Dear Dr. Roach: A few months before my 94th birthday, I developed tiny pimples and an unbearable itch on my scalp. Two different dermatologists tried shampoos and sprays, and a biopsy showed that I have no disease (such as cancer), just psoriasis of the scalp. It has not gone away. Is there any kind of antibiotic or other help available? My life has been ruined by (of all things) a scalp problem.
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K.S.
Psoriasis is a serious skin condition that I have respect for and take very seriously indeed. Not only can the symptoms be severe (this wouldn鈥檛 be the first time I鈥檝e heard someone describe his life as 鈥渞uined鈥� by severe itching), but psoriasis also can affect the joints. Sometimes it needs treatment not only to the skin (鈥渢opical鈥�), but to the whole body (鈥渟ystemic鈥�). Psoriasis is now thought of as an auto-immune disease. Antibiotics are not effective against psoriasis, since infection isn鈥檛 the underlying cause.
Steroids, which suppress the immune system, are the usual first treatment for psoriasis of the scalp. Very potent steroids are used, and treatment can be augmented by drugs similar to vitamin D. Other topical agents 鈥� including coal tar (yes, it really is coal tar, like what is used for sealing parking lots, but in small concentrations), ultraviolet light and laser treatment 鈥� are helpful for some people. I would find a dermatologist with expertise in treating psoriasis. A support group also may be helpful.
Dear Dr. Roach: Lately, I鈥檝e heard a lot about the herbal supplement Protandim. Many people swear by it. I would appreciate your thoughts on this product.
I.B.
I reviewed the published data on Protandim back in 2013 and promised to take another look once more published data became available. Since then, a study was published in Brazil, randomizing runners to Protandim or placebo for three months. There was no difference in performance or quality of life between the two drugs. I have not found any well-done studies that support the use of Protandim. People do indeed swear by it, but I can鈥檛 say it is any better than a placebo.
Dear Dr. Roach: A while back I took naproxen for pain for the first time. Since starting this medicine, I have been dreaming more, and I remember the dreams when I wake up, which is unusual for me. Does dreaming interfere with my sleep? I鈥檓 tired in the mornings.
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I.S.
Vivid or abnormal dreams are reported with a few medicines, and naproxen is one where it does seem to be common. It was first reported back in 1991, and many people share similar stories. Some drugs are very well-known for causing this problem, among them are varenicline (Chantix, used to help quit smoking), mefloquine (Lariam, for malaria prevention) and efavirenz (Sustiva and part of Atripla, for HIV).
REM sleep, the phase of sleep during which we dream, is very important for brain functioning, so dreaming is generally a good thing for health. However, if your dreams are upsetting you, and especially if they are keeping you from sleeping, then you need to consider changing medication. There are many other options besides naproxen, so speak with your doctor.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
