Tripod Ask the Doctor FAQs: Common Ailments

FAQs: Common Ailments

I have a question about skin tags...are they serious, and should one see a dermatologist about them? Thanks.
I am a 40 year old African-American female. I have always had moles, mostly on my neck, but in the past five years they seemed to have multiplied. They are not skin moles as they are round and rubbery. I play with them all the time, pulling on them twisting them around. My question is: Why do I keep getting more, and is there any way I can get rid of the ones I have and keep them from coming back? Also, why are only the round rubbery ones on my neck?
-- CL
For the sake of this discussion, let's assume that you both have true skin tags. That's important to be sure about, since you do not want to overlook other growths of the skin, some of which may be cancerous. Many people ask whether their skin tags are something to worry about or not.
Skin tags, as the name might imply, are harmless growths that appear on the skin. They are very common. Mostly found on the neck, the armpits, and elsewhere on the trunk, they tend to develop in middle age. You may find only one or two, or there may be literally dozens. The cause is unknown. They are typically soft and attached to the skin by a small stalk. They look as if you could just pinch them off. Some may have a little pigment in them, but they do not get dark or black the way a true mole, or even a melanoma will do.
Unless you belong to an HMO, insurance companies will not pay to have them taken off. But if the skin tags become irritated from clothing, rubbing, or pressure, your doctor can use liquid nitrogen or electrical cautery to have them removed. He or she can also simply snip them off with a scissors (after a novocaine injection). A visit to a dermatologist is generally not necessary unless the diagnosis is in doubt.
-- R. Jandl,11/20/96, Category: common ailments

My lips get so dry that I pick them until I get the top layer of skin off because they are so tight feeling until I do this. This used to only happen in the winter but now it is the whole year. What am I lacking and what can I do to get moisture in them? I use lip ointment but it does not do the trick.
-- CH
Ouch! That sounds painful.
Dry lips are not usually indicative of any disease or nutritional deficiency. Lips, and skin in general, are normally drier in the winter because the air around us is drier. Certain people tend to be more prone to dry skin or lips and will need to pay a bit of extra attention. Although it may provide some temporary relief, licking the lips will just make it worse. Every time there is a cycle of wetting followed by drying, a small amount of natural oils is removed from the lips, aggravating the problem further.
The answer is to keep the lips moistened continuously with an occlusive ointment such as Vaseline (petroleum jelly). You may need to put it on the lips up to five or ten times a day for it to work, especially if your lips are already extremely dry. Using a little bit everyday will help to keep them from getting so bad. Don't skimp on it -- be generous. Use it frequently.
Whatever you do, don't peel the dry skin off with your fingers. This will expose raw underlying tissue without its protective barrier of mature skin to prevent further drying. The best thing is to prevent your lips from getting that bad in the first place is to use ointment.
-- R. Jandl, 11/6/96, Category: common ailments

I have been experiencing serious, ugly acne all over my face for the past two years. Before this time, my face would clear up easily, but now nothing seems to help. I have been under so much stress lately -- due to relationships (of course). I have tried the topical treatments, but it made the situation worse. Now I have some scars from previous acne. I really try not to touch them, but I feel that they might go away quicker, which I now know is not true. I have just been to my doctor, and she prescribed tetracycline 250 mg. I have just started to take it, but what I am wondering is whether or not it will be as ineffective as the topical treatments I have tried. I know that everyone is not the same, but generally, what is the rate at which the acne actually clears up on the people that do take it?
Before there is any talk of medication, the first thing to remember about acne is that it helps to avoid using oily cosmetics or creams, since these can clearly aggravate it. If you are on a birth control pill containing androgenic progestins, you should consider switching to one that does not. And if you take steroids for body building, be aware that this too will cause acne. You absolutely don't need to worry about diet. Scrubbing with cosmetic pads does not help, and alcohol or peroxide will have little benefit other than removing excess oil on the skin (which may help it to look better).
The treatment of acne depends on what kind of acne you have. Although it is perhaps a bit of an over-simplification, there are basically two types: obstructive acne and inflammatory acne.
In obstructive acne, what you see are blackheads and small whiteheads or pimples that do not have any redness or inflammation around them. These changes are caused by a blocking of the sebaceous gland ducts by the accumulation of dead skin cells. Blackheads can be removed by squeezing them to express the plug. A glass eye dropper does the trick well. This will remove existing blackheads, but won't prevent new ones. The best medication for the prevention of new blackheads and whiteheads is called retinoic acid (available as Retin-A, or Tretinoin). By thinning the outer layer of skin and loosening existing plugs, both old and new lesions will be treated. Sometimes creams such as benzoyl peroxide (available over-the-counter) are used for additional benefit.
The other type of acne is inflammatory. This starts out the same as obstructive, but becomes inflammatory when the contents inside the plugged gland begin to spread into the surrounding skin, and when a particular bacteria (called Proprionibacterium acne) which normally lives in the glands produces substances that break down the liquid contents of the gland, increasing their toxicity to the surrounding tissues. The result of all this activity is a red, painful pimple -- or pustule. Some pustules are close to the surface of the skin; others are very deep. More severe cases of acne have deep pustules that leave scars after they heal because of the destruction of normal skin tissue.
With mild inflammatory acne, benzoyl peroxide creams are helpful, as well as topical antibiotic lotions. They both act by being toxic to the bacteria. Antibiotics such as tetracycline may also be taken by mouth and generally work well. Remember, though, that it may take 6 to 8 weeks to see an improvement. This is because antibiotics prevent new lesions, but have no effect on the old ones. In more severe cases, a form of retinoic acid may be taken orally (Accutane, or Isotretinoin). This is only used in refractory cases since there may be significant side-effects, the scariest of which is its potency as a fetal teratogen. A very detailed protocol involving pregnancy tests, contraceptive use, and documentation of informed consent is available. This is provided by the manufacturer and should be followed closely before a woman is started on this medication. This is obviously not a decision to be taken lightly. When used, however, the results may be dramatic.
Take heart. With a little patience, the tetracycline may help more than the creams you have tried in the past. Good luck!
-- R. Jandl, 10/18/96, Category: common ailments

How does a person come in contact with the bacteria that causes ringworm? How contagious is the infection?
-- JG
Ringworm is a strange name given to a skin infection that is neither a worm nor a bacteria. The infection is actually caused by a fungus. The "ring" part of the name comes from its tendency to cause a ring-like rash with red borders.
Ringworm is usually caused by a type of fungus called Trichophyton. It is not easily transmitted from one person to another, although some people are more susceptible to fungal skin infections than others. For example, diabetics have an increased risk, and heredity may play a role, too. You really don't have to worry about touching someone's ringworm rash, since the fungus is everywhere in the environment and you are constantly exposed to it anyway.
If the fungus happens to affect your feet, especially the areas between your toes, it is called "athlete's foot." If it affects the groin, it is often referred to most unpleasantly as "crotch rot." But it can also affect the scalp, the area of a man's beard, or the whole face. You may hear your doctor refer to any one of these rashes as "tinea."
Although the fungus may infect all of these places, it is only called ringworm when it causes the characteristic ring-like rash on the trunk or extremities. Ringworm will appear as a faintly red, slightly scaly rash, no larger than a quarter. In the summer, with a tan, it often shows up as a contrasting pale spot on the skin. And if you were to shine an ultraviolet light on it (which doctors will do to make the diagnosis) the rash will show bright white.
There are a large number of anti-fungal creams -- the best available only by prescription -- that will usually cure the ringworm.
-- R. Jandl,10/13/96, Category: common ailments

What can a person do if they're allergic to a pet (cat)? I hear there is a shot you can take to help with the allergic reaction?
--LC
I am a 23 year old female. I have been diagnosed with severe allergies to cats and dust mites. I recently moved into a new apartment and my allergies have been terrible -- I can't get through a night without waking up sneezing. What could I possibly be allergic to in a new apartment? (I thought they cleaned it before new tenants...)
--ML
These are good questions given how common and troubling allergies can be. Allergies really could be the topic for a whole encyclopedia. So, rather than try to cover everything, and given the complications of trying to answer a particular individual's allergy problems, I thought I would comment specifically on the use of allergy shots.
In wondering whether or not allergy shots would be helpful for an individual, the first thing to do, and one often overlooked, is to verify -- if you can -- that the person's symptoms are actually due to allergies. There are, for example, other reasons why someone might get a runny nose, or red, irritated eyes, or asthma. If the symptoms are not due to an allergy, than allergy shots are not going to help. Careful attention and thought about your circumstances, and a little sleuthing, may help you to identify that it is your cat, or your pillow, or the season of the year, or something you eat that brings on your symptoms. Also, if there is a good response to a trial of medication such as an anti-histamine or an inhaled cortisone spray, that may increase the likelihood you are dealing with allergies.
Allergy testing is a complicated and controversial area. It is done all the time, of course, but may reflect an over-zealous practitioner or patient rather than something that is likely to be helpful. Almost everyone who is tested for allergies (skin patch testing or blood tests are most commonly used) will be found to have multiple allergies. Then what? How do you know, for example, whether or not any of those allergies, or which one of those allergies, are causing your symptoms? That is much harder to prove. Then, if you do decide to start allergy shots, it commits you to taking a shot usually once a week for a matter of years. This is a big commitment, and one most people won't bother with unless their symptoms trouble them enough. That should be thought about before the test is done.
What are allergy shots? Allergy shots are a wonderful challenge to conventional medical thinking about disease which is based on the avoidance of things that make you sick such as micro-organisms, chemicals, food, etc. Allergists actually use a principle of homeopathy, that like can treat like. (See explanation in Homeopathy: Hair of the Dog.) Homeopathy is treated with derision by much of orthodox medicine. Although used for hundreds of years, its effectiveness is still controversial. Nonetheless, it works for allergies. The allergist makes up a very dilute solution of everything that you tested positive for and gives it to you as an injection. The dose is too low for your body to have a perceptible reaction, but the ever-wary immune system does see it and processes that interaction differently from what would happen were you to get a large dose of the allergen (which could literally kill you). Over time the dose of allergen is increased, the immune system develops tolerance, and your symptoms subside. The shots can be very effective, and if a persons symptoms are bad enough, it can definitely be worth the trouble.
So, for the right person, and with the cautions mentioned above, allergy testing and allergy shots are something to consider. For specific homeopathic remedies for allergies, check out the third column in Tripod's series on homeopathy: Homeopathic Allergy Relief.
-- R. Jandl, 8/21/96, Category: common ailments

I was recently bitten by a tick. Now I have swollen, hard lymph nodes on that side of my scalp (behind my ear). Should I be concerned about this?
-- JM
Well, it depends on a number of things. Let's assume that the tick bite was somewhere near where the lymph nodes are enlarged -- such as the scalp for instance. There are several things to keep in mind. A simple tick bite, all by itself, does not usually cause lymph node enlargement. Lymph nodes do become enlarged when your immune system is being stimulated. It may or may not be caused by direct bacterial invasion into the lymph system, but that's an important distinction to make. If the tick has introduced bacteria beneath the skin and an infection has started, than antibiotics are called for. This is more likely to be the case if the lymph nodes are tender and red, or if red streaking is present around the nodes.
Could there have been some other disease or infection introduced by the tick? It's certainly possible. These days, Lyme disease often comes to mind. It's important to remember that the tick that carries Lyme disease is no larger than the head of a pin. If it is larger than that, you don't have to worry. And of course, Lyme disease is more likely if you live in an area endemic for the disease (southeastern New England, for example). There are many other tick-born diseases, but as in the Lyme disease example, the absence of any other symptoms (such as a rash, joint pains, fevers, etc.) would make them pretty unlikely.
Of course, there are numerous reasons why lymph nodes may enlarge -- everything from tumors to cat scratch fever. Some causes require no specific treatment. Others can cause more serious problems. Therefore, it's a good idea to show any lymph node enlargement to your doctor.
-- R. Jandl,8/7/96, Category: common ailments

Can floating eyespots be treated and cured?
Floating eyespots, or floaters, are very common. People that have them will describe a speck or tiny pattern that seems to move across their vision. They are usually gone within a couple of minutes, but sometimes take longer to disappear completely.
Floaters are actually tiny clumps of cells floating through the vitreous humor inside of the eye. The vitreous humor is a jelly-like fluid that fills the eyeball. These cell clumps just drift across your vision, casting a shadow on the retina, eventually drifting out of the field of vision and getting absorbed or dissolved. There is really nothing you can do to prevent this from happening, but they are harmless anyway.
One caution to mention, however. A shower of floaters, or floaters associated with flashing lights, black spots in your vision, or deterioration in your vision, may signal a detaching retina. These symptoms should be treated as an emergency in order to prevent permanent loss of vision.
-- R. Jandl,6/26/96, Category: common ailments

Five years ago I had surgery and "gave" some of my own blood for my own use if I needed it. The lab that drew the blood notified me that I had hepatitis. They said I was fine, but not to EVER donate blood. I don't remember what type of hepatitis they said I had. I think it was A. What type doesn't affect your health but you will have it forever? I am confused. I was an extremely active alcoholic at the time. Sober two years now. Could the booze have caused the hepatitis?
--CC
Recently, a question was answered regarding viral hepatitis and its transmission. Perhaps we should add some additional information to correct possible misconceptions regarding hepatitis A.
Hepatitis A is a viral infection of the liver. It is the "good" one to get in the sense that once your body has fought off the infection, you are done with it. Hepatitis A does not cause chronic hepatitis (unlike hepatitis B and C). What can be detected in your blood -- usually for life -- are antibodies against hepatitis A. Antibodies are proteins manufactured by your immune system to fight off infections. These antibodies serve as a flag to indicate that the virus was once there. The virus itself will not be detectable.
Alcohol abuse, as you seem to realize, also causes hepatitis. This is a serious cause of disease and death in alcoholics, but it is not an infection. Viral hepatitis will not cause alcoholic hepatitis, although conceivably the two could be present at the same time.
Whether it is for screening blood products for safety, or diagnosing illnesses, blood tests are often done for hepatitis. Generally, the tests are for liver enzymes that are released into the blood stream during infection. As a rule of thumb, when those enzymes go up, then hepatitis becomes a possible diagnosis. Excess alcohol use is a common cause for elevation of those enzymes. So is viral hepatitis. After testing for antibodies against the different forms of viral hepatitis, sometimes a liver biopsy is done to determine the actual cause of the hepatitis.
Congratulations on two years of sobriety! Fortunately, the liver is a forgiving organ. Mild and temporary injuries from alcohol or viruses can usually be repaired.
-- R. Jandl,6/24/96, Category: common ailments

My 23 year old son was on tetracycline last summer and was not told he should avoid the sun. He received a bad burn on his back and the doctor said that he was burned on the INSIDE because the tetracycline kept his pores open. He seemed to recover nicely. However, this year he complained that when the sun hit his back (through his shirt), he felt as though it were burning on the inside. He is very fair; red hair & freckles. He tries to avoid the sun religiously. Will his symptoms eventually disappear and is he at risk of having skin cancer?
--AH
Based on your doctor's description, it sounds as though your son has experienced something called photosensitivity. With a medication such as tetracycline (often used for acne, bronchitis, and certain STD's) there is a risk of getting a reaction to sunlight. Somehow, the medication sensitizes the skin to certain wavelengths of light. In some instances, the reaction has an immunological or allergic basis. Sometimes the skin will look and feel like a typical sunburn, with anything from a mild to severe reaction. At other times, there may be more of a bumpy red rash that extends to parts of the body not directly exposed to the sunlight.
The idea that tetracycline has "kept his pores open" would not be literally true, but is a way, I think, of expressing the idea that the reaction occurs beneath the outer level of skin. Once the episode of photosensitivity has ended, the rash has cleared, and tetracycline (or other photosensitizing drug or chemical) is no longer being taken, the reaction will not re-occur. If sun sensitivity in the form of a rash, nausea, joint pains, or other symptoms occur, he should be checked out by a doctor.
Sunburns are indeed a risk factor for skin cancer. One episode, however, would not be considered alarming. The usual cautions about using sun block with an SPF of 15 or higher and protective clothing apply.
-- R. Jandl,6/24/96, Category: common ailments

Hi -- great idea to have this sort of anonymous thing via the internet. I am a little too embarrassed to go and see my doctor about my problem -- I hope you can help. I am 24 years old and have occasional (once every two months or so) pain in my anus when I use the toilet (so to speak!). I am a little worried that this pain is abnormal -- a symptom of something serious. I occasionally get hemorrhoids from all the wiping that occurs. From memory, this pain in my anus occurs around those times when I have hemorrhoids -- it is a dull deep pain.
The only other problem I have with my digestive system is that I am lactose intolerant and sometimes get bloating and wind when I consume milk products -- I mostly consume soy milk rather than regular milk. Is this related? Can you help?
These really are embarrassing questions for most people to ask, but we're glad you took the plunge because the problem is actually very common.
The two most common causes of pain in the anus or rectal area during bowel movements are hemorrhoids and fissures. Hemorrhoids are dilated veins (like varicose veins) that may become swollen and irritated, and may bleed from time to time. Fissures are just that -- small breaks in the mucosal lining of the anus. They both often occur due to constipation. Stools, when they are hard, can create a split in the lining of the anus, or enlargement of the rectal veins. This can be quite painful and may continue over a period of time, getting aggravated every time you go to the bathroom. Sometimes you may see a little blood with fissures, but hemorrhoids are more likely to be associated with bleeding.
Although rectal cancer may be in the back of your mind, keep in mind that common things are common. And at the age of twenty four, hemorrhoids and fissures are much more common than rectal cancer! Risk factors for rectal cancer include age (it's higher in later years), a diet low in fiber, a history of ulcerative colitis, and a history of rectal cancer in a close family member. Lactose intolerance does not predispose to hemorrhoids, fissures, or rectal cancer. Nonetheless, if the symptoms are new or have never been diagnosed they should be checked, if only to confirm your impressions and to rule out other potential causes of rectal pain.
-- R. Jandl,6/24/96, Category: common ailments

Doctor Bob, I have just got over a case of Mono. Yet in my throat, but not on the tonsils, a white patch that is mildly painful still is lingering after the other patches cleared up, is this normal? Also I was told that I would have to wait anywhere from 4-6 weeks to three months before I can wrestle again. Can you give me the usual time? Thanks.
Infectious mononucleosis has a well earned reputation for causing profound weakness and fatigue. In fact, many viruses cause these symptoms. Weakness, fatigue, aches and pains, can actually be helpful to a doctor in trying to figure out whether a person's illness is viral or not. It truly seems that the more rest you can get during an illness like mono, the better you feel, and the sooner you'll get better. Since mono often lays you up for a couple of weeks, once you begin to feel normal there's usually a strong desire to resume regular activities. That's not such a great idea. More often than not, resuming normal activities too early will result in a relapse of the illness. It pays to be patient.
How early is too early? There is no exact cut-off. It depends how sick you were, how fast you are getting better, complications you may have had and what you intend to do. We are talking weeks here, and sometimes months -- not days. I usually advise patients with mono to listen closely to their bodies.
Often just resuming work or classes, or even just being awake for five or six hours can be exhausting. And for a couple of months after the illness, pushing oneself physically (which includes wrestling, I would imagine) could easily cause a set-back. Your patience now will likely lead to better performance and greater well-being in the long-run.
By the way, although I can obviously not make a diagnosis, white spots in the back of the throat during mono are little areas of pus from your body's efforts to fight off the disease. They may take a while to go away, and are generally not a worry. How you feel is more important.
-- R. Jandl,5/23/96, Category: common ailments

I have asthma and take a bronchodilator (Berotec). My concern is that my hands shake after I take a puff. This causes problems for me in school since I am a dental student and precision is required. Are there any medications similar to this without the side effects of shaking?
-- SD
Your concern is a common one. I was not familiar with the medication Berotec, but discovered that it is similar to what we call albuterol in the US (the brand names are Ventolin and Proventil). When inhaled, these medications will dilate the bronchial tubes making it easier to breath within a matter of minutes, and relieving the wheezing associated with asthma. A small amount of the medication gets absorbed into the body where it can cause the shakiness that you describe. Some people are more sensitive to this side-effect than others.
There are different ways to approach this problem. For someone who is using an inhaler of this type every day, or even several times a week, they should consider adding a steroid inhaler. The steroid inhalers block the inflammatory response in the bronchial tubes to help prevent wheezing in the first place. The current thinking is to use these medicines early. If this is done, it should decrease the need for an inhaler that gives you the shakiness.
Another type of inhaler is ipratropium (or Atrovent). Like albuterol it is used to relieve wheezing after it gets started. It causes less stimulation, and less shakiness, although in some cases it is not as effective.
Whether or not a lower dose is possible to use, and whether it would be reasonable to try other approaches for asthma is something I would defer to your physician.
-- R. Jandl,5/3/96, Category: common ailments

I was diagnosed with scarlet fever and was prescribed an antibiotic. The doctor said I could go back to school in 24 hours. I know that scarlet fever was very serious back in the olden days, but is it just a strep infection that can be easily treated with antibiotics??? By the way, no one else in the family came down with the infection even though we had very close contact. Why is that?
-- KM
Scarlet fever is actually a variant of strep throat, caused by a strain of the strep bacteria. This particular strain produces a toxin responsible for the distinctive "scarlet red" rash.
In the past, scarlet fever had the potential of being a serious illness, causing sudden high fever, sore throat and vomiting. However, since antibiotics have become readily available, it is pretty much treated like any other strep throat -- with antibiotics. Antibiotics have both lessened the severity of infections, as well as reduced the chances of an epidemic, making it much less common than it used to be.
Your chances of getting it are variable, depending on how intimate your contact has been, whether drinking glasses, toothbrushes, etc., have been shared, what your "resistance to disease" is, and other factors. At the earliest sign of illness, family or other close contacts should be evaluated to see if antibiotics are indicated.
And in case you're curious about the rash, you'll see it most commonly on the trunk and abdomen, and it may be more intense in the armpit and groin areas. It is described as bright pink or red, has a sandpaper quality to it if you rub your fingers along the skin, and is followed in a number of days by a striking peeling of the skin. Another hallmark of the disease is a "strawberry tongue" -- the tongue appearing bright red with white spots.
-- R. Jandl, 4/19/96, Category: common ailments

Can I become "hooked" on nasal decongestant sprays and can they raise the heart rate?
-- JC
Yes, indeed. Nasal decongestants in the form of sprays or drops are notorious for their capacity to get you hooked. The problem is that they actually work, and people like to use them. But keep using them, and you can get into trouble.
For example, if you are someone who has chronic nasal or sinus congestion, post-nasal drip, or allergies, use of an over-the-counter nasal decongestant will give you quick relief. Which is great. The trouble is that over time the lining of your nasal passages become more dependent on the medicine in order to get the same decongestant effect. In addition, it seems that the chemicals in the decongestant itself begin to irritate the lining of the nose to such an extent that it begins to actually cause swelling and congestion. So, although you may get relief for awhile, eventually the duration and quality of the relief diminishes. I've known people to use four or five sprays a night for years when they should be only using two sprays a night for three or four days, just so they could sleep without breathing through their mouths.
The only solution if that happens to you, is to go cold turkey. Stop the spray or drops, turn on a vaporizer and drink lots of water to keep the mucous loose, and suffer for a few days until you get back to normal. It will be worth it.
You're right on the other point, as well. Decongestants do have a tendency to make your heart beat faster. They have an effect on the body that is similar to adrenaline.
-- R. Jandl, 4/12/96, Category: common ailments

I've had warts on my fingers for years. These seem to be simple viral warts. I've gone to our family physician, who has frozen them, electrically zapped them, and frozen them again. I'm not sure that he's doing everything possible, and wonder if I need a dermatologist. I've been so distraught over these ugly, sometimes painful, eruptions, that I've willingly tried the grated raw potato "cure", as well as several "magic" type cures. It wasn't successful, to say the least.
Recently, I have been ingesting one vitamin A, 10,000 IU, tablet daily, and a 100 IU vitamin E tablet. (These came from the health food store). We've also tried using salicylic acid, with no lasting success. I am healthy in every other aspect, physically and emotionally. Any other suggestions for another treatment? We are at wits end as to what to do about all of the warts.
-- DM
As you have discovered, and others can attest, warts can either be a minor cosmetic problem, or, as in your case, very troublesome and annoying.
What is the cause of this variation from person to person? Well, it's not very clear. As you probably know, warts are caused by a virus, the name of the virus being human papillomavirus, or HPV. There are more than 60 types of HPV, with different types preferring different areas of the body such as the hands, the soles of the feet, the genital areas, etc. It is an infection that stays in your body whether or not you actually see warts on the skin (or in the genital region if you have genital HPV).
Warts have a capricious habit of spontaneously coming and going, and have spawned countless myths and home therapies. In general, we can say that the appearance and persistence of warts must relate to factors affecting the relationship between your body and the virus. This could potentially include genetic factors (both yours and the virus'), immunologic factors, nutrition, stress, and environmental factors such as sunlight, chemicals, etc. But which of these factors are really important is hard to know. I do find alternative remedies recommended, including vitamin A, beta carotene, vitamins C, B complex, and E, zinc, L-cysteine, garlic paste, and others, but am not aware of any good studies substantiating their effects. And anecdotal reports suggest that even hypnosis might work.
Warts are common earlier in life, then tend to go away as you get older. Warts on the fingers and hands are a nuisance, but are harmless. Therefore, in treating them, the cure should not be worse than the disease, and it is important to avoid using therapies that leave scars, or that might be toxic. Most warts go away spontaneously (up to two-thirds go away by themselves within two years). This should be reason for optimism, and should also be kept in mind when evaluating anecdotal reports of cures.
It sounds as though you are getting good care. But consultation with a dermatologist may be helpful in order to explore other treatment options.
-- R. Jandl 4/4/96, Category: common ailments

What is pink eye? What are the methods of treatment? What are the long term effects of the condition?
Pink eye is a term which usually refers to a group of associated conditions known as conjunctivitis. These may be viral, bacterial, or allergic in origin and all represent an inflammation of the conjunctiva, the transparent membrane that lines the inside of the eyelids and covers the white part of the eyeball.
Most commonly, the white of the eye becomes pink or red, there is often itchiness or a sense of grittiness present, and the eyelids are often stuck together with crusty drainage after a night's sleep. This occurs very commonly in association with an upper respiratory infection (cold, sore throat) but may develop without any associated symptoms. Most commonly seen in children, pink eye can be found in any age group. It is uncomfortable and a nuisance, but does not usually cause any long-term eye problems. It is considered self-limited, meaning that it resolves on its own in most cases, usually within 2 -3 weeks.
Treatment of conjunctivitis is based on the underlying cause, and usually includes the administration of antibiotic or antihistamine/decongestant drops or ointments. In severe cases, cortisone drops may be used. Supportive measures such as moist compresses (hot or cold) and resting the eyes (keeping them closed) may be helpful.
It is important to remember that bacterial and especially viral conjunctivitis are extremely contagious and can spread in an epidemic-like manner throughout a school or home. If you or a family member or house mate develop pink eye, keep the following guidelines in mind: wash your hands frequently to avoid spreading the germs, avoid touching or rubbing your eyes, use only your own washcloth, towel, and pillow, and don't share eye makeup. When bacterial conjunctivitis is present -- usually signified by pus on the lids as opposed to a clear honey-colored discharge -- you must use the antibiotic drops for a minimum of 24 hours before you are no longer considered contagious.
If you experience pain in the eye, blurry vision, or eye pain triggered by bright lights, something more than conjunctivitis may be present, as these symptoms otherwise do not usually occur.
-- C. Ebelke, 1/26/96, Category: common ailments

Does diet have anything to do with acne? Do I have to watch what I eat?
Basically, no. There is a long tradition of attributing acne to chocolate, cheese, oily foods, or other things in the diet. However, when scrutinized more closely, none have been shown to cause or aggravate it. So, relax and enjoy your food.
-- R. Jandl, 1/18/96, Category: common ailments

What causes charlie-horses? I seem to get them when I'm sleeping; they tend to be pretty painful. What can I do to prevent them?
-- KC
Charlie-horses are muscle cramps. They commonly affect the major calf muscle (the "gastrocnemius") and occasionally the smaller muscles of the foot. They very often occur at night, awakening sleepers in a very unpleasant way. Although it is commonly believed that an electrolyte problem (e.g., low potassium) or a buildup of lactic acid is to blame, this is actually only very rarely the case.
Nocturnal muscle cramps seem to be related to the position of the lower leg while sleeping -- essentially with the toe pointed. In this position, the calf and feet muscles are in their most shortened, and therefore most vulnerable position. This can somehow trigger sudden contraction, causing cramping and severe calf pain. You can often see or feel the hardened muscles.
Rarely reflective of serious underlying disease, nocturnal muscle cramps can nonetheless be extremely uncomfortable and bothersome. Prevention includes stretching exercises, and attempts to change leg position while sleeping (easier said than done!). The way to deal with a charlie-horse is to stretch the muscle as soon as you can, in order to break the spasm. This can be done by "heel-pointing" (i.e., extending your toes and foot upward) or jumping out of bed to stand on the leg which will stretch the calf muscle more forcefully. Gently massaging the calf can help, especially afterwards to keep it from recurring. More persistent cramps should be treated with heat. Passively and slowly stretching the contracting muscle often helps (e.g., gently pulling the foot towards your head using your hands).
For many years quinine sulfate was used to treat nocturnal leg cramps, with variable results. Recently, studies have been done which indicate that for many people high dosages must be used to be effective. Unfortunately, there are potential side-effects including nausea, vomiting, hearing loss, visual impairment, cardiac problems and platelet abnormalities.
-- C. Ebelke, 1/17/96, Category: common ailments

I have been having problems with an ingrown toenail for about a year. I trimmed off the ingrown section the other day and am wondering if the nail is just going to re-develop into another ingrown nail, or will heal and return to normal. Or will I have to have the nail removed ?
-- TM
Ingrown toenails are very common. They may cause pain, swelling and redness around the nail, and most commonly affect the great (or big) toe. Usually, the edge of the nail curls and begins to grow into the underlying soft tissue. This may be caused by improper cutting of the nail, by the nail edges growing faster than the center, by unusually curled nails, or by pressure from poorly fitting shoes.
Prevention is certainly preferable to dealing with one of these unpleasant occurrences.......Toenails should be trimmed regularly (e.g., monthly) and should be cut straight across the top, not curved at the sides. Care should be taken not to cut the nail too short. Properly fitting shoes are of great importance as well (not too tight).
Should an ingrown toenail develop, try carefully trimming the offending portion of nail with clippers, soak the toe in warm water, and "train" the nail to grow in the right direction by pushing the tissue on the side of the toenail gently down to uncover the side of the nail. Increasing pain, increasing redness, or the presence of any pus should be checked out. A minor office procedure in which a portion of the nail is removed at the base is sometimes the only long-term solution for a chronically ingrown toenail.
-- C. Ebelke, 1/17/96, Category: common ailments

Why are antibiotics perscribed when a patient has the flu? This seems to be a very common practice by physicians at this time of year.
-- SE
Thank you, thank you, thank you for asking this question. The practice of prescribing antibiotics indiscriminately for a variety of conditions in which they are of no help saddens and frightens me to no end, and likely has a variety of causes. Chief among these, I hate to say, are TIME and MONEY. Given that the average appointment with a physician lasts about 10 minutes, and given that in our culture the thought of advising someone to wait out an illness is the exact opposite of what is expected, it is no wonder that antibiotics are grossly over prescribed. It takes much less time to write a prescription than it does to explain the difference between bacterial and viral infections, to discuss the symptom-relieving measures which are the best treatment for most flu-like viral syndromes, and to reassure someone that they will indeed get better without an antibiotic prescription.
It takes even more time to discuss the use of two anti-viral drugs which are of slight utility in treating influenza A, but are useless in cases of influenza B, and since there is no way to easily distinguish these two syndromes from one another at the time someone has symptoms, this discussion becomes even more complicated.
Compared to that, antibiotics are easy. Everybody knows, and asks for, penicillin or erythromycin or (insert name of favorite antibiotic here.) Additionally, I suspect that in our increasingly competitive health care system, some physicians may fear that if they don't give their patients exactly what they ask for, they'll go see another physician who has a looser pen, or they'll switch health plans.
The problem you allude to is quite pervasive and not confined to the treatment of influenza. Most "sinus", and many other common viral syndromes are over treated with antibiotics (which, for obvious reasons should be called 'antibacterials') and over the past two decades this has contributed to selective evolutionary pressures which have led to the emergence of bacteria that are increasingly and astoundingly resistant to many antibiotics. This does not bode well for future generations.
In any case, if your physician prescribes an antibacterial drug, it can't hurt to inquire as to whether or not such a prescription is really necessary. Who knows, if enough people began to ask such questions, maybe this unhealthy practice could eventually cease.
-- B. Kopynec, 12/21/95, Category: common ailments

When I try to open my mouth too wide, the joint of my jaw hurts badly and sometimes cracks like a knuckle, or my entire jaw moves around. I play a reed instrument... could I be holding the instrument wrong in my mouth and stressing the muscles or the tendons or something? What do I do? This HURTS!!! Sometimes I can't eat because I can't open my mouth enough!
Although we cannot render a diagnosis, your symptoms remind us of TMJ Syndrome. TMJ (Temporo-Mandibular Joint ) syndrome is characterized by a dull aching pain in the area of the jaw, sometimes radiating into the ear, neck, or side of the head; difficulty fully opening the mouth (especially in the morning); and joint sounds such as clicking and popping. Sometimes the jaw will actually lock up for a moment. It is very common, affecting up to 75% of people at some point in their lives. Women are more prone to it than men, and the typical age group is from the teen's to the 40's.
The problem can be initiated by the jaw joint ("temporomandibular joint") per se, or by the muscles used in chewing. And often, both the joint and the muscles contribute to the problem. For example, the joint itself may have been injured by previous trauma, damaged from chewing incorrectly or because of a congenital misalignment of the jaw, dislocated repeatedly by yawning, irritated by sustained grinding of the teeth at night ("bruxism"), or damaged from an arthritic disease. Alternatively, when the chewing muscles are strained (perhaps by holding the reed in your mouth?) the muscles can spasm, leading to headaches and pain. Later this can lead to irritation/dysfunction of the temporomandibular joint, which in turn further aggravates the muscles.
Emotional stress is a very important cause of nighttime clenching and grinding, and may lead to TMJ syndrome. If you are not sure this applies to you, your dentist may be able to tell you if you are clenching and grinding, by seeing whether or not there is excessive wear of the cusps of your molars.
For those who have TMJ syndrome, it is important to rest the jaw by avoiding chewing on hard foods. Anti-inflammatory medications (like aspirin or ibuprofen), and muscle relaxants are often used to help with the symptoms. Physical therapy, relaxation therapy or other stress reduction techniques, and biofeedback, can also be helpful. Sometimes a splint, or mouth guard, provided by a dentist or oral surgeon, is used to prevent grinding. Rarely, in severe cases, the joint may require reconstructive surgery. Usually, the symptoms respond to the simpler treatments and are often self limited.
--A. Calhoun, R. Jandl, 12/7/95; Category: Common Ailments

Does garlic really have antibiotic properties? Can it be used to minimize/negate the ill effects of dysentary while traveling? What is the best strategy to combat traveler's diarrhea?
-- AD, UC Berkeley
There are a number of laboratory studies suggesting that garlic contains some compounds with antibiotic properties. Indeed, garlic, or its extract, are recommended for their anti-fungal and anti-viral activities, as well as a host of other seemingly unrelated conditions, by alternative medicine specialists. However, there is nothing that we found to show that any of these laboratory effects have been proven to actually benefit people. From the information available to us at this time, garlic should not be used for traveler's diarrhea, and does not have clinically proven antibiotic properties.
If you are interested in knowing more about how to prevent traveler's diarrhea, check with the Centers for Disease Control & Prevention in Atlanta, Georgia.
--L. Hill Einbinder & R. Jandl, 11/16/95; Category: Common Ailments

I have a mole on my side. It is 1/4" in diameter, scaly, sometimes itches. I have had it for approximately three years. It is getting bigger. It is brown and round -- kind of button mushroom shaped. Can it be biopsied without a visit to a hospital? Is that the only way to tell if it is cancerous?
Moles, or nevi, are very common and increase during life. Some will occasionally disappear, most are very stable in size, but some will slowly grow. They can be flat or raised, depending on which layer of skin they develop in. Most have a uniform color and smooth border. The skin surface of a mole can become dry and itch like any part of your skin, but most often we are unaware of their presence. Skin cancers are often confused with moles, and it takes a trained observer to distinguish them. There are several types of skin cancers, but the most serious is called a malignant melanoma. These are related to excessive amounts of sun damage and are more common in people with fair skin that contains less of the body's natural pigment, melanin. Melanomas tend to be dark black, but can be multicolored with browns and reds. They often have an irregular border and can be both flat or raised. If this isn't confusing enough, there are many other types of skin lesions that can be raised, itchy, and discolored.
We can often tell, by experience, if a particular skin growth is a concern, but sometimes the only way to tell is by a skin biopsy, or excision, of the "mole." Unfortunately, even relatively benign appearing moles can sometimes be found to be cancerous. Therefore, most doctors will have a low threshold for recommending a biopsy. Biopsies are simple and common office procedures that your primary care provider or dermatologist could recommend or perform for any unusual growth. By all means, any new, enlarging, or discolored skin growths should be reviewed with your doctor.
-- A. Calhoun, 11/7/95

I am nearly 30 and am still dealing with back acne. I've been to several MD's and dermatologists and, short of Accutane, have had little luck in getting rid of them. What could you recommend to get rid of the acne and existing scars?
This sounds like a difficult problem. By now you are probably an expert in current therapies for acne. They range from topical benzoyl peroxide, retinoic acid and antibiotics, to oral antibiotics, to Accutane, or steroid injections of large nodules. The specific treatment used depends on the kind of acne a person has, and what their previous response to treatment has been. Accutane can be very effective for difficult cases of cystic acne, but there may be side-effects, the most serious being birth defects. Accutane is absolutely contraindicated if there is a chance of becoming pregnant. While this side-effect is not a concern for men, ultimately, your choice of treatment, comes down to weighing the potential side-effects of the treatment against the benefits of reducing your acne problem.
In terms of the scars, dermabrasion or collagen injection of the scars may be of benefit if done by skilled hands. Your dermatologist should really advise you on this.
-- R. Jandl, 11/7/95

I have had hemorrhoids since carrying my first child. They reappeared and worsened with each of my next two pregnancies. The last was 16 years ago. Recently they have started to bleed, or should I say gush, during a bowel movement. The water is red with blood. There is no spoting, or continued bleeding after the movement. Is this serious enough to see the doctor? Are there over-the-counter medicines the pharmacist might be able to recommend?
-- YL
Hemorrhoids are dilated veins occurring in the anorectum involving what are called the venous plexuses. Hemorrhoids occur both internally and externally. They are often aggravated by the body's changes during pregnancy. Troublesome pain, bleeding, or protrusion of the veins may be indications for their surgical removal if other conservative measures fail. Over the counter preparations are not helpful for the bleeding. It would be wise to consult your physician.
-- R. Durning, M.D., 10/30/95

I'm having a hard time going to sleep. My weight also changes daily, sometimes varying as much as eight pounds in one 24 hour period. I've tried sleeping pills, but they don't work. Also, it seems I don't have much energy. Any Ideas ?
Generally speaking, sleeping pills are not a good idea. Although useful for brief periods of stress or insomnia, regular or daily use leads to dependency. If there really are serious, long-standing problems with getting adequate sleep, it is important to think about and address any medical or psychological difficulties that may be present. In other words, it's best to get to the root of the problem and deal with that, rather than just take pills or remedies to deal with the symptoms.
Most people are aware of how to help themselves sleep better and feel better. For example, it's best to avoid naps during the day, avoid all caffeine, cut back or stop any stimulant drugs and alcohol, don't watch TV or eat in bed -- just go there to sleep (or make love!). Exercise promotes a natural physical fatigue, and there are many techniques available for reducing stress, such as meditation, yoga, and others.
Trouble sleeping and lack of energy can be signs of depression or stress. If medical problems have been ruled out, it may be worth while consulting with a mental health professional.
-- R. Jandl, 10/27/95

How can strep-throat be passed, and what can happen if it is not taken care of well?
-- PT of St. Lawrence University
For strep throat basics, please refer to the other strep question in this section. Strep throat is quite contagious and is spread easily with close physical contact (e.g., kissing) or by sharing eating utensils or vessels. It may also be passed via infected droplets from the respiratory system (e.g., coughing, sneezing). In light of all of this, prevention is not easy, but fairly frequent hand washing does seem to help.
As far as what can happen if a strep infection is inadequately tended to (i.e., a complete 10-day course of appropriate antibiotics are not taken), you've hit the main reason that we get concerned about strep infections. The most significant potential complication is the development of rheumatic fever, a serious, but now rare, disease that may damage the heart. In addition, a kidney disease called post-strep glomerulonephritis may occur as well. Finally, you may have read or heard about the emergence of drug-resistant bacterial infections. The casual use of antibiotics for sore throats that are not strep, and the discontinuation of antibiotics by people once they feel better but before the bacteria is eradicated from their system, are part of the problem.
-- C. Ebelke, 10/11/95

I have noticed that whenever I eat cheese such as cheddar or Monterey Jack, I always, without fail, find a huge pimple somewhere on my nose. I've never had this problem before--is this a common occurrence?
-- PZ
Many people have observed an association between foods that they eat and acne. Chocolate has been a popular example. And in your case, cheese seems to be the culprit. However, when these associations are actually put to the test, it turns out to be very difficult to prove any relationship between specific foods and acne. Therefore, it is generally said that foods do not cause acne.
Perhaps there are instances where an individual is peculiarly sensitive to a particular food, and perhaps science just hasn't caught up to the fact. However, it seems more likely that since both eating cheese and getting acne are common events, the two will be frequently seen in association.
-- R. Jandl, 10/23/95

My boyfriend has bad allergies. He is always coughing and sneezing, but he says that he has been that way forever. Is there anything that a doctor could do for him?
-- JD, University of Tennessee at Martin
In short, yes. If his symptoms really are based on allergies, there's a good chance that something could be done. Usually, an evaluation will begin with a good history to determine whether or not allergies are the cause, and if so, what they might be. Sometimes, skin testing or blood testing for allergens is employed, although the significance of the results are debated.
The first and most obvious next step involves avoidance or elimination of the offending allergens, which may be a daunting task. There are also medications available including over the counter antihistamines and decongestants. Newer non-sedating antihistamines are available by prescription. Cortisone nasal sprays may be very effective for the runny nose, sneezing, and post-nasal drip. If symptoms are significant enough to be interfering with daily activities, or are a more serious threat to health, and if he is willing to go through the trouble of frequent office visits, an allergist can prescribe desensitizing injections which are often given on a weekly basis for many months or years and can be very effective.
-- C. Ebelke, 10/13/95

I'm trying to decide if I should get a flu shot this season. I never have. I'm a 57 year old woman. I teach primary school children and get three to four colds each year. Also get a mild flu every year around Christmas time. The colds wipe me out for a long time as coughts seem to linger and it takes longer to get back up to "speed" with my job, exercise plan, etc.
I've been told I could get sick from the shot. My doctor says I could get one if I want, but am not in High risk category. What do you think?
-- MCH
Teachers are not considered to be in a high risk category for catching the flu, although as you well know, school is a tremendous reservoir for infections of all kinds. It is important to distinguish "the flu" from the "common cold" and other sicknesses. People often use the words interchangably, but this is incorrect as "the flu" is a much more severe infection in most people where the respiratory symptoms of cough, sore throat, etc., are accompanied by fever, intense muscle aches and pains, and profound fatigue. Generally speaking, you are really sick. The flu shot will help protect you from getting the flu per se, but will not protect you from the host of other viruses that plague young children. Your best protection against all of it is to be rested, to eat well, and to not be stressed or depressed (both of which can depress your immune system). Keep in mind too, that the main reason the flu shot is used in people over the age of 65, or in younger people who have certain diseases, is that these are the people must likely to suffer complications from the flu (such as pneumonia, or even death). It's in these groups that the shot is felt to be worth the cost, the nuisance, and the potential side-effects.
The flu shot is unlikely to cause more than a day or two of achiness, fatigue, or low-grade fever. Most times there is no reaction at all. Certainly, if you wanted to do absolutely everything you could to avoid getting sick, the flu shot is something to consider.
-- R. Jandl, 10/10/95

I've been feeling wiped out really and can't get enough sleep, no matter what. My throat is pretty sore, too. Could I have mono?
Mono can certainly cause profound fatigue, and is often accompanied by a sore throat. To help you better assess the situation, let's talk a little about this fairly common illness.
Mono, or "infectious mononucleosis," as it is formally called, is caused by the Epstein-Barr virus. It occurs in any age group, but is most prevalent between ages 10 - 35, particularly in teenagers. It is highly contagious, particularly through close contact like kissing (hence one of its other names, "the kissing disease") and through sharing drinking glasses, utensils, etc.. The onset of symptoms is between seven and 50 days after exposure to the virus, often beginning with fatigue, headache, and malaise. A sore throat, fever, and enlarged lymph nodes in the neck may follow. As this illness progresses, which may be over a period of days to weeks, generalized lymph node swelling can occur. About 10 percent of folks with mono develop temporarily enlarged livers; almost half of mono sufferers develop an enlarged spleen for a short time.
If you do have the symptoms mentioned here, how can you tell if you do indeed have mono? Diagnosis is easily accomplished with a quick and accurate blood test which can be performed at most clinics and labs.
Treatment of mono is mostly supportive, i.e., doing things that make you more comfortable, since there are no antiviral drugs available which could cure it. Regular evaluations of spleen and liver size are important during and for a few weeks following the active illness. Drinking lots of clear liquids to stay well-hydrated and getting plenty of rest are good things to do, but also of great importance is a visit to your health care provider to make sure there are no complications. In the vast majority of cases folks are back on their feet in a few weeks to a little over a month with no long-term problems to report.
-- C. Ebelke, 10/6/95

What exactly is Strep throat? What's the big deal?
"Strep throat" refers to an infection caused by the bacteria Streptococcus pyogenes, also referred to as Group A Beta-hemolytic Strep. There's quite a bit of it around; it's present in about 5-38% of adults who are checked. Strep often comes on pretty suddenly, when the affected person will frequently notice a painful sore throat, difficulty swallowing, and/or a fever. If runny nose or a lot of sneezing are present, chances of this being Strep are less. If you have been in contact with someone with diagnosed Strep, your chances of getting the illness are higher as it is fairly contagious. The diagnosis is made by throat culture, a very simple and painless office test, together with the overall clinical picture.
The significance of a Strep infection lies mostly in what can happen following the initial sore throat. The infection may lead to a variety of complications including rheumatic fever, a very serious condition which can affect the heart. This is entirely preventable with a ten-day course of antibiotics, usually penicillin or erythromycin. Contrary to popular belief, preventing complications (as opposed to shortening the course of the initial illness) is the primary reason for prompt and complete antibiotic therapy. It is extremely important to complete taking all of your antibiotics although you will probably feel much better after just a day or two. If you suspect that you might have a Strep infection, contact your health care provider for advice.
-- C. Ebelke
Link to a question about conditions related to strep.

Sometimes I have a hard time falling asleep at night. I know I don't have insomnia or anything serious, but it's strange. What's up and what can I do?
Having occasional difficulty falling asleep is a very common problem, and it is quite a different story from true insomnia. Insomnia is actually defined as persistent difficulty falling or staying asleep that compromises daytime functioning. It's estimated that between 15 and 20 percent of folks seek attention for this problem during visits to their primary care providers. It affects people of all ages and represents almost a billion dollars spent yearly on medications to aid in achieving that blissful state of peace known as sleep.
There are a multitude of possible reasons for why you may be having difficulty falling asleep. Commonly, it is difficult to turn off the events of the day or to stop thinking about whatever pressing things may be on your mind. To help relax when you're trying to catch some zzzzz's, relaxation tapes by your bedside are often useful. Meditation and yoga practice offer many valuable tools as well.
Another situation that can make turning in difficult, and often occurs with the high demands and long hours kept by students, is eating or drinking or using stimulating substances within a few hours of retiring. These substances include the obvious ones like caffeinated beverages (coffee, colas, caffeinated teas) as well as less apparent sources of caffeine such as chocolate. Obviously, any stimulant drugs ( No-Doz, amphetamines, etc.) will continue to do their job even after you've decided you've had enough. If you're having trouble falling asleep, definitely look into this category as an easy solution.
Paradoxically, exhaustion can pose a problem in trying to fall asleep, but with a little extra time, and some peace and quiet, your body will know what to do.
-- C. Ebelke, 9/22/95

I get poison ivy all the time. What's the best thing to do for it?
Poison ivy, poison oak, and poison sumac can all cause an intensely itchy allergic skin reaction which can be pretty uncomfortable. As a rule, the rash begins at the site of exposure within a few days of initial contact with the offending plant. You will usually experience intense itching of the affected area, followed by clusters of small blisters, often in a linear configuration with some surrounding redness. The rash may spread wherever the oil of the plant has gone, and may cover large parts of your body.
Treatment is based on drying the rash out and decreasing local inflammation, as well as making the itching more bearable. Calamine lotion is an old standby that often soothes the burning and itching. If a relatively small area is involved, a paste of baking soda and water applied to the rash may help to dry it out; Burrough's Solution (available at most pharmacies) may also be used. Cortisone cream may diminish the itchiness and decrease inflammation. None of these methods should be used on the face. Oral Benadryl, available OTC, may decrease the intensity of the itching as well.
If poison ivy or any rashes occur near the eyes or become widespread, medical attention should be sought.
The easiest way to deal with plant dermatitis is to avoid it altogether! Wear protective clothing (ie, pants, long-sleeved shirts) in situations with potential exposure (hiking, gardening, etc.). Washing exposed clothing soon after such activities is also a good idea. A commercially available product, Tech-nu, is a lotion which is good to use following exposure on hands or other potentially affected areas as it destroys the plant oil responsible for spreading the rash.
-- C. Ebelke

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