DEAR DR. ROACH: My daughter was diagnosed with lymphomatoid papulosis. It’s not a bad case, but it’s enough to make me worry. I know it’s rare for this to turn into cancer, but there is always a chance. Doctors often misdiagnose it, but thankfully I have the best pathologist in the world. My daughter is being treated with UVB light, which worked in the past, but now is not helping. I don’t want to do methotrexate. I worry about every dot that pops up on her, and if it doesn’t go away, I think the worst. — M.W.M.
ANSWER: Lymphomatoid papulosis is a rare disease, most common in people in their 40s, but can happen in children and older adults as well. The cause is unknown, and although a virus is suspected, it hasn’t been found. It is not contagious.
The rash of LyP is not specific and needs to be confirmed through biopsy. Spots are relatively large (but less than an inch), and usually red but with a white center that can turn black. The rash comes and goes. A skilled pathologist in combination with an experienced dermatologist is necessary to make the diagnosis.
Adults are treated with methotrexate if the lesions are in a cosmetically important area, especially the face. UVA light is better studied than UVB light, especially in children, but an expert would be the most appropriate to recommend the best treatment. Your concern about cancer is understandable. Rates of associated cancer — specifically, lymphoma, a blood and bone marrow cancer — have been reported in 5% to 50% of people with LyP. Unfortunately, apart from people with a specific gene rearrangement, there’s no way yet known to predict who is likely to get lymphoma nor any way of preventing it. She will need to be vigilant. Fortunately, the lymphomas, if they do develop, are usually effectively treated.
DEAR DR. ROACH: I recently opened up some stored tuna that my son had saved for me. He loves to hunt his own food. When I ate it, I realized that when he had gone to Alaska, he had not only hunted tuna but also black bear. He had used the black bear grease to cure the tuna. I was mortified that he had used a protected animal to preserve his tuna. I reluctantly ate it anyway. Now, I am worried about my health. Will anything happen to me healthwise because I have eaten the grease from a black bear from Alaska? The bear was wild, so could it have had a disease, like rabies? I’m sure it has never been vaccinated. — Anon.
ANSWER: Black bears are hunted in many states, and although it is regulated (you need a license) in Alaska, they are not a protected species under the Endangered Species Act. Black bears are hunted for both sport and meat. The major health risk from consuming bear meat is trichinella, a muscle parasite. The meat must be heated to a high temperature to be sure of killing the parasite. Grease from the bear should not have trichinella risk. Another concern is rabies. Rabies is possible but rare in bears. I doubt it could be transmitted from grease, though, as rabies virus lives in nervous tissue, not fat.