Ophthalmologist essential in the management of OCP

DEAR DR. ROACH: I have a red lesion inside my lower eyelid, with minor occasional symptoms of burning, discharge and blurred vision. The eye just doesn’t feel “right.” The lesion was removed and biopsied in December. The lesion is already back, and the pathology report suggested “ocular cicatricial pemphigoid.” I am 61 years old and have fibromyalgia. I used to wear contacts with no problems. Any insight you can provide would be appreciated. The information on the internet scares me. -- K.E.

ANSWER: Ocular cicatricial pemphigoid is a special form of pemphigoid, which itself is an autoimmune disease causing blistering of the skin and mucus membranes. In OCP, the disease usually starts in one eye, but most people develop the disease in both eyes within a few years. Early symptoms may resemble conjunctivitis, with burning, tearing and irritation of the eye. Although biopsy is helpful to establish the diagnosis, a false-negative biopsy can come back for people with the disease, and a biopsy consistent with OCP may occur in people with similar diseases -- so making the OCP diagnosis with certainty is difficult. An ophthalmologist with experience in OCP is valuable for both diagnosis and management.

Good general eye care is important for anyone with OCP. You’ll need frequent regular visits and early evaluation of suspected infection. More-severe disease is treated with systemic medications commonly used for other autoimmune diseases, including dapsone and methotrexate.

With early treatment, progression can be slowed or stopped in many people. Unfortunately, in others OCP is a slowly progressive disease.

A source on the internet you can trust is the Genetic and Rare Diseases Information Center website, at https://tinyurl.com/zpt4etx.

DEAR DR. ROACH: Your recent column on acute disseminated encephalomyelitis led me to wonder which immunizations cause ADEM, and how common is it? -- K.L.

ANSWER: It’s understandable to be concerned about vaccines, as they do have real side effects, and we need to be sure that they are worth it.

But it’s not warranted in the case of ADEM. Vaccination is a rare trigger of ADEM, an autoimmune disease in which the body attacks the myelin protein in the brain. ADEM itself is a rare disease: Specialty referral centers see only a few cases per year. Only 5 percent of cases of ADEM are related to vaccines. Although several vaccines have been implicated, rabies and smallpox vaccines probably have the greatest risk, and the measles, mumps and rubella vaccine may have the largest number of cases. However, the risk from the MMR vaccine is very small: We are talking approximately 2 cases per million vaccines given. The risk of developing ADEM from the actual diseases (measles or rubella) is much higher than the risk from the vaccine, so just from the standpoint of ADEM, it still is far better to get the vaccine. To emphasize that point, in the original column, it was the illness, not a vaccine, that may have been the trigger for the ADEM.

DEAR DR. ROACH: I had a heart stent placed. The doctor tried the newer statins, Lipitor and Crestor, but I had severe pain in my calf. Can you suggest an older statin that might help? -- B.S.

ANSWER: Statins are indicated for anybody with known heart disease, but some people cannot tolerate them. The older (and less potent) statins pravastatin and fluvastatin are least likely to cause problems. Some people also benefit from the supplement CoQ10.

If really no statins can be tolerated, then I’d consider ezetimibe, or even one of the new injectable PCSK9 inhibitors, although these are very expensive and lack long-term data.

A prudent diet, regular exercise, quitting smoking and control of diabetes and blood pressure (if appropriate) can go a long way toward reducing heart disease risk.

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