Gold may trigger breakout

DEAR DR. GOTT: You recently wrote about lichen planus and gold as a risk factor. I’ve had lichen planus for more than five years, and you are the only reference I’ve encountered that claims gold could be a problem. I have two gold bridges and two gold caps. Could these be contributing factors?

DEAR READER: This inflammatory condition can affect skin and mucous membranes. When on the skin, it resembles raised, flat bumps or lesions that are itchy and somewhat purple in color. They can crust or scab, resembling poison ivy or other forms of plant dermatitis. When mucus membranes of the mouth are affected, white patches that resemble lace can appear and be quite painful. Lichen planus occurs when the immune system attacks the cells of the skin or mucus membranes.

As I previously reported, triggers can include allergens, tattoo pigments, specific medications for hypertension, arthritis or heart disease, and the use of nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen.

One source of information for the gold connection I reported on is Medline Plus, which states that risks include “exposure to medications, dyes and other chemical substances (including gold, antibiotics, arsenic, iodides, chloroquine, quinacrine, quinide, phenothiazines and diuretics).” Furthermore, an Oct. 1, 2010, New York Times article indicated a risk of lichen planus from gold. There have been reports of gold caps causing the breakout, but I cannot find sufficient legitimate documentation to support this. Therefore, I suggest you return to your dentist for his or her opinion.

DEAR DR. GOTT: I have fingernails with horizontal ripples and lines, and they are concave. Any ideas? I’ve been to several doctors who couldn’t help me.

DEAR READER: There are a number of reasons why fingernails become ridged or concave. They include injury, extensive exposure to moisture or nail polish, fungus and bacterial infection, kidney or liver disease, and various other possibilities. Depressions across the fingernail and horizontal ridging are known as Beau’s lines, which can occur following illness, malnourishment or direct injury to the nail. Horizontal ridges might also be an indication of diabetes. Those that curve inward may be associated with iron-deficiency anemia. Vertical ridges that extend from the cuticle to the tip of the nail are common and can occur with advancing age.

Speak with your physician. Ask if laboratory testing is appropriate.