My father suffered unnecessarily, I think, because he was misdiagnosed for several years with psoriasis when it was actually Sezary syndrome. Mycosis fungoides and Sezary syndrome are two forms of cutaneous T-cell lymphomas (cancer).

I believe my father died because a surgeon operated on his back without realizing how fragile his skin was from the Sezary syndrome. I think that a lack of information created a situation that could have been handled differently, and perhaps, my father would still be here.

I am sure that there are actual cases of psoriasis but I would hope that if there are patients with red, scaly, itchy skin that fails to respond to treatment, they would at least investigate these life threatening diseases.

DEAR READER:
Mycosis fungoides in a type lymphocyte cancer (lymphoma) that affects the skin. Lymphocytes are infection-fighting white blood cells. T-cell lymphocytes are specialized versions which help the body’s immune system. This is a relatively rare type of cancer with only about 1000 new cases diagnosed per year in the United States. It is more common in African-Americans than Caucasians and in more men than women. It usually presents at around age 50, but is occasionally seen in children and adolescents. The cause is unknown.

Mycosis fungoides ordinarily develops slowly over many years. In fact, because of non-specific laboratory testing of early lesions, it is often misdiagnosed as a benign ailment. The average time span between onset of symptoms and proper diagnosis is about six years.

In its early stages, the skin may become itchy and develop dry, dark patches, similar to those associated with psoriasis or eczema. As the disease progresses, tumors may develop. As more of the skin becomes affected, intense itching, scaling, thickening of the skin and more can develop. Skin infections can become more frequent due to cuts and tears as a result of scratching.

Mycosis fungoides is a chronic condition that, unless caught very early, is often fatal. Depending on the stage of disease at diagnosis, life expectancy can range from normal (for early cases) to as little at one year (for advanced cases). It is important to be under the care of an oncologist once properly diagnosed. For those who have been diagnosed with conditions such as eczema or psoriasis that fail to respond to appropriate medications, ask about further testing to determine if there is, in fact, a different cause.

Thank you for writing to remind me about this rare, but very serious skin cancer.

To give you related information, I am sending you a copy of my Health Report “Psoriasis and Eczema”. 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.

A few years later I developed an itch in my ear and decided what’s good enough for my dog is good enough for me. It worked! My wife was at least kind enough not to throw me out of the house before I shook!

DEAR READER:
I am passing along this tip to my readers for their use and input. Thanks for writing and letting me know about this novel approach to itchy ears.

DEAR READER:
I suggest that you may have an auto-immune disorder for which there is no cure, only control. This occurs when the immune system malfunctions and mistakenly attacks and destroys healthy body tissue.

Depending on the type of disorder, something as simple as supplements to replenish a hormone or vitamin the body is lacking might be appropriate.

Request a referral to a dermatologist or other specialist to determine what testing will provide a diagnosis.

For the past two or three years he has had an itch primarily on his back and shoulders but sometimes is all over. The dermatologist has tried many salves, creams, cortisone and other things. He also ordered a biopsy which turned out normal. What do you advise?

DEAR READER:
Itchy skin can be difficult to treat. It is often caused by irritants and is accompanied by a rash. Your husband appears to have run the gamut of dermatologic causes and now needs to move on.

First, I recommend that he stop swimming for two or three weeks. Many people experience skin dryness, itchyness and/or rash because of some of the chemicals in the pool. This is especially true for public pools where chemical levels are often higher than home pools, due to the fact that more people use it therefore more bacteria and contaminates must be eliminated.

Another possible cause could be an environmental allergy. Perhaps a trial of over-the-counter antihistamines such as Claritin or Zyrtec is appropriate. If all else fails, your husband should see an internist who can further test him and if necessary refer to other specialists.

Have you ever heard of such intense itching associated with leukemia? Is there any relief to be had? He is about to lose his mind.

He is also constantly cold because of his low red blood count but doesn’t wear wool, preferring layers, sport silk underwear and fleece jackets. At night he uses an electric blanket.

DEAR READER:
Your husband has is a type of cancer that affects the blood and bone marrow. Chronic lymphocytic leukemia (CLL) is a slow, progressive form of leukemia that affects a specific type of white blood cells known as lymphocytes.

Chronic lymphocytic leukemia is caused by damage to the DNA of newly forming cells in the bone marrow. Leukemia can develop for two reasons; one is due to damage that turns on oncogenes which control cell division and the other is due to damage that turns off tumor suppressor genes that tell cells when to die. In either way, the affected cells cease to function properly. In your husband’s case, the lymphocytes then gather in the blood and other organs and interfere with the normal blood cell production.

The reason this happens is unknown but doctors and researchers have found that many people with CLL have chromosome deletions (loss of part of one of the 23 pairs of chromosomes that make up DNA). Some individuals have an extra chromosome or other type of chromosomal abnormality. Most cases of CLL aren’t inherited but a small percentage of sufferers have a family history of the disorder or of lymphoma.

Often, there are no early signs or symptoms but in some cases fever, weight loss, night sweats, fatigue, lethargy and/or loss of appetite can be present. The disorder is often an incidental finding during normal blood testing. Symptoms of advanced CLL stages can include anemia (which can lead to paleness, fatigue, shortness of breathe and more), low white blood cell count (may cause frequent infections) and low platelet numbers (leads to bruising, abnormal blood clotting, etc.). Chronic lymphocytic leukemia may also cause bone or joint pain, liver and spleen swelling and enlargement of lymph glands in the stomach, groin, neck or underarm.

There are procedures and new medications available for treatment of aggressive or advanced CLL; however, there is no known cure.

I urge your husband to return to his oncologist for further testing and to discuss the possibility of treatment. While no one seems to know the cause of your husband’s skin issue, perhaps it will subside if the CLL is treated.

I would also like to add that persistent itching may also be a sign of kidney damage. Perhaps your husband’s condition has now progressed to a point where it may be causing organ damage. Another possibility is if your husband has recently undergone radiation treatment.

I believe your best chance of finding a solution will to be to start with the oncologist. Your husband needs answers, especially since his chronic lymphocytic leukemia appears to be worsening. If he or she cannot help, it may be time to turn to the super-specialists of a teaching hospital or clinic such as the Mayo Clinic or others. Let me know what happens.

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

DEAR READER:
Eczema is often extremely difficult to control. It stems from a malfunction of the body’s immune system. The condition is known as an itch that rashes. When the uncontrolled urge to scratch occurs, further skin irritation results, often causing rash, scaling and crusting lesions.

There are many triggers causing eczema. They include animal dander, dry skin, harsh soaps, showering too frequently, using too hot water, and more. The most effective control is to keep the skin moisturized. A good moisturizing lotion with vitamin E is recommended. While easier said than done, suggest your daughter not scratch any lesions. If this is a habit she might do in her sleep, she can wear cotton gloves to bed. She should bathe in warm, not hot, water. If her home is dry, she might use a humidifier. If these suggestions don’t work, she might ask her physician for a prescription medication.

I’d like to ask your thoughts about recurrent, chronic hives. I’ve suffered from this problem for several months. I itch, I scratch, and then I get welts. They generally disappear in a half hour or so but pop up again somewhere else. It happens two-eight times a day, every day. Antihistamines help but do not totally get rid of the symptoms. I recently took a six-week trip from Florida to Nova Scotia, thinking all during the trip that the complete change of food and atmosphere would help the hives if they were from an allergic response. They kept on coming, daily, during the trip, just as they do at home.

My allergist has tested for me foods, chemicals and inhalants. I am allergic to some trees and grasses but when I have the hives I do not have respiratory symptoms. My dermatologist drew an X on my back with his fingernail, but no hives resulted. The welts do not appear if there’s no itch first. A blood test only revealed that I have a rather high eosinophil count (19% in the last test).

I’ve spent hundreds of dollars on tests and doctors, with no conclusive results. Based on reading I’ve done, I think this is idiopathic and I may just have to learn to live with it but I don’t recall ever seeing chronic hives discussed in your column. Any thoughts or ideas you have would be helpful, not only to me but to many others as well.

DEAR READER:
Chronic, recurring hives can be very difficult to treat. The problem is often compounded by the fact that almost half of all cases are idiopathic, meaning they have no known cause.

Your elevated eosinophil count is telling. These specialized white blood cells are usually only active during certain allergic diseases, infections (primarily parasitic), and in the presence of certain medications. Allergic disease can include asthma, eczema, hay fever, and autoimmune disorders. Medications include amphetamines, certain psyllium laxatives, certain antibiotics, interferon and tranquilizers.

Most chronic hives occur daily (as yours do) but last for several hours. Hives also tend to itch only after developing. Because yours do not appear until after itching and scratching, your dermatologist correctly performed a pressure test. This test using a blunt point and in individuals with delayed pressure urticaria (hives), the area drawn on will develop welts. This may occur within minutes but may take several hours before they are obvious. Again, however, you are atypical with welts only appears after scratching. I am tempted to say that you have a strange combination of delayed pressure urticaria and eczema (an area of dry skin that itches then rashes after scratching); however, I am not a dermatologist.

I urge you to seek out second opinions from a dermatologist and allergist. They may be able to provide new insight and order new testing. Because your symptoms are chronic, recurring and clearly affecting your quality of life, I recommend you visit the dermatology and/or allergy clinics of a teaching hospital. I note that you live in Florida. You are in luck because there is a specialty resource known as The Mayo Clinic located in Jacksonville, FL. You may also wish to check out some of the universities near you to see if any offer clinics at area hospitals where medical students and professors see the general public. This is a great option because you will be getting excellent care and aiding in a student’s education.

In the meantime, I recommend you take antihistamines as a preventive to reduce your symptoms.

To give you related information, I am sending you a copy of my Health Report “Allergies”. 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.