DEAR DR. DONOHUE: For all practical purposes, I have gone underground. I am a recluse. I have scabies and don’t want anyone to know. I can’t imagine where I picked it up. I find all this immensely embarrassing. Please provide some details on this.

I have taken the treatment, but I still itch. Itching is another thing that keeps me from socializing. It’s fierce. Does this continued itch mean I am not cured? — H.M.

ANSWER: Scabies isn’t something you should be ashamed of. It happens to all people, in all social strata and in all countries throughout the world. More than 300 million inhabitants of Earth contract it every year. It’s extremely common.

The condition is transmitted through a mite. Mites belong to the same class of insects as spiders. Mites are so small that you need a magnifying glass to see them.

When the female mite finds her way onto human skin, she digs a burrow, where she lays her eggs. The burrow is small too. It might be seen as a straight or wavy red or gray line. Places where the mite likes to settle down are the finger webs (the skin between adjacent fingers), the wrists, elbows, under the arms, the female breast, buttocks and genitals. The principal sign of infestation is intense itching that worsens at night.

No other illnesses are known to be spread by the scabies mite. People often ask if AIDS can be caught from a scabies mite bite. The answer is no.

A number of medicines rid people of the scabies mite. Permethrin cream 5 percent (Nix, Elimite) is quite effective. Crotamiton (Eurax) is another reliable preparation. Ivermectin (Stromectol) comes as an oral medicine or as a lotion. It, too, gets good results.

Itching frequently continues for a week or two after the mite has been eliminated. It’s an allergic response. An antihistamine such as Benadryl can reduce its intensity. So can cortisone creams and gels.

DEAR DR. DONOHUE: For three months I suffered from pain in my right hip. The cause is osteonecrosis. When the pain started, I had hip X-rays, but they didn’t show any changes to suggest it. Right now I am on crutches while doctors are trying to determine what is the best treatment for me. What do you recommend? I am a woman and only 35 years old. — G.L.

ANSWER: Osteonecrosis (“osteo” is “bone”; “necrosis” is “death”) also goes by the names aseptic necrosis and avascular necrosis. The blood supply to a portion of bone suddenly cuts off, and the involved bone dies. Quite often, the hip is the bone targeted.

What sets this process in motion can’t always be discovered. Sometimes it results from another illness, like lupus or sickle cell anemia. Alcoholism is a cause. High doses of cortisone medicine are another cause. It might come about from an injury; athletes have suffered from it due to injuries.

Treatment depends on how much bone is involved and to what stage of illness the process has advanced. With only a small portion of bone involved, conservative treatment of resting the hip with crutches is a choice. At more advanced stages, removing a core of involved bone sometimes can stimulate new bone formation. The possibility of joint replacement is something that has to be considered in far-advanced cases.

DEAR DR. DONOHUE: I was in the hospital for two weeks because of pulmonary edema. I know it means fluid in the lungs. What I don’t know is where this fluid comes from or why it happens. Will you fill me in? — T.Z.

ANSWER: The fluid is the liquid part of blood. When the lungs are filled with it, the situation is very much like drowning. A heart that is too weak to effectively pump blood or that has defective heart valves can cause blood to back up in the lungs, and the fluid oozes out of lung blood vessels. Kidney or liver failure can lead to it. A drop in the body’s production of an important protein, albumin, is another cause. Usually, the heart is the problem.

Diuretics to rid the body of excess fluid are one treatment. Additional treatment depends on finding the specific cause.

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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