Dermatologist for skin reactions
DEAR DR. ROACH: I get horrible fever blisters when I go on any tropical vacation and am exposed to lasting sun. These blisters develop on my lower lip.
I have tried sunscreen, but nothing has worked. On my most recent trip, the blisters appeared on the final day and took nearly three weeks to heal. It’s painful and horribly embarrassing.
Is there anything I can do? Should I see my dermatologist?
ANSWER: The sun can cause many kinds of skin reactions.
In some people, the light itself causes the problem (these reactions are called photodermatoses).
In others, the sun causes a reaction in combination with exposure to a particular substance.
Sometimes, it’s a fruit, especially limes. In people with blisters around the mouth, I think of mangoes, especially if you are enjoying them in the tropics.
Some skin diseases just get worse in the sun: Lupus is the classic example, but there are many others (my textbook lists about 50, some quite rare).
A dermatologist is indeed the person to see. In the meantime, wear sun-protective clothing on your next tropical vacation, and consider a blocking sunscreen like zinc oxide in the areas where the blistering has occurred in the past.
DEAR DR. ROACH: My doctor recommends a tonsillectomy based on the fact that I suffer from chronic strep. I am apprehensive about this surgery as an adult.
What are the realistic risks of the surgery versus continuing to experience regular cases of strep throat?
ANSWER: Strep throat infections that are chronic (lasting more than three months) or recurrent are indications for tonsillectomy in adults; however, this is an uncommon surgery in adults, and there isn’t a lot of published data on the effectiveness of treatment.
Some data show that tonsillectomy does reduce incidence of infection, as would be expected.
Other data show improved quality of life and fewer missed work days.
My own experience is limited to a handful of patients: All have had significant improvement in the number and severity of infections.
On the other hand, the surgery itself is unpleasant, and that’s putting it mildly.
There is a significant risk of major complications (perhaps around 3 per cent).
One patient told me that the first two weeks after surgery were horrendous, but gradually improved over time.
As always, it’s a balance between benefits and risks of surgery. But it’s a difficult enough surgery that you are wise to be apprehensive, and I would recommend surgical consultation only if your symptoms were severe enough and significantly impact your life.
DEAR DR. ROACH: What is your opinion on screening for ovarian cancer in a woman with a family history (in my case, a sister)?
One gynecologist stressed an annual ultrasound, while the other discouraged me from doing so. I am worried that if I wait until symptoms develop, the cancer might be pretty advanced.
ANSWER: I really understand why people with increased risk for ovarian cancer are interested in screening.
Unfortunately, we still don’t have any screening tests, such as an ultrasound or CA-125 blood test, that are good enough to recommend yet. I hope this changes soon. Promising work is progressing.
Consider genetic testing for a familial cancer syndrome, such as BRCA or Lynch syndrome.
People with one of these cancer syndromes are at high enough risk that screening may be of benefit, and there are ongoing studies to help identify the best strategy.
Speak to your gynecologist about a referral to a genetic counselor. If you test negative for these genetic syndromes, you are at lower risk (but unfortunately, even low-risk women still may get ovarian cancer).
You certainly should be vigilant for even mild symptoms of ovarian cancer; these are nonspecific and may include abdominal discomfort, bloating or swelling.
Urinary urgency (a sense of needing to get to the bathroom right away) also should prompt a visit to your gynecologist, more so than in people without a family history.
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.