DEAR DR. ROACH: What is the best way to eliminate skin tags? Is there an over-the-counter item that will work effectively? There are many products that claim to remove them, but most don’t. — G.L.

ANSWER: Skin tags (acrochordons) are benign but unsightly outgrowths of normal skin usually found in places where the skin rubs against itself, such as in the groin or axilla (underarm).

They don’t need to be removed if they aren’t bothering you. If you want to remove them for cosmetic reasons, the best way to remove them is to see your doctor or dermatologist to get it done definitively. I usually use a scalpel blade (I use anesthetic), but they can be removed with liquid nitrogen or with a surgical electrodessicator.

I’m not convinced that any of the over-the-counter creams or oils are very effective. I don’t recommend attempting home surgery, because skin tags can bleed and occasionally need a stitch. Also, clean instruments and proper technique are essential for a good result and to prevent infection.

DEAR DR. ROACH: In a recent column, you noted that swollen lymph nodes rarely are something to be concerned about. In March 2012, two lumps popped up in my neck below my left ear, both about the size of the tip of my index finger. I went to my doctor, but a neck CAT scan was inconclusive. An ear, nose and throat doctor attempted a needle biopsy, but could not get adequate cells. Finally, a surgical procedure removed one lump, and it was metastatic melanoma. The primary was on the crown of my head and was removed, after which I spent an unpleasant year on interferon. Since then, I have had a few basal and squamous cancers removed. So, lumps — in my humble opinion — are not something to be ignored. — J.E.D.

ANSWER: Unfortunately, ”rarely” doesn’t mean ”never.” There are characteristics of a lymph node or mass that should raise warning flags to the physician. Larger-size and multiple masses are of concern. The location of yours (below the ear, called the ”posterior auricular chain”) is not typical for the usual kind of reactive node found under the jaw.

But I appreciate your writing, because occasionally lymph nodes do represent something serious. Painless nodes are more concerning: Those lasting more than four weeks or those larger than 1 or 2 centimeters should be evaluated.

DEAR DR. ROACH: In regard to your recent column on cold sores, my dermatologist gave me a prescription for Valtrex, 1-gram tablets. The instructions were to take one tablet as soon as outbreak symptoms appear. The first telltale symptom is a tickling itch at the outbreak site. Within a couple of hours, the symptoms disappear, and I often do not take the second recommended tablet 12 hours later.

It works! I used to have one or two outbreaks per year. I have had only two outbreaks in the past 15 years, and those were only because I did not react quickly enough with the medication. My doctor gives me a prescription renewal every two to three years. Valtrex is available in generic form, is inexpensive and has no noticeable side effects. — T.A.

ANSWER: For people who do have a noticeable early warning symptom, treatment with antiviral medications, including valacyclovir (Valtrex), famciclovir (Famvir) and acyclovir, can speed recovery. In some situations, it even can prevent the outbreak. They are relatively safe medications, but development of resistance is a potential problem, and kidney stones are a rare side effect. Some people notice headache or nausea, but most people find that it’s worth it.

READERS: The booklet on herpes and genital warts explains these two common infections in detail. Readers can obtain a copy by writing:

Dr. Roach

Book No. 1202

628 Virginia Dr.

Orlando, FL 32803

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 4-6 weeks for delivery.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.

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