#Middlebury
DEAR DR. ROACH: After having several strange-looking “pimples” on my thighs and one on my face, I was told it is lymphomatoid papulosis. One or two people in a million are diagnosed with this. I know that it is not contagious, but what is it? What causes it, how is it treated, and what can I do to avoid these? They take weeks to heal. – R.R.
ANSWER: Lymphomatoid papulosis is a rare disease. It is in the category of cutaneous lymphoproliferative disorders. It is a chronic disease, and lasts years or even decades. The underlying cause is not known exactly, but it is related in many ways to other lymphoproliferative diseases, such as mycosis fungoides and Hodgkin’s lymphoma. The cells of the skin lesions you notice have similar genetic rearrangements as lymphoma cells. Fortunately, LyP has an excellent prognosis, although people with LyP are at increased risk for developing one of these serious conditions.
The papules of LyP can appear on the extremities or the hands and face, and less commonly on other places on the body. They may start off as small red papules, get larger and then crust over. Often, several exist at different stages.
Diagnosis may not be easy, as it takes an experienced dermatopathologist (pathologist with special training in skin diseases) and enough tissue to look at the genetics of the cells. Treatment is not necessary for every person with LyP. But for those who do require it, one might be ultraviolet-light treatment. More severe cases may require methotrexate, but this needs to be managed by an expert.
Experts have recommended six-month visits to evaluate for early signs of enlarging lymph nodes, which might indicate the development of a lymphoproliferative disorder.
DEAR DR. ROACH: I would like your opinion, as a noninterested party, on laser therapy. I see many ads touting its advantages and success in treating bone-on-bone knee osteoarthritis.
My orthopedic doctor recommended knee replacements on both my knees. I had arthroscopic surgery on the left knee four years ago and was recommended total knee replacement on the right knee about three years ago. How long can I put off surgery, and what is the outlook if I don’t have it done?
I am an 80-year-old female in good health, except for the osteoarthritis. I use naproxen when needed. If it works, I think laser therapy would be less pain and downtime.
ANSWER: Low-level laser therapy has been studied in people with osteoarthritis, and some of the studies have shown reductions in pain and stiffness. The laser is thought to have an effect on circulation. However, the laser generally has been effective in people with mild to moderate disease, and bone-on-bone is severe. I think laser may help some people, but some of the benefit probably is due to placebo effect.
As far as putting off your knee replacements, I have been through this many times with my own patients. Some get it done right away; others avoid surgery until they can’t take it any longer, with worsening pain, stiffness and inability to exercise. Most people have told me that they wish they had done the surgery sooner.
By the way, I am interested in helping people, but have no conflicts of interest.
Dr. Roach regrets he is unable to answer individual letters, but he will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.
(c) 2018 North America Synd., Inc.
All Rights Reserved
You must be logged in to post a comment.