Dear Dr. Roach: I am 76 and have been bothered by sensitive skin, usually dryness on my back and itchiness on my ears.
My dermatologist prescribed medications for my itchy back and ears; but, it does not really stop the recurrence of the itchiness. I started to have an itchy scalp, and don’t know if this was caused by hairspray or shampoo.
Other than dryness of the skin, what could be the possible cause of the itchiness? Could it be eczema? I asked my dermatologist, and he did not give me a definitive answer.
N.D.
Atopic dermatitis (commonly referred to as eczema) is a common cause of scalp itching and may also affect the ears. However, the list of possibilities is long and includes fungal infections (tinea capitis); other inflammatory conditions like seborrheic dermatitis (which is a frequent cause of dandruff); contact dermatitis (hair care products are the usual culprits); and psoriasis. My textbook lists 30 other less-common causes.
Your dermatologist has a great advantage over me, since he has done an exam, but sometimes even an experienced dermatologist can’t tell the exact diagnosis just by an exam. A trial of medication (often starting with skin hydration and moisturizers, but many times including a topical steroid cream) can be helpful in both treatment and diagnosis. Occasionally, a skin scraping or skin biopsy is necessary to be sure of the diagnosis.
Dear Dr. Roach: I have had bipolar affective disorder for decades. I currently take Rexulti, Pristiq and Lamictal, which prevents me from using NSAIDs for occasional pain relief. So, I have been using acetaminophen for headaches, muscle pain, etc.
I have recently been diagnosed with an essential tremor and am taking primidone, which is working well. Unfortunately, primidone and acetaminophen are incompatible.
I am currently using deep inhalations of Vicks VapoRub for headaches. Believe it or not, it does provide some relief, but it really isn’t a long-term solution.
Do you have any suggestions as to what can satisfactorily replace NSAIDs and acetaminophen for occasional pain relief?
R.M.
That list of medications already contains two significant potential drug interactions: one between primidone and lamotrigine (Lamictal) and another between primidone and brexpiprazole (Rexulti). Lamictal increases the levels of primidone, while primidone reduces the levels of Lamictal. Primidone also decreases levels of Rexulti.
These two interactions together can cause primidone to have adverse effects, while reducing effectiveness of both Lamictal and Rexulti. Your doctor may have already adjusted the doses of the medications to account for this. If the medicines are working well and are not causing side effects, you don’t have to do anything.
I am always concerned when one doctor prescribes one set of medication without the other realizing (maybe a psychiatrist prescribed your Rexulti and Lamictal, while, perhaps, a neurologist prescribed primidone). I would make sure all your prescribing doctors know about these possible interactions. Your pharmacist can also check for interactions.
Primidone makes acetaminophen (Tylenol) less effective, but is otherwise not a dangerous interaction. Unfortunately, Tylenol also reduces Lamictal levels by about 20%. Pristiq makes anti-inflammatory drugs like ibuprofen or naproxen more likely to cause bleeding. Given these multiple interacting medications, I would indeed be very careful about adding in additional medicine.
I recommend non-medication treatments for headaches, such as heat, ice, massages, rest and biofeedback. For aches and pains, I would consider topical anti-inflammatories, such as diclofenac gel.
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