Hard-skin illness can affect internal organs
DEAR DR. DONOHUE: Please explain the disease scleroderma. I have never heard of it before. I have a granddaughter who has been told she has it. What are the symptoms and the treatments? The news given to us has been devastating. — E.W.
ANSWER: Scleroderma (SKLARE-uh-DUR-muh) is an apt name for this illness. Unfortunately, the word is a Greek word. It means “hard skin,” and that’s exactly what the illness produces. The skin hardens, tightens and thickens. It can become so tight that it’s difficult or impossible to bend the fingers or to turn the lips into a smile. Scleroderma is a family of illnesses, each with a different prognosis and a somewhat different treatment approach. I’m addressing systemic sclerosis, the scleroderma variety that affects internal organs as well as the skin.
What happens is an overproduction of collagen, the body’s support protein. Layer upon layer is deposited in the skin. Internal organs are similarly affected, and they include the heart, lungs, esophagus and kidneys. Affected lungs lead to shortness of breath and a rise in lung blood pressure. A collagen-filled heart muscle becomes a poor pump. With the esophagus, swallowing can be difficult, and heartburn is common. Collagen-filled kidneys raise blood pressure and, untreated, fail to filter the blood of waste material.
The cause of this illness remains undiscovered.
Treatment centers on which organs are most involved. For example, ACE-inhibitors — blood pressure medicines — lower blood pressure and preserve kidney function, once the key factor in mortality. Medicines also can ease lung involvement and the rise in lung blood pressure, an issue separate from body blood pressure. And these are just a couple examples of what treatments are available.
I’d like to introduce you and your family to the Scleroderma Foundation. A few paragraphs don’t do justice to this complicated illness. The foundation will furnish you with literature and inform you of the latest developments in treatment. The toll-free number is 800-722-HOPE, and its Web site is www.scleroderma.org.
DEAR DR. DONOHUE: My 14-year-old, beautiful, intelligent granddaughter started pulling out her eyelashes, and now her eyebrows. She started when she was 3. I am afraid her scalp will be next.
What is this condition called? How can we help her? She’s scheduled to see a psychiatrist. — N.D.
ANSWER: The condition is trichotillomania (TRICK-oh-TILL-uh-MAY-knee-uh). You can be helpful by supporting the child, not being punitive, and realizing that the child isn’t responsible for this habit. It’s thought to result from a buildup of tension, and the relief is obtained by pulling out hair. The scalp is the usual place for hair-pulling, but eyebrows and eyelids are other places often targeted.
Without help, your granddaughter might do this forever. With help, she can learn how to suppress the urge and how to substitute better tension-relieving processes. Sometimes, medicines can be helpful, especially at the onset of therapy.
You might never have heard of this condition. Most haven’t. But it is common. In the past month, I have answered trichotillomania questions three times. That’s an indication of how many people have the problem and how desirous they are for treatment.
DEAR DR. DONOHUE: I am a senior citizen. For the past five years I have received Botox injections and wonder where the Botox goes after it leaves the injection site after about six or seven months. Does it stay in the body forever? Does it go to an organ?
Suddenly, I am worried about this. — S.B.
ANSWER: The body, as it does with all injected medicines, breaks down Botox, and the breakdown products are eliminated. It’s the way nature takes care of all foreign materials that find their way into our bodies.
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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