Dear Dr. Gott: My ten-year-old grandson has had guttate psoriasis for more than a year. His dermatologist said it was caused by strep throat. Although the strep throat is no longer a problem, the psoriasis definitely is. Last summer, it faded with exposure to sunlight. Until February, it wasn't too bad, but for the past several months it has been terrible. The red spots are literally all over him, even on the bottoms of his feet. He is using a steroid cream, which seems to have little or no effect, and takes Concerta for ADHD.

Can you offer any suggestions? Can diet, clothing, detergents, stress and/or animals affect this problem?

Reply: Guttate psoriasis is a noncontagious, uncommon form of psoriasis that presents with small, red spots that resemble teardrops appearing on the arms, legs, trunk and other skin surfaces. The lesions may be covered with silver-coloured, flaky scales. The disorder presents most frequently in people younger than 30 and usually follows strep throat, bacterial infections, sunburn, burns, insect bites, stress and the ingestion of some medications.

Diagnosis is made through visual examination of the lesions. Treatment is directed toward controlling the symptoms and preventing secondary infection. A physician might suggest exposure to the sun or prescribe antibiotics, cortisone creams, oral steroids, moisturizers, dandruff shampoos, prescription medications with vitamins A or D, or phototherapy.

The Concerta that your grandson has been prescribed carries many side effects, including allergic reaction (rash, hives, etc.), sore throat, convulsions and unwanted behavioural changes. Whether it is related to his psoriasis or not, I don't know. Is there any correlation between the time he was diagnosed with guttate psoriasis and was placed on the medication?

His parents may choose to speak with his paediatrician to determine whether another drug might be substituted or if he can be switched to an herbal for control of his ADHD. I am not making light of his diagnosis, nor am I endorsing any specific product, but I can report that ginkgo biloba, lemon balm, hawthorn and lobelia have been used successfully by some but should be used only under the direction of a qualified physician.

Dear Dr. Gott: This letter is in regards to your recent article concerning the woman with Behcet's disease.

I was diagnosed with Behcet's in 1990 and saw 27 doctors before being diagnosed and finding my way to remission. The woman in your article is suffering from one of the worst parts of Behcet's: the inability to eat due to mouth and throat lesions. She is starving to death, and at this point, food is the medicine that she needs more than anything. This, too, happened to me. I lost 80 pounds and was in bed for months, waiting to die.

Finally, a doctor prescribed Costanzi's solution, a compound used for those with mouth cancer, etc. I know you cannot prescribe medication, but this woman needs to know that Costanzi's will allow her to swallow again. It kills the pain long enough to take those much-needed bites of food. All she needs to do is swish and swallow, wait a few moments, and then eat or drink. Behcet's is a lonely disease. I wish I could impart to this woman and her family that they must never lose hope, and that remission is an absolute possibility. The average remission for a person with Behcet's is eight years. I have more than doubled that.

Very often, doctors overprescribe. The overload of medications and the side effects are what keep a patient bedridden. In their quest to "cure" me, my doctors went so far as to try chemotherapy and did abdominal surgery, thinking I might have an undetected tumour. I did not. Please know, I do appreciate those efforts and understand them. A great many doctors are not educated about Behcet's. So people are left to reading medical journals and joining associations. They are left to focus on the symptoms they are either experiencing or are waiting to occur and are frightened to death. In any case, these are all my opinions, and I wouldn't want to unduly influence someone else.

My main concern in writing is the Costanzi's solution. It very well might help this poor woman. This compound, first formulated by a haematologist, might bring her a moment of sheer relief. I remember praying for that – 30 seconds of relief! To this day, although I am considered in remission, if my immune system gets knocked or if I get too tired, I might get a lesion, and Costanzi's saves the day (as does lidocaine gel for lesions elsewhere). This might happen once or twice a year, and who couldn't live with that? I know what the future holds but live day-to-day, a life full and busy. I wish the same for this woman and her family.

Reply: I have reprinted your letter in its complete form because of the positive ray of hope in dealing with this complicated disorder.

Costanzi's is an oral remedy developed by Dr. John Costanzi of the University of Texas Medical Branch. Its purpose is to help debilitated patients with conditions such as oral ulcerations related to AIDS, chemotherapy and other conditions. As you pointed out in your attachment, it is comprised of Benadryl elixir, tetracycline liquid, Nystatin oral suspension and Synalar solution. Disclaimers emphatically stress that any healthcare professional who chooses to use this solution does so solely at his or her own risk and the risk of the patient.

Benadryl elixir (diphenhydramine) is an antihistamine and anticholinergic that works by blocking histamine action. Tetracycline is an antibiotic prescribed for fighting bacterial infections. Nystatin treats candidiasis of the mouth; and Synalar (a steroid) treats inflammation. As you can see, this is a whammy of a solution of infection fighters that Costanzi combined successfully to fight oral lesions. It certainly might be a possibility for a Behcet's patient, who should bring it to the attention of his or her diagnosing physician to determine whether it is worth a try. Because I am not an oncologist, nor have I had any experience in dealing with the solution, I cannot do any more than report your findings.