DEAR DR. DONOHUE: My sister has a burning tongue. What causes it, and what can be done for it? — H.G.

ANSWER: Burning tongue — or burning mouth syndrome, since the gums lips and palate also can be involved — is a puzzling condition, one difficult to have and difficult to treat. You’d be surprised at the number of older people who develop it. No one is positive why it happens. Because more women than men develop it and because its appearance is usually later in life, the drop-off of estrogen production was once thought to be its cause. That can’t explain why some men come down with it. A newer theory is that it’s a neuropathy, a problem caused by nerve damage. If that is the case, explaining why it disappears in some is impossible.

Your sister has to see a dentist and a doctor. A dry mouth, yeast infection of the mouth, deficiencies of many B vitamins, iron deficiency, anemia and some medicines can be involved. Treatment of these disorders extinguishes the burning.

The fact of the matter is that these conditions are rarely found. Then treatment options are few. Artificial salivas help soothe a burning tongue if the mouth is dry. A change in toothpaste might bring relief; tell her to look for one that does not contain sodium lauryl sulfate. Amitriptyline, an antidepressant, is prescribed not for depression but for its pain-relieving properties. Klonopin, used for anxiety and for seizure control, comes as a dissolving mouth wafer and has worked for some.

A home remedy said to be effective is a mouthwash composed of five drops of hot pepper sauce in one teaspoon of water. Swish it in the mouth briefly and then spit it out. The mixture briefly intensifies the pain, and then it subsides. Keep a glass of cold water handy in case it doesn’t subside. It’s wise to start with a very dilute solution, one drop in a teaspoon of water.

DEAR DR. DONOHUE: I take risedronate, the generic for Actonel, for osteoporosis. It is a bit expensive for me. I am a 74-year-old male, and my DEXA scan has shown mild improvement in my osteoporosis. I’ve been taking it since 2003. I have read that it’s best to take a break after five years. Your comments, please. — M.S.

ANSWER: The optimum duration for the treatment of osteoporosis isn’t known. Bisphosphonates, the medicines most often prescribed for it, are Fosamax (alendronate), Actonel (risedronate), Reclast (zoledronic acid) and Boniva (ibandronate). They slow bone breakdown. Many experts feel rest from medicine can be taken in five years; others say 10. These medicines remain in bones for a very long time. If you do stop, continue to have periodic checks on your bone health. And continue to take calcium and vitamin D, and exercise daily.

TO READERS: The booklet on colon cancer explains how this cancer is detected and about its treatment. Readers can obtain a copy by writing: Dr. Donohue — No. 505, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: My husband has pityriasis rosea. Will you discuss this condition? What is the cause and cure? — E.S.

ANSWER: Pityriasis rosea is something that usually happens to those between the ages of 10 and 35. The classical picture starts with a large, oval patch of pink skin that varies in size from an inch to 4 inches in diameter and is found on the back or chest. One or two weeks later, an eruption of salmon-pink, smaller patches appears on the chest, back, upper arms and upper legs. A delicate scale, like tissue paper, covers each patch. On deeply pigmented skin, the outbreak is darker than the surrounding skin. Most have no symptoms. A few itch. If itching is a problem, an antihistamine and a cream or ointment containing cortisone control it.

It probably is a viral infection, although the virus hasn’t been identified.

It resolves on its own. That can take up to six weeks, perhaps a little longer.

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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