Dr. Paul Donohue, author of Your Good Health, has announced his retirement after writing this popular column for 30 years. We are pleased to introduce Dr. Keith Roach, who will co-write Your Good Health with Dr. Donohue starting today. Drs. Donohue and Roach will continue until the end of this year, when Dr. Roach will become the sole writer.
Dear doctors: Please give me new medicine information for psoriasis. I break out on my scalp very bad, and also on my face, back, chest and arms. It's slowly getting worse. Sometimes my skin is very itchy.
M.T.
Psoriasis is an illness you can blame the immune system for. It sends signals to the skin that prompt the lowest layer of cells to rise to the surface so quickly that they lack the maturity to protect the underlying layers of skin cells.
Red patches covered with silvery scales result. Often, psoriatic patches itch. The scalp, elbows, knees and back are targets of psoriasis. The nails can develop pits that look like they're the result of a very slender ice pick.
The choice of medicine rests on where the patches are, how severe the outbreak is and the type of psoriasis a person has. Topical medicines are chosen to treat moderate to mild outbreaks. "Topical" indicates that the medicine is applied directly to the skin. Dovonex (a synthetic version of vitamin D) and Vectical ointment are two widely used topicals.
Stronger medicines belong to the cortisone family. Temovate and Diprolene are two examples.
Methotrexate and cyclosporine are two oral medicines that correct the immune system's excesses.
The newest psoriasis treatments are biological agents designed to rein in the wayward immune system. Their names include Enbrel, Remicade, Humira, Amevive and Stelara. They're administered in the doctor's office.
This information isn't of much use to you. All the above medicines require a prescription. Your best bet for conquering psoriasis is putting yourself in the care of a dermatologist, who can choose for you the medicines that will give you the best chance of controlling this often distressing skin illness.
Dear doctors: I recently was diagnosed with shingles, which appeared on the edge of my left underarm. I was given a week-long course of Valtrex. Two of the symptoms I experience are some chest pain and mild shortness of breath. I take only ibuprofen for the pain. Is chest pain normal in shingles?
May I still get the shingles vaccine when my skin clears?
P.R.
The chest can be painful if the rash spreads across it. Shortness of breath, however, isn't a common symptom unless the chest pain is forcing you to take shallow breaths. Play this safe. Let your doctor know what's going on.
You can and should get the shingles vaccine after you recover. Second attacks are more common than was once believed.
Dear doctors: You answered a question from a person who had Raynaud's disease and neuropathy. The person wanted to know if they are related. You said they are not.
OK, then, I have Raynaud's and neuropathy. Tests have proven it. Maybe the writer should have further testing?
B.L.
Raynaud's is a blood vessel disease. The arteries that supply the feet and hands upon exposure to cold clamp down so tightly that blood can't flow to the fingers and toes.
Neuropathy is damage to nerves that causes either muscle weakness or loss of sensation, or the appearance of often-painful sensations.
You're right. A person can have both, but they are unrelated illnesses. There's a medical saying called Hickam's dictum. It is: A patient can have as many diagnoses as he or she wishes.
Dear doctors: I've taken a multivitamin for five years. During this time, I've been dizzy and had three falls. I quit taking the vitamin four months ago. My dizziness went away. I tried half a pill. Again, I became dizzy. What are your thoughts on this?
H.S.
Your successful experiment surprises us. We have never heard of such sensitivity to multivitamins. Perhaps it comes from the fillers, substances in the pill that hold it together.
You've made your point with credible evidence. We wonder if any other readers have had a similar experience. It's news to us.
Drs. Donohue and Roach regret that they are unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may write the doctors at P.O. Box 536475, Orlando, FL 32853-6475.
