DEAR DR. DONOHUE: We are of Italian descent. My daughter-in-law was born and raised in Malaysia. She doesn’t take my granddaughter to the doctor as often as I think she should. Our granddaughter is almost 6 years old. Ever since she was an infant, she would develop spontaneous fevers, sometimes very high. They would last a day or two and then disappear. Of late, the fevers are accompanied by joint pain in her knees, to the point that she can’t walk. Once the fever subsides, she’s fine, and the symptoms are gone.

Any idea what this could be? — E.R.

ANSWER: Your son and daughter-in-law have a parental duty to take this child to a pediatrician, either now or at the next episode of fever. They’re seriously negligent if they don’t.

A possible explanation of the child’s problem is familial Mediterranean fever, FMF. It’s recurrent attacks of fever that can begin in infancy. The fever lasts one to three days. Often, abdominal pain accompanies the fever. Joint pain at the knee, ankle or hip is another possible companion to the raised temperature. The attacks occur unpredictably, from every few days to every several years. Vigorous physical exercise triggers them in a few. For the most part, however, the trigger remains a mystery.

The name “familial Mediterranean fever” came about because this condition affects people whose roots lie in countries surrounding the Mediterranean Sea. Greeks, Italians, Spaniards, Turks, Arabs and Jews are among those at risk.

Colchicine, a gout medicine, works for FMF. It lessens the number of attacks and, more importantly, prevents the development of amyloidosis, a consequence of FMF. Amyloid is a protein that infiltrates organs and causes them to fail. The kidney is one of those organs.

FMF isn’t the only illness that features recurrent attacks of fever. Five other illnesses have similar symptoms. This little girl needs an exam soon.

DEAR DR. DONOHUE: I have been diagnosed with lichen planus, and then later with lichen sclerosus. Please tell me the difference, and how lichen sclerosus is treated. — J.S.

ANSWER: Early dermatologists were infatuated with the word “lichen.” They used it to describe many different skin and mouth conditions. It’s a Greek word describing the greenish, mossy growth seen on trees and rocks. It’s a combination of fungi and algae. This kind of lichen has nothing to do with medical lichen conditions.

Lichen planus is an outbreak of intolerably itchy, flat, angled, purple spots. In time they are covered with white lines. Sometimes the outbreak is in the mouth or on the genitals. The cause is unknown. It’s treated with powerful cortisone medicines, like betamethasone.

Lichen sclerosus is a skin outbreak that can appear on any part of the skin, but most often on the genitals. It’s mostly a female condition that appears after menopause, but prepubertal girls get it too. Its cause also is unknown. Involved skin develops slightly raised patches covered with a thin veneer of what looks like wrinkled cigarette paper. The patches itch or produce burning pain. When they heal, they’re replaced with scar tissue. Again, treatment involves powerful cortisone medicines, such as clobetasol cream. Relapses and remissions are common.

DEAR DR. DONOHUE: I am responding to a recent letter from a woman who said she cannot apply lotion to her back.

Tell her to try this. Put the lotion on the back of a long-handled cooking spoon and use it like a backscratcher. I’ve done this successfully for years. — B.S.

ANSWER: What a great idea.

I suppose if you want to spread a cream or gel, you can use the depression side of the spoon to apply the material. You’re a candidate for a Nobel Prize.

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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