Dear Doctor: I am 67 years old, with arthritis in my hands and feet. My daughter recently had a fall, and X-rays showed signs of arthritis in her foot. She’s only 34. What are the most important things she can do to keep it from progressing, or at least slow it down?

Dear Reader: When we talk about arthritis, we’re referring to a range of conditions that result in pain, stiffness and swelling that affects the joints, most often in the hands, feet, hips and knees. Although rare, the inflammation from certain types of arthritis can affect other parts of the body, such as the kidneys, heart, eyes and lungs. Arthritis occurs in people of both sexes, and of all ages, races and body types. It is estimated that up to one-fourth of Americans are living with some type of arthritis, which makes it one of the leading causes of disability in the U.S.

The two most common types of arthritis are osteoarthritis and rheumatoid arthritis. The former is caused by wear and tear of the joints. The latter is an autoimmune disease in which the person’s own immune system attacks and damages the connective tissues. Both result in similar symptoms, which include stiffness in the morning and after inactivity, pain while walking, localized joint pain and swelling, tenderness or warmth within the joints.

There are several things your daughter can do to manage the progression of arthritis. (And these can benefit you, as well.) One is to maintain a healthy weight, which lessens the daily toll on the joints in the feet, hips and knees. A healthful diet, with an emphasis on lean proteins and a wide variety of fresh fruits and vegetables, is important. So is minimizing foods known to kick up inflammation, which includes refined starches, added sugars, red meat and saturated fats and trans-fats.

It may seem counterintuitive, but staying active lessens arthritis pain, keeps joints moving and increases range of motion. Go for joint-friendly exercises that are enjoyable enough to do regularly. These include low-impact options such as walking, cycling, tai chi, yoga, Pilates, swimming and water aerobics. Strength training, which helps to build up the muscles that support your joints, can also be very helpful. However, it’s best for this to be done under supervision, at least in the beginning.

As when adding any new exercise to your daily routine, it’s a good idea to first check in with your health care provider. Which leads us to a final bit of advice: If your budget and health insurance allow, we think it would be wise for your daughter to have at least one visit with a rheumatologist. They can assess her condition, provide her with a baseline from which to evaluate the progression of her arthritis and help educate her on what to expect in the future. If she’s experiencing pain, they can help her explore a range of options to deal with it. The more she knows about arthritis in general -- and her condition in particular -- the more active she can be in participating in her own care.

(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 heard two teenagers in line at the drug store talking about the skin microbiome and how you shouldn’t use soap on your face because it wipes out the good bacteria. We hear a lot about the gut microbiome lately, but is the skin microbiome really even a thing?

Dear Reader: The word “microbiome” refers to any community of microorganisms that live together peaceably in a specific environment. To reflect the fact that they don’t cause illness, it’s said that they “colonize” an area rather than “infect” it.

In terms of the human microbiome, we’re talking about the vast array of microbes that live upon and within our bodies. These colonies are typically composed of bacteria, bacteriophages, fungi, protozoa and viruses. Depending on their location, they number into the millions, billions and, in the gut microbiome, trillions.

In addition to the gut, anatomical sites of distinct microbiomes in and on the human body include the nose, mouth, esophagus, lungs, genitals and even the hidden depths of the belly button. And, yes, the skin, which is often referred to as the largest organ in the body, is the site of a microbiome. Multiple ones, in fact. They differ depending on their specific locations, and are affected by the variety of environments they interact with, including oily, moist and dry.

For instance, the skin between your toes, which spends long stretches of time in the moist darkness created by socks, shoes and perspiration, hosts a different profile of microbes than does the skin on your scalp, behind your ears or on the backs of your hands.

The epidermis, which is the top layer of the skin, is a tough environment for microbes. It’s dry, acidic and low in nutrients, and great swaths of it are exposed to the elements. And, yet, millions of bacteria, viruses and fungi find a way to make it their home. Depending on their location, they survive on the available proteins, oils, salt or moisture. Research shows that, as with our gut, many of the microbe colonies on our skin play a role in fending off potential pathogens. They also play a role in wound healing, in maintaining skin’s overall health and in how we smell. All of which is good reason to take a look at our bathing and skin care routines.

Dermatologists have long suggested that harsh soaps, too much scrubbing and daily bathing with overly hot water can strip the epidermis not only of helpful oils, but also wreak havoc on beneficial microbe colonies. To protect your skin’s microbiome, think in terms of gentle, pH-balanced soaps, and gentler overall treatment. That means save the scrubbing with loofas and brushes and other rough materials for the truly grubby areas. Instead of a vigorous rubbing with a towel when you are finished bathing, gently dab and pat your skin dry. And, in case you were wondering, you definitely want to keep up the vigilant hand washing that helps keep us safer during the coronavirus pandemic.

(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 was diagnosed with trigeminal neuralgia a few months ago, which I had never heard of before. I have learned that successful treatment can vary from patient to patient. Can you address this disease in your column?

Dear Reader: Trigeminal neuralgia is a rare and extremely painful condition that occurs when the proper functioning of the trigeminal nerve becomes disrupted. This is the fifth cranial nerve, which is actually a pair of nerves that originate in the brain and run to the left and right sides of the face. Each side of the nerve is made up of three distinct branches. They provide sensation to the upper, middle and lower portions of the face, and also to the oral cavity.

When someone has trigeminal neuralgia, or TN, they experience sudden and severe bolts of intense pain that last anywhere from a few seconds to a few minutes. They occur between the jaw and the forehead, usually on just one side of the face, and often arrive in clusters. People describe TN’s piercing pain as akin to an electric shock. The sensations can be triggered by the slightest touch or vibration, so actions like putting on makeup, shaving, brushing one’s teeth or even being exposed to a breath of wind can lead to excruciating pain. The intensity of the pain, as well as its unpredictability, can become debilitating. It isn’t known why, but trigeminal neuralgia rarely occurs during sleep.

Although TN can occur at any age, it has been linked to the aging process and is most often seen in people over the age of 50. It’s also more common in women than in men. The main cause is believed to be contact between the trigeminal nerve and one of the blood vessels located where the nerve exits the brainstem. There is some evidence that TN runs in families. Researchers suspect this may be due to inherited blood vessel configurations. The condition is also associated with disorders such as multiple sclerosis, in which the protective myelin sheath that covers many of the nerves in the body suffers damage.

Treatment for TN begins with medications. Anticonvulsants and antispasmodics have been found to be somewhat successful at suppressing the trigeminal nerve’s sporadic firing. Up to 90% of patients report at least partial pain relief. Unfortunately, the effectiveness of these drugs often plateaus and then fades. Some patients find they are unable to tolerate the drugs’ challenging side effects, which can include dizziness, nausea, fatigue, drowsiness and tremor.

When drug therapies prove ineffective, surgery can become an option. This ranges from the use of radiation or chemicals to damage the nerve and “jumble” the pain pathways, to major surgery to separate the trigeminal nerve from the blood vessel that is compressing it.

Most recently, several small studies have found localized injections of Botox to be quite effective at suppressing nerve activity. This resulted in markedly fewer episodes and less pain. Study participants reported that the benefits lasted for three or more months. Although this is a promising avenue of inquiry, Botox is not yet an approved treatment for TN.

(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.)