DEAR DR. DONOHUE: I am writing about my 7-year-old granddaughter. She has lost pigment on both of her knees, her ankles and her knuckles, and has white patches on other parts of her body. Can you explain what causes this? Is there anything to be done for her? We are so concerned about this. – J.M.

ANSWER: What you describe fits vitiligo. People with the condition have an immune system that attacks melanocytes – skin cells that contain the pigment melanin. Melanin imparts skin color. Loss of it produces patches of white skin. The process can be widespread or limited to a few patches.

Most of the time, vitiligo just happens. For a few people, however, it’s a sign of another illness. Diabetes, pernicious anemia, adrenal gland malfunction and thyroid gland disturbances are among those other illnesses.

Much can be done to stimulate restoration of melanocytes. Not all treatments work for all people. With extensive involvement, complete restoration of normal skin color is less hopeful.

Narrowband ultraviolet-B light works for some people. High-intensity light directed only at the affected skin patches also works. That’s called targeted light therapy. Sometimes a laser beam is used in targeted light therapy. Calcipotriol cream – a synthetic vitamin D – can be helpful. It is frequently used in combination with a cortisone cream. Protopic and Elidel ointments moderate the immune attack on melanocytes and can lead to repigmentation. The FDA requires a warning to be put on those ointments. It states there is the possibility that they can lead to skin cancer and lymphoma, although no causal relationship has been established.

Your granddaughter has many options. Her parents should make sure that the depigmented patches are protected with sunblock when she plays outside.

DEAR DR. DONOHUE: One year ago, I weighed 130 pounds. Today I weigh 100. I am not dieting. I eat three big meals a day, and I snack between meals. What is going on? I am 66. – N.D.

ANSWER: Weight loss in the face of good calorie intake is an alarm-sounding danger. A doctor has to investigate a number of important conditions.

One is malabsorption. There are many illnesses in which calories and nutrients cannot pass through the digestive tract and get into the blood.

Cancer is an issue that can’t be ignored. It’s the illness that has to be the first thing looked for.

Don’t waste any more time. Put yourself in the hands of a doctor quickly.

DEAR DR. DONOHUE: When I went through menopause, my doctor put me on estrogen. He said it would help my bones, stop the hot flashes and prevent heart attacks. Now my daughter is going through menopause, but her doctor won’t put her on estrogen. Why not? It worked for me. – J.C.

ANSWER: At one time, most women who were going through menopause were given estrogen to help them with menopausal symptoms, to keep their bones strong and to prevent heart attacks. However, it’s been learned that estrogen doesn’t decrease the heart-attack risk.

In fact, in women between the ages of 50 and 79 who took estrogen for more than 10 years, the risk of a heart attack increased. Estrogen, therefore, isn’t universally given anymore for menopausal symptoms.

Doctors are taking a second look at the study that showed the negative effect of estrogen on heart disease. It might be that low-dose estrogen works well and is safe for the heart. Stay tuned.

DEAR DR. DONOHUE: I brought a list of all my illnesses and all the medicines I have taken when I saw my new doctor for the first time. When the nurse saw my list, she told me that the doctor didn’t have time for so many details. Was I wrong in bringing it? – S.S.

ANSWER: No, a list is a good idea when you see a new doctor. It’s a bad idea to bring a 20-page autobiography with all the details of your life from Day 1.

The doctor can pick out the important facts and ask you for pertinent information.

DEAR DR. DONOHUE: I take my pulse in my neck. I was told that the neck pulse differs from the wrist pulse and that pressure on the neck can cause a heart attack. Any truth to either? – B.D.

ANSWER: Pulses are the same no matter where they are checked.

Too much finger pressure on the carotid artery in the neck can cause a slowing of the heart. Sometimes it makes people pass out. If you use gentle pressure, you’re safe.

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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