Trucker MD
The largest organ in the human body?

By John McElligott, MD

New research has found that the most common condition that sends people to the doctor isn’t flu, or diabetes, or blood pressure – it’s a skin disorder. A new report from the Mayo Clinic claims skin disorders account for 42.7 percent of the doctor visits.

That’s actually no surprise to health care providers. The biggest organ or “system” in your body is your skin (and hair and nails), or what physicians call the integumentary system.

One of the most common problems that prompts my trucker patients to consult me is a skin rash or a skin lesion.

Like most truckers, my medical issues happen when I’m on the road. So now I have a nasty red bump on my hand that hurts and I am able to squeeze some gunk out of it. What is that? Is it dangerous? Should I see a doctor?

Any skin lesion with a pustule is contagious until proven otherwise. This is especially true if the bump/pustule is painful. Painful bumps with a pustule can be a staph infection and even “methicillin-resistant Staphylococcus aureus,” which we simply call MRSA.

The latter is your worst nightmare. These bumps/pustule/rash need to be approached with strict hygiene starting with the following:

  1. Do not squeeze the pustule/bump
  2. Wash with warm soap and water as often as possible.
  3. My advice is to cover the pustule/bump with Vicks VapoRub topical ointment and cover with a large Band-Aid.
  4. When you remove the Band-Aid, take care not to touch the area where the wound will start to drain.
  5. Remove the Band-Aid and place in a sealable baggy.  Do not put the discarded dressing in a trash receptacle without bagging it first as MRSA can live on objects for long periods of time. If it’s a biodegrable dressing, you can flush it down the commode.
  6. Wash your hands often using soap and water or hand sanitizer.
  7. See a doctor if the lesion is larger than a dime or becomes painful.

These simple tricks can prevent a very serious condition that can contaminate a truck and even a home and everyone living there.

Can a rash help diagnose diabetes, even before lab tests?

Yes. There are many rashes that, in my experience, for several years precede frank diabetes – the real thing as opposed to “pre-diabetic.” The following are in order of my observations over my career.

Acanthosis nigricans is a condition in which tan or brown raised areas appear on the sides of the neck, armpits, and groin. Sometimes they also occur on the hands, elbows, and knees. Acanthosis nigricans usually strikes people who are very overweight. Often we screen obese children for diabetes by having them raise their arms in the air and looking for the brownish discoloration under their arm pits. 

Another type of rash is a fungal infection. The culprit in fungal infections of people with pre-diabetes is often Candida albicans. This yeast-like fungus can create itchy rashes of moist, red areas surrounded by tiny blisters and scales. These infections often occur in warm, moist folds of the skin. Problem areas are under the breasts, around the nails, between fingers and toes, in the corners of the mouth, under the foreskin (in uncircumcised men), and in the armpits and groin. Fact: Fungi love feeding on the excessive sugar in the body.

Several kinds of bacterial infections occur in people with pre-diabetes. You can see styes (infections of the glands of the eyelid); boils; folliculitis (infections of the hair follicles); carbuncles (deep infections of the skins and the tissue underneath); or infections around the nails of the feet.

Inflamed tissues are usually red, hot, swollen and painful. Several different organisms can cause infections, the most common being Staphylococcus bacteria, also called staph. Earlier in this column, we talked about MRSA. Well, MRSA loves sugar, like that found in the system of a diabetic person. This person will be a carrier in many cases. The bacteria stay in the nose and is spread by nose picking and scratching another body part or shaking hands with someone else. LL

John McElligott is an MD, Fellow of the American College of Physicians, and medical director of the St. Christopher Trucker Development and Relief Fund. Jeff Heinrich, who serves as the column’s medical editor, has a Doctor of Education degree and is Physician Assistant Certified.
