Wise to con­sider side ef­fects of treat­ment

Cape Breton Post - - ADVICE/GAMES - Keith Roach

DEAR DR. ROACH: I am a 70-year-old woman with lichen planopi­laris. While I know that this is rare and not life-threat­en­ing, it is nonethe­less ex­tremely up­set­ting to me. Are there any promis­ing treat­ments, and what side ef­fects do they have? I was told that with one drug you must have your eyes checked reg­u­larly, and I would not want to put my health in dan­ger just to stop hair loss. -- D.D.

AN­SWER: Lichen planopi­laris is a spe­cial form of lichen planus, one that af­fects the scalp and causes hair loss. It is an in­fre­quently seen dis­ease, and it oc­curs more of­ten in women. It seems to be an­other dis­ease in which the body’s im­mune sys­tem at­tacks a spe­cific tis­sue -- in this case, the hair fol­li­cle. With enough time, the hair loss be­comes per­ma­nent, so treat­ment is best be­gun early. There is no cure, but treat­ment can slow hair loss and re­duce other symp­toms, such as itch­ing and burn­ing.

Steroids, which sup­press the im­mune sys­tem, are the usual first treat­ment, ei­ther as creams (us­ing very po­tent steroids) or by di­rectly in­ject­ing the steroid into the skin. Some au­thor­i­ties rec­om­mend both.

For peo­ple who don’t re­spond, sys­temic drugs can be used. The one I think you re­ferred to is hy­drox­y­chloro­quine (Plaque­nil). It is used to treat other au­toim­mune dis­eases, such as lu­pus and rheuma­toid arthri­tis. Vi­sion changes do hap­pen in a mi­nor­ity of peo­ple tak­ing this med­i­ca­tion, so pe­ri­odic eye checks by a pro­fes­sional are manda­tory. How­ever, it is still con­sid­ered a rel­a­tively safe medicine, and I have (for­tu­nately) never had a pa­tient de­velop vi­sion prob­lems on it (and I have had a lot of pa­tients on it, man­aged by my­self and a rheuma­tol­o­gist). Hy­drox­y­chloro­quine also can cause stom­ach up­set and dam­age to both the nerve cells and blood cells. About half of peo­ple will have a good or par­tial re­sponse.

Other drugs used in LPP in­clude the even more pow­er­ful im­mune sys­tem sup­pres­sants cy­closporine and my­cophe­no­late (Cel­lCept).

I won’t min­i­mize the ef­fect that hair loss can have on a woman (or a man), but I think you are wise to first con­sider the pos­si­bil­i­ties of adverse ef­fects from these pow­er­ful drugs.

DEAR DR. ROACH: I have had re­ac­tions to lo­cal anes­thet­ics. I had a mole re­moved from my back, and im­me­di­ately felt heat move up my spine and hit my head. Three days of hor­ri­ble headache fol­lowed. This was re­peated dur­ing den­tal work. My den­tist tried li­do­caine with­out ep­i­neph­rine, with no im­prove­ment. We tried Mar­caine (bupi­va­caine). It was great, no pain, un­til three hours af­ter the den­tal work -- and the headache lasted two weeks. Though I am un­usu­ally sen­si­tive to pain, I have had biop­sies with only ice packs. I have had deep den­tal scrap­ing/clean­ing with­out anes­thetic. Af­ter see­ing my tears in an­tic­i­pa­tion of li­do­caine, a den­tist this week filled a cav­ity with­out anes­thetic. What do I do? -- P.E.

AN­SWER: I have heard of a few cases of headache in re­sponse to lo­cal anes­thet­ics, but days (or weeks) of symp­toms is be­yond my ex­pe­ri­ence.

There are two dif­fer­ent fam­i­lies of lo­cal anes­thet­ics; they are me­tab­o­lized dif­fer­ently by the body. Both li­do­caine and bupi­va­caine are in the aminoamide fam­ily. It might be worth try­ing one in the aminoester fam­ily, such as pro­caine or tetra­caine.

READ­ERS: The book­let on hep­ati­tis ex­plains the three dif­fer­ent kinds. Read­ers can ob­tain a copy by writ­ing: Dr. Roach Book No. 503, 628 Vir­ginia Dr., Or­lando, FL 32803, En­close a check or money or­der (no cash) for $4.75 U.S./$6 Can. with the re­cip­i­ent’s printed name and ad­dress. Please al­low four weeks for de­liv­ery.

Dr. Roach re­grets that he is un­able to an­swer in­di­vid­ual letters, but will in­cor­po­rate them in the col­umn when­ever pos­si­ble. Read­ers may email ques­tions to ToYourGoodHealth@med.cor­nell.edu or re­quest an or­der form of avail­able health news­let­ters at 628 Vir­ginia Dr., Or­lando, FL 32803. Health news­let­ters may be or­dered from www.rb­ma­mall.com. (c) 2017 North Amer­ica Syn­di­cate Inc. All Rights Re­served

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