August 28, 2008
Mite Causes Mighty Itch, Use Permethrin
DEAR DR. DONOHUE: What can I do to get rid of scabies? I had a terrible itch on my fingers and hands, and it was diagnosed as eczema. The eczema medicine didn't work. My doctor sent me to a dermatologist, who made the scabies diagnosis. The whole affair embarrasses me, and I don't want anyone to know. I applied the skin cream twice, but I still have the itch. Can't this terrible thing be cured? I am at my wits end. - C.F.
ANSWER: Scabies isn't an embarrassment. Hundreds of millions of people worldwide have it, and it strikes those in the most exclusive of locations as well as those in overcrowded slums. It's not a felony. A very tiny mite causes scabies. Mites belong to the same family as spiders and ticks. The scabies mite measures 0.3 mm by 0.4 mm. You need a magnifying glass to see it well. The fertilized female scabies mite burrows into the skin and digs a tunnel to lay her eggs. The tunnels look like fine, wavy, dark lines.
The prominent symptom of scabies is intolerable itching, which grows even more intolerable at night. The fingers, hands, elbows, breasts, navel, buttocks, thighs, feet and the skin under the arms are the places where the mite is most often found.
Permethrin cream, applied from the neck down to the soles of the feet and left on for eight to 14 hours almost always puts an end to the scabies story. The oral medicine ivermectin works equally well.
Itching after treatment is common, and it can linger for weeks and weeks. It's a manifestation of allergy to the mite and its products, and it takes time for the allergic reaction to subside. Antihistamines can control the itch.
If you are convinced that the scabies mite hasn't been done in, see the dermatologist again. He or she can take skin scrapings and examine them for the mite or her eggs.
DEAR DR. DONOHUE: My mother is fixated on bowel movements. If she doesn't have a daily movement, she takes a laxative. If that doesn't work, she gives herself an enema. She weighs only 100 pounds and eats like a canary. She thinks a daily movement removes toxins that can make her sick. Can you talk some sense into her? - M.T.
ANSWER: Your mother grew up in an era when it was thought that a daily bowel movement was essential to good health and when the "toxin" theory was in vogue. People can go three days without a movement and be quite healthy. Constipation isn't judged by frequency of eliminations but more by the hardness of the stool and the amount of straining it takes to empty the rectum.
Your mother has to overcome her preoccupation or she's going to make herself sick. If she wants to do something for herself, she can increase her calorie and fiber intake and forget her daily ritual.
DEAR DR. DONOHUE: I am a man of 85 years. About six months ago, I bumped my head on a dresser drawer. My head hurts all day. Pain pills don't work. The doctor said my head pain is due to tension headaches because I am nervous and jittery. A brain scan didn't show anything wrong. The doctor said he can't help me and that I should see a psychiatrist. I know my head, and I know it hurts and it's not tension. What do I do? - A.M.
ANSWER: You should see a neurologist.
When did you have the brain scan? If it was two to six weeks after you bumped your head, it might not have shown a subdural hematoma - a collection of blood over the brain. You need a special kind of brain scan, or an MRI of the brain.
A headache that continues this long is not normal. As you say, you know your head.
DEAR DR. DONOHUE: Do you have any comments on the grapefruit diet? I understand that it works wonders quickly and that it keeps weight from coming back. My friends are very enthusiastic about it. They tell me it is promoted by the Mayo Clinic and is quite safe. - W.R.
ANSWER: The grapefruit diet is one of those diets that crops up again and again with depressing regularity. I don't know where it started or who started it. And I don't know which version you are referring to. I do know that it would be short of a miracle if grapefruit could melt fat; it can't. The grapefruit diet doesn't work.
The Mayo Clinic has nothing to do with this diet.
DEAR DR. DONOHUE: Regarding the person with hives, I had the same misfortune and went from doctor to doctor without any relief. Finally, I was referred to an allergist, who put me on Xyzal and Zyflo CR. I was able to get off all the medicines that had made me so drowsy, and I have not had a bad recurrence for five months. - J.D.
ANSWER: Maybe they will work for others. Xyzal is an antihistamine, and Zyflo CR is an asthma medicine. We'll see if others get the same results you did.
Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853- 6475. Readers may also order health newsletters from www.rbmamall.com.
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