SHINGLES: THE AFTEREFFECTS
Question: About a year ago, my wife contracted a severe case of shingles. Although the rash is gone now, the severe pain persists. Her doctors have prescribed only pain-relief pills. Is there a permanent cure?
Answer: The pain that remains after an attack of shingles is known as postherpetic neuralgia, and it is notoriously hard to vanquish. Some drugs have proved helpful, but not for all people. They include capsaicin (often sold as Zostrix), a topical medication; amitriptyline (Elavil), an antidepressant; pheny-toin (Dilantin), carbamazepine (Tegretol), or gabapentin (Neurontin), anticonvulsants; injections of corticosteroids; and lidocaine skin patches. In other people, only time brings relief; the pain can last for months or years.
Some dermatologists prescribe oral cortisone, taken for three weeks after shingles first appears, to prevent the pain that persists after an attack. But the efficacy of this particular treatment remains unproven.
Question: I have rosacea, mostly on my cheeks. What can I do about it?
Answer: In some people, avoiding hot or spicy foods, hot beverages, and alcohol will minimize this chronic blood-vessel inflammation, which appears as redness or pustules on the cheeks, nose, chin, forehead, or eyelids. If those measures don’t help, your physician can prescribe oral or topical antibiotics that will control the condition. If that doesn’t work, a doctor might prescribe metronidazole gel (MetroGel) for a particularly stubborn case. But avoid hydrocortisone cream; long-term use can cause changes that resemble rosacea itself.
Question: I have a bad case of seborrheic keratoses—grayish, like growths all over my torso. They’re not painful, but they are unsightly. What should I do?
Answer: Seborrheic keratoses don’t become cancerous, so they’re purely a cosmetic matter. A dermatologist could remove them easily, since the soft growths don’t adhere strongly to the skin. Most dermatologists simply freeze the skin to numb it and then scrape the growths off with a curette (a rounded cutting instrument). If necessary, an electric current first destroys the growths.
The procedure produces minimal bleeding and the wounds heal without scarring. However, you may be uncomfortable while you’re healing, and it could cost several hundred dollars to have the more pervasive growths removed.
Question: Winter or summer, the skin on my heels cracks and splits, sometimes to the point of bleeding. What causes this problem and how can I rid myself of it?
Answer: First see your physician to check for fungus infection or psoriasis. If those are ruled out, your heels are probably cracking because the skin is too dry. A common treatment involves “moisture trapping”—tap-water baths followed by immediate application of a nonirritating agent such as mineral oil or petroleum jelly before putting on socks and shoes. Other creams and lotions containing water or fragrances may exacerbate the problem, so it’s best to avoid them.
Question: What’s the safest, most effective way to remove blackheads on the nose or elsewhere on the face?
Answer: If your blackheads are associated with facial acne, seek professional help because of the possibility of infection. For the occasional blackhead, first wash your face (and hands) with soap and warm water, then, using a blackhead remover, press down the skin around the blackhead to extrude the oxidized matter plugging the pore. Contrary to myth, this practice does no harm.
TETRACYCLINE FOR ACNE
Question: I’ve been taking tetracycline for several years to treat my adult acne. Are there any side effects?
Answer: Usually only minor ones. Tetracycline and other antibiotics help suppress acne-promoting bacteria in the skin’s oil glands. Doctors often prescribe long-term tetracycline treatment for moderately severe acne. After a few weeks at full dosage, the dose is reduced to the smallest amount that will control the problem. Years of experience—thousands of patients and millions of prescriptions—have shown that side effects are usually mild and disappear when the drug is discontinued. Among the most common ones are diarrhea, stom-ach cramps, and vaginal yeast infections. In some people, tetracycline makes the skin more sensitive to ultraviolet radi-ation—and more susceptible to severe sunburn. Pregnant of breast-feeding women should avoid tetracycline; it may dis-color the teeth of the fetus or newborn infant and slow the growth of the infant’s teeth and bones.
If you are taking any other drugs along with tetracycline, you should tell your doctor, since some drugs may decreas the effect of tetracycline. Conversely, if you are taking oral contraceptives containing estrogen along with tetracycline, the tetracycline may decrease the effect of the birth-control pills and thus increase the possibility of unwanted pregnancy.
ACNE SCARS IN MIDDLE AGE
Question: I’m in my early forties. Because of teenage acne, my complexion is severely pitted and pockmarked. Is there any treatment or procedure to relieve this condition?
Answer: A procedure called dermabrasion, in which the skin is literally sanded down, can make scars less obvious and improve overall appearance. This procedure is usually performed under local anesthesia, and can be done by a dermatologist or plastic surgeon on an outpatient basis. After dermabrasion, the skin remains uncomfortably raw for 10 to 14 days; redness may linger for as long as several months.
FAREWELL TO KELOID SCARS
Question: I’ve had keloids on my chest for 25 years and they seem to get thicker and more itchy each day. I’ve had them removed by both conventional and laser surgery and injected with cortisone, but they always come back. Can anything more be done?
Answer: Keloids are thick, raised, ropy scars that can occur after a surgical procedure or accidental laceration. The tendency to develop keloids appears to be hereditary. In certain people—particularly African-Americans, Asians, and Hispanics—recurrence is common and hard to avoid. Treatment depends on both the size and location of the keloid and includes injection with cortico-steriods, surgical removal, laser therapy, cryosurgery, and others. As with any disorder that has multiple treatments, no one particular method is good for all patients.
It’s best to remove the keloid and immediately inject the area with cortisone. Additional injections should be given at the first sign of itching, which foreshadows the keloid’s reappearance. Within two years, most keloids treated this way are permanently banished. Keloids that aren’t bothersome in comfort or appearance can be safely left alone.
NO CURE FOR VITILIGO
Question: I have had vitiligo for more than 20 years. When I was first diagnosed, I was told there was no treatment for this condition. Is that still the case?
Answer: Yes and no. There’s still no cure for vitiligo, the patchy loss of skin pigmentation that occurs in 1 percent of the population. But newer, more sophisticated skin dyes—hydroxy-acetone, for example—can help to camouflage the whitish patches. Oral medications called psoralens can sometimes sensitize any remaining pigment cells to stimulation by ultraviolet light, helping to retard further loss of skin color. But ¿is treatment may increase the risk of skin cancer and should be reserved for severe cases. Unfortunately, treatment with psoralens usually isn’t effective in cases as long-standing as yours. Some cases of vitiligo are associated with thyroid disease, so you should have a TSH (thyroid stimulatory hormone) test. Vitiligo patches can be especially vulnerable to sunburn, so the use of sunscreens is recommended.
Health handbook introducing you to read the article: SKIN CARE: SCRATCHING AN ITCH
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