Trending
DEAR DR. ROACH: I have a skin rash (granuloma annulare), and my dermatologist said that there really isn't a cure for it. It's in various areas of my body -- my upper back, my trunk and a few other places. The dermatologist recommended using metformin to see if this helps.
All my labs are excellent, so metformin has never been something that any of my docs suggested. She even looked at my labs and said that they were great but wants to see if metformin might help. Have you ever heard of this? Should I find a different dermatologist? I'm a 67-year-old female who's in excellent health.
-- S.T.
ANSWER: No, I hadn't heard of using metformin to treat granuloma annulare, but I did some research that provides some reasons as to why it might help, specifically in a 2026 study. The authors suggested that metformin might have a role in treating it. However, there isn't any evidence to suggest benefit (yet). Metformin might work, and I'd love to see a study; in fact, I won't recommend it until I do see a study.
I've often used metformin in patients to prevent diabetes and as an adjunct to help with weight loss. The potential harm from metformin, especially at a low dose, is fairly low. The most common side effect is nausea, but most people get used to it after a few days.
A very expensive class of drugs that is often used for blood cancers (JAK inhibitors) also show promise for granuloma annulare.
DEAR DR. ROACH: In a recent column, you advised that any older person, especially those with underlying memory issues, should have a plan to prevent delirium after a planned procedure. Can you flesh out what such a plan would entail?
-- T.T.
ANSWER: Preventing delirium ideally involves many interventions -- some by family, some by nurses, and some by physicians. The overall goal is to make the patient feel comfortable and oriented.
For family members, this means being there, especially when the family member or loved one is awake. They should make sure that the patient has their glasses, hearing aids and dentures, if applicable. A calendar and clock within sight can be helpful, and reminders of where and when they are can gently be done during conversation.
Nursing staff can help by encouraging mobility as much as medically advisable. Restraints should be avoided as they're almost always harmful. The room should be light during the day and dark and quiet at night. Safer pain medications should be preemptively used to prevent pain. Proper nutrition and hydration are essential.
Prevention is far better than treatment.