While I'm at break at work, I thought I'd explain a little bit about what I do. In our outpatient dermatology department, we work primarily with psoriasis and dermatitis patients. In a nutshell, I work with tar, ultraviolet lights, and maggots (more on the maggots at a later date!) Our psoriasis patients go through a rather rigorous 21 day treatment program called the Goeckerman Program. They are typically admitted as an inpatient and receive 24 hours of wet dressings. We put steroid creams on their body which help to reduce the itching and inflammation. Then we wrap their body with wet gauze (the solution can be medicated) and then we cover the wet gauze with soft dry blankets called bouies. At the end of our "wrapping session," they look like mummies. The patients stay in the wet dressings for three hours when they are an inpatient, and we decrease the length to two hours when they are transitioned to outpatient. Once they are an outpatient, these patients are tested to a small amount of tar on their body to make sure they don't have a reaction. They are also tested to 5 different doses of ultraviolet B light (UVB). Here is a typical schedule for them for the day:
7am - Oil - We put Wesson cooking oil over their body and wipe it off with soft paper cloths. The oil helps to moisturize their skin and remove the tar in preparation for lights.
7:15am-7:30am - UVB lights - We have a special lamp called a Hot Quartz lamp to emit the light. When I work in the light room, I wear a 65 SPF sunscreen and usually have to reapply after lunch because we are exposed to quite a bit of light. Depending on their skin type and their light tests, we generally start their light treatment dose anywhere between 2 seconds and 13 seconds. We expose each body part separately in order to maximize the benefit of the light. At the beginning of the 21 days, they are only in the light room for 15 minutes, but at the end of their treatment program, some patients can be in the light room for over 2 hours!
7:30am -8:00am - Tub bath - After the light treatment, the patients soak in the a tub with a special bath oil for 30 minutes. Patients really enjoy this part of the day because they finally feel clean!
8:00am-8:15am - Shampoo - Psoriasis can often times affect the scalp, so we shampoo their hair to remove scaling.
8:15-8:30am - TAR!! - After their shampoo, we put tar which is mixed in a petroleum base (Vaseline) all over the patient's body. The tar is black and has an odor, but all of us nurses are pretty immune to the smell. Since the tar stains clothes and is very messy, we provide cotton pajamas and a sweat suit for them to wear.
8:30am - 8:45am - Scalp Treatment - Once the tar has been applied and the patient is dressed, we put a medicated solution in their scalp to decrease the scale, inflammation, and itch. This is a typical schedule for the psoriasis patient's in the morning. They will return again in 4 hours for a "Tar Smear," where we will again do another application of tar. And then they will return again in 4 more hours for another tar smear and another scalp treatment. This completes their day and they will return the next day for the same routine.
Dermatology isn't covered very much, if at all in nursing school. Maybe I missed that day... I've learned so much and I've really come to love this patient population. The patients are absolutely wonderful and because they are here for 3 weeks, we become their "second family." They are appreciatve of anything we do, especially on a day like today - Thanksgiving - when many patients are away from their families. Today, one of my patients bought Amaya a beanie baby turkey - "Gobbles" - to celebrate her first Thanksgiving. Working on the holiday makes me thankful for my job and also thankful for my health.