Ask the doctor - skin conditions

Read expert medical advice with doctors' questions and answers from Prima, SHE and Good Housekeeping

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Relieving rosacea
I have rosacea and I've been using metronidazole gel for it, yet so far the improvements have been minimal. Are there any dietary changes or alternative treatments that you could recommend?

Rosacea is an inflammatory skin condition that causes the face to flush easily and small pimples to appear, with fine, dilated capillaries. Avoiding common triggers such as alcohol, exposure to sunlight, heat, hot liquids, spicy foods, stress and vigorous exercise may help. You
could also try topical creams, including the Kalme range which contains antioxidants, caper extracts and other ingredients that have been found to reduce skin redness and sensitivity by 70 per cent. For more information, visit www.skinshop.co.uk or call 0871 871 9975. Applying aloe vera gel can help reduce inflammation. If there is no improvement, talk to your GP, as you may need oral antibiotics. He
or she can prescribe camouflage creamsto mask redness - the British Red Cross offers a service to assist with their use. For details, visit www.redcross.org.uk or call 0844 871 1111 to find your nearest branch. Private laser and pulsed light therapy is also available to treat dilated
capillaries but sadly so far this is not usually available on the NHS.

Dr Sarah Brewer, Prima (Sept 09) 

 

I'm worried about my moles

I have pale skin and lots of moles, and I know that they can turn cancerous. I don't want to panic or bother my GP unnecessarily, but also I don't want to leave it too late. How do I know which ones are worrying?

I get huge numbers of people in my surgery concerned about moles, and I'm always pleased that they consult me. Catching a malignant melanoma early is absolutely vital to improving your chances of a cure. This kind of skin cancer accounts for about 1 in 10 cases, but 9 out of 10 deaths from skin cancer. Your risk of melanoma is more closely linked to how many times - and how badly - you've been sunburnt than overall sun exposure. Unfortunately, having pale skin does raise your risk. The good news is that most malignant melanomas show early symptoms - you just need to know what to look for. Check for a mole
that follows the ABCDE rule:
■ Asymmetry (growing more on one side)
■ Borders (irregular edges)
■ Colour (not the same colour all over, or
becoming black)
■ Diameter (increases in size to more than ¼ inch)
■ Elevation (used to be fl at but is now raised).

Dr Sarah Jarvis, Good Housekeeping (Sept09) 

 

Is there a gentle remedy for my itchy scalp?

I have a dry itchy scalp with fine flakes, which haven't responded to any of the usual antidandruff shampoos. Are there any new, more natural or gentle products I could try?

Scalp problems seem to be getting more common - I certainly receive lots of queries on this theme. A number of gentle products can help relieve a dry, itchy scalp. Jason Natural Dandruff Relief Shampoo (£7.95) contains anti-infl ammatory ingredients, plus essential oils from neem, rosemary and tea tree, while Aloedermal Anti- Dandruff Shampoo (£7.05) is based on healing aloe vera. Both are available from Revital healthfood stores (visit www.revital.co.uk or call 0800 252875). I also like Malki Dead Sea Shampoo (£7.69 from Boots) for reducing itching, and Yin Yang Scalp Cream (£15 from www.yinyangskincare.co.uk) with tincture of organic nettles and zinc. If the problem persists, see your GP to check you don't have psoriasis or another scalp problem needing a different approach.

Dr Sarah Brewer, Prima (Apr 09)

 

Will these white patches fade?

 

I've developed pale patches on my skin, which don't hurt, but are sometimes itchy. My GP gave me a lotion to use a few weeks ago, but they haven't gone. He was a bit dismissive and I don't want to go back if they're going to fade on their own. Can you help?

If your GP has given you a lotion, he probably thinks it's a condition called pityriasis versicolor. This is caused by a fungal infection on the skin and causes pale patches - which don't hurt, although they can be itchy - and stops that part of your skin from tanning. It's usually treated with anti-fungal lotions - but you need to remember that the white patches may not disappear until after you've had a bit of sun. The other most common cause of white patches is a condition called vitiligo. The skin pigment disappears completely from these patches, so they are very pale. It won't do you any serious harm, but unfortunately it is diffi cult to get rid of. We think it's an auto-immune condition - your body's own immune system turns on itself. It can also be associated with other auto-immune conditions like diabetes, or with a kind of anaemia, so it's worth having these other conditions ruled out.

Dr Sarah Jarvis, Good Housekeeping (Apr 09)

 

I have horrible psoriasis on my scalp

 

My skin flakes off and it looks as if I have terrible dandruff. It also makes my scalp sore. I've used coal tar shampoos for years, but they aren't controlling it any more. What else can I do?

The skin condition psoriasis usually causes thick, red, flaky patches. It can affect any part of your skin, but the scalp, along with the elbows and knees, are among the most common sites. It isn't catching, but at best it's unsightly, and the difference it makes to your appearance can be very distressing. We don't know exactly why, but coal tar preparations can help enormously. Dovonex, which is based on vitamin D, can also help. For more resistant cases, topical steroids can do the trick. They tend to work more quickly than other treatments - in days rather than weeks - but they can cause side effects like thinning of the skin if you use them for too long. A new strong steroid treatment, Etrivex, is now available on prescription. You apply it once a day, leaving it on your scalp for 15 minutes before washing it off. It's worth asking your doctor about it if other treatments aren't working.

Dr Sarah Jarvis, Good Housekeeping (Feb 09)

 

 

My sons have pimply arms

 

My sons both have rough, pimply skin on their arms, like sandpaper. Can you suggest anything to help?

Known as keratosis pilaris, roughness of the skin on the upper arms and legs is linked with atopic eczema. It's treated with lots of moisturising emollients that help to soothe and rehydrate sensitive skin, such as the Avène skin care range from Boots. These products contain water rich in silicates and are effective at reducing eczema. Apply to the upper arms at night, then apply loose clear film, and a bandage on top to improve penetration. Use aqueous cream to cleanse their skin rather than soap, and encourage them to wear cotton instead of woollen or nylon clothes to avoid overheating and scratching. Cod liver oil supplements supply both omega-3 essential fatty acids and vitamin A, which can improve pimply skin, scaling and itching.

Dr Sarah Brewer, Prima (Feb 09)

 

 

Is my vegetarian diet affecting my nails?

My nails have begun to look sunken and ridged. Could this be due to lack of a vitamin or mineral? I've been vegetarian for years, but take calcium, zinc and multivitamin supplements.

It could be, as vegetarians sometimes develop iron deficiency. This can result in anaemia and concave, spoon-shaped brittle nails, a condition known as koilonychia. See your GP for an examination and blood test to check for anaemia. If this is diagnosed, you'll need iron supplements. Also increase your intake of wheatgerm, wholemeal bread, egg yolk, green vegetables and dried fruit. Improve iron absorption by washing these foods down with a vitamin C-rich drink, such as orange juice.

Dr Sarah Brewer, Prima (Jan 09)

 

How can I help my scar to fade?

A scar from a gallbladder operation three months ago is still red and unsightly as well as itchy. Will anything fade it?

To encourage it to heal, take vitamin C (1g daily) to boost collagen formation, and evening primrose oil to improve tissue suppleness. You can rub Bio-Oil (£8.95 from most pharmacies and supermarkets) directly on the scar to help it fade. Alternatively, if the wound is fully closed, apply an adhesive silicone gel sheet (such as Elastoplast Scar Reduction Patches, £19.99 from pharmacies) which helps flatten, soften and fade red and raised scars.

Dr Sarah Brewer, Prima (Jan 09)

 

My skin isn't improving

Can you tell me anything about pityriasis versicolor? Nothing my dermatologist has prescribed has improved my skin.

Pityriasis versicolor is a fungal skin infection caused by a type of yeast known as pityrosporum that can infect the skin, producing the characteristic rash. Branlike fine scales on the skin cover numerous round or oval patches that are initially pale pink or brown. They slowly lose their colour to leave white areas that may show up only after exposure to sun, when surrounding skin is tanned. The patches may persist for a while even after successful treatment, because of loss of pigmentation. The lesions should slowly fade, but try applying neat lavender essential oil to them, and if you're still worried, see your doctor again.

Dr Sarah Brewer, Prima 

 

Why have I got spots?

At 44 I've developed quite large spots on my back and forehead, despite a healthy diet. Could the cause be hormonal?

Many women develop oily skin, excess facial hair and spots as their oestrogen levels fall in later life, as this lets the effects of the small amount of testosterone we make come to the fore. See your doctor in order to confirm the diagnosis and rule out other possible causes, such as polycystic ovaries. One of the most effective over-the-counter treatments is benzoyl peroxide, which you apply to affected areas once or twice a day as a cream, lotion or gel. It eliminates bacteria on the skin, as well as reducing inflammation and preventing blackheads. After two months of treatment,  you should notice a significant 60 per cent improvement. Effective anti-acne treatments containing antibiotics are also available on prescription. Maintain hormone balance with an evening primrose oil or soy isoflavones supplement. 

Dr Sarah Brewer, Prima 

 

 

 

Psoriasis help

Although steroid creams help my psoriasis, I'm desperate to stop using them. Can you suggest any other treatments I could try?

Psoriasis is a condition where the skin cells replicate too quickly, leading to raised red patches and silvery scales. It is thought to be caused by the immune system going into overdrive. Steroid creams help, but are not a long-term solution. Use a good emollient such as E45 or DiproBase cream. Mild to moderate cases can be treated with vitamin D (Dovonex) or vitamin A (Zorac) derivatives (prescription only); both are thought to promote normal skin growth and reduce irritation. Tar preparations such as Exorex are available from your GP or pharmacy, but may irritate the skin, while phototherapy using ultraviolet light, has also been found to be effective. Severe cases can be treated with methotrexate, which slows down cell replication, and ciclosporin, which suppresses the immune system. However, there are risks involved, which should be discussed with your GP. Biologics, the latest class of drugs, block specific parts of the immune system. They are only recommended for severe cases that have not esponded to other treatments.  If you're looking for a more natural alternative, sufferers have reported significant improvements from exposure to the sun and sea water. Meanwhile, herbalists recommend taking evening primrose oil and fish oil supplements, and gently rubbing oregano oil on the affected areas.
Dr Louise Selby, SHE

Why have I developed psoriasis?

I’ve recently been diagnosed with psoriasis and am waiting to see a dermatologist. What can I do to improve it?

Psoriasis is an inflammatory disease that causes new skin cells to form ten times faster than normal. As a result, they push up to the surface faster than dead cells can be shed from the body. The live cells build up and form red raised patches covered with dead cells that look like silvery scales. The cause is unknown, but it often runs in families, which suggests a genetic link. Psoriasis has also been linked with abnormalities in essential fatty acid (EFA) metabolism. EFAs found in fish oils have an anti-inflammatory effect, which has been shown to lessen psoriasis lesions. Other topical treatments that can help include Dead Sea mineral salts and mud, Mahonia ointment, made from Oregon grape extract, and Zambesia Botanica (from £5.95, Express Chemist, 0800 542 1203), a range of products from the African Kigelia tree.
Dr Sarah Brewer, Prima

I’m sick of my shadows

Will sleeping more, drinking more water or tapping the skin lightly help get rid of my dark under-eye circles?

Dark shadows are sometimes linked with tiredness and lack of sleep, in which case getting more rest may be beneficial. It is unlikely that drinking water or tapping the skin will have any effect though. Products containing essential fatty acids, B vitamins and plant extracts may help, such as Provenance Solutions Dark Circle Eye Cream (£12.76 from www.passion4health.co.uk or call 01932 571155). They can also be disguised with careful make-up and concealer.
Dr Sarah Brewer, Prima

 

My Aga saga

I've moved house and now have an Aga. I'm not used to it, though, and keep burning my forearm when reaching in to get things out. What's the best way to treat these painful burns?

Traditional treatments include applying aloe vera gel or lavender essential oil. For a modern solution, which promotes healing and reduces scarring, use a treatment such as Acriflex Cooling Burn Gel (£3.99 for 30g from pharmacies). It rapidly cools, soothes, reduces pain and redness, is antiseptic and draws moisture into the area to promote healing. I'd also recommend using the BBQ/Aga Mitts from Antony Worrall Thompson's range of kitchen linens (£5.21 from www.awtonline.co.uk or 01204 702300) - they're perfect for barbecues and Agas.
Dr Sarah Brewer, Prima

 

I've been diagnosed with rosacea and I need something to cover the veins on my cheeks. 

Acne rosacea causes facial redness that may turn into thread-like veins and acne-like spots. Use a non-greasy, high-protection cream, as symptoms are usually worse in the sun, and avoid alcohol, spicy food and hot drinks. Rather than heavy make-up, I recommend mineral make-up that covers without irritation. Sukicolor has a Tinted Active Moisturiser (£38 for 40ml, SPF15) and a Liquid Formula Concealer (£35 for 15ml) that combine minerals with anti-inflammatory white willow and antibacterial essential oils to fight redness and hide blemishes while they heal. Visit www.touchmyface.co.uk or call 020 3006 9841.
Dr Sarah Brewer, Prima

 

I hate these yellow marks

I have an upsetting skin condition called seborrhoeic dermatitis that means my skin leaves horrible yellow marks on everything pale it touches, especially pillows. Will anything help?

This type of dermatitis isn’t life-threatening but it can be unsightly and very distressing.It's a kind of inflammation of the skin and usually affects the scalp and head, although it can spread to the chest and back. Skin infection by a yeast called pityrosporum is thought to be a factor, so anti-yeast treatments may help. A shampoo called ketoconazole (available from pharmacies) can be applied twice a week for two to four weeks. For skin elsewhere on your body, talk to your GP about antifungal creams. You may need repeat courses of these treatments, as the yeast can return. The condition can also be aggravated by stress and being over tired, so it may be worth looking at your lifestyle, too.
Dr Sarah Jarvis, Good Housekeeping

 

Catching psoriasis

A colleague at work has psoriasis, and has red flaky patches all over her arms and legs. I’m worried I might catch it, but I don’t want to upset her. What should I do?

Stop worrying and be as sympathetic as you can. Psoriasis isn't catching in any way. It is, however, a miserable condition that can make sufferers feel both embarrassed and isolated - so a quiet chat with your other work colleagues may help to clear up any misconceptions and allow you all to treat her in the same way as everyone else.
Dr Sarah Jarvis, Good Housekeeping

 
Keratosis

I’ve just had a growth called a keratosis removed from my leg. Luckily, it wasn’t cancerous but I’ve been left with a nasty scar. My consultant has told me it was caused by sun exposure, but I’ve never heard of this complication before. Why are we never warned about it?

Solar keratoses are non-cancerous, which is probably why you've heard very little about them. They look like scaly red patches on your skin and they can wax and wane over time. They can be frozen off, but a lifetime of sun exposure can leave you with hundreds of them. As they do carry a small risk of turning cancerous, it's important for you to get new or rapidly changing ones checked out. Remember to watch your skin all year round as sun-related skin cancers don't show up only in summer.
Dr Sarah Jarvis, Good Housekeeping
 

Eczema in winter

All my family tend to be prone to dry skin and eczema, which causes endless itching and irritation. It always seems to be much worse when we have the central heating on. Why is this and what can we do?

Central heating makes the atmosphere very dry and skin problems like this are usually made worse by hot, dry conditions. The best solution is to turn the heating down or, if you prefer, put damp towels on the radiators and saucers of water nearby to reduce the drying effect. Also, applying lots of moisturiser (unscented and uncoloured) is a must, and whatever else you've been given to treat your skin. Detergents and fabric conditioners probably don't play a major part, but they can sometimes make matters worse - so look for brands approved by a major body, such as the British Skin Foundation or the National Eczema Society.
Dr Sarah Jarvis, Good Housekeeping
 

Preventing boils

I find that I suffer a lot with boils whenever I’m feeling stressed and below par. Is there anything I can do to stop them developing? They’re really painful and can also be quite embarrassing.

People tend to be more prone to infection when they're run down. Boils are a common problem and affect mostly the groin and underarms. It's a good idea to look after yourself at the best of times, and even more important when you're under pressure. Make sure you eat regularly, don't drink too much, get enough sleep and have some quality ‘me' time. You should probably see your GP, too, to rule out diabetes - boils can occasionally be an early sign of this disease.
Dr Sarah Jarvis, Good Housekeeping

Acne rosacea

About six months ago, the skin around my nose started to look red, and then little spots appeared. Now the whole area is flaky and, although I’ve tried several different creams, the spots keep coming back. 

You may well have a condition called acne rosacea. It can start in your 20s, although it may not appear until much later in life. It tends to start with redness over your nose and cheeks, which may come and go at first. Later, this redness often becomes permanent, and spots that look like acne start to appear. It's rarely painful, although you may get a burning sensation over your face. In the first instance, try to avoid factors that make the redness worse. These vary between sufferers, but can include alcohol, some skin products, certain kinds of food, wind and sunlight. If that doesn't do the trick, see your GP with a view to getting antibiotics - either tablets or a lotion - which you would apply for several weeks.
Dr Sarah Jarvis, Good Housekeeping
 

Boils as a symptom

I get terrible boils in my armpits and groin, and my GP doesn’t seem to be able to suggest how I can stop them from occurring. Can you suggest anything that might help?

First of all, you should have yourself tested for diabetes. The more common type 2 diabetes often comes on very slowly, and recurrent minor infections such as boils and thrush can be a warning sign. I wonder, though, if you have a condition called hidradenitis suppurativa. This causes recurrent boils, but it isn't a sign of serious disease. Long-term antibiotics and washing daily with an antibacterial scrub might help.
Dr Sarah Jarvis, Good Housekeeping
 

Psoriasis and arthritis

A few years ago I experienced swelling and pain in my knees, ankles and wrists. It came back recently and my doctor says I have a kind of arthritis caused by psoriasis but I thought that was a skin condition?

I can understand why you're confused because, as you quite rightly say, psoriasis is usually thought of as a skin condition. But what many people don't realise is that it can also cause inflammation of the joints - leading to arthritis - and, very rarely, problems with the liver and the eyes. It's a good idea to find out more and I think talking to other people with the same condition would be a big help, too. Self-help and support groups are both excellent ways of sharing your ideas and experiences with others. You can contact the Psoriatic Arthropathy Alliance on 0870 770 3212 or the Arthritis Care helpline on 0808 800 4050.
Dr Sarah Jarvis, Good Housekeeping
 

Can I make my dull skin glow again?

My skin is dull, grey, tired and unhealthy. Can anything make my complexion look more radiant?

To help perk up your skin, use a revitalising exfoliator or a peel-off  mask to remove any build-up of dead skin cells on the surface. Eat at least five servings of fresh fruit or vegetables per day and drink plenty of mineral water. Take a vitamin and mineral supplement providing around 100 per cent of the recommended daily amount (RDA) of as many micronutrients as possible. Evening primrose oil is especially good for giving a soft, luminous quality to skin. Take 1g daily and look out for moisturisers containing evening primrose or borage oil, such as Nurture Energising Day Cream by Healthspan, priced £5.95 (call 0800 072 9510 for mail order). If you can afford it, an occasional facial will also help. Make sure you get enough sleep, too – late nights and overworking affect skin health.
Dr Sarah Brewer, Prima
 

I have an embarrassing problem with dandruff... help!

I bought an expensive black dress for a ball recently, and was mortified when it was covered in white specks. My anti-dandruff shampoo hasn’t worked. Any advice?

Bad dandruff (seborrhoeic dermatitis) is thought to be triggered by hypersensitivity to a skin yeast called pityrosporum ovale, which lives on the scalp. One of the most effective treatments is a shampoo such as Nizoral (£5.75 from all good chemists), which contains the antifungal agent ketoconazole. Dandruff can be reduced by increasing intakes of essential fatty acids – so eat more oily fish, nuts and seeds, or take flaxseed or omega-3 fish-oil supplements. Dry, scaly skin is linked with a lack of vitamins, especially A, B2, B3, C and biotin, and the minerals iodine, manganese, selenium and zinc. Therefore, supplements may be beneficial.
Dr Sarah Brewer, Prima
 

Treating psoriasis

I'm 26 and have suffered with psoriasis for the last three years. It's getting worse and I've been thinking of going to the Dead Sea in Israelfor treatment. Is it worth the expense?

Many patients swear by it. There are formalised treatment facilities there that use the water which has very high salt and mineral content. At 1,200 feet below sea level, the Dead Sea has a unique climate that allows people to sunbathe without burning. UV light can help clear up the plaques caused by the condition. But you would be at high risk of skin cancer, particularly if you went regularly. Studies show that 80-90 per cent of people visiting the Dead Sea can expect their psoriasis to clear or improve, but you'd need to stay for three to four weeks to get significant benefits.

Meanwhile, the first defence is a topical treatment. The most easy to use are those with salicylic acid (which helps to remove scale) or a vitamin D analogue, as these can be applied to normal skin as well as the psoriasis patches. Tar-based products work well but tend to be messy. Use a regular emollient (moisturiser) such as Epaderm (£6.45 for 125g) or Diprobase (£2.59 for 50g). Use aqueous cream to cleanse and an emollient in the bath, such as Oilatum (£4.85 for 250ml). Use any prescribed psoriasis cream regularly.

A dermatologist can advise on creams and more powerful treatments such as light treatment in the form of PUVA or TL01 UVB treatment. They may also recommend potent tablets.
To find out more, contact the Psoriasis Association.
Dr Louise Selby, SHE
 

Can I control acne?

I had serious acne as a teenager and now my 12-year-old daughter is showing signs of developing the same condition. I would really like her to avoid the heartache that I experienced. Is there anything she can take to stop the spots?

About 90 per cent of teenagers develop some degree of acne. Even so, many find it horribly stigmatising and embarrassing, as you yourself once experienced. Often it is mild but it is estimated that about three in 10 teenagers have acne bad enough to need treatment to prevent scarring. Untreated acne usually lasts about four to five years.

Make sure your daughter is following a healthy diet and cleansing her face twice a day. A gentle soap such as Clinique Facial Soap, £9.50, would be perfect. These days there are lots of acne treatments and I am sure you will find one to suit your daughter. I would suggest starting with an over-the-counter preparation such as Brevoxyl cream (£5.82 for 40g, www.pharmacy2u.co.uk).If this is not strong enough then try an antibiotic preparation such as Zineryt topical solution (prescription only) or tetracycline tablets 500mg twice a day (prescription only). You will need to try a treatment for at least two months before deciding whether it is working. Once your daughter is older she could think about taking an oral contraceptive such as Dianette or Yasmin. Alternatives include Retin-A and adapalene gels, both of which are effective treatments.

If all else fails a dermatologist may suggest a course of isotretinoin (Roaccutane). This is only prescribed for severe acne that has not improved with other treatments. The dose is tailored to each patient. However, there are questions concerning the safety of this drug and it has been blamed for causing depression and suicidal tendencies in a small number of patients. There are other side effects including dryness of the skin, lips, mouth and eyes. It is important that women do not become pregnant while taking the drug, or for a month afterwards, as it is damaging to an unborn child. Care is required if patients have a history of depression as there have been reports of related problems, although it has not been confirmed if isotretinoin was the cause.
The Acne Support Group, 0870 870 2263; www.stopspots.org
Dr Louise Selby, SHE
 

I hate looking in the mirror

For years I’ve suffered from rosacea, which means that my face is constantly red and spotty. I’ve tried several types of treatment, but nothing seems to work. Can you help?

You’re not alone. Around six million people in the UK have rosacea, which causes flushing, redness, inflammation and sometimes acne-like spots on the face. Topical steroid creams are often used, but can actually make matters worse – you need to tail them off slowly to prevent a flare-up. You should wear sunscreen with an SPF of at least 15 whenever you’re out, and avoid alcohol-based cleansers and exfoliants. If spots are the main problem, a cream or gel containing metronidazole or a gel containing azelaic acid can work very well.
Dr Sarah Jarvis, Good Housekeeping
 

I regret my tattoo

I have a large tattoo on my arm, which I’ve grown to hate. Should I consider having laser treatment?

Laser treatment is one of the most effective treatments for removing tattoos. It breaks up the tattoo pigment into small particles under the skin, so they can be removed by the body’s own scavenger cells. Treatment is relatively painless, especially if a local anaesthetic cream is prescribed. If large areas are treated, you may experience mild burning sensations similar to sunburn. Treated skin usually turns white immediately, then fades to purple, which settles after around a week. The commonest side effect is paleness of the treated skin, but some people develop mild crusting or blistering. Scarring is rare. You will need to avoid direct exposure to sunlight for three months after treatment.   Dr Sarah Brewer, Prima
 

I’m fed up of dry lips

I’m not sure if the cracks in the corner of my mouth are cold sores or winter chapping. Can any natural remedies help?

Herpes cold sores usually form a blister that bursts to form an extremely painful ulcer. Cuts at the corner of the mouth are more likely to be due to chapping, a fungal yeast infection, or low levels of iron or B-group vitamins. Try taking a multivitamin and mineral supplement, and using an oral anti-fungal product such as Daktarin Oral Gel (£4.30 for 15g from pharmacies). A herbal adaptogen that helps build resistance to both stress and infection can also help, such as Siberian ginseng.
Dr Sarah Brewer, Prima
 

Help! I have a fungal infection

Treatments prescribed by my dermatologist haven’t improved my pityriasis versicolor. Can you tell me more about it?

Pityriasis is a yeast that lives on the skin of many people without causing problems, and the spores are also in the air. If conditions are right (warm), it can become more invasive. At most risk are people who suffer from profuse sweating, excessive production of skin oils and those with lower immunity. It is not contagious. If it becomes invasive, the yeast produces fine, bran-like scales on the skin’s surface. These cause round pale pink or brown oval patches, which gradually become depigmented to leave white areas that may only show up after exposure to the sun. The lesions may persist even after successful treatment, so it’s possible your infection has gone and the lesions will slowly fade. The most effective alternative treatment is tea tree oil applied twice daily. Taking olive leaf or grapefruit seed extracts can help, while extract from the bark of the Brazilian lapacho tree is used to help build immunity against fungal infections.
Dr Sarah Brewer, Prima
 

Prevent cold sores the natural way

Every winter I get awful cold sores. I use the over-the-counter remedy Zovirax as soon as I feel the tingling, but often they return. Are there any preventative measures I could try?

Cold sores are caused by the herpes simplex type 1 virus. Once you are infected, the virus stays in the body, flaring up at varying intervals. Cold sores tend to occur when you’re ill, run down or eating poorly. I suspect that in winter you pick up more coughs and colds, so your immune system is not as good at keeping the herpes virus under control. Using Zovirax cream as soon as you feel a tingle will reduce the length and severity of each attack.

In addition, I would suggest you follow a healthy eating plan with a diet that incorporates plenty of fresh fruit and vegetables (at least five portions a day). Try to avoid eating junk food, make sure you get plenty of sleep and don’t burn the candle at both ends – not easy during the festive season, I know! Regular doses of echinacea, vitamin C supplements and Siberian ginseng should help to boost your immune system too, and you may find that they reduce the frequency of attacks.

Aciclovir tablets, available on prescription only, can be used at the onset of an attack of herpes and might prove a little more effective than the Zovirax cream, which also contains aciclovir. Alternatively, you may take a twice-daily 400mg dose to prevent recurrences, usually for six to 12 months. To find out whether this is a possibility, make an appointment to discuss the problem with your GP.
Dr Louise Selby, SHE

Why are my cheeks so flushed?

Over the last six months I have developed flushed red cheeks. People assume that I’ve been drinking, but I’m teetotal! I’ve also noticed spots and dryness. What could this be?

I think you’ve developed acne rosacea, a skin condition where tiny blood vessels under the skin on your face enlarge and dilate and become super-sensitive to certain triggers – the most common being alcohol, hot drinks, spicy foods, extreme temperatures and stress, so avoid those if you can. I would also recommend sun block when out in the sun; keep cool, and remember to drink plenty of water. If nothing eases the problem, you may need treatment. Oral or topical antibiotics and oral/topical isotretinoin are effective for the spots. Treatment needs to be continued for two to three months to assess the effectiveness. Clonidine tablets (available  only on prescription) prevent the tiny blood vessels from dilating and can be used to treat the flushing.

Camouflage cream will help cover discoloration. Try Fade Out Facial Redness Remedy (50ml £5.95, www.expresschemist.co.uk). Laser therapy can also be effective in reducing the blushing longer term. The laser light heats up the tiny blood vessels in the skin and destroys them. For a national network of laser clinics, visit www.sknclinics.co.uk
Dr Louise Selby, SHE
 

What will improve my eczema?

I have a rash on my hands that has been diagnosed as pompholyx. Steroid creams relieve itching but have not improved the appearance.

Pompholyx is a form of eczema where intensely itchy blisters and painful cracks form on the hands. The cause is unknown, but it has been linked with a build-up of sweat under the skin, or a contact allergy to detergents or other chemicals. Ask your doctor to refer you for patch testing, as specific allergies are often found. Among healthcare workers, for example, one of the commonest causes is wearing powdered latex gloves. Switching to powder-free, non-latex gloves may solve the problem. Itching and scaliness are sometimes improved with evening primrose oil supplements, but at least 3g daily are needed for three months before assessing the benefit. Omega-3 fish oils also have an anti-inflammatory action, and aloe vera gel often helps, too.
Dr Sarah Brewer, Prima

My stained arm is ruining my appearance

I broke my wrist two years ago and the skin on the back of my hand is now discoloured. What would help?

Staining under the skin can result from blood substances released from a severe injury, and tends to fade with time. Because the staining is under the skin, bleaching creams are unlikely to have an effect. You can try using a fake tan on both hands to even out the colour, or apply camouflage make-up, available from pharmacies. Laser or intense pulsed light therapy – designed to reduce darker skin tones – may be able to improve the cosmetic appearance. Ask your doctor for advice on whether treatment at a private laser clinic is likely to help.
Dr Sarah Brewer, Prima
 

My weak nails are awful

My nails have recently become very brittle. I get one or two breaks a day, often painful. What can I do?

First, check with your doctor to ensure you don’t have a fungal nail infection which can cause vertical splits and may need treatment with a paint-on anti-fungal lacquer. Otherwise, brittle nails are often linked to lack of vitamins, minerals (especially iron or zinc) and essential fatty acids. Eat a healthy, wholefood diet full of fruit, vegetables, nuts and seeds and consider taking a multinutrient supplement designed for nail health.
Dr Sarah Brewer, Prima

 

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