DEAR DR. ROACH: I am a 74-year-old woman in good health. I was diagnosed with pyoderma gangrenosum on my left leg. I was in a lot of pain. Can you tell me the cause of this rare disease? Also, is there a special diet I should be on? -- H.
ANSWER: Pyoderma gangrenosum is an inflammatory disease of the skin. The name suggests a terrifying infectious cause (“pyo” is the Latin root for “pus,” and “gangrene” describes the eating away of tissue), but the name is misleading -- the disease is not due to infection. In pyoderma gangrenosum, a blister or nodule on the skin rapidly expands and forms an ulcer, usually on the leg or trunk. The lesion often is quite tender. A biopsy almost always is performed to confirm the diagnosis. Treatment is with anti-inflammatory drugs -- especially steroids, but other drugs that suppress the immune and inflammatory systems sometimes are used.
Over half of people with PG have some other underlying condition, and experts recommend searching for the common associated conditions, even in people who are otherwise healthy. It’s particularly important to look for inflammatory bowel disease; blood disorders, like myeloma or leukemia; and arthritis syndromes, like rheumatoid arthritis.
Many people with inflammatory conditions such as pyoderma gangrenosum or rheumatoid arthritis feel that their symptoms improve with a diet rich in fruits, vegetables, fatty fish, nuts and fiber. The data to support this is lacking; however, it’s a healthy diet in general and might help.
DEAR DR. ROACH: I developed tennis elbow in both elbows about two months ago. My doctor suggested naproxen and a tennis-elbow brace. Is there any physical therapy that would lessen the symptoms? -- L.J.
ANSWER: Tennis elbow is caused by chronic inflammation at the epicondyle of the humerus, most commonly the lateral epicondyle. (The lateral epicondyle is a bony prominence on your elbow, on the side your thumb is on when your palm is up). Tennis elbow is mostly a condition of inexpert form, and if indeed you got yours from tennis, a tennis coach will be a good investment.
In addition to advice on proper motion, a brace is part of standard treatment, as is a short course of an anti-inflammatory medicine, like naproxen. I absolutely believe in physical therapy, but the precise strengthening and stretching that should be done are beyond the scope of this column and need to be overseen by an experienced physical therapist.
DEAR DR. ROACH: What causes vaginal yeast infections? -- J.P.A.
ANSWER: Yeast (specifically, Candida albicans) is a normal part of the microbial flora in women, but it is considered an infection when the yeast become invasive and cause inflammation of the vulva and vagina.
It’s not always clear what causes the yeast to go from being part of the normal flora to being invasive, but one common cause is antibiotic use. This is especially true of broad-spectrum antibiotics, which kill many different types of bacteria, including healthy ones. Loss of these healthy bacteria allows the Candida yeast to grow. Women with poorly controlled diabetes are more prone to develop yeast infections, and undiagnosed diabetes should be suspected in a woman with recurrences. Other types of immune-system disease, especially HIV but also drugs that suppress the immune system, can cause problems as well.
Sexual activity may increase risk for yeast infections, but women who never have sex also might get them, and treating the sexual partner has been shown to have no benefit.
Yeast infections can be treated with anti-yeast drugs, either by direct application (vaginal cream) or systemically, with an oral medication.
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