Patient asked: Two nights ago I went out for a walk and was ravaged by mosquitoes. Now one of the bites is surrounded by a 3” circle that’s red and swollen. Is this an allergic reaction?

Dr.Kogan’s opinion: I don’t think so. Allergic reactions to insect venom tend to be localized and develop minutes (rather than days) after exposure. Instead, this sounds like cellulitis, a type of skin infection that occurs when bacteria enter through the surface breaks. Skin typically becomes red, warm and tender- symptoms that tend to spread to the surrounding skin. When I recently moved to Florida, I had to brush up on my mosquito-related medical literature. It turns out that they are one of the most common triggers of cellulitis in the hot climates. Their bites break the skin and the bugs can be carriers of infectious bacterial strains. Cellulitis can turn into a serious systemic infection, so see your doctor ASAP. I wish I had some holistic tips on the treatment but – alas! – Cellulitis must be treated by a 10 days course of an oral antibiotic like cephalexin or dicloxacillin. Now, for prevention of mosquito bites – there is a plethora of holistic remedies – like lemon eucalyptus essential oil and lemongrass oil. Place one drop of each, preferably organic essential oils into a small cup of organic massage oil, like jojoba for example, and still well. Use on exposed skin to help repel mosquitoes when taking those nice sunset walks in Naples.

Patient asked: I started taking an Omega-3 fish oil supplement because I heard it helps lower risk for a heart attack. But now I am hearing that some of these pills are tainted with toxic chemicals. Should I toss mine?

Dr.Kogan’s opinion: Because supplements are not regulated by FDA in our country, many supplements are full of flour, stearate and gelatin instead of containing the promised ingredients. In case of fish oil in particular, there have been many reports of contamination with PCBs (polychlorinated biphenyls) – a family of industrial chemicals that are carcinogenic in high doses. There are also reports of contamination with very high levels of mercury, when manufacturer does not subject fish oil to proper distillation protocols. There are some reputable independent labs which test supplements for authenticity and quality control. If your particular fish oil product fails their testing criteria – you should in fact throw it out. Generally, I would only take supplements if my medical doctor who is responsible for my health recommends a specific one and explains to me why the benefit of taking it would outweigh the side effects. When a new patient tells me that they have been taking supplements indiscriminately – I recommend testing blood for lead, mercury, and copper, and other heavy metals, as most of the supplements are made outside of the US and are often contaminated.

Patient asked: For the past month or so, I’ve had this strange burning sensation on my tongue, even when I am going out of my way to avoid spicy foods. When the pain subsides, I am left with dry bitter taste in my mouth. What’s going on here?

Dr.Kogan’s opinion: You are describing the telltale signs of burning mouth syndrome, a condition which affects women seven times more often than it affects men, and is especially common during and after the menopause. It has been linked to everything from acid reflux to oral thrush, stress, and a shortfall of vitamin B12. I recommend that you see your doctor, who can help you determine the root of the problem. Generally, treating the underlying cause will put an end to this frustrating condition. But in the meantime, to alleviate the burning sensation you ‘re feeling, try taking 270 mg of alpha-lipoc acid twice daily with food. I have had good experience with ALA Release (sustained –release lipoic complex) from Allergy Research Group. Alpha-lipoic acid can help repair the injured nerve ending on your taste buds in about a week.

Patient asked: A few weeks ago I noticed a red dry patch of skin on my chest. Not long after, I was chatting with a friend who said she was just diagnosed with a precancerous mole. It got me thinking about this old blemish. What could it be?

Dr.Kogan’s opinion: It sounds like you are dealing with actinic keratosis, the most common type of sun damage here in Florida. The blotches tend to appear on areas most often exposed to the sun’s harmful UV rays (like the chest and the scalp) and are more common among fair-skinned people. 60% of people over the age of 40 have at least one of these patches, which are also known as solar keratosis. They typically measure less than one inch in diameter and tend to feel rough, dry, or scaly. The lesions, which often take several years to develop, are usually brown or pink and may lie flat or be slightly raised. Without treatment, 5% of actinic keratosis lesions will develop into a non-melanoma type of skin cancer called squamous cell carcinoma. That’s why when I see these lesions, I always refer them to high quality local dermatologists to check them out and treat them appropriately. To reduce your risk for the future new actinic keratosis, avoid midday sun and always wear sunblock that protects against both UVA and UVB rays and apply an SPF of at least 50 to the exposed areas.