The other day I happened to freeze my hands. Yes, not that frostbite, and not frostbite at all, but so, slightly freeze. All right, all right-my gloved fingers froze, so I remembered a story told by a patient at the reception.
And it was so.
Served this patient in tank troops, but once their part of, fulfilling what the March-throw engulfed in peatland and one of tanks, commander which he was, suddenly began fail in peatland quagmire. This did not happen quickly due to the fact that it was winter and there were severe frosts, shackled the ground over the burning peat thick crust. However, apparently not so dense to withstand the weight of the tank. Disaster seemed inevitable! The account went on seconds and in the next moment our commander, having jumped down on the earth, already picked up the end thick as a boa and a heavy steel rope from other tank to throw it a loop on a hook of the and thereby to rescue not only the crew, but also the fighting machine entrusted to it.
Grabbing the rope with his bare hands, he threw it over the hook and doomed to become a melted iron sarcophagus with people inside, the heavy tank, under the terrible roar of engines, began to climb out of the moor. Slowly, in clouds of black-and-blue exhaust smoke, several war machines tied with a steel rescue rope pulled another. And everything would have ended well, if not for the picture that opened the eyes of his comrades, after the smoke cleared and all the tanks were already firmly on the ground. Between them, their commander, comrade and friend was frozen to the rope of salvation. Almost fainting, he hung on to the rope still stretched between the tanks, but he could not release it from his hands.
Desire to wanting to help comrade fled ahead of reason and attempts force to tear off his hands from metal, were replaced by attempts to warm their same under aid urine. All was avail. The metal seemed to be embedded in his palms. Distraught with pain and despair, the soldier performs the feat a second time, but over himself. He rushed to the side, and on the ringing from the 50-degree cold steel, the skin of his heroic palms remained forever.
– Acquired keratoderma of the palms – barely holding back the emotion of admiration from what he heard, I informed him about my diagnosis. – I'll try to help you, " I said reassuringly, examining and feeling his hands, roughened by layers of crusts and deep cracks.
"Thank you, doctor," he said softly, and, as if embarrassed, habitually hid his hands, pressing them to his sides, as if forever closing the mystery of the story, but opening up to me the space of responsibility for his promise.
I immediately thought, the responsibility is that? Responsibility is a moral obligation to accept the consequences of one's actions and words. I remember that then I took a pause, they say-it is necessary to think. And he sat down for books about the features of the cytoskeleton of the skin, from where I came three key knowledge that helped this guy to find a healthy look and functional integrity of the skin of the palms, and I, as they said in the 90's, " answer for the Bazaar."
So, here is this knowledge, colleagues:
- First. The more intense and faster was the impact that caused hyperkeratosis, the sparing and longer should be keratolytic therapy.
- Second. Architectonics of the cytoskeleton is a prerequisite for the development of morphogenesis of epidermal and dermal cells and the basis of the functionality of the latter.
- Third. For each layer of keratolytically removed epidermal cells, an adequate stimulus of their growth pool is needed.
In practice, it looks like a combined appointment of keratolytics, retinoids and keratoplastics. Of course, individually selected doses of local and systemic effects.