Four year old has unhealthy habit

Q: My wife has the nails painted on our four-year-old daughter and once applied, our daughter will bite her nails and ingest the paint on the nails. I do not believe this is safe and would like your opinion as soon as possible as my wife values your opinion. Thank you.

A: Far be it for men to stick together, but I must agree with you. Having said this and before I get into the ingredients of the product (which varies from manufacturer to manufacturer and is modified frequently), I must interject that often times there is an underlying cause for such a situation. While your daughter is very young, some children may be under stress from attending day care and being subject to peers they do not know or may be uncomfortable with, they may perceive a degree of hostility on the home front, may be bullied by older siblings, may be afraid of the dark at bedtime, and so forth. The possibilities are endless. You and your wife might take a step backward to review what is potentially going on in your daughter’s little life and determine if some degree of anxiety is occurring in this very common nail-biting situation. Then have a talk with her and answer any questions she might have. If appropriate, seek outside help in solving the issue(s). I shouldn’t read into a situation but your daughter might have chewed her nails prior to your wife’s decision to paint them. Perhaps she was even taking a psychological approach to coax your daughter into discontinuing nail biting.

Now, on to the ingredients which are nothing less than overwhelming. Nail polish is a lacquer that has been modified countless times over the years as new enhancements are discovered that delay cracking or peeling. The polish itself consists of an organic film-forming polymer with additives. It is dissolved in a volatile organic solvent such as nitrocellulose that has been dissolved in butyl acetate or ethyl acetate. Plasticizers that contain dibutylphthalate and camphor are included, as are pigments or dyes such as stannic oxide, titanium dioxide, iron oxide, ultramarine, manganese violet, chromium oxide greens, and others. If you wife is applying a polish that looks shiny, the product may also include aluminum powder, bismuth oxychloride or mica. Thickening agents such as stearalkonium hectorite must be added to preserve the sparkles and adhesive polymers such as tosylamide-formaldehyde resins
allow the polish to stick to the surface of the nails.

Teens and older females may also opt for a base coat to strengthen the nails, the polish itself, and a top coat that forms a hardening barrier designed to prevent or at least delay chipping and peeling. Finally, some individuals opt for a gel polish that is formulated from a type of methacrylate polymer and – get this – doesn’t dry until it is cured under an ultraviolet lamp. So, instead of polish lasting a few days, the gel polish is reported to last almost two weeks. Keep in mind a typical non-acetone polish remover will be ineffective for removal and the gel must be literally pushed off the nails with an orange wood stick once the nails have been soaked in acetone for a period of between 8 and 15 minutes. Fun, huh?

So, what can I say? You both should sit down with your daughter and indicate she will no longer have her nails painted if she continues the habit. Personally, I would rather opt for a carrot or celery stick dipped into a good dressing for a snack than I would ingesting the ingredients that are almost unpronounceable. Good luck.

Can this medical disorder be avoided?

Q: Please tell me what diet, if any, I should be following to prevent diverticulitis. I know I have to stay away from seeds and nuts but what about tomato seeds and cucumber seeds. Thank you in advance.

A: According to the Mayo Clinic, there are no specific foods known to trigger attacks of diverticulitis, nor are there any specific diets proven to prevent such attacks. In the past, such foods as nuts, popcorn and products with seeds such as cucumbers and strawberries were to be avoided. With new research, this theory has been found to be incorrect, or has at least been brought into question. For years we also believed that a low fiber diet was a risk factor, yet the evidence to support the claim remains unclear. Interestingly, today a higher intake of nuts — according to some sources – might actually cause a patient to avoid having an attack of diverticulitis – at least when it comes to adult males. As can be expected, controversy abounds on diet playing a role in the exacerbation of symptoms of diverticulitis. .

Diverticula are small outward pouches that bulge from the lining of the digestive system, specifically in the lower colon. They rarely cause problems and are rather common in individuals 40 and older. It’s when the pouches become infected or inflamed that diverticulitis sets in, causing nausea, fever, abdominal pain, and changes in bowel habits. Other symptoms may include left lower quadrant pain, diarrhea, and an elevated white blood cell count. Some individuals may actually experience less common symptoms of constipation instead of diarrhea, right sided abdominal pain instead of left, and a rectal bleed. Keep in mind that other disorders such as inflammatory bowel disease (IBD) also present with similar symptoms so an individual cannot jump to the conclusion that diverticulitis is to blame. The degree of the symptoms will depend on the extent of the infection.

Known risk factors for diverticulitis include specific medications such as steroids, opiates, NSAIDs (non-steroidal anti-inflammatory drugs including ibuprofen and naproxen), leading a sedentary lifestyle, and a high animal fat diet.

Diagnosis will likely require a CT scan for confirmation if images reveal thickening of the wall of the colon and inflammation extending into the fat surrounding the colon.

On the home front and in an attempt to avoid the disorder, drink sufficient fluids, exercise at least 30 minutes each day if at all possible, and include fresh fruits, vegetables and whole grains in your daily diet. As stated previously, it simply isn’t clear if a high fiber diet will effectively decrease a person’s risk of developing diverticulitis but the ingestion of high fiber foods will help foods pass more quickly through the colon. And, as opposed to old schools of thought, it appears you can eat cucumbers and tomatoes that you apparently have been avoiding. For years we also believed that a low fiber diet was a risk factor, yet the evidence to support such a claim remains unclear. Interestingly, today a higher intake of nuts according to some sources might actually cause a patient to avoid having an attack of diverticulitis – at least when it comes to adult males. Lastly and without documentation for confirmation of success, some researchers feel that individuals who do develop diverticulitis may lack what is termed “good” bacteria in their colons. Therefore, probiotics may be considered for those individuals that do not have a compromised immune system. Probiotics are available in powders, capsules, tablets, dairy drinks and yogurt. The method by which an individual chooses to include them in the diet doesn’t matter. The product does.

Why would anyone be surprised that we should all attempt to eat well-balanced meals, exercise, obtain sufficient sleep, have regular physical examinations, and avoid stressful situations. Whether the topic is the common cold or diverticulitis, the same rules apply. Take care of yourself to the best of your ability. You’ll be glad you did.

What’s the difference in drugs for hypertension?

Q: I was previously on Triam/HCTZ tabs for hypertension. Then my physician changed my prescription to hydrochlorothiazide. What is the difference between the two medications? I am also on levothyroxine and Fosamax.

A: Triamterene/hydrochlorothiazide is a dual diuretic – a water pill used for treating both hypertension and water retention. As stated, the medication is actually a combination of two diuretics approved by the FDA some 50 years ago. The purpose of diuretics is to eliminate salt and water from the body and decreasing blood pressure. To perhaps confuse things, hydrochlorothiazide can be used alone in the treatment of edema and hypertension. As a means of compensation for the sodium and water lost during stepped up urination, the kidney works overtime to reabsorb more sodium and more water by removing potassium from the blood to replace the lost sodium and water. This process causes blood potassium levels to fall. Enter triamterene and the similar drug spironolactone that was designed to prevent reabsorption of sodium in exchange for the potassium. Thus, triamterene is referred to as a potassium sparing diuretic and the combination of the two diuretics perform well together to eliminate salt and water without a loss of potassium.

Hydrochlorothiazide (HCTZ) was designed to help treat individuals with kidney disorders, congestive heart failure, cirrhosis, hypertension, and the edema caused by a person taking estrogen or steroids. There are a number of drugs that can interact with hydrochlorothiazide, including over-the-counter medications, vitamins, herbals and other prescription drugs. Thus, it is extremely important a physician be aware of all medications a person may be on prior to beginning any drug. Interestingly, HCTZ may interfere with thyroid rest results and you have indicated you are on levothyroxine, a hormone replacement therapy. The product levothyroxin treats hypothyroidism, and prevents a goiter caused by hormone imbalances, cancer, surgery, or radiation therapy. It might be interesting to speak with your prescribing physician as to when you first began the medication and if you were on the combination triamterene/hydrochlorothiazide at the same time. And, your physician might also consider your osteoporosis or low bone mineral density, for which you are presumably taking Fosamax.

In response to your question, you may have been switched from the first drug to the second because your physician a) determined it would control your hypertension better; b) because you didn’t require the double whammy; or c) because of your potassium levels. And, there may be a d, e, f, g and still more reasons.

I recommend you ask your physician why the change and what the results now show as opposed to what they failed to show previously. You have a right to know, so don’t ever be afraid of posing the problem. Respect his or her decision and stick with the medication if you have confidence in your health care provider, but stay informed.

Non-MD straightens out dad’s medical issue

Q: My 90-year-old dad suffered with gout for many years. He has walking problems but other than his skin cancer which is under a doctor’s care, he is sharp and in good shape for his age.

I begged him to talk with his doctor about his blood pressure medication possibly causing his gout. He refused, saying his doctor has him on the best medication for his gout and he wants to stay on the drug. About six months ago I came on my regular rotation day to help my parents. My dad was in extreme pain due to his gout. He wanted me to call his doctor which I told him I would, but I indicated I wanted to speak to the doctor about his gout and his blood pressure medication being the cause of his horrible outbreaks which were then weekly. His doctor apologized and said he never thought of his blood pressure medication being the cause, but possibly it was.

He told my dad to stop taking the medication (which he did) and within several days, he was out of pain and able to put pressure on his foot which was where the gout had been for years. His doctor told us to buy a blood pressure monitor and to monitor his readings. His numbers were low – 122/60. Do I need to say he likely didn’t need the medication at all?

I have learned so much from your column and want to maybe help other people who might be suffering as my dad did for so many years.

As an aside, we love my parent’s doctor. My folks trust him as I and my family do, but sometimes we need help with a medical column. Thank you for your great service.

A: Thank you and now you can indicate you have received help via a medical column.

One thing we often forget is that physicians are human and sometimes err without really meaning to. That doesn’t imply we will make a rapid switch to another physician but that we can tactfully (or more forcefully if necessary) suggest that he or she may be overlooking something that should be investigated. You did and thankfully, his physician perhaps reluctantly but did ultimately make the connection that made all the difference in the world in your dad’s care.

I know of one physician who put a patient on medication that had a potential side effect of diabetes. Sure enough, when blood was drawn the patient was found to have elevated readings that the physician demanded required injectable medication nightly. The medication was expensive, the self-administered shots were painful, and the bottom line was that they weren’t ever needed in the first place. It was only after the patient was admitted to a nursing home for rehabilitation and his readings were more closely monitored, that the personnel there discontinued the drug responsible for the elevated readings and the injections, as well. To this day his readings are normal but it was literally like pulling teeth to get the prescribing physician to admit to the connection.

Those medications known to aggravate gout may include diuretics such as hydrochlorothiazide, and others like the popular Lasix (furosemide). And as we can all appreciate, some people may be able to take almost anything without experiencing unwanted side effects. Then there are others, such as your father, that may be experiencing devastating effects that take extended periods of time to sort through before a connection can be made.

I commend you for sticking to your guns and contacting his physician. Perhaps we can all sit up and take notice. We’re not perfect. We make mistakes and may not always have the right answer. And, with luck, we are never too old to learn.

Marriage can be full of disagreements

Q: My wife and I have this unending disagreement about orange juice. I say to have our kids drink it when they have a sinus infection so that the vitamin C gives a boost to their immune systems. My wife claims that the juice is too acidic for the stomach to handle on top of the mucus drainage that goes into the stomach, thus upsetting the stomach even more.

I have never had this problem. Do some people experience large amounts of drainage to the stomach while others do not? Wouldn’t orange juice be good for any case scenario?

A: Without realizing it, you hit the nail on the head when you said some people really like the taste of orange juice, while others may find it too acidic. Keep in mind, however, that mucus drainage originates from the sinuses, not from the stomach. Therefore, children may experience an uncomfortable feeling at the back of the throat that may cause vomiting, rhinorrhea, wheezing, and a great deal more. And, an already irritated throat or stomach can be made much worse by drinking a juice that is acidic.

According to the American Academy of Pediatrics, babies one year of age should have a limit of up to six ounces of 100% juice a day. Fruit juices contain extra calories and sugar but lack the fiber that a fresh orange contains. An article that appeared in the journal Pediatrics in 2001 stressed that children who drink excessive amounts of juice are prone to diarrhea, gas, and stomach distension. And, 100% juice should be introduced to the system gradually since a baby who has never had orange juice prior may have an allergic reaction that includes nausea, upset stomach, a cough, difficulties breathing, hives, and watery eyes.

One of the conditions we have to keep in mind other than an upset stomach from too much acid is the affect the juice has on a child’s teeth. Too much juice has been reported to literally remove the enamel from teeth. The simple way to combat this is to dilute the juice with water. And, when making a purchase at your local market, be sure to get a juice that is fortified with calcium The child will still receive the preferred flavor with a diluted product and will bypass major dental issues that are sure to occur.

While you don’t mention the ages of your children, U.S. Dietary Reference intakes recommend toddlers between the ages of one and three receive 15 mg of C per day. Children between the ages of four and eight should receive 25 mg per day. Those between the ages of nine and 13 should receive 45 mg per day. Tropicana 100% indicates an 8 ounce (240 mL) serving provides 100% of a person’s daily requirement without any mention of age of the individual drinking it. The recommended daily requirement for an adult is 90 mg for men and 70 mg for women. Other products weigh in with varying reports.

The bottom line is that we could have a round table discussion with eight (one for each ounce) doctors, parents and nutritionists and would come away with eight different answers. I believe the best thing for children is to dilute the juice with water which will cut down on calories, help preserve their teeth, will be less harsh on their tender throats, and will be a safer bet when the discussion comes up at the breakfast table again.

Nurse gets man’s mineral levels back on track

Q: I’ve been on cholesterol medication, mostly statins, since a heart attack 13 years ago. Immediately after the attack I gave up smoking, started watching what I ate, and began exercising. After about three years of consistent bad legs which I attributed to being old, a nurse suggested trying potassium. After a few months of experimenting, I found that by taking three 99 mg potassium tabs and two 600 mg calcium tabs every day, I eliminated the pain. Although I got blood labs done quarterly, nothing ever showed up to indicate a vitamin deficiency. When I told my family doctor, he said he couldn’t argue with the results, so to keep taking them. And, I have.

With the possibility of statins causing muscle damage, what are the chances of the potassium and calcium simply masking the symptoms while my muscles were being damaged? As my further experiment, I have twice stopped taking the vitamins and the pain came back full force after about three days. It then took another three to four days to stop when I started taking them again.

A: In all fairness, you have taken many positive steps safeguarding your personal health. Following your heart attack you discontinued smoking, took better control of your diet and began an exercise regimen. Congratulations to you. No one could ask for more. Then when a nurse suggested a potassium supplement, that was the ticket for appropriately addressing your leg pain.

Statins have worked wonders for lowering cholesterol levels, yet they have, unfortunately, been associated with increased muscle pain of the lower extremities in some patients. This was made public following a study published in the journal American College of Cardiology at the Center for Healthy Aging at the University of Copenhagen. A number of people on the medication report symptoms of muscle pain that can lead to problems with compliance, keeping people away from either taking the medication or from exercising – both of which are not good choices. Depending on the severity of the deficiency, low potassium levels can cause fatigue, muscle spasms and twitches, reduced reflexes, paresthesias, elevated blood pressure readings, cardiac arrhythmias, and more. As an aside, fluvastatin is on the market and has a lower incidence of muscle side effects. You might ask your prescribing physician his or her opinion on this medication.

A calcium deficiency can lead to osteoporosis and its precursor osteopenia, hypertension, dementia, cardiac arrhythmias, muscle cramps, numbness and tingling of the extremities, bradycardia, joint pain, and a great deal more.

I don’t feel you are masking any symptoms by taking the two supplements. And my guess as to why the condition never surfaced in the past is that you likely had lab testing to assure that your liver was not affected by the statin, yet you may never have had a vitamin/mineral panel to bring to light any deficiency. Your physician may have asked you if you eat a well-balanced diet and if your answer was yes, he or she likely felt such testing was not necessary in the past. Fortunately for you, the nurse you spoke with pulled the proverbial rabbit out of the hat and got you back on the right track. I’ve been reminded countless times that we must listen to nurses when it comes to patient care. They are with patients – whether at a bedside in hospital or in a physician’s office. They know their patients, know when things aren’t right, and really should be listened to more often than they are. By the way, with the supplements you’ve added, you should now have your potassium and calcium levels checked and followed, because as we age, changes may occur in our kidneys and adding extra potassium and/or calcium could be devastating if your levels become too high. Congratulations again for taking her advice and helping you. And through this correspondence, perhaps you, too, can help others.

Young senior weighs surgery vs. alternatives

Q: I am a 74-year-old male and have needed new knees for some time. I had to give up playing tennis 10 years ago. Pursuing my passion for walking has become increasingly uncomfortable. However, the number of my friends whose new knees haven’t worked as desired and a natural resistance to surgery have kept me from the operating table. And, the entire range of doctors I have consulted over these years has offered me only the alternatives of surgery or medication. None have even come close to suggesting not-for-profit alternatives.

A chance discussion with a trainer whom I was seeing for another issue has given my knees a new lease on life – and at no expense. He simply told me to strengthen the muscle that runs down the inner side of my legs. I do it by lying on my side and lifting the leg closest to the floor. I built up gradually to 100 repetitions for each leg and over the month or so that it took me to get there, the discomfort when I walk has diminished dramatically as the strengthened muscles take pressure off my knees. Much of the time I can even get up from a sitting position without using my arms to support me.

Surely the highly trained doctors I have visited must be aware of this benefit. Are they unable to prescribe effective exercises, or do economics rule their decisions? More to the point, do you know if there are medical specialists beyond the level of therapists I can consult with for further professional advice?

I do a series of exercises to tone my body and to keep a bad back at bay. It would be wonderful to be able to develop a physician-prescribed exercise program so my aging body could benefit more fully from its natural capacity to offset some of the problems of aging. Both Medicare and I can easily afford the occasional aspirin instead of large medical bills.

A: You are one phenomenal guy! You are articulate, well-versed and a pleasure to hear from. And, perhaps even more important, you have taken measures into your own hands to back away from a possible surgical procedure after speaking with others in the same situation.

Knee replacement surgery a/k/a arthroplasty is an invasive procedure that actually resurfaces the knee when damaged by arthritis. This particular form of surgery is often performed on individuals who have suffered from a severe knee injury or who has severe arthritis, the most common form of which is osteoarthritis. When osteoarthritis is present, there is a breakdown of joint cartilage that commonly causes pain. Individuals with severe cases of degenerative joint disease often have their quality of life compromised, simply because they cannot walk, climb stairs, bend at the knee, and more. Then there are varying forms of arthritis such as rheumatoid arthritis that may occur. Thus, the purpose of knee replacement is to relieve the pain that cannot be controlled by other forms of treatment and to improve function and quality of life.

Simplistically, there are two groups of muscles in the knee – the quadriceps at the front of the thighs that straighten the legs and the hamstring muscles on the backs of the thighs that help bend the leg at the site of the knee. Then there are tendons and ligaments. Tendons hold muscles to bones and ligaments resemble elastic bands that connect bone to bone.

Medical treatment is recommended by orthopedic specialists prior to deciding on surgery. Such considerations include physical therapy, anti-inflammatory OTCs such as glucosamine/chondroitin, or prescription drugs, cortisone injections, the use of a cane, and weight loss to name a few.

As with any procedure, the benefits must outweigh the risks. Complications including infection, blood clots, an adverse reaction to general anesthesia, pain and stiffness, and more must be a part of the equation before this or any other surgical procedure for any reason is initiated. Then, once the procedure is completed, physical therapy will be coordinated. So, this is no small thing to think about. Fortunately, you chose to opt for leg strengthening exercises that virtually eliminated the thought of surgery. Because I do not know what part of the country you are from, I cannot recommend a specialist beyond the expertise of a physical therapist or a physiatrist who specializes in rehabilitative medicine. I can only suggest you contact your nearest large, teaching hospital and ask for a suggestion. You’re a great guy. Stay well!

Is there a link to gallbladder issues from birth control drug?

Q: My 34-year-old daughter for at least the last six months has experienced digestive problems. After going through many medical tests, her physician ordered a HIDA scan which indicated that her gallbladder is not functioning properly. She has made an appointment with a surgeon to determine her options. She also knows another young woman who experienced the same thing and her doctor determined it was the result of the Yaz or Yasmin birth control pills she had been on. Is there any information you can give us as to the connection between birth control pills and the gallbladder?

A: Yasmin is a form of birth control (a contraceptive) that prevents ovulation and causes modifications of the cervical and uterine lining, making it difficult for a fertilized egg to attach to the uterus. The product is also used to treat moderate forms of acne in females who are at least 14 years of age who have begun their menstrual cycles and want the protection of a contraceptive.

There are a number of instances in which a female should not take this medication, including the presence of uncontrolled hypertension, circulatory issues, heart disease, liver disease or liver cancer, having a history of uterine or breast cancer, jaundice caused by birth control pills, blood clots or a blood clotting disorder, and more. There are medications that make Yasmin markedly less effective in preventing pregnancy, including taking antibiotics, being on medication for seizures, taking antibiotics/barbiturates/hepatitis C drugs, having headaches or migraine headaches, and more. The prescribing physician should be made aware of any history of diabetes, depression, hypercholesterolemia, seizures, irregular menstrual cycles, and gallbladder disease. The ethinyl estradiol and rospirenone (hormones in Yasmin) can pass into breast milk which, in turn, can harm an infant and slow the production of breast milk, so it should not be taken if a woman is breast feeding or pregnant. A woman’s physician should be made aware of any chest pain, difficulties with vision, speech or balance, jaundice, and more.

Side effects of the gastrointestinal tract may include nausea, abdominal pain, gastroenteritis, and gallbladder disease, yet some recent studies suggest the risk of gallbladder disease may be minimal. One Canadian Medical Journal article linked Yaz to gallbladder disease, yet an article in Drugwatch, the maker of Yaz (Bayer) refuted the study, indicating the symptoms were insignificant.

The gallbladder is a pear-shaped organ on the right side of the abdomen that holds digestive fluids that are released into the small intestine. There are known concerns of gallbladder disease associated with the use of progestin used in oral contraceptives according to one study using the IMS LifeLink Health Plan Claims Database for women who were using an oral contraceptive containing ethinyl estradiol combined with a progestin continuously for at least six months during the period from 1997 through 2009. The result was a small but statistically significant increase in the risk for development of gallbladder disease associated with desogestrel, drospirenone and norethindrone. There was no significant increase in the risk associated with other formulations of oral contraceptives. Recent reports in the media discuss gallbladder disease that has necessitated cholecystectomy associated with the use of drospirenone, a fourth generation progestin. The drug, combined with ethinyl estradiol is marketed as Yaz and Yasmin in the US and in Canada. It is one of the largest prescribed oral contraceptives in the country that brought in $2 billion in sales worldwide in 2009 alone. The scientific evidence on the risk of gallbladder disease connected to drospirenone appears only anecdotal.

So, your friend’s physician is on the money if he/she associated her symptoms with the use of a specific contraceptive. I urge you to visit your prescribing physician for his or her input on the matter.

Dermatologist diagnoses patient with Grover’s disease

Q: My dermatologist diagnosed a skin rash a year and a half ago between my breasts and my navel as Grover’s disease. Because of the extreme itching accompanying the rash, we have tried numerous techniques for alleviating the itch so as to bring comfort. Nothing seems to work. We tried two ointments – Mupirocin that I’ve discontinued and Triamcinolone acetonide USP 0.15% that I continue to use. I also have ultraviolet light sessions in my doctor’s office. Still, nothing has lessened my symptoms and the rash appears to be spreading to my back.

The doctor says there is no known cure for this disease but it is not contagious. I am hoping you can supply me with more positive information for a treatment, cure, or alleviation of the symptoms. By the way and of further information, I did have X-ray radiation therapy for breast cancer prior to the onset, but not in the same area. Any advice or suggestions you might have would really be appreciated.

A: Grover’s disease a/k/a acantholytic dermatosis or transient acantholytic dermatosis is an annoying and rare skin condition characterized by red lesions that itch and commonly appear on the torso, back and legs. The condition is generally found in Caucasian men over the age of 40 or 50 although, and to a lesser degree, women may carry the diagnosis. The actual ratio is thought to be three to one for the male population over that for women. Generally benign, this self-limiting disorder is persistent and difficult to manage.

While the exact cause remains unclear, there may be a relation to blockages in the sweat glands in the upper layers of the skin. However, this theory is often questioned, since most cases present in the wintertime when the skin is dry, rather than in the summer when we are more likely to sweat. Another trigger for Grover’s other than heat exposure is being subjected to extreme changes in the temperature. Symptoms may last between six and twelve months and may come and go at will, without explanation. A hallmark is pruritis (itching) with variable degrees exhibited between patients. Diagnosis may be determined by a dermatologist because of the appearance of the rash; when any doubt remains, a skin biopsy may be necessary for confirmation.

Home remedies, while undocumented, includes such things as taking vitamin B supplements and eliminating foods and beverages that contain sulfides and gluten from the diet. Minor outbreaks may be controlled with prescription-strength topical cortisone creams, while more severe cases may require oral medications including tetracycline or Accutane for up to three months. When the drugs fail to bring relief, PUVA phototherapy, oral anti-fungals or cortisone injections may be appropriate, yet there have been incidents when phototherapy may exacerbate Grover’s rather than calm it. Oral retinoids including acitretin or isotretinoin (Accutane) have brought relief to some patients, yet both products have side effects that may cause a physician to refrain from writing such prescriptions.

I’m afraid I haven’t the words of encouragement you are seeking but you are not contagious, the disorder is self-limiting (usually lasting no more than 6 to 12 months), may clear with the therapy you are on, or your physician may choose to try something else such as systemic oral steroids. On the home front, you might consider diet modifications and lastly, you may have had some of the blanks filled in which will alert you as to what is occurring to you personally with this unpleasant condition. In the big scheme of things, this is a relatively new disorder, since it was only identified in 1970, so perhaps physicians can learn along with you as research continues.