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Dr. John: Alopecia, abscess danger, peripheral neuropathy

12:24 PM, Jan 9, 2013   |    comments
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Question #1
Hello Dr.Torres, My question is my husband is 27 and is suffering from hair loss all the back, sides, and the front of his head is completely bald. It started with small spots on his head that over 2 weeks time got bigger and bigger, at this age plus no family history of hair loss what could be the cause and can you recommend a doctor or specialist to see?

Answer
This condition is called alopecia. Although there are many different types of alopecia the most common one is Alopecia Areata. This type of hair loss can happen anywhere on the body where hair is growing. It usually occurs in different types of patterns which tend to be circular patches of missing hair in different areas. The cause for alopecia isn't always known but the current thinking is that it can be caused by autoimmune issues, where the body's immune system attacks its own hair follicles, genetics or possibly even a viral cause. Diagnosis is usually clinical and oftentimes done in the primary care provider's office. Sometimes a biopsy can help further identify what type of alopecia is causing the hair loss. Some alopecia can resolve spontaneously over a few months time period. Other times different types of medication, mostly topical, can help. If hair loss is extensive, greater than 40% of the entire area, then medication might not work as well at restoring the missing hair. It's best to start off with a primary care provider. They can provide diagnosis and treatment and can further refer to a dermatologist if more detailed treatment is needed.

Question #2
How serious is an infection in your blood from an abscess. Are they easy to cure?

Answer
An abscess is a walled off type of infection that contains bacteria and the pus it produces. Bacteria is great at defending itself so forms this walled off area to try and ward off the body's defenses. Small ones typically don't spread and oftentimes drain or resolve spontaneously. Larger ones, and longer lasting small ones, oftentimes need surgical drainage. Sometimes antibiotics are used as well. These ones also tend to be the ones that more likely spread bacteria into the blood stream and throughout the body causing even more problems. They are also tougher to treat. When it comes to abscesses one current concern is the increasing number of them caused my MRSA, Methicillin-resistant Staphylococcus Aureus. This type of abscess tends to grown more quickly, spread faster and is harder to treat because it's resistant to common antibiotics used against them. Smaller abscesses can initially be treated at home. Warm packs applied against them during the day can help bring them to a head. One word of caution though is to avoid squeezing any abscess. This can cause the abscess to burst deeper into the body, further spreading the infection. For any abscess, if it continues to grow or continues to last despite home treatment, then visiting a doctor for more definite treatment is advisable.

Question #3
Hi Dr, Torres, At 53 YOA, I literally woke up one morning feeling like I was walking in shoes full of soft sand and numb fingertips. Extensive testing confirmed peripheral Neuropathy. I was put on 60mgs of Prednisone for six months. No relief from numbness. Weaning myself off Prednisone on a 16 week program, but the Neurologist gives no other options. Any ideas? Mark

Answer
This condition is known as peripheral neuropathy and occurs when the nerves start to lose function. Although there are many different causes, diabetes is one of the bigger reasons this happens. When the nerve function is lost it usually results in a heavy or numb feeling and oftentimes also results in a pain sensation in the affected area. If diabetes is the cause controlling sugar levels can help make sure this neuropathy doesn't spread. Pain control is also important and many people have found good relief with antidepressants. When peripheral neuropathy occurs in the feet it's important to keep a close eye on foot care. Since the feeling in the feet will be affected it can be hard to detect small cuts or scrapes that can quickly lead to bad infections. So inspecting the feet daily can help make sure any small issues don't turn into bigger problems.

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