DEAR DR. DONOHUE: Three years ago, I got the shock of my life when my doctor said my alkaline phosphatase was elevated. He sent me for a liver biopsy. A gastroenterologist made a diagnosis of primary biliary cirrhosis. I cannot find any information on it. Can you help me?- B.C.

ANSWER: Say “cirrhosis,” and everyone assumes the cause is alcohol. Not so. Cirrhosis is a scarred liver, and many things cause it. Primary biliary cirrhosis is an example of a case when something else causes it.

It’s predominantly a female illness, and it usually appears between the ages of 35 and 60. Frequently, affected people have no symptoms, and it’s discovered just as yours was – via an elevated blood level of alkaline phosphatase, an enzyme that indicates bile-duct and liver injury.

The diagnosis is confirmed with a liver biopsy. Many patients remain without symptoms for prolonged periods, but eventually most develop cirrhosis.

The cause is an immune system gone haywire. It attacks bile ducts – channels that drain bile from the liver into the gallbladder. Undrained bile destroys liver cells.

When symptoms appear, one that is quite annoying is itching. Fatigue, diarrhea and yellowing of the skin and the whites of the eyes (jaundice) are also common. Since bile is necessary for fat absorption, and since vitamins A, D, E and K are absorbed with fat, deficiencies of those vitamins can occur.

Ursodiol is standard treatment. You mentioned you take it. If itching becomes a problem, cholestyramine can often control it. Supplements of vitamins A, D, E and K might be needed.

If it becomes necessary, liver transplant is the ultimate cure for this illness.

DEAR DR. DONOHUE: I developed shingles on the right side of my face in December 2003. I have been in constant pain ever since. At times the pain is almost unbearable. I have been to a pain-management clinic, seen many doctors and taken many medicines, but have gotten no relief. Not only is my face sore, but it itches. Is that normal for shingles? Can you suggest anything for the pain? – B.G.

ANSWER: The pain that lingers long after the shingles rash has gone is called postherpetic neuralgia. (“Herpes” here has no reference to cold sores or to herpes genital infection. With shingles, the virus is Herpes zoster.)

People usually describe the pain of postherpetic neuralgia as burning or as an electric-shock pain. Others call it stabbing, tearing or aching. Itching is also possible, but that happens infrequently.

You’ve been through the entire list of treatments from the doctors you have seen, so I won’t go over those medicines here. There is a new medicine for postherpetic neuralgia. It is Lyrica (pregabalin). I can’t promise it will provide a miraculous cure, but since you haven’t yet used it, it would be worth a try. I am keeping my fingers crossed for you.

The shingles booklet tells the story in greater detail. Readers can obtain a copy by writing: Dr. Donohue – No. 1201, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I have been diagnosed with bullous pemphigoid. What is it? How do you treat it? – I.J.

ANSWER: “Oid” at the end of a medical word means “looks like.” Bullous pemphigoid looks like a more serious illness, pemphigus. Before the days of cortisone drugs, pemphigus was often a fatal disease. Pemphigoid almost never was (or is).

Bullous pemphigoid is an outbreak of what, at first, look like hives. The hives turn into blisters (bullae). There may be clusters of them or only a single blister. Usually they appear on the lower abdomen, groin, arms, legs, palms or soles. Not all those places are affected at the same time, only a few of them.

The cause is the immune system’s turning against the skin. Why? The reason is a mystery.

If the outbreak is only a few blisters, cortisone creams can be applied. If it is extensive, oral cortisone drugs are prescribed, often with azathioprine or cyclophosphamide. You have every reason to expect that your illness will be controlled and may even completely disappear.

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.