Daughter needs attentive physician

DEAR DR. GOTT: I hope you can help my daughter, as I am worried about her. She is not getting the help she needs. In February 2009, she started suffering from a skin condition on her scalp, which flakes. She also started losing large amounts of hair. She then developed a rash on her face and body.
She has been seen by three doctors and four dermatologists all connected to a local medical center, which is part of a college. One of them said she had polycystic ovary syndrome (PCOS), and another said she didn’t. She has had nine lab tests, including a CA-125, a testosterone test and a DHEA test. She is still waiting for some of the results because the doctors and medical center are being lax about sending the information to her new off-campus physician.
When this first started, my daughter suggested to one of her doctors that perhaps her birth-control pills were the problem, but the physician refused to change them until my daughter quit smoking, which she did. She also suggested that my daughter get her tubes tied instead. My daughter, 41, has no children but hopes to some day.
This new doctor did an ultrasound and found a black mass on one of her ovaries that he is watching, but he does not respond to her repeated calls about her lab results. The lab has said it sent some of the results to him and that they cannot help her. She just graduated college and is trying to find a job, but it is being made hard by the fact that she has this rash and is losing her hair. She is getting very discouraged and depressed, and cries all the time. She also doesn’t have insurance, so this whole thing is costly.
Please help.
DEAR READER: Based on your description, the first thing that comes to mind is psoriasis or some other type of dermatitis. However, if she has seen four dermatologists, this common skin condition should have been recognized and diagnosed quickly.
Psoriasis causes the body to overproduce skin cells, which it then cannot flake off as normal. It results in skin plaques that are red with silvery-white scales. When scratched or picked at, the plaques may come off but will result in bleeding.
Scalp psoriasis typically starts within the hairline and may present as nothing more than dandruff. Mild cases may even respond well to over-the-counter dandruff-control shampoos or treatments. More severe cases eventually spread beyond the hairline, down onto the neck, ears and forehead.
Psoriasis may also appear on other areas of the body. It commonly affects the arms, elbows, knees and lower legs. There are several types of psoriasis, and each carries its own distinct appearance. For example, psoriasis of the nail can cause thickening, pitting and ridging of the fingernails that may, at first appearance, resemble a nail fungus.
Psoriasis also carries complications. Scratching can lead to bleeding and increased risk of skin infections. In severe cases, it can cause feelings of social isolation, anxiety or depression because of the sufferer’s reaction (or that of others) to their appearance.
As for her diagnosis of PCOS based on her rash, I cannot comment other than giving general information about the condition.
The Androgen Excess and PCOS Society developed criteria for the diagnosis of androgen excess to include PCOS. The criteria currently consists of having excess male hormones, ovarian dysfunction and the exclusion of related disorders. However, newer determinations find there are forms of PCOS without overt evidence of increased male hormones. Additional research results are pending with regard to clarification.
PCOS may also be associated with obesity, infertility, pre- or type 2 diabetes, and a skin condition known as acanthosis nigricans (AN), which causes darkened, velvety patch of skin, commonly on the nape of the neck, armpits, inner thighs or under the breasts. It may occur on any part of the body where folds or creases are present, such as the fingers. AN is not a rash but a simple darkening of the skin. It may itch, but this is rare, just as it does not typically affect the scalp or other areas of the body that do not bend or crease.
I believe your daughter needs to find a physician who will work with her to determine the cause of her problems. There is a saying among doctors and other healthcare providers that goes something like, “If you hear hoofbeats, think horses, not zebras.” It seems to me that her physicians have been looking for zebras.
To provide related information, I am sending you a copy of my Health Report “Dermatitis, Eczema and Psoriasis.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title.