Dear Dr. Roach: I am a 92-year-old man with lots of age-related problems. I am dealing with them, but a few months ago I noticed that my right hand, particularly the little finger and the one next to it, became numb. It was mildly numb at first, but it’s become more and more unpleasant and is somewhat painful now. I have difficulties writing and even pushing the computer keys, and it makes my life miserable. Even falling asleep is getting difficult, because the fingers are restless and painful in any position.
How should I deal with this? What kind of doctor I should go to, and is there is any treatment (but not a radical one) to ease this condition? Is there any hope that eventually it will disappear?
Dear J.I.: It sounds like what you have is a neuropathy, a condition where a nerve isn’t working properly. The most likely cause for numbness and pain in the smallest or pinkie finger (medically just called the fifth digit) and its neighbor, the fourth, is a condition called cubital tunnel syndrome. It is caused by compression of the ulnar nerve as it goes between the ends (condyles) of the humerus bone. Less commonly, the nerve can be “pinched” at the level of the shoulder or in the neck. Your regular physician usually can diagnose this condition, but a neurologist would be the specialist who knows most about this.
If it is the elbow, wearing a brace at nighttime to keep the elbow in a slightly bent position would be the first-line treatment. Unlike carpal tunnel, where the median nerve is compressed in the wrist, surgery is difficult and not nearly so successful.
Dear Dr. Roach: I have rosacea. My dermatologist has prescribed metronidazole 0.75 percent cream, which I have used for about 30 days with little change. She also has said that oral antibiotics could be used. However, my primary care physician says that my rosacea is not bad enough to use oral antibiotics, which he prescribes very judiciously. Are there other things that I may use to keep this from getting worse, or even to cure it? I have tried to determine what may have caused it, but the only possible thing that I can blame it on is stress.
Dear D.J.: Rosacea is a chronic skin condition that often relapses. Unfortunately, there isn’t a cure, so treatment is aimed at improving symptoms. There are several subtypes of rosacea, and metronidazole cream, a topical antibiotic, is used most often for papulopustular rosacea, which, as its name implies, has papules (raised lesions) and pustules (bumps filled with pus) in addition to the redness and flushing common to all forms of rosacea.
Determining (and avoiding) triggers may be more important than medications. Hot liquids and foods (both spicy and hot in temperature) are frequent triggers, as are sunlight, alcohol and exercise. Psychological stress, like you mention, is also a frequent cause.
You may not have given the metronidazole enough of a chance yet, as it can take up to 12 weeks for full effect. Before I would use oral antibiotics (and I agree with your PCP that these should be used cautiously), I would consider a trial of topical azelaic acid (Azelex or Finacea).
Improvement is usually seen within four weeks.
Email questions to ToYourGoodHealth@med.cornell.edu.