DEAR DR. DONOHUE: I am 49. My main problem is dandruff. I have had this problem for 26 years. It even occurs in my beard, mustache and ear canal. I have used Head and Shoulders and Nizoral shampoos, and also beer as a shampoo. I hope you have some suggestions for me. — T.S.

ANSWER: Dandruff is flakes of scalp skin that constantly fall off the head. Many conditions lead to it. The most common is something called seborrheic (SEB-oh-REE-ik) dermatitis. It targets the scalp, but also may strike the eyebrows, the eyelids, the skin between the eyebrows, the nasolabial folds (the groove that runs from the lower side of the nose to the corner of the lips) and the ear canals. It often itches.

You’ve used some of the recommended shampoos. (Beer is not one of them.) You must leave the shampoo on the scalp for five to 10 minutes. Some good shampoos, in addition to the ones you mention, are Nizoral A-D, Selsun Blue and Ciclopirox (prescription required). I know you tried Nizoral, but it is an excellent choice for killing the fungus partially responsible for this condition. Try it again, but leave it on for the prescribed time. These same products come in gels, creams and foams for face and ear involvement. Apply the products daily for a week, including the shampoos; then three times a week for the next four to six weeks. Then you can adopt a once-a-week schedule for life. Be careful about applying these medicines to the ear canal. Do so very gently.

If itching is a problem, you can buy cortisone 1 percent as a gel, cream or liquid. Liquid is best for the hairy surfaces. You can use the cortisone three times a day if need be.

If all this comes to naught, then you have to put the problem in the hands of a dermatologist.

DEAR DR. DONOHUE: My mother has hiccups all day. She eats breakfast, then after breakfast, they start and continue all day until she’s asleep at night.

What can she do? — H.V.

ANSWER: How long has your mother had hiccups? Usually, they last two days at the longest. More-prolonged hiccups called for prescription medicines.

Your mother can try the age-old remedies. One is to inhale deeply and then quickly exhale two times. On the third go-around, inhale deeply and hold the inhalation as long as possible. A second remedy is swallowing a teaspoon of sugar. The sugar irritates the throat, which sends a message to the brain to stop hiccups. A third treatment is breathing into a paper bag. The air inside the bag soon accumulates carbon dioxide, and that often ends hiccupping. A fourth maneuver is drinking from the opposite side of a glass. You bend over at the waist and then put the opposite side of the glass into your mouth and start sipping. Readers have provided me with these remedies throughout the years.

A prolonged siege of hiccups, one that has gone on for three days or more, is best treated by seeing a doctor who can prescribe medicines. In truly resistant cases, surgical procedures are considered. One is severing one of the phrenic nerves, the nerves that innervate the diaphragm, the breathing muscle that lies between the chest cavity and the abdominal cavity. Spasms of this muscle are responsible for hiccups.

DEAR DR. DONOHUE: I have three sisters and one brother. Three are obese. All are borderline diabetics. Two have had breast cancer. All have had a knee or hip replacement. All have high blood pressure and high cholesterol. They’re on the way to becoming invalids at an early age. Yet not one doctor has ever suggested they lose weight. I say shame on those doctors. — C.N.

ANSWER: Are you sure their doctors haven’t given them that advice? Maybe they’re telling you a story that isn’t factual. At any rate, I’ll take over. Siblings of C.N., lose weight. Your life is at stake if you don’t.

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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