Transcript Osteopathic Dermatology

Osteopathic Dermatology
Osteopathic Medicine
• Benefits of modern medicine
– Rx / Surgery / Technology
• Added benefit
– Hands-on diagnosis & treatment
– Osteopathic Manipulative Therapy (OMT)
• Helping each person achieve a high level of
wellness
– Focus on health promotion & disease prevention
Holistic Approach
• “Whole person approach” to health care
• More than just the sum of your body parts
• More than just a collection of organ systems
that become injured or disease
• All body’s systems are interconnected & each
one affects the others
Osteopathic Oath
• I do hereby affirm my loyalty to the profession I am
about to enter.
• I will be mindful always of my great responsibility to
preserve the health and the life of my patients, to
retain their confidence and respect both as a physician
and a friend who will guard their secrets with
scrupulous honor and fidelity, to perform faithfully my
professional duties, to employ only those recognized
methods of treatment consistent with good judgment
and with my skill and ability, keeping in mind always
nature’s laws and the body’s inherent capacity for
recovery.
Osteopathic Oath
• I will be ever vigilant in aiding in the general welfare of the
community, sustaining its laws and institutions, not engaging in
those practices, which will in any way, bring shame or discredit
upon myself or my profession. I will given no drugs for deadly
purposes to any person, though it be asked of me.
• I will endeavor to work in accord with my colleagues in the spirit of
progressive cooperation, and never by word or by act cast
imputations upon them or their rightful practices.
• I will look with respect and esteem upon all those who have taught
me my art. To my college I will be loyal and strive always for its best
interests and for the interests of the students who will come after
me. I will be ever alert to further the application of basic biologic
truths to the healing arts of o develop the principles of osteopathy,
which were first enunciated by Andrew Taylor Still.
OMM
• Restore normal physiologic function
• Disease caused by physiological imbalances
– Nerve impingement
– Localized tissue congestion
– Impaired autonomic regulation
• Osteopathic Manipulative Therapy (OMT)
– High velocity low amplitude – thrusting through dysfunctional joint
– Muscle energy – move to barrier of restriction & apply isometric counterforce
as patient moves to neutral
– Counterstrain – position of ease that relieves pain sensation of tender point &
held for 90 sec
– Myofascial release – restricted fascia encouraged into ease
– Craniosacral – manipulation of cranium to normalize physiologic motion of
bones, dura & CSF
– Lymphatic drainage – promote normal drainage of fluid from congested tissue
Tenets of Osteopathic Medicine
• The American Osteopathic Association’s House of
Delegates approved the Tenets of Osteopathic
Medicine as policy which follows the underlying
philosophy of osteopathic medicine
• 1- The body is a unit; the person is a unit of body, mind
and spirit
• 2- The Body is capable of self-regulation, self-healing,
and health maintenance.
• 3- Structure & function are reciprocally interrelated.
• 4- Rational treatment is based upon the understanding
of the basic principles of body unity, self-regulation,
and the interrelationship of structure & function.
1- Mind & Spirit
• Psychosocial implications
– Acne / Scarring
– Psoriasis – Qol
– Vitiligo
• Mental State
– Triggers - Anxiety / Stress
• Acne / Atopic Dermatitis / Psoriasis
• Pruritus vulva & scroti / Burning mouth syndrome
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Neurotic excoriations / Acne excoree
Delusions of parasitosis
Trichotillomania
Factitial skin disease
2- Self-healing & Health Maintenance
• Self healing
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Insect bites
Viral Exanthems
Molluscum contagiosum
Pityriasis Rosea
Granuloma Annulare
Lichen Striatus
• Health Maintenance
– Photo-protection education
– Skin exams
3- Structure & Function
• Brachioradial pruritus
• Notalgia Paresthetica
4- Body Unity
• Treat the whole person
• Exam
– Not only look but also touch
– Use tactile perception to assist in diagnosis
• Skin disease may be sign of internal disease
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Acne – may be result of hyperandrogen state
Generalized GA – may be sign of DM
Clear Cell Syringomas – may be sign of DM
Psoriasis link to metabolic syndrome
Internal Malignancy
• PNP / Muir Turre / Dermatomyositis
Burning Mouth Syndrome
• Burning & stinging of oral mucosa
• Possible Trigeminal N. autonomic dysfunction
• OMT
– Craniosacral
• Normalize parasympathetic physiology
Xerostomia / Sjogren’s Syndrome
• Sphenopalatine Ganglion Release
– Using fifth finger
– Superior, posterior lateral area of the pharynx
– Manually massage & stimulate the sphenopalatine
ganglion
Notalgia Paresthetica
• Sensory neuropathy
– Unilateral midscapular itch, paresthesia or
hyperesthesia
– Lead to Macular Amyloid
• May be due to T2-T6 injury
• OMT
– Muscle energy
– Myofascial release – Occipital release
– Counterstrain
Brachioradial Pruritus
• Pruritus over arms, elbow and forearm
• Solar dermopathy
– UV light triggers spinal dysfunction
• OMT
– Muscle energy
– Myofascial release – Occipital release
– Counterstrain
Vulvodynia / Scrotodynia
• Vulvar discomfort, burning or pain
• OMT
– Myofascial release – Pelvic diaphragm release
– Counterstrain – pelvic floor muscles
– Spontaneous ligamentous release
• Liberate Pudendal Nerve (S2-S4) entrapment
Stasis
• Lipodermatosclerosis
• Elephantiasis Nostras Veruccosa
• OMT
– Myofascial release
– Lymphatic drainage
• Effleurage – strokes of palm from distal to proximal
– Mobilize lymph & venous flow
• Pedal pump – light dorsal & plantar flexion
– Augment lymphatic return
Hyperhidrosis
• Palmar / Plantar / Axilla
• OMT
– Rib raising
– Occipital release – augment parasympathetic
output
– Cranial manipulation – effect on sympathetic
output