DEAR DR. ROACH: One encounters many forms of “hand sanitizer” products these days: in medical waiting rooms, restrooms, public places and in our kitchen. These are waterless, very quick drying products; we even have them in our automobile. When one has many daily occasions to clean the hands, is it better (for your skin) to use soap and water, or the modern hand-sanitizer products? — N.M.G. ANSWER: The jury is out on which is more effective, if you compare good technique with one against the other. Both are effective at reducing bacteria on the hands. However, alcoholbased sanitizers are easy to use, portable, fast and are less irritable to the hands than repeated washings. There is better compliance with them, and so they are more effective in the real world. Sanitizers are not effective against all germs. They do not kill the spores of Clostridium difficile, a cause of severe diarrhea. However, soap and water wash the spores off and are effective where sanitizers are not, so soap and water should be used in cases of known or suspected C. diff diarrhea. Sanitizers also are not effective against norovirus, another infectious diarrhea. They also can’t remove grease.
. DEAR DR. ROACH: After two years of seeing several doctors and being misdiagnosed and treated with
wrong medications, my 27-year-old daughter has been diagnosed with psoriatic arthritis. Her joint pain has been constant during this time. What kind of longterm damage has been done during this time? — A.F. ANSWER: Psoriasis is a common inflammatory skin condition, with wellknown plaques — raised red patches with silvery scales or flaked skin — most commonly seen over the elbows, knees or on the back. Only a minority of people with psoriasis will ever develop psoriatic arthritis, but you have to have psoriasis to get psoriatic arthritis. Sometimes, the arthritis shows up before the skin lesions, making the diagnosis difficult. Unfortunately, damage to the joints can happen early in the course of psoriatic arthritis, but only an X-ray can show the extent of damage. Your daughter may need aggressive treatment. A rheumatologist experienced in psoriatic arthritis is essential.
. DEAR DR. ROACH: During a checkup with my internist, I was told that I have a rather large lipoma on my back. I was told that it is to-
tally harmless and can be removed if it bothers me. Now I realize that I am somewhat concerned about it, as I had ovarian cancer two years ago. Can I really be sure it is benign without a biopsy? I don’t want to find out in a few years that it is cancerous. — S.R. ANSWER: A lipoma is a very common fatty tumor. They almost always are benign. If there is a suspicion of malignancy (called liposarcoma), an MRI scan can be done or a biopsy obtained. Surgery is seldom required.