DEAR DR. ROACH: A few years ago, I developed visible fat between my naval and my rib cage. My doctor told me that it’s a ventral hernia, which is nothing serious. I was told surgery is an option but not necessary. I am a female, 75 years old. Should I be concerned?

— A.M.

ANSWER: If your doctor is right, which I have no reason to doubt, you probably have an epigastric hernia, a defect in the abdominal wall. These are more common in men, and are usually small, about 1 cm or so.

Under abdominal pressure, the abdominal contents, including fat or the omentum (a sheet of fat and connective tissue), can poke through the abdominal wall defect. Most often, these do not require surgical correction unless they are symptomatic. At age 75, I wouldn’t be in a rush to get elective surgery unless it’s for a very good reason.

There is one other possible condition it might be. It’s called diastasis recti, which isn’t actually a hernia, but might be what your doctor meant. This is a wide separation of the two rectus abdominus muscles. Under abdominal pressure, the abdominal wall tents out, and it may seem as though the abdominal fat is more prominent in that area. Even if there is no actual defect, the abdominal contents come through. This is another condition that seldom requires surgical intervention.

DEAR DR. ROACH: Last summer, I was gardening when I acquired white blotches on my skin. It seems permanent. It took the pigment over lots of areas on my hands and arms. I am very upset about this. I normally tan nicely. I am elderly. Is there anything I can do to get my skin back to normal?

— M.H.

ANSWER: Although an exam would be necessary to confirm, my best guess is that you are describing vitiligo. It is unusual, but not impossible to develop vitiligo at older ages; however, 70-80% of adults with vitiligo developed it by age 30.

The underlying cause for vitiligo is not 100% known, but most experts feel it is probably caused by the immune system attacking melanin-producing cells. People with vitiligo are at risk for other auto-immune diseases, including thyroid disease and pernicious anemia, which supports the autoimmune theory. Some people think it is contagious; it is not.

There is no cure for vitiligo. Treatments are moderately effective at regaining some or most of the normal skin color. Topical steroids and phototherapy are probably the most commonly tried.

There are other causes of loss of skin pigment, including some common gardening chemicals. The fact that the patches are on your hands and arms backs up this possibility. Apart from stopping contact with the offending chemicals, I know of no good treatment for chemical vitiligo.

A dermatologist is the best source to discuss the likely cause and treatment of your condition. I do want to mention that camouflage makeup can have a significant beneficial impact on the psychological effect of people with vitiligo.

I found lots of good information about this condition, as well as some support groups at several websites, one of which is vitiligosupport.org.

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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 [email protected] or send mail to 628 Virginia Dr., Orlando, FL 32803.


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