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Caring for skin goes deeper than applying lotion

Heather Carter, an above-knee amputee, participates in a therapy session at Walter Reed National Military Medical Center in Bethesda, Maryland. Caring for skin around amputation sites is one of the most critical roles of a military dermatologist. (U.S. Air Force photo by Sean Kimmons) Heather Carter, an above-knee amputee, participates in a therapy session at Walter Reed National Military Medical Center in Bethesda, Maryland. Caring for skin around amputation sites is one of the most critical roles of a military dermatologist. (U.S. Air Force photo by Sean Kimmons)

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FALLS CHURCH, Va. — As a cold snap takes over, we quickly feel the effects of dry hair and itchy skin. We pay attention if a rash develops or if we lose pigment in our complexion. These are changes we can easily see. Protecting ourselves from harmful sunburn or improving skin’s appearance can be other common skin concerns for us. But in a dermatologist’s world, that’s not all there is to skin.

When Army Colonel Jon Meyerle returned from Kuwait in 2008, a significant number of wounded service members were arriving at Walter Reed National Military Medical Center who had survived the war but lost limbs. The director at Walter Reed’s Military Advanced Training Center, or MATC, sought his input as a dermatologist to successfully outfit amputees with the latest in prosthetics.

Army Colonel Jon Meyerle, sits in front of a total body digital skin imaging system. The system takes standardized, full-body photographs of patients to help track changes in skin conditions over time. Images can be assessed by a patient’s medical provider at a later date. (Courtesy Photo)Army Colonel Jon Meyerle, sits in front of a total body digital skin imaging system. The system takes standardized, full-body photographs of patients to help track changes in skin conditions over time. Images can be assessed by a patient’s medical provider at a later date. (Courtesy Photo)

“It was my first exposure to amputee care," Meyerle said. “A high percentage of people with lower extremity amputations suffer from skin disease and are unable to wear prosthetics due to skin breakdown at the stump site from bearing weight.”

Meyerle says amputees can have issues with sweating, skin breakdown, ulcers, and allergic reactions to prosthetic socket material. Stump skin may undergo other changes due to a poorly fitting prosthesis. In his research, Meyerle is looking for ways to make the amputee stump skin more like skin on the palms of our hands or soles of our feet.

“The idea is, if you can toughen that skin, you can make the stump more resistant to the friction, heat and other irritants that you're exposed to when you're wearing a prosthesis," said Meyerle, who uses the full arsenal of cosmetic and dermatological tools at his disposal. These include injecting Botox at the stump site to stop sweating, and using laser hair removal to reduce hair growth and help the prosthesis socket fit better.

“Wearing a prosthesis requires the kind of skin care someone in a tropical environment needs when wearing boots all the time,” he said.

When not practicing military dermatology, conducting research, or seeing patients, Meyerle oversees 18 residents from both the Army and Navy as director for the military's largest dermatology residency training program at the Uniformed Services University in Bethesda, Maryland. He also teaches medical students, non-dermatologists, and health care extenders, like nurses.

Meyerle’s specialty is treating autoimmune disorders of the skin that result in blistering, medical dermatology conditions, and skin cancer – these areas are his primary research focus, along with work on amputee skin care, teledermatology, and standardized body scan imaging.

"Dermatologists see men, women, old, young, and every age in between,” said Meyerle. “People come to look younger with Botox, fillers, or other cosmetic procedures, like getting rid of spider veins.”

He identified warts, acne, and eczema as common reasons people pursue treatment, and said children see dermatologists for vascular malformations, like a birth mark. Most often, older people see dermatologists for various skin diseases, skin cancer, and pre-cancer, he said.

According to Meyerle, dermatologists eyeball the skin for moles that “don't fit.” If they see a concerning one, dermatologists often will view it under magnification with a dermatoscope. Meyerle’s research with standardized imaging is a potential diagnostic aid that could help identify high-risk lesions.

"The promise of standardized skin imaging is tracking people over time,” said Meyerle. “If lesions or moles on the skin change, an imaging machine can tell you what is new or different. Comparing images allows you to decide whether to continue monitoring or to do a biopsy. Imaging could mean fewer dermatologists can do the work of many,” he added.

Without skin imaging widely available to patients, we have to visually monitor moles on our skin. Meyerle says patients can do monthly self-skin examinations by following “the ABCDE rule,” which stands for Asymmetry, Border, Color, Diameter, and Evolution. While doing self-scans, Meyerle recommends looking for uneven moles – those with a jagged edge, atypical colors, or multiple colors, or moles larger than a pencil eraser. Meyerle says keeping an eye on moles that change over time is particularly important.

"People can get new moles until their 50s,” he said. “So, just because you get a new mole, that doesn't mean it is concerning.”

Meyerle said moles do change over time. They can lose pigment; become more raised or elevated; and in women, they can change during pregnancy. Recognizing bad moles is a process of pattern recognition. It’s also one of many ways a military dermatologist stands on guard for patient health and well-being.

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