Dear Doctor: I’ve heard there’s a serious disease that can happen years after you recover from the measles. Is that true? I thought once the fever and rash are gone, then you’re OK.

Dear Reader: You’re referring to a condition called subacute sclerosing panencephalitis, also referred to as SSPE, which is a progressive neurological disorder that can arise in children and some adults who have had the measles. In most cases of SSPE, measles was contracted at an early age, often younger than 2 years old. Despite having recovered from the initial illness, the measles virus within these patients persists. About six to eight years later, the virus reactivates. The reason why is not yet known.

When this happens, the immune system mounts a response. Symptoms of SSPE begin gradually, with subtle changes in cognition, mood and behavior. This is followed by escalating problems with movement, including uncontrolled spasms in the limbs and body. As the disease progresses, patients may experience seizures and vision loss and become unable to walk.

Although the advance of the disease is gradual, it is relentless. Eventually, the brain loses the ability to direct and control the autonomic nervous system, which oversees breathing, heart rate, temperature and other bodily functions. In some patients, the disease moves swiftly, but most die within one to three years after diagnosis. At this time, there is no known treatment or cure.

Cases of SSPE had long been believed to be quite rare, affecting 4 to 10 of every 100,000 patients who get measles. However, recent studies, one done in Germany and one conducted here at UCLA, suggest the numbers are actually higher. Among the cases studied in California, 1 in about 600 infants under the age of 1 who had the measles went on to develop SSPE years later. When looking at children under the age of 5, 1 in about 1,400 who recovered from the measles was later diagnosed with SSPE. The median age of an SSPE diagnosis was 12. However, researchers found cases in children as young as 3 and in adults as old as 35.

Measles is one of the most infectious diseases in the world. Prior to 1963, when an effective vaccine became widely available in the United States, virtually everyone got the disease by the time they reached their mid-teens. Due to nationwide vaccination efforts, measles was declared eliminated in 2000. However, a series of recent outbreaks have been a cause for concern. It is recommended that children receive their first dose of the measles, mumps and rubella (MMR) vaccine between the ages of 12 to 15 months. This must be followed up with a second dose between the ages of 4 to 6 years. If they are traveling abroad, infants between the ages of 6 and 11 months should also receive a dose of the MMR vaccine.

A major study, the most recent to debunk a connection between vaccinations and autism, was published in March. Researchers studied data from 650,000 children born in Denmark between 1999 and 2010. They found no connection between the MMR vaccine and autism, even among those with risk factors for the disorder.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: I’m a white man in my mid-40s, and I have significant dark areas under and around my eyes. I feel awkward inquiring about this, but people stare and judge, and I’ve become self-conscious. What is the cause? Can you offer any advice on how to lessen these dark areas?

Dear Reader: Ask any dermatologist, and they’ll tell you that dark circles under and around the eyes are a common concern among their patients, men and women alike. We field a lot of questions about them in our practices as well.

While typically not a health issue, dark areas around the eyes can be aging, and they can make someone look tired or ill, even when they’re healthy and fully rested. Our faces are our calling cards to the world. Research shows that within the first few seconds of meeting someone, even before a word has been spoken, we’re unconsciously forming first impressions based on the way the other person looks. It’s not surprising that, despite being benign, dark circles are unwelcome.

When it comes to the cause, there are a few broad categories. One is something known as genetic hyperpigmentation. That is, due to genetics and heredity, the skin beneath or around the eyes is actually a darker hue. Other factors that can lead to changes in pigmentation include sun exposure, allergies and allergic reactions, certain medications and hormonal changes, to name just a few.

Another reason for the appearance of dark circles is that the underlying blood vessels are becoming visible. This can occur when the skin in the area becomes thinner, which happens as we age. Another potential cause is that the blood vessels under and around the eyes have become dilated. Not only does this make them more easily visible, but the blood in the area can pool or leak out, adding to the illusion of darker pigmentation. Poor diet, chronic lack of sleep, excessive use of alcohol or tobacco, physical exhaustion, poor circulation, certain medical conditions and allergies can all contribute to, or exaggerate, this effect.

In some people, the physical structure of the eye area can also play a role in dark circles. Whether it’s the result of aging, genetics or even weight loss, some people have a depression around the eye sockets. These can cause shadowing that reads as dark circles.

Reversing the appearance of dark circles isn’t easy. Treatment options for genetic hyperpigmentation include the use of concealers, lightening creams, chemical peels and laser therapy. For dark areas not due to genetics, changes to lifestyle and behavior may be helpful. These include getting enough sleep. (Your whole body will thank you.) Avoid added salt, which contributes to swelling that can make dark areas more pronounced. If you have allergies, take steps to treat them. Avoid rubbing your eyes, which stretches and stresses delicate tissues and can cause inflammation and capillary damage.

The application of a cold compress can counteract dilation in the under-eye area. Also available are a range of creams that contain vitamin C, caffeine and retinoids to build collagen and constrict blood vessels. Whatever approach you choose, it’s important to be realistic. You’ll be managing the condition, not reversing it.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Hello dear readers, and welcome to another monthly letters column. We’d like to begin by revisiting a recent column about valsartan, a blood pressure medication that is the subject of a Food and Drug Administration recall. The recall is due to impurities found in certain lots of the drug. Since this was a selective recall associated with specific manufacturers only, we included websites where readers can check whether their own prescriptions are affected. Apparently, these sites didn’t make it into every print edition of the column, so we’re repeating the information here today. In the time since our column ran, the valsartan recall has spread to include additional manufacturers of the drug.

Find the list of recalled valsartan drugs at: www.fda.gov/downloads/Drugs/DrugSafety/UCM615703.pdf.

For a list of valsartan meds not part of the recall, visit: www.fda.gov/downloads/Drugs/DrugSafety/UCM615704.pdf.

-- After a column about chicken pox, quite a few of you weighed in to urge anyone who has had chicken pox to get the shingles vaccine. As we’ve written before, we heartily agree. Unfortunately, there is presently a shortage of the new vaccine, Shingrix, which provides better protection than the older one. For local availability, check vaccinefinder.org and Shingrix.com.

-- We recently wrote about post-operative cognitive dysfunction, a condition that can arise in some patients, particularly older ones, following surgery under general anesthesia. A nurse from Lincoln, Nebraska, asked us to point out that among the risk factors for this condition, in which patients experience post-surgical disruption to memory and cognition, are alcohol use and abuse. Patients and caretakers should make the medical team aware of alcohol consumption prior to surgery.

-- Asthma has come up in several recent columns. A case worker who visits families wondered whether the essential oil diffusers she sees in some homes might play a role in asthma flares. The answer is yes. Studies have shown that some diffused essential oils, including eucalyptus, lavender and others, release volatile organic compounds (VOCs) into the air. These, like tobacco smoke, dust, pet dander and other airborne irritants, are environmental components that can act as triggers for bronchospasm.

-- We’ve had several letters in which, for reasons relating to menopause or hysterectomy, women wonder whether they should try hormone replacement therapy (HRT). Hormone replacement therapy has always been -- and, we suspect, always will be -- controversial. This is due to a range of potential side effects, which can be dangerous. Up to 80 percent of women experience menopausal symptoms such as hot flashes, night sweats, weight gain, low energy, mood changes and depression. In a quarter of those women, symptoms are severe enough to warrant therapy. Usually this consists of lifestyle interventions, behavioral interventions and nonhormonal treatments such as Paxil or Effexor.

Only in severe cases should HRT be recommended. In our opinion, HRT should never be used in menopausal women who are asymptomatic. A free and useful app that we recommend to patients dealing with the effects of menopause is MenoPro.

Thank you, as ever, for not only reading the column but for engaging with us as well. Whether it’s a question, correction or kind words, we love hearing from you.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)