Sea bather's Eruption, Helping Bones in Those with Osteoporosis, and the Role of Diet in Cancer Prevention

Douse the Fire of Seabather’s Eruption With Vinegar While spending a month in Cuba, my travel companion experienced seabather’s eruption, which was described by Drs Mary Sy and Gary Williams in their Photo Essay “The Dermatologic Perils of Swimming” (CONSULTANT, August 2004, page 1229). Fortunately, some Cuban onlookers knew how to treat this condition (referred to locally as “El Caribe”) (Figure). After vinegar was applied to the eruption, the pruritus and burning diminished almost immediately. —— Laurie Brebrick, APRN-BC Milwaukee Although no published controlled studies have demonstrated that topical application of vinegar ameliorates the symptoms of seabather’s eruption, there are frequent anecdotal reports of its effectiveness. Moreover, vinegar has been studied as a palliative treatment for the stings of other species of jellyfish, and data extrapolated from these studies support the use of vinegar to relieve the symptoms of seabather’s eruption.1 The probable mechanism of action is that the acidity of the vinegar neutralizes the effects of the toxins injected by the jellyfish nematocysts. Interestingly, there are also anecdotal reports that a paste of baking soda and water (which has an alkaline pH) may provide relief. Caution swimmers not to use vinegar to try to remove the jellyfish larvae from the skin immediately after they get out of the water. That practice may only serve to trigger the envenoming barb-firing mechanism and precipitate the eruption! The soothing effect of the acidic vinegar or alkaline baking soda paste comes from neutralization of the venom after it has penetrated the skin. — Gary P. Williams, MD Associate Professor of Pediatrics University of Wisconsin Madison REFERENCE: 1. Hartwick R, Callanan V, Williamson J. Disarming the box-jellyfish: nematocyst inhibition in Chironex fleckeri. Med J Aust. 1980;1:15-20.   How Best to Help Bones in a Woman With Osteoporosis and Lower GI Bleeding Is it prudent to prescribe an oral bisphosphonate for an elderly woman with osteoporosis who has had acute hemorrhaging from a lower colonic diverticulum, for which a transfusion of 3 units of packed red blood cells was required? Would teriparatide be a more appropriate choice in this setting? — Robert P. Blereau, MD Morgan City, La Oral bisphosphonates, such as risedronate and alendronate, have been associated with adverse events of the upper GI tract—predominantly esophagitis and gastritis. Acute bleeding from the lower GI tract, such as the hemorrhaging from a colonic diverticulum in this woman, would not be caused or aggravated by an oral bisphosphonate. However, as long as your patient remains ill and requires hospitalization, it would be wise to withhold oral bisphosphonate therapy. This is because it would be difficult for her to adhere to the strict requirements of fasting and remaining upright for 30 to 60 minutes that are associated with this therapy. Teriparatide, which is given as a daily subcutaneous injection, is generally reserved for patients with severe postmenopausal osteoporosis (those with more than 2 vertebral fractures). Most of these patients have previously been unresponsive to or intolerant of oral bisphosphonates. — Hugh Taggart, MD Consultant Physician Belfast City Hospital Northern Ireland     What Role for Diet in Cancer Prevention? What is the evidence that diet can reduce or increase the risk of common cancers? Is this evidence strong enough to warrant counseling patients to follow particular dietary guidelines? — MD Obesity, a marker of a positive energy balance, is strongly related to the risk of cancer.1 As for specific foods, alcohol and red meat are the two that have been most often associated with cancer.1 When you counsel patients, it is advisable to take into account the effects of diet on all chronic diseases, including cardiovascular disease, hypertension, and diabetes, as well as cancer. With this broader aim in mind, there is sufficient and strong evidence to advise patients to maintain or achieve a healthful body weight; exercise regularly; eat plenty of fruits, vegetables, whole grains, and legumes; avoid refined carbohydrates and sugars; and avoid or reduce consumption of red meat. — Karin B. Michels, PhD, ScD Associate Professor of Obstetrics, Gynecology, and Reproductive Biology Harvard Medical School Boston REFERENCE: 1. Michels KB. The role of nutrition in cancer development and prevention. Int J Cancer. 2005;114:163-165.