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:
Most forms of psoriasis are cyclic, meaning symptoms flare up, subside, and then flare up again. An outbreak can present with red, scaly patches of skin, itching, painful joints, and more. Common forms can appear anywhere on the body, including the inside of the mouth.

Risk factors include a family history of the disease, immune disorders, stress, exposure to cold, certain medications, and more.

Treatment depends on the location of the outbreak. Some lesions might be controlled with an over-the-counter topical cream. Corticosteroids are prescription anti-inflammatory drugs prescribed frequently. And, as you pointed out, some drugs can be quite cost prohibitive.

Keep your skin moisturized, especially after bathing. Avoid harsh soaps and very hot water. Both will dry your skin and aggravate the lesions. Use a sun block prior to going out of doors in daily sunlight. Controlled exposure can improve lesions, but take caution not to overdo, as too much sun will trigger an outbreak.

Alternative control includes synthetic forms of vitamin D that may reduce inflammation of the skin and block cells from reproducing. Medicated chest rubs can be applied to affected areas to relieve the itch and stop the scaling.

Besides being healthful, eating a banana a day can benefit psoriasis, not for the fruit, rather for the peel. Simply rub the inside of the peel over small or mildly irritated areas two or three times a day. Cut the balance of the peel into patches large enough to cover the most serious lesions. Hold in place with paper tape. Replace daily. The results will be astonishing.

To give you related information, I am sending you copies of my Health Reports “Dermatitis, Psoriasis & Eczema” and “Compelling Home Remedies”. Other readers who would like copies should send a self-addressed, stamped number 10 envelope and $2 for each report to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).

I am writing to you now because I hope that you can explain psoriatic arthritis. This is a very painful, sometimes disabling, type of arthritis. Little is known about it, despite the fact that it affects a great number of people.

Patients with psoriatic arthritis also have psoriasis so they are doubly affected. They have to put up with the constant skin lesions on top of the painful arthritis. It is treated with the same biological medications as RA. I am a sufferer and am tired of trying to explain the difference so I hope you will be able to help get the word out in your column.

DEAR READER:
Psoriatic arthritis is fairly easy to figure out based on the name: arthritis which is related to and develops in those with the skin disorder psoriasis. This is not to say that every psoriasis sufferer will develop psoriatic arthritis. For those who do develop it, the skin manifestations often develop first followed by the symptoms of arthritis. However, for a few, the arthritis develops first.

Primary symptoms include joint pain and/or swelling, stiffness and joints that are warm to the touch. There are five different types known. Some patients may even experience more than one type.
Asymmetric psoriatic arthritis is pain in the joints on one side of the body or pain in more than one joint on both sides (for example, the right hip, left elbow, etc.). It is the mildest form, usually involving five or fewer joints.

Symmetric psoriatic arthritis is pain on both sides of the body. It often affects more than five joints and is more common in women than in men. The psoriasis associated with this type is often severe.

Distal interphalangeal (DIP) joint predominate psoriatic arthritis primarily affects the small joints of the fingers and toes that are nearest the nails. It is rare and is more common in men. It is most often associated with psoriasis of the nails.

Spondylitis is a form of psoriatic arthritis that affects the spine.

The final type is arthritis mutilans, better known as destructive arthritis. It occurs only in a small percentage of those with psoriatic arthritis. Over time it can destroy the small bones of the hands, usually the fingers, leading to permanent damage and disability.

Risk factors include already having psoriasis, a family history of psoriatic arthritis, and being between the ages of 30 and 50.

There is no cure, but fortunately, there are several treatment options available. As the first writer correctly stated, many of the treatments used for rheumatoid arthritis are also used for psoriatic arthritis. Non-steroidal anti-inflammatory drugs (NSAIDs) are a common first step. These medications reduce swelling and may help control pain and stiffness. Over-the-counter varieties include ibuprofen and aspirin. Your doctor may prescribe stronger NSAIDs if OTCs are unsuccessful.

Corticosteroids such as prednisone or methotrexate may be used. Because of the relatively high risk of side effects these medications are generally used at the lowest possible dose for short periods of time, such as during flare-ups.

Disease-modifying anti-rheumatic drugs (DMARDs) are used to limit the amount of damage done to joints. Because they are slow acting, they are usually prescribed in conjunction with NSAIDs.

Immunosuppressant medications literally suppress the immune system to limit the amount of joint damage. Because both arthritis and psoriasis are autoimmune (caused by the bodies inability to differentiate between self and invader), they can provide excellent results. However, because of potentially serious side effects, they are often only prescribed to those with severe or disabling symptoms.

TNF-alpha inhibitors may be considered in those with severe disease. These drugs block the protein that causes inflammation.

Rarely surgery may be necessary to repair or replace joints that have been severely damaged.

Regardless of which type you have, it is important to exercise regularly to keep joints limber. If overweight, losing weight can also reduce the pressure on affected joints and may delay the use of stronger medications.

Anyone who is interested in learning more about psoriatic arthritis, its causes, symptoms and treatments should go online. There are several excellent sites available.

For those individuals with symptoms, I recommend you see your primary care physician or a rheumatologist as soon as possible for a proper diagnosis. Early treatment can reduce the severity and potential damage done to the joints.

To give you related information, I am sending you copies of my Health Report “Dermatitis, Psoriasis and Eczema” and “Understanding Osteoarthritis”. Other readers who would like copies should send a self-addressed, stamped number 10 envelope and $2 per report to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).

DEAR READER:
Chronic use of steroids can lead to osteoporosis. I assume this is the cause of your problem. I urge you to start taking 1000-1500 mg of calcium and 800 IU of vitamin D daily immediately.

For added benefit I recommend you discontinue the steroid medications. Ask your dermatologist about non-steroid, alternative treatments. While psoriasis and eczema are annoying, they are harmless and both have shown positive responses to some home remedies such as medication chest rubs or banana peels.

As for osteoporosis medications, speak to your physician or an endocrinologist who will be able to answer your questions and quell your concerns.

To give you related information, I am sending you copies of my Health Reports “Osteoporosis” and “Dermatitis, Eczema and Psoriasis”. Other readers who would like copies should send a self-addressed, stamped number 10 envelope and $2 per report to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).

My son is now 54 years old. He continues to drink goat’s milk. He purchases ½ gallon of the unpasteurized variety, and a quart of goat’s milk yogurt once a week from a local farm. This simply remedy has continued to keep his psoriasis in check and eczema at bay all these years without any doctor’s medicine.

DEAR READER:
This is a new treatment to me for two common skin ailments. I am glad to hear that your son has benefited from this simple remedy for so many years.

I would not recommend using unpasteurized milk of any variety, especially for babies or children, but I cannot argue with success. I have, therefore, chosen to print your letter for reader interest. My only alteration would be use the pasteurized variety which reduces the risk of getting sick due to bacteria in the milk.

Readers, let me know what you think.

To give you 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 number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Do you know anything about this condition? Can you offer any suggestions?

DEAR READER:
Nummular dermatitis (ND) is a form of eczema. It usually occurs on the arms and legs but can appear anywhere on the body. The rash generally starts as papules (raised areas of skin) that then turn into plaques (flattened patches, such as those associated with psoriasis). These areas are generally very itchy and are frequently accompanied by abnormal dryness. The areas are prone to infection, cracking, bleeding and so forth caused by scratching.

There are two peak ages of occurrence. Those between 60 and 70 are most commonly affected with a predominance in men. The second group is individuals between the ages of 20 and 30. Those in this group tend to be female and many also have atopic dermatitis (common eczema). This disorder is rare in children.

Symptoms often come and go with winter. Cold or dry conditions may worsen the condition while sun, humidity and the use of strong moisturizers appear to reduce symptoms. Areas of old patches are often where new outbreaks occur. There is no known cause but most authorities believe it may be multi-factoral.

Treatment for generalized (over most of the body) ND can include bed rest, oral antibiotics or steroids and being in a cool (not cold) environment. Taking cool or lukewarm baths or showers at least once or twice daily immediately followed by a moisturizer, such as Vaseline, can be beneficial. The skin must be damp while the moisturizer is applied to seal it in. Depending on the severity of the outbreak, whether it is generalized or localized, some sufferers may require oral steroids, antihistamines, sedatives, or antibiotics.

Your current treatment of triamcinolone acetonide is a topical anti-inflammatory glucocorticoid which is essentially a steroid cream. As for suggestions, I am not a dermatologist. In my opinion you are on an appropriate treatment. Just as there is no cure for common eczema, there is no cure for this form. If you have further questions about prevention, treatment and self-care techniques, I urge you to speak to your physician who, undoubtedly, has access to the newest treatments available.

To give you 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 number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

For many years I was embarrassed by problems with dandruff and flaking on my clothes. I would also have facial skin problems related to rosacea. My dermatologist gave me several different prescriptions but none ever seemed to give me any long lasting relief.

Somehow or another, I found a very simple solution that has helped me tremendously. I use a product called Brass, ZP-11 Anti-Dandruff Hairgroom. I rub it into my scalp after shampooing and then rub a light application onto my face and eyebrows. Something in the formulation works for me. It is a very inexpensive product at about $6 a bottle. Perhaps some of your readers will benefit from it as I have.

DEAR READER:
I have not heard of this product before. However, if it works for you, congratulations.

Readers, if any of you have had experience with this product please let me know your results, either pro or con. Also let me know where it can be purchased (for the future barrage of letters I am sure to receive asking where it can be bought).

To give you 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 number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.