DEAR DR. DONOHUE: I suffered from psoriasis for years. I have been seen by three different doctors and have used a variety of cortisone creams, all with no lasting relief. I even took oral prednisone, but its effects were short-lived. Aloe and vitamin E didn’t help. My present doctor says I can go with hard-core treatments, but my liver enzymes are elevated. I am seeing a liver specialist next month. Should I try a fourth dermatologist? — D.D.

ANSWER: Raised red patches of skin covered with silvery scales are the hallmarks of psoriasis. It’s an autoimmune disease, one in which the immune system has attacked the skin. Young and immature skin cells at the lower depths of the skin rush to the skin’s surface in a matter of days. It’s a process that normally takes weeks and weeks. These cells cannot function like veteran skin cells do.

Psoriasis usually can be controlled. It can’t be cured. One goal is to rehydrate the skin by taking only tepid baths, patting oneself with a towel after the bath and leaving a residue of moisture on the skin. The immediate application of moisturizer, like petroleum jelly, keeps the skin hydrated.

You have tried many cortisone-type skin creams, some of which are quite potent. It’s disappointing that they didn’t work. Other skin creams, different from the cortisone ones, are Dovonex and Vectical.

Have you tried ultraviolet therapy? Exposure to UV light in the doctor’s office can be effective. The treatment’s effectiveness is increased by taking drugs called psoralens before UV exposure. Sunlight has a healing effect, but avoid sunburn at all costs; it makes matters worse.

If your liver doctor gives approval, the “hard-core” medicines should be considered. One is methotrexate, which has been around for quite some time and has produced good results. The newest group of medicines is called biologicals. They include Remicade (infliximab), Enbrel (etanercept) and Humira (adalimumab). They have turned around psoriasis treatment for those not benefited by the standard regimens.

DEAR DR. DONOHUE: I have a situation, and I am not sure why it’s happening. I said something to my doctor during my last yearly physical. I am 73, and I am in good health. Blood pressure is 118/70, and all 25 items on my lab report are normal except for one. That is T. Bili. It is 1.04 mg/dL, with the normal being up to 1.00. I take no medication. Is this significant? — L.M.

ANSWER: T. Bili is total bilirubin. Red cells that have reached their 180-day lifespan release their hemoglobin. Hemoglobin is the stuff inside red cells that holds onto oxygen as the cells pass through the lungs. Released hemoglobin is further degraded, and finally arrives at the liver, where it is demolished for disposal. Bilirubin is one of the degradation products. The liver changes it into substances that are excreted from the body.

When the liver is not working well, bilirubin piles up in the blood. It turns the whites of the eyes and the skin yellow if blood levels keep rising. That’s jaundice.

Your elevation is so minuscule that it can be dismissed. Other liver tests were done on that panel of 25 tests, and they were normal. I have to deal with your toe question later.

DEAR DR. DONOHUE: I was born with a caul. I heard that it represents many things like luck, happiness and beauty, but it also can mean the opposite. Can you tell me what it is? — M.A.

ANSWER: It’s a remnant of the amnion, one of the covering membranes that encloses the fetus. Some of it might stick to the baby. It’s not a sign of anything. Your beauty would have been just as stunning even if you hadn’t had a caul.

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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