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Q: My mother has dandruff and suddenly I have it. She has talked to doctors, and they all say there is nothing they can do. She has tried several over-the-counter medications.

I recently heard it is caused by stress. Is this just a rumor, or is dandruff really an indicator of high stress levels? -- D.S.

A: Dandruff represents a mild form of scalp disorders that includes seborrheic dermatitis and scalp psoriasis. Dandruff is characterized by the presence of mild scaling of the scalp without redness; seborrheic dermatitis has generalized redness, and scalp psoriasis has well-defined patches of redness.

The cause of dandruff is not known, and I couldn't find any studies that show dandruff is increased by stress. However, some people under stress will scratch their head and cause inflammation and skin flaking.

I'm surprised your mother was told nothing could be done. Recommendations for treatment usually begin with daily shampooing with over-the-counter dandruff shampoos, especially those containing tar, zinc pyrithione or selenium.

Seborrheic dermatitis responds to ketoconazole, a prescription fungicide shampoo, when used twice weekly. This response suggests that seborrheic dermatitis may be a reaction to a naturally occurring yeast in the scalp called Pityrosporum ovale.

Steroid creams, applied twice daily, can be added, if necessary, and a stronger selenium shampoo is often recommended for resistant cases.

If the dandruff remains severe and persists, or if you see inflammation or other symptoms, you or your mother may want to see a dermatologist. The condition may not be dandruff.

Update on multiple sclerosis: A report recently published in the Proceedings of the National Academy of Sciences presents some of the most significant findings in years on the development and treatment of multiple sclerosis.

The report presents persuasive evidence that a naturally occurring substance in our bodies -- uric acid -- may be a major factor in preventing progression of MS, as well as preventing its start in the first place.

Researchers from Thomas Jefferson Medical School in Philadelphia reported that uric acid had a major positive impact on EAE -- the closest equivalent of MS found in mice.

By raising the level of uric acid in the blood of mice through injections, the researchers were able to forestall the development of EAE and dramatically reduce symptoms in mice with EAE.

To see if the findings in mice would apply to humans, the researchers did two follow-up studies. In the first, they found that people with MS had lower levels of uric acid than people without MS on the same diet.

Their second study evaluated the medical records of 20 million people. It showed that people with gout -- which is usually marked by an excessive amount of uric acid in the blood -- had one-tenth the risk of getting MS as people without gout.

These studies may also point to why such a high percentage of people with MS are women. Women, on average, have a lower uric acid level than men.

If this reported relationship between MS and uric acid continues to prove valid, it can lead to some exciting benefits. New medications can be created that mimic the effect of uric acid and perhaps not have any side effects such as gout.

Another approach is to change the diet so more uric acid is made naturally. This can be accomplished by eating more foods that contain substances called purines. High levels of purines can be found in animal organs like liver, as well as in beans and peas. Moderate levels are found in all meats, as well as spinach and lentils.

I can't say at this point how much impact eating more beans, peas, lentils and spinach will have on the symptoms of MS. But since these foods are good for almost everyone, except those with gout, people with MS might want to add more of them to their diet.

Dr. Allen Douma welcomes questions from readers. Although he cannot respond to each one individually, he will answer those of general interest in his column. Write to Dr. Douma in care of Tribune Media Services, 435 N. Michigan Ave., Suite 1400, Chicago, IL 60611.

This column is for informational and educational purposes only. It is not intended to provide medical advice or take the place of consultation with a doctor or other health-care provider.

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