DEAR DR. DONOHUE: Please help me understand polycystic ovary syndrome — or, as it now is called, hyperandrogenism. My granddaughter is 13. Several months ago, her mother noticed a patch of hair on her chest and a slight mustache. Her pediatrician checked her testosterone level, and it was high. The doctor sent her to a pediatric endocrinologist, who did a battery of tests. They were normal except for the testosterone. She feels my granddaughter should be on the birth-control pill. Untreated, this condition could lead to diabetes and heart problems. My granddaughter is of normal height and weight. Your input would be appreciated. — A.D.

ANSWER: Originally, large ovaries studded with cysts, hair growth in places common in men but not in women (chest, face), obesity and irregular periods or loss of periods were the emphasized signs of polycystic ovary syndrome (PCOS). Now attention is directed to the overproduction of the male hormone testosterone (hyperandrogenism). Other signs include insulin that doesn’t lower blood sugar like it should and infertility. Not every woman with PCOS has all these signs. PCOS often makes itself known shortly after the onset of puberty.

How best to treat PCOS depends on the woman’s age and her wishes. For someone your granddaughter’s age, birth-control pills are ideal, because they provide the female hormones that regulate menstrual periods. The importance of that lies in preventing uterine cancer, which might develop without regular periods. If, when she’s older, your granddaughter wants to start a family, then a different approach with different medicines is appropriate.

Treatment has other important purposes. For one, it restores normal blood sugar control. It abolishes other metabolic problems that can lead to heart disease. Eventually, it will control the growth of unwanted hair. That can take some time. In the meantime, your granddaughter can get rid of the hair in a number of ways, including shaving, until the hormone situation is righted.

DEAR DR. DONOHUE: The article you wrote on stasis dermatitis interested me. I have it. My lower legs are discolored reddish-brown with flecks of darker pigmentation. The ankles and lower legs swell until I elevate them. Does the “leakage” you referred to mean water? I think a more thorough explanation of this would be helpful to readers and me. — L.H.

ANSWER: If you’re a leg watcher, you’ll see that many people have stasis dermatitis. It’s a discoloration of the skin of the ankles and lower legs. The problem lies in leg veins. Something has gone wrong with their valves. Those valves make it possible for blood to flow upward and out of the leg veins to its final destination: the heart. Blood piles up in the veins. The fluid part of blood leaks out of them and causes swelling. Red blood cells also leak out. The disintegrating red blood cells release their iron, and that accounts for the color change of your skin. At first the skin discoloration is on the purple side. It eventually turns brownish.

You’re doing the correct thing by elevating your legs. That stops the leakage of fluid from the veins and the accompanying red blood cells. Compression stockings also keep blood moving up and out of leg veins.

DEAR DR. DONOHUE: I have Morton’s neuroma in both feet. The left one troubles me more, and even at night. Surgery was recommended, but more than 70 percent of the people I talked to who had surgery either had no improvement or the condition worsened. I had a cortisone shot that worked, but symptoms returned after it wore off. All input will be appreciated. — L.H.

ANSWER: When strands of tough tissue, very similar to scar tissue, wrap themselves around foot nerves, the result is a Morton’s neuroma. This happens to nerves in the front and sole of the foot, just below the toes. Compression of the nerve causes pain. It feels like you’re walking on a stone. Wider shoes that are well-padded can reduce the pain. An ice massage of the painful area is another pain reliever. Think again about surgery. Your poll isn’t correct. Most people find it highly successful. If I were you, and if all other measures to control the neuroma failed, I wouldn’t hesitate to take the surgical option.

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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