Dear Dr. Roach: I am 73 and go to the dermatologist two to three times each year. He “zaps” me about 20 times and burns off “cancer cells” or maybe “potential cancer cells.” Some have been cancer and were healed with Mohs procedure.
While I am grateful for the care he gives me, I also sometimes feel that he zaps because each zap means more money.
G.B.
I often get questions like this, where a patient has a concern that their doctor is performing unnecessary medical care for the purpose of enriching himself or herself. I always have trouble believing it, since I can’t really imagine it, but I recently read about an oncologist pleading guilty to treating with chemotherapy people who didn’t really have cancer. Still, I truly believe that, in your case and probably more than 99 per cent of the time, the doctor is being extra cautious to treat you for the sole purpose of reducing your likelihood of developing an invasive skin cancer later on.
Dear Dr. Roach: Seven years ago, I contracted pityriasis rubra pilaris. Four years ago, all symptoms cleared and, except for residual dry scar tissue, completely vanished.
The incredible itching was relieved only by Accutane, which has been removed from the marketplace. I was made aware of the suicide-promoting side effects of this drug and was monitored while using it. What relief can I attain if PRP returns?
D.D.
Pityriasis rubra pilaris is a rare skin disease. There are six subtypes and I will focus on type 1, the most common in adults.
While genetics and possibly infection may contribute to PRP, abnormal vitamin A metabolism is thought to play a large part, which may be why vitamin A derivatives such as isotretoin (Accutane) are effective. In PRP, the rash starts at or near the head and spreads to the trunk, arms and legs. The rash is scaly. The skin on the palms and soles can become thick and orange-coloured. Symptoms can be quite severe. About 80 per cent of the time, symptoms go away spontaneously within three years and usually do not return.
Treatment is with steroids if it’s just in a limited area, or systemic for people with extensive disease. Methotrexate and ultraviolet light are sometimes used.
Accutane is still available as a generic under the brand names Amnesteem, Claravis and Sotret. A related medicine, acitretin (Soriatane) is also available.
