Dr. Roach: This murder mystery is not likely lurking in your refrigerator

Keith Roach
To Your Health

Dear Dr. Roach: We watch a murder mystery show on TV. The detective finds any number of dead people who have been poisoned by almond and cherry pits. I drink almond milk several times a day. Am I in any danger?

— L.J.

Dear L.J.: Stone fruit pits (the kernels inside the stone) contain the substance amygdalin, which the body converts after consumption into hydrogen cyanide. Hydrogen cyanide is indeed poisonous. It has been a favorite of mystery authors for many years. Dame Agatha Christie was a pharmacist and knew her poisons well, frequently using them in her stories. However, there is not a large amount of amygdalin in peach or plum kernels, apple seeds nor bitter almonds. Regular sweet almonds, from which almond milk is made, have almost none.

Cherry pits contain a fair bit more. The amount you’d have to consume would be large. Not only that, but people almost never get sick from these because they generally don’t swallow the pits, and also because whole pits or kernels are not easily digested. Nefarious villains in crime novels (or on TV) will crush large numbers of these pits or kernels and give this (or an extract) to their unsuspecting victims.

You need not worry. Almond milk has almost no amygdalin. Even swallowing a few fruit pits by accident won’t cause problems. But never swallow chewed or crushed pits or kernels.

Dear Dr. Roach: About two months ago I was diagnosed with Candida albicans, which appeared as a red rash under my breast. It itches and burns. I saw two doctors: One treated me with nystatin powder, and the other with a fluconazole pill weekly. Neither has done much good. It isn’t quite as red, but it still itches, burns and drains. Are there any other treatments?

— B.B.

Dear B.B.: Intertrigo is the name of the skin inflammation that occurs where skin folds over each other. The groin and underarms are common locations, but underneath the breast is very common, especially in women with larger breasts, where there is more skin to skin contact.

Both bacteria and fungus can exacerbate the skin inflammation, and Candida albicans, a type of yeast, is among the most common. Nystatin and fluconazole are both active drugs against Candida.

While addressing the fungus is an important part of treatment, there are other parts that your doctors may not have emphasized. The first is to keep the area as dry and as exposed to air as possible. It’s much more common to see intertrigo in the summer; the moisture from sweat exacerbates skin irritation and makes a good place for the fungus to grow and further irritate the skin. After washing the area with a mild soap and water, the skin should be dried thoroughly. A hair dryer with no heat is a good way of drying the area quickly. Using absorbent, breathable fabrics helps a lot. Powders, even nonmedicated ones like talc or cornstarch, will also help when applied daily. Since the nystatin isn’t helping, you might ask your doctor for a different one, such as ketoconazole or miconazole. These have anti-inflammatory as well as antifungal properties. Severe itching usually responds to mild steroid cream such as hydrocortisone, applied once or twice daily.

Oral fluconazole is powerful medicine. If you don’t get better in 2-4 weeks with all of these treatments, it might be time to confirm the diagnosis, possibly with a culture or even biopsy. Finally, consider getting tested for undiagnosed diabetes, since diabetes predisposes to intertrigo.

Readers may email questions to ToYourGoodHealth@med.cornell.edu.