Dermatologist best doctor to see for lichen planus


Hello again, dear readers, and welcome to part two of this month’s letters column. Our volume of mail continues to grow -- thank you! -- so we’ll keep abreast of your questions with additional columns as needed.

-- We recently discussed lichen planus, which affects the skin and sometimes the mucous membranes, including in the mouth. On the skin, it’s a shiny, itchy, flat-topped rash, often purplish in color. Within the mouth, it often produces a lacy pattern of white dots that may hurt or burn.

The column prompted this question from a reader: “Can you please advise me as to what specialty of physician would be best able to diagnose the disease?” he asked.

When someone suspects they have lichen planus, a visit to a dermatologist is a good idea. They can recognize the visual symptoms, and if needed for a definitive diagnosis, can remove a bit of skin to be examined under a microscope. In some cases, a blood test may be used to rule out other conditions with similar symptoms.

-- A column about an intriguing study into the positive effects that black beans can have on insulin resistance caught the attention of a lot of readers. The researchers found that obese mice who ate cooked black beans had improved sensitivity to insulin and an improved gut microbiome. This proved true only when the mice were fed the actual beans, and not components of the beans.

One reader asked for a clarification. “I’m not sure what you mean when you say ‘components’ from the black beans were not beneficial,” she wrote. ”Does that mean pureed or chopped black beans do not have health benefits like whole ones do?”

The benefits come from cooked black beans, no matter how they are treated in preparation or cooking. The “components” in the study refers to certain molecules and nutrients that were isolated from the whole beans. That’s not something you can achieve in a home kitchen.

Elizabeth Ko, MD and Eve Glazier, MD
-- Many of you have shared your experiences with plantar fasciitis. That’s the painful inflammation of the thick band of tissue that connects the heel bone to the toes. A retired pediatrician (and avid tennis player and ballroom dancer) joined several readers in suggesting the use of a splint to brace the affected foot, both at night during sleep and during the day.

“Many of us extend our ankles during sleep and worsen the condition,” she wrote. “Light splints to gently stretch the Achilles’ tendon at night are fairly comfortable. Heavier splints are good for daytime use, too.”

Night splints keep the ankle in a neutral position, thus passively flexing the calf and gently extending the plantar fascia. While many people find this technique to be helpful, it doesn’t work for everyone. For those who wish to try, the devices are affordable and are widely available at drugstores and from online retailers.

Thank you, as always, for taking the time to write. We love hearing from you, and will be back soon with more of your letters.

(Send your questions to [email protected], or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)