I have never seen anything in your column about sebaceous hyperplasia. I read that it is quite similar to acne and that a person could use an acne treatment to keep the condition in check. Could you give your thoughts on this?

Although sebaceous hyperplasia can be mistaken for acne, sebaceous hyperplasia happens mostly to middle-aged adults, or newborns. These bumps appear most commonly on the forehead and cheeks and have an umbilicus, a small hole, in the center.

They are enlargements of the oil-producing sebaceous glands. They happen particularly in people with oily skin.

Treatment can be challenging. Reducing dietary fat and using a good-quality skin-care regimen for oily skin may help. Dermatologists can treat these when they are cosmetically important, not because they cause harm in themselves.

Although they can be mistaken for basal cell cancers of the skin, they are not cancerous or pre-cancerous. They are mostly treated mechanically, and by that I mean using a surgical technique like cauterization or excision. But these techniques can leave scars.

Laser and phototherapy have good cosmetic results but are expensive. Isotretoin, a systemic acne drug with significant side effects, also has been shown in a small study to be effective.

I am currently taking 20 mg of Xarelto daily and have a screening colonoscopy scheduled soon. The preparation instructions said not to stop taking blood thinners, but didn’t specifically mention Xarelto. I contacted the office and spoke with a scheduler, who said those instructions applied to all blood thinners. Previously, I was told that I would need to go off of blood thinners for five days prior to a colonoscopy. Since this was a contradiction to the instructions from the clinic, I have tried to reach out to other medical sources to see if I could get a consensus on what to do, but no one has responded to me yet. There is a strong history of clotting problems in my family. Would you weigh in on this matter? The last time I had a screening colonoscopy was around 2005, and there weren’t any issues. I realize this is a scope and not surgery, but it has me concerned enough that I am considering putting this off until I can get a satisfactory response.

Most screening colonoscopies now are done with patients still on their anticoagulants, although for patients on warfarin (Coumadin), it is preferred for levels to be on the low end of the therapeutic range. This is a standard recommendation by the American Society of Gastrointestinal Endoscopy.

The situation would be different for a high-risk endoscopic procedure, such as removing a large polyp. I have had to deal with this situation many times in my practice, and most often, all anticoagulants are stopped then restarted after the colonoscopy.

There are some people who are at such high risk for clots that we use injection medications to prevent blood clots until the night before the procedure, but that is normally reserved for the highest risk of all. It’s a judgment call as to whether to use the injection anticoagulants to prevent clots around the colonoscopy.

Dr. Keith 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. © 2019 North America Synd., Inc.


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