DEAR DR. DONOHUE: My daughter, now 30, has a severe case of acne. I thought her acne would go away as she grew older. Could there be something medically wrong that's causing it? - M.L.
A: Acne most often starts at puberty and disappears in the early 20s. However, that's not always the case. Close to 10 percent of acne patients are in their 40s, and some struggle with it until quite late in life.
Acne comes from an overproduction of male hormone, a clogging of skin pores, an excessive output of skin oil and the proliferation of a bacterium named P. acnes. Your daughter could have a condition where she is making too great a supply of male hormone. Polycystic ovary disease, other ovary conditions and adrenal gland problems are examples of things where excess male hormone leads to acne persistence into older ages. However, women (and men) can have persistent acne without any serious medical disorder. Your daughter should be checked by her doctor for a possible endocrine problem.
If she has no underlying medical issue, then her attack on acne centers on eliminating the four acne causes I mentioned. Acne treatment usually begins with benzoyl peroxide, whose brand names are many. It comes as a lotion, a cream or an ointment, and it is available without a prescription. It fights the P. acnes bacterium. A step up on the treatment ladder is use of antibiotic creams, lotions or ointments containing clindamycin or erythromycin. Another approach is the use of vitamin A-related substances to unplug clogged skin pores. Retin-A, Differin and Tazorac are examples. The next step up is oral antibiotics like doxycycline or minocycline. For severe acne, the doctor can inject cortisone into large, bothersome acne lesions. Birth-control pills for women right any imbalance between male and female hormone, and are often successful in suppressing acne.
DEAR DR. DONOHUE: I would like to know about pulmonary fibrosis. Does it usually follow COPD? Is it similar to cystic fibrosis? What is the usual treatment? - R.M.
A: Collagen, the body's all-purpose filler and supporting material, is the stuff that makes up scars. You can think of pulmonary fibrosis as lungs filled with collagen strands - scar fibers. The most common variety of this disorder is idiopathic pulmonary fibrosis. "Idiopathic" indicates that a cause isn't known. COPD (chronic obstructive pulmonary disease - emphysema and chronic bronchitis) can be seen with pulmonary fibrosis, but the two are distinct processes. Cystic fibrosis, a genetic illness, usually appears early in life and is not related to pulmonary fibrosis, which mostly comes on after age 50.
Scar tissue interferes with oxygen passage into the blood. The two common symptoms of pulmonary fibrosis are breathlessness on slight physical activity and a dry cough.
Cortisone drugs are the drugs usually chosen as the first therapy, and prednisone is the cortisone drug usually prescribed. Sometimes azathioprine is given in conjunction with it. Oxygen is supplied when indicated. Many other treatments are under evaluation. A lung transplant is the ultimate solution to the problem, when such is possible.
DEAR DR. DONOHUE: I never read much in your column about high liver enzymes. My enzymes are 442. I consume beer (no liquor) every day, probably on average between six to eight beers.
Is this reversible? - H.R.
A: Enzymes are proteins found in all body cells. They make sure that cell chemistry proceeds at the optimal tempo. Without them, things would proceed at a snail's pace. Some organs, tissues and cells have enzymes unique to them. When blood levels of those enzymes rise, that indicates those cells are dying.
Two frequently monitored liver enzymes are AST (also called SGOT) and ALT (also called SGPT). The upper normal value for these enzymes is around 40. Your value is 10 times that limit.
You have to stop all alcohol. Your enzyme levels should return to normal if you do, and your liver should recover. Who ordered these tests? That person should step in, direct your recovery and make sure no other process is adding to liver injury.