Q. I suffered so much with an itchy skin problem that I finally consulted my doctor. He looked at it and pronounced his diagnosis of lichen planus. Can you tell me more about this, in words I might understand? I am still bewildered by the diagnosis and want to know what I can do about it.
A. While not common, lichen planus is by no means unknown. Approximately 1 percent of the population is at risk to develop the disease, which occurs more frequently in women than in men.
It usually is seen during middle age and can involve the skin on the arms, wrists and legs. Though rarely seen on the face, it can involve the hair and nails as well. The mucous membranes in the mouth are affected in about 50 percent of the cases, involving the inside of the cheeks and margins of the tongue. Children are rarely touched by this skin disease.
While the skin lesions may vary in their appearance, they are usually itchy (known medically as pruritus), which can be a source of much discomfort to the patient. The cause is unknown, but it may be a side effect of medication use or exposure to some chemicals.
The disease is often associated with diabetes, and it is possible that there is an underlying immunological cause for the ailment. The disease usually will disappear after a time, even without treatment, but may recur.
Medications are frequently prescribed to relieve the intense itching that you describe, usually containing an antihistamine. Corticosteroids are also frequently prescribed, both as a local application to help relieve symptoms or as an oral preparation, when symptoms are more severe. A number of other medications including antibiotics and anti-fungal agents have also been reported to help in many cases.
Q. I am getting conflicting advice on this question and would be grateful for your advice. Can you please tell me if you should feed a child who is having acute diarrhea? Some friends say yes, but my mother says no. What do you say?
A. Acute diarrhea in a small child is not the same relatively benign discomfort it is for an adult. Infants and small children with diarrhea can become dehydrated extremely quickly and may die. It's always been the standard treatment to withhold solid food from a baby with diarrhea and give him or her only water or a rehydration fluid for the first 24 to 48 hours.
More up-to-date recommendations, however, point to the value of giving babies lactose-free formula after they've already received some fluids. Babies that received a soy-based infant formula (not one with milk in it, which can cause further diarrhea) had diarrhea for a shorter period of time than did babies treated with just water and rehydration fluid. Because of this finding, it might be a good idea to start a baby on some formula early in the course of his or her illness.
Rehydration fluid is water with important nutrients like potassium added. It's sold in pharmacies under the name Pedialyte. Your doctor can also tell you how you can make your own rehydration fluid and how to use it. It would be wise to ask your doctor about this subject and go along with that advice.
Write to Dr. Bruckheim in care of the Chicago Tribune, Room 400, 435 N. Michigan Ave., Chicago, Ill. 60611.