DEAR DRS. DONOHUE AND ROACH: I take a vitamin D every day, but I also put sunscreen on my exposed skin when I go outdoors. Won’t the sunscreen interfere with the effects of the vitamin D? — L.P.

ANSWER: Low vitamin D is increasingly being diagnosed, and has been implicated in many conditions. What is absolutely clear is that vitamin D is necessary for proper bone health, and many Americans — particularly those who live in the northern two-thirds of the country (and all Canadians!) are at higher risk. Darker-skinned people also are at higher risk for low vitamin D levels, and low vitamin D has been shown to be a reversible cause of weakness in the elderly.

Preliminary studies have linked low vitamin D to cancer, but it is too early to say whether replacing vitamin D will reduce cancer risk.

Most people make their own vitamin D with a short period of sun exposure to their face and hands, and sunscreen does indeed prevent the skin from making the active form of vitamin D in sunlight.

Since you’re taking supplemental vitamin D (in the form of vitamin D-3), the sunlight isn’t necessary. You are, in effect, bypassing the skin’s involvement.

DEAR DRS. DONOHUE AND ROACH: I take methotrexate and Remicade for rheumatoid arthritis. Both the doctor and the pharmacist have told me not to drink alcohol with these medications. Neither one could tell me why alcohol is contraindicated. Recently, a nurse told me that moderate drinking is OK. I am not a big drinker, but occasionally I enjoy wine with a dinner out. However, I don’t want to do anything that will affect the good results I am getting. Do you know why alcohol is prohibited? — C.M.

ANSWER: The concern is damage to your liver, which is the major toxicity for methotrexate and is possible with Remicade. I won’t contradict your doctor and pharmacist in your particular case. However, an occasional glass of wine (meaning a few times per month, and never more than two at a time) is unlikely to cause most people harm.

Your doctor should be monitoring your liver via blood tests, so it may be that in your case, you already have some early signs of liver involvement from the medicines. You should ask him or her if a glass of wine once or twice a month would be a problem for you.

READERS: The booklet on asthma and its control explains this illness in detail. Readers can obtain a copy by writing: Dr. Donohue — No. 602, 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 DRS. DONOHUE AND ROACH: In 2006, my husband, who was 45, had skin changes on his lower legs and was sent to Rochester University Medical Center, where he was diagnosed with generalized morphea. He was placed on methotrexate; however, the skin changes have spread from just his lower legs to his upper legs and torso. In the past three years, it has gotten progressively worse. He has ulcers on his lower legs that don’t heal. They tell us there is no cure for this disease. Most people, even doctors, have never heard of morphea. It would be nice to see some information. What could it end up doing to his body? — M.P.

ANSWER: Morphea is a rare disease — only about 25 cases are diagnosed per year for every million people in the population. It is related to the autoimmune disease scleroderma, and is sometimes called “limited scleroderma,“ but does not have the degree of internal organ involvement of systemic scleroderma. Morphea consists of areas of hardened and thickened skin, affecting women more than men. It can appear at any age.

It is difficult to treat, as it can come and go, leaving after three to six years, or it can develop a chronic course over decades. Morphea can affect small blood vessels, and that — along with the methotrexate, which suppresses the immune system — can make people more susceptible to ulcers and infection. Ultraviolet light has been used successfully in morphea, as have vitamin D derivatives and steroids.

It is worth another trip to the experts at Rochester University.

Drs. Donohue and Roach regret that they are unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may write the doctors or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers also may order health newsletters from www.rbmamall.com.

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