works optimally
and efficiently,” he says. “As we get
older our body mechanics work less
well and consuming glucoraphanin
regularly helps to keep things ticking
over normally.” It has been shown to
help lower blood pressure, to protect
against heart disease and to be
protective against some forms of
cancer, but it is the evidence for its
effects on blood sugar control that are
most compelling.
According to the charity Diabetes
UK, about 13.6 million people in
Britain have prediabetes — meaning
their blood sugar levels are higher
than usual, but not yet high enough
for them to be diagnosed with
type 2 diabetes. By 2030 the charity
estimates that 5.5 million people in theThe new
super-soup
that cuts the
risk of type 2
diabetes
Just one bowlful a week lowers
and maintains blood sugar levels.
The secret ingredient: a specially
bred broccoli. Peta Bee tries it