DEAR READER: Dapsone is commonly prescribed to treat dermatitis, herpetiformis (a skin condition that commonly appears on the elbows and knees), acne, infection and more.

Lichen planus appears in the mouth or on the skin as an itchy, swollen rash. While its exact cause is unknown, it is thought to be related to an allergic or immune reaction, from exposure to specific medications, chemical substances that include gold rings or necklaces, hepatitis C and other causes.

Diagnosis is made through visual examination or skin-lesion biopsy. Once made, treatment might include antihistamines, lidocaine mouthwashes, topical corticosteroids, creams, ointments or ultraviolet-light therapy. The condition may last for an extended period, but is generally not harmful.

Methemoglobinemia is a blood disorder that occurs when an abnormal amount of a type of hemoglobin builds up in the blood. There are two inherited forms. The first is passed on by both parents, who don’t ordinarily have the condition themselves but carry a gene that causes it. The second form is known as hemoglobin M disease, caused by a defect in the hemoglobin molecule itself. In this case, only one parent passes on the abnormal gene.

The acquired type is more common than the inherited form and occurs following exposure to anesthetics, specific antibiotics and nitrates that are used as additives to prevent meat from spoiling.

Symptoms present with shortness of breath, headache, fatigue and a blue tint to the skin. The treatment of choice is methylene blue. Alternatives include exchange transfusions and hyperbaric-oxygen therapy.

From your brief explanation, my guess is that you were prescribed dapsone because of lichen planus. While you may have been allergic to the medication, I don’t believe it was the cause of your lichen planus but was the treatment of choice because of it. If I have misinterpreted your letter, we can take it up again at a later date.

To provide related information, I am sending you a copy of my Health Report “Blood — Donations and Disorders.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order made payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

DEAR READER:
Hidradenitis suppurativa is considered to be a severe form of acne that causes chronic skin inflammation. It is marked by the presence of blackheads and one or more tender lesions which often enlarge, break open and drain pus.

It commonly occurs around hair follicles and oil and sweat glands. It is frequently found in the armpits, anal area and groin. It can occur in any area where skin rubs together such as the inner thighs. It can affect one or several areas of the body.

Women are more likely to develop hidradenitis suppurativa. A family history of the condition increases the risk of developing it. It generally affects those between puberty and age 40; however, it can occur in those over 40 and, rarely, children.

Symptoms include small pitted areas that contain blackheads (often in pairs), pea-sized lumps under the skin that are painful, one or more red, tender, pus-filled lesions that can burst and drain unpleasant smelling fluid accompanied by itching, burning or excessive sweating and painful sores that continually leak fluid that heal very slowly or not at all, leading to scarring.

Symptoms generally start at puberty. They often begin with a single painful lesion that persists for weeks or months. For some, symptoms are mild. Others may experience progressive worsening and spreading. Excessive weight, stress, hormonal changes, heat or perspiration may exacerbate symptoms.

Scarring, under skin tunnels, cellulitis (skin infections) and restricted movement are common consequences. It is, therefore, important to report all symptoms to a physician, or better still, a dermatologist.

Treatment depends on the severity, location, number of locations, recurrence and more. Mild cases can often be treated with self-care. More severe cases may require prescription medications or surgery. Medication can include antibiotics, oral retinoids (to stop oil gland functions and preventing plugging of hair follicles), corticosteroids/immunosuppressants (prednisone and others), and non-steroidal anti-inflammatories (Advil, etc.).

Persistent or severe cases and those with deep lesions may require surgery to drain or remove them. Those patients who develop tunnels or tracts under the skin may need to have them surgically opened to promote healing. A final option is complete removal of the lesion and surrounding skin following by closure with skin grafting or skin flaps. These steps do not prevent future outbreaks, however.

Home care can include warm compresses to reduce swelling, washing affected areas with antibacterial soap followed by applying over-the-counter antibiotic creams. Loose-fitting clothing and undergarments can reduce skin irritation as well as can avoiding shaving the areas. Reducing weight can limit the number of areas where skin rubs against skin, thus leading to less irritation. Daily zinc gluconate supplements may reduce inflammation and prevent new outbreaks.

If you are not already doing so, I recommend you see a dermatologist who can help you decide on treatment options and keep you up-to-date on the latest breakthroughs.

I couldn’t tell the difference in the early stages of the transition. About a year later, however, the change was very apparent. At this point I was put on minocycline twice a day and have taken it for over six years.

My skin has always been very oily and I have inordinate amounts of seborrheic keratoses, some too big to freeze off. Now, if I stop my minocycline for three weeks, what looks like pus drips off my nose. Once I start the medication again, it takes another four months to get back to normal.

Is there any way off this treadmill? Like me, it’s old.

DEAR READER:
Rosacea is an increasingly common, chronic condition with about 14 million sufferers. It primarily affects the face but can also appear on the chest, scalp, ears and neck. It is generally characterized by redness on the checks, nose, chin or forehead. There are four types of rosacea, subtype 1 (flushing and persistent redness), subtype 2 (persistent redness with red bumps and pus-filled pimples), subtype 3 (thickened skin usually with enlargement of the nose) and subtype 4 (affects the eye, usually dry eye, tearing/burning, swollen eyelids, recurrent styes and more).

Rosacea has no known cause but it is believed that those with fair skin who blush/flush easily are at higher risk than others. It occurs in women more frequently. However, affected men tend to have severe or advanced cases. There is no cure but, with early treatment, it can be controlled.

Treatment generally starts with oral antibiotics and topical creams. These usually bring the condition under immediate control and is then maintained with long-term use of topical therapy. Some individuals may receive treatment with intense pulsed lights or lasers. Some may have visible blood vessels removed, nasal deformities from excess tissue corrected or doctors may attempt to reduce extensive redness.

If you would like more information, I recommend you visit the National Rosacea Society’s website, www.rosacea.org.

You also mentioned seborrheic keratoses. These are benign, non-invasive skin growths that usually develop around midlife or after. They generally appear as sharply margined, raised, yellow/light tan to black waxy or scaly oval lesions on the face, chest, shoulders and back. Because they are benign and harmless, you do not need to worry about them. They can be a nuisance if they are irritated or rubbed by clothing or are cosmetically unsightly. Your dermatologist may be able to remove or reduce the appearance of the larger lesions with other procedures, such as curettage (scraping) or electrocautery if they truly bother you. In some instances, two of the procedures will be used in conjunction (usually cryosurgery and curettage or electrocautery and curettage). Seborrheic keratoses have no known cause but may be related to sun exposure. Normally only one or two will appear over many years. See your dermatologist if the lesions start to bleed or if they appear rapidly because this may be a sign of skin cancer.

A dermatologist is your best bet. Ask him or her about possible treatment options and express your concerns about the current treatments you are receiving for your skin disorders. You may choose to go to another dermatologist for a second opinion. Your dermatologist appears to be handling your care very well. Good luck and let me know how this turns out.

Is this a bad practice? Is there anything I can do to arrest this process when those unavoidable interruptions occur? Is this an indication of a deeper, perhaps hormonal issue that can be treated?

DEAR READER: Acne is often triggered by stress, a common phenomenon that is challenging to treat. You seem to have found an answer to your problem. The regular use of low-dose ibuprofen will not harm you.

I do not believe that you have a hormonal imbalance. On the other hand, you don’t mention your age in your letter. If you are menopausal, hormone replacement therapy could help you. If you are pre-menopausal or post-menopausal, I suggest that you be seen by a gynecologist who can test your hormone levels and offer suggestions.

Your primary care physician can examine you and suggest treatment for your acne. He or she may also choose to refer you to a dermatologist for further evaluation.