Ask the Doctor: Ticks, keratosis pilaris and telecommunications

Dr. Rob Riley joins us each week from the South Bend Clinic. Here are his responses from June 4.

Laurie: What is the best way to remove a tick? There are so many differing opinions.

There sure are! Here’s the best way: Get some tweezers and grab the tick as close to the skin as you can, trying not to squeeze the body of the tick if you can avoid it. Then gently pull straight up off the skin surface until the tick comes loose. Sometimes a little bit of the mouth parts of the tick will get left behind and that’s not a big deal. Those tend to work themselves out and you don’t need to go in there and dig them out. Just keep the area clean with soap and water. I encourage people to avoid using some of the other methods you hear about that involve either caustic chemicals or hot objects. Those methods are likely to cause injury to the person as well as the tick, so gently pulling them out is the way to go. If you’re not comfortable doing this yourself, I’m sure your doctor is willing to help.

Hanna: What’s the best lotion to use for keratosis pilaris?

First, a little background. Keratosis pilaris is a pretty common skin condition that most people haven’t heard of. It’s characterized by little bumps that are associated with pores in the skin. It mostly affects kids and young adults, usually on the arms and thighs. Sometimes there’s some redness, too, but not always. People don’t usually have any symptoms of this—they just don’t like the way it feels or looks. As our viewer suggests, moisturizers can be helpful. Ointments are the greasiest and probably the most effective, but most of the time lotions or creams will work just fine. I’ve typically recommended Eucerin cream but there are a lot of options that all work about as well, so experimenting with different over the counter products is reasonable.

Rose: When will doctors use telecommunications to treat patients that are medically fragile and cannot leave their homes?

So-called telemedicine has been just getting started recently. This may become an important part of healthcare delivery in the future. One of the current barriers is payment. Doctors have typically provided telephone care to their patients for free and insurance companies don’t tend to pay for telemedicine visits. That may change in the future. Another concern is quality of care. A physical examination is often an important part of an office visit and one that’s currently difficult to reproduce adequately remotely. There was a recent study in children suggesting that children treated by telemedicine may be overprescribed antibiotics. So we have some work to do. In the meantime, it may be helpful for our viewer to know that many doctors will still make a house call when the situation calls for it.