FAMILY MEDICINE® COLUMN

By John C. Wolf, D.O.Associate Professor of Family Medicine Ohio University College of Osteopathic Medicine

TEENAGE WORRIES: RINGS UNDER EYES AND MALE BREAST LUMPS

This week I am addressing two questions posed by different readers. Their common feature is that they deal with concerns of adolescence.

Question: My 15 year-old daughter has dark circles under her eyes. What causes this?

Answer: There are several possible causes for the dark circles you notice under your daughter's eyes. First, it may be that she is just now developing the subtly darker color of the lids that is characteristic of most adults. However, since this was pronounced enough for you to write me, I suspect that her color change is more dramatic than that of other adult family members. And the family connection is important, as there is considerable natural variation in lower-eyelid coloration.

The eyelid skin is quite thin; and, therefore, it easily stretches and appears like "bags" or "circles" under the eyes when it is stretched by congestion in the veins of the region. The most common cause for this type of congestion is simple fatigue. Look in the mirror at your own eyes on Friday after five long days of work and five evenings of tending to those necessary responsibilities at home. A bit baggy and dark in color aren't they?

The most likely cause for your daughter's condition is that she is chronically sleep deprived. I'll bet that she is late getting to bed and is then up early every school morning. When she gets the chance, she probably "crashes" for 12 hours or more of sleep. If so, she is chronically sleep deprived.

Another possible cause for the "dark circles" is an allergic condition called atopy. In this disorder, the skin often itches, and as a consequence, is chronically rubbed. In individuals of African-American heritage or others with a dark complexion, the chronic irritation produces increased pigmentation of the skin around the eyes. This is called hyperpigmentation. In contrast, Caucasians with atopy typically have redder eyelids that have a fine scaling texture. However, sometimes even light-skinned people can have hyperpigmentation due to allergy.

Question: I am a 12 year-old male, and I recently noticed a small lump under my nipple. It alarms me. What could it be, and what should I do about it?

Answer: As I've said to my readers many times before, I can't make an accurate diagnosis without the benefit of being able to ask you more questions and also being able to examine you. That said, however, I can make an educated guess about your condition. Any adult finding a lump in his or her breast area immediately worries about breast cancer. Fortunately, breast cancer in a 12 year-old male is very, very rare. Therefore, let's consider a more likely cause. Most men mature to adult stature and physique somewhere between ages 18 and 21. (Yes, I know that some women claim men never become mature, but that is an entirely different topic!) Not all of the steps in these complex physiologic changes are understood, but it is clear that hormones responsible for sexual development play a big role.

It is quite common for the changing hormone levels of early adolescence to cause growth of breast tissue in both males and females. The "bump" you've noticed is probably just developing breast tissue. Often this development is asymmetrical, so that the breast "bump" or "bud" as we physicians call it, is larger on one side than it is on the other. This breast development is a brief annoyance of early adolescence, and it will not give you female breasts. Instead, it will subside as other physical signs of male adulthood ensue.

Though your "bump" is probably not indicative on any health problem, you should still see your doctor to be sure.

"Family Medicine" is a weekly column.

To submit questions, write to John C. Wolf, D.O., at Post Office Box 110, Athens, Ohio 45701.

Past columns are available online at http://www.FamilyMedicineNews.org.