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DEAR DR. ROACH: I am a 77-year-old female. After experiencing hair thinning for over a year, I was diagnosed with incomplete lupus by a rheumatologist. My blood markers were high, but I don't have typical symptoms. My primary care physician and cardiologist aren't convinced, and I don't "feel" like I have it.

I started taking Plaquenil, which is very hard on my digestive system. I get severe gas pains in my chest for a couple of hours in the evening, even though I take it with both food and milk.

What is the benefit of Plaquenil? Will I do harm if I stop taking it? Is there another drug I can take? I see my rheumatologist in February and will ask them these questions, but I wanted your opinion. -- C.R.

ANSWER: Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease, while cutaneous lupus are a group of diseases where lupus is localized to the skin. Systemic lupus often includes the skin, and people can have cutaneous lupus as part of systemic lupus. But cutaneous lupus can exist without other systemic involvement. Systemic lupus is an uncommon disease, diagnosed in approximately 1 person per 10,000 each year.

The diagnosis of SLE is not always straightforward. The blood tests used as a screening test (such as the antinuclear antibodies and anti-double-stranded DNA antibodies) are not definitive. In addition to skin findings, systems affected by lupus include the joints, the lungs and heart (or their linings), the kidneys, the central nervous system, and the blood and blood vessels.

"Incomplete lupus" is a term used to describe a person who has some symptoms of lupus but not enough to make the diagnosis with certainty. Only a subgroup of people who are diagnosed this way will go on to develop other symptoms of SLE.

Plaquenil is used for both systemic lupus and cutaneous lupus. Since the one symptom you have told me about is hair loss, I can tell you that about 60% to 70% of lupus patients experienced hair regrowth with Plaquenil. If this is your main concern, you have to consider the side effects (severe gas pains) against the benefit you are getting in hair growth.

There are several other treatments for lupus-related hair loss that may have fewer side effects. You should ask your rheumatologist when you see them, or you can also get a referral to a dermatologist with expertise in hair loss.

DEAR DR. ROACH: I used to drink pretty heavily and was diagnosed with delirium tremens (DTS) when I withdrew from alcohol after I was admitted for an elective surgery. I currently drink two glasses of wine a day and am scheduled for a different surgery in a week. What should I do to prevent withdrawal? -- Anon.

ANSWER: I recommend cutting down to one drink a day from now until the surgery, but you should also tell your surgical team about your history of DTS. We do have medication to reduce the risk of alcohol withdrawal, but you will be at a lower risk by cutting down for the next week.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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