Dear Dr. Gott: What do I do for a sore or pimple on the inside of my bottom lip? I was told it is a pyogenic granuloma. It was frozen off once but came back. It was then cut out and again came back. What can I do now?
Dear Reader: A pyogenic granuloma is a small, reddish bump on the skin. It bleeds easily because it has a lot of blood vessels.
These lesions often appear on the skin after an injury and usually occur on the face, hands or arms. They are also often found in the mouths of pregnant women. They are common in children and can be annoying due to the easy bleeding.
Treatment varies. Most small pyogenic granulomas disappear on their own. Larger ones may need to be removed by a surgeon. You have already tried cryotherapy (freezing) and traditional surgery. Laser surgery and electrocautery may be options to discuss with your physician.
If the entire lesion is not removed, it will likely return. This is probably why yours has returned twice now. Given this, your surgeon may choose to remove more of the surrounding tissue to ensure it has been excised or destroyed. Scarring is common, and, with more extensive surgery, the scarring will likely be greater. Unless the lesion is interfering with daily activities such as eating or brushing your teeth, you may simply choose to leave it alone.
Dear Dr. Gott: I am writing to you about my husband. He is 44 years old and was recently diagnosed by one neuromuscular physician with a rare disorder called Isaac’s Syndrome, or neuromyotonia. A second neuromuscular physician diagnosed him with Benign Fasciculation Syndrome.
His symptoms are persistent spasms of one muscle or a group of muscles, joint pain, muscle weakness and trembling hands. All of this has led to sleeplessness and a lack of concentration. He has a past medical history of degenerative joint disease of the cervical and lumbar spine but is otherwise in good health.
Could you supply us with any information on these rarely diagnosed disorders? Is there any help for my husband?
Dear Reader: Two separate physicians have given your husband two separate diagnoses. Both are rare and both involve muscle twitching as a primary symptom.
From your very brief note, I do not know what testing your husband has had, how long his symptoms have persisted, their frequency and what treatments he has tried.
Unfortunately, with so little information, I cannot answer your question satisfactorily. Consult another neuromuscular specialist or a neurologist for a third opinion. Your husband needs thorough testing to include blood work, imaging studies and nerve-conduction tests. Muscle twitching can have many causes, both benign and serious.
He needs a definitive diagnosis so that treatment can begin. While awaiting a third opinion, I urge your husband to try to relax as much as possible, because stress and tension caused by worrying can lead to worsening symptoms for any condition.
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